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Childhood brain stem glioma is a disease in which benign (noncancer) or malignant (cancer) cells form in the tissues of the brain stem.

The brain stem is the part of the brain connected to the spinal cord. It is located in the lowest part of the brain, just above the back of the neck. The brain stem is the part of the brain that controls breathing, heart rate, and nerves and muscles used in seeing, hearing, walking, talking, and eating. Most childhood brain stem gliomas are pontine gliomas, which form in a part of the brain stem called the pons.

Although cancer is rare in children, brain tumors are the most common type of childhood cancer other than leukemia or lymphoma.

This summary refers to the treatment of primary brain tumors (tumors that begin in the brain). Treatment for metastatic brain tumors, which are tumors formed by cancer cells that begin in other parts of the body and spread to the brain, is not discussed in this summary. Brain tumors can occur in both children and adults; however, treatment for children may be different than treatment for adults. (Refer to the PDQ treatment summary on Adult Brain Tumors for more information.)

The cause of most childhood brain tumors is unknown.

The symptoms of childhood brain stem glioma vary and often depend on the child’s age and where the tumor is located.

These and other symptoms may be caused by a brain stem glioma. Other conditions may cause the same symptoms. A doctor should be consulted if any of the following problems occur:

• Loss of balance and trouble walking.
• Vision and hearing problems.
• Morning headache or headache that goes away after vomiting.
• Nausea and vomiting.
• Unusual sleepiness or change in energy level.

Tests that examine the brain are used to detect (find) childhood brain stem glioma.

The following tests and procedures may be used:

• CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
• MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the brain and spinal cord. A substance called gadolinium is injected into a vein. The gadolinium collects around the cancer cells so they show up brighter in the picture. This procedure is also called nuclear magnetic resonance imaging (NMRI).

Childhood brain stem glioma is diagnosed and removed in surgery.

If the tumor has not spread widely within the brain stem, a biopsy may be done by removing part of the skull and using a needle to remove a sample of the brain tissue. A pathologist views the tissue under a microscope to look for cancer cells. If cancer cells are found, the doctor will remove as much tumor as safely possible during the same surgery.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) depends on:

• The type of brain stem glioma.
• Where the tumor is located and if it has spread within the brain stem.
• Whether or not the child has an underlying condition called neurofibromatosis type 1.
• Whether the glioma has just been diagnosed or has recurred (come back).

Treatment options depend on the type and location of the glioma.

After the childhood brain stem glioma has been removed, tests are done to find out if there is tumor remaining. The extent or spread of cancer is usually described as stages. For childhood brain stem glioma, the tumors are described by type:

• Diffuse intrinsic pontine glioma is a tumor that has spread widely throughout the brain stem.
• Focal or low-grade glioma is a tumor that is localized to one area of the brain stem.

Recurrent Childhood Brain Stem Glioma

Recurrent childhood brain stem glioma is a tumor that has recurred (come back) after it has been treated. If childhood brain stem glioma recurs, it may do so many years after initial treatment. The tumor may come back in the brain or in other parts of the central nervous system.

There are different types of treatment for children with brain stem glioma.

Different types of treatment are available for children with brain stem glioma. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.

Because cancer in children is rare, taking part in a clinical trial should be considered. Clinical trials are taking place in many parts of the country. Information about ongoing clinical trials is available from the NCI Web site. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.

Children with brain stem glioma should have their treatment planned by a team of doctors with expertise in treating childhood brain tumors.

Your child’s treatment will be overseen by a pediatric oncologist, a doctor who specializes in treating children with cancer. The pediatric oncologist may refer you to other pediatric doctors who have experience and expertise in treating children with brain tumors and who specialize in certain areas of medicine. These may include the following specialists:

• Neurosurgeon.
• Neuropathologist.
• Radiation oncologist.
• Neuro-oncologist.
• Neurologist.
• Rehabilitation specialist.
• Neuroradiologist.
• Endocrinologist.
• Psychologist.

Five types of standard treatment are used:

Surgery

Surgery is used to diagnose and treat childhood brain stem glioma as discussed in the General Information section of this summary.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.

Radiation therapy to the brain can affect growth and development in young children. Certain ways of giving radiation therapy can help keep radiation from damaging healthy tissue:

• Conformal radiation therapy uses a computer to create a 3-D picture of the tumor. The radiation beams are then shaped to fit the tumor.
• Hyperfractionated radiation therapy is a way of giving radiation therapy in smaller-than-usual doses two or three times a day instead of once a day.

The way the radiation therapy is given depends on the type and stage of the cancer being treated. Radiation therapy may be used alone or in addition to chemotherapy.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly in the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Because radiation therapy to the brain can affect growth and brain development in young children, clinical trials are studying ways of using chemotherapy to delay or reduce the need for radiation therapy.

Cerebrospinal fluid diversion

Cerebrospinal fluid diversion is a method used to drain fluid that has built up around the brain and spinal cord. A shunt (long, thin tube) is placed in a ventricle (hollow space) of the brain and threaded under the skin to another part of the body, usually the abdomen. The shunt carries excess fluid away from the brain so it may be absorbed elsewhere in the body.

Watchful waiting

Watchful waiting is closely monitoring a patient’s condition without giving any treatment until symptoms appear or change.

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Untreated Childhood Brain Stem Glioma

Untreated childhood brain stem glioma is a tumor for which no treatment has been given. The child may have received drugs or treatment to relieve symptoms caused by the tumor.

Standard treatment of diffuse intrinsic pontine glioma is usually radiation therapy.

Some of the treatments being studied in clinical trials for diffuse intrinsic pontine glioma include the following:

• A clinical trial of chemotherapy combined with radiation therapy.
• A clinical trial of a new kind of treatment given during and/or after radiation therapy.

Information about these and other ongoing clinical trials is available from the NCI Web site

Standard treatment of focal or low-grade glioma may include the following:

• Surgery with or without radiation therapy.
• Cerebrospinal fluid diversion followed by watchful waiting.

Information about ongoing clinical trials is available from the NCI Web site

Treatment of brain stem glioma in children with neurofibromatosis type 1 may be watchful waiting. The tumors are slow-growing in these children and may not need specific treatment for years.

Check for U.S. clinical trials from NCI’s PDQ Cancer Clinical Trials Registry that are now accepting patients with untreated childhood brain stem glioma.

Recurrent Childhood Brain Stem Glioma

Treatment of recurrent childhood brain stem glioma depends on the type of tumor, whether it comes back in the place in which it started or in another part of the brain, and the type of treatment previously given.

Standard treatment of recurrent diffuse intrinsic pontine glioma is usually palliative therapy, to relieve symptoms and improve the patient’s quality of life. The patient may also be treated in a clinical trial of a new treatment. Information about ongoing clinical trials is available from the NCI Web site.

Standard treatment of recurrent focal or low-grade childhood brain stem glioma may include the following:

• Surgery.
• Radiation therapy.
• Chemotherapy.

Source: National Cancer Institute ( www.cancer.gov ), National Institutes of Health

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Diabetes and Your Eyes

Have your eyes checked once a year. You could have eye problems that you haven’t noticed yet. It is important to catch eye problems early when they can be treated. Treating eye problems early can help prevent blindness.

High blood glucose can make the blood vessels in the eyes bleed. This bleeding can lead to blindness. You can help prevent eye damage by keeping your blood glucose as close to normal as possible. If your eyes are already damaged, an eye doctor may be able to save your sight with laser treatments or surgery.

The best way to prevent eye disease is to have a yearly eye exam. In this exam, the eye doctor puts drops in your eyes to dilate your pupils. When the pupils are dilated, or big, the doctor can see into the back of the eye. This is called a dilated eye exam and it doesn’t hurt. If you’ve never had this kind of eye exam before, you should have one now, even if you haven’t had any trouble with your eyes. Be sure to tell your eye doctor that you have diabetes.

Here are some tips for taking care of your eyes:

• For adults and adolescents (10 years old and older) with type 1 diabetes: Have your eyes examined within 3 to 5 years of being diagnosed with diabetes. Then have an exam every year.
• For people with type 2 diabetes: Have an eye exam every year.
• For women planning to have a baby: Have an eye exam before becoming pregnant.
• If you smoke, quit.
• Keep your blood glucose and blood pressure as close to normal as possible.

Tell your eye doctor right away if you have any problems like blurry vision or seeing dark spots, flashing lights, or rings around lights.

Diabetes and Your Heart and Blood Vessels

The biggest problem for people with diabetes is heart and blood vessel disease. Heart and blood vessel disease can lead to heart attacks and strokes. It also causes poor blood flow (circulation) in the legs and feet.

To check for heart and blood vessel disease, your health care team will do some tests. At least once a year, have a blood test to see how much cholesterol is in your blood. Your health care provider should take your blood pressure at every visit. Your provider may also check the circulation in your legs, feet, and neck.

The best way to prevent heart and blood vessel disease is to take good care of yourself and your diabetes.

• Eat foods that are low in fat and salt.
• Keep your blood glucose on track. Know your A1C. The target for most people is under 7.
• If you smoke, quit.
• Be physically active.
• Lose weight if you need to.
• Ask your health care team whether you should take an aspirin every day.
• Keep your blood pressure on track. The target for most people is under 130/80. If needed, take medicine to control your blood pressure.
• Keep your cholesterol level on track. The target for LDL cholesterol for most people is under 100. If needed, take medicine to control your blood fat levels.

Diabetes and Your Kidneys

Your kidneys help clean waste products from your blood. They also work to keep the right balance of salt and fluid in your body.

Too much glucose in your blood is very hard on your kidneys. After a number of years, high blood glucose can cause the kidneys to stop working. This condition is called kidney failure. If your kidneys stop working, you’ll need dialysis (using a machine or special fluids to clean your blood) or a kidney transplant.

Make sure you have the following tests at least once a year to make sure your kidneys are working well:

• a urine test for protein, called the microalbumin test
• a blood test for creatinine

Some types of blood pressure medicines can help prevent kidney damage. Ask your doctor whether these medicines could help you. You can also help prevent kidney problems by doing the following:

• Take your medicine if you have high blood pressure.
• Ask your doctor or your dietitian whether you should eat less protein (meat, poultry, cheese, milk, fish, and eggs).
• See your doctor right away if you get a bladder or kidney infection. Signs of bladder or kidney infections are cloudy or bloody urine, pain or burning when you urinate, and having to urinate often or in a hurry. Back pain, chills, and fever are also signs of kidney infection.
• Keep your blood glucose and blood pressure as close to normal as possible.
• If you smoke, quit.

Diabetes and Your Nerves

Over time, high blood glucose can harm the nerves in your body. Nerve damage can cause you to lose the feeling in your feet or to have painful, burning feet. It can also cause pain in your legs, arms, or hands or cause problems with eating, going to the bathroom, or having sex.

Nerve damage can happen slowly. You may not even realize you have nerve problems. Your doctor should check your nerves at least once a year. Part of this exam should include tests to check your sense of feeling and the pulses in your feet.

Tell the doctor about any problems with your feet, legs, hands, or arms. Also, tell the doctor if you have trouble digesting food, going to the bathroom, or having sex, or if you feel dizzy sometimes.

Nerve damage to the feet can lead to amputations. You may not feel pain from injuries or sore spots on your feet. If you have poor circulation because of blood vessel problems in your legs, the sores on your feet can’t heal and might become infected. If the infection isn’t treated, it could lead to amputation.

Ask your doctor whether you already have nerve damage in your feet. If you do, it is especially important to take good care of your feet. To help prevent complications from nerve damage, check your feet every day

Diabetes and Your Gums and Teeth

Diabetes can lead to infections in your gums and the bones that hold your teeth in place. Like all infections, gum infections can cause blood glucose to rise. Without treatment, teeth may become loose and fall out.

Help prevent damage to your gums and teeth by doing the following:

• See your dentist twice a year. Tell your dentist that you have diabetes.
• Brush and floss your teeth at least twice a day.
• If you smoke, quit.
• Keep your blood glucose as close to normal as possible.

Keeping your blood glucose in your target range, brushing and flossing your teeth every day, and having regular dental checkups are the best ways to prevent gum and teeth problems when you have diabetes

Source: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health.

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What is constipation?
Constipation means that a person has three bowel movements or fewer in a week. The stool is hard and dry. Sometimes it is painful to pass. You may feel “draggy” and full.

Some people think they should have a bowel movement every day. That is not really true. There is no “right” number of bowel movements. Each person’s body finds its own normal number of bowel movements. It depends on the food you eat, how much you exercise, and other things.

At one time or another, almost everyone gets constipated. In most cases, it lasts for a short time and is not serious. When you understand what causes constipation, you can take steps to prevent it.
What can I do about constipation?
Changing what you eat and drink and how much you exercise will help relieve and prevent constipation. Here are some steps you can take.

 

1. Eat more fiber.
Fiber helps form soft, bulky stool. It is found in many vegetables, fruits, and grains. Be sure to add fiber a little at a time, so your body gets used to it slowly. Limit foods that have little or no fiber such as ice cream, cheese, meat, snacks like chips and pizza, and processed foods such as instant mashed potatoes or already-prepared frozen dinners. The chart below lists some high-fiber foods.

 

High-Fiber Foods

Fruit Vegetables  Breads, Cereals, and Beans 
Apples
Peaches
Raspberries
Tangerines Acorn squash, raw
Broccoli, raw
Brussels sprouts, raw
Cabbage, raw
Carrots, raw
Cauliflower, raw
Spinach, cooked
Zucchini, raw  Black-eyed peas, cooked
Kidney beans, cooked
Lima beans, cooked
Whole-grain cereal, cold (All-Bran, Total, Bran Flakes)
Whole-grain cereal, hot (oatmeal, Wheatena)
Whole-wheat or 7-grain bread 

 

 

2. Drink plenty of water and other liquids such as fruit and vegetable juices and clear soups.
 
Liquid helps keep the stool soft and easy to pass, so it’s important to drink enough fluids. Try not to drink liquids that contain caffeine or alcohol. Caffeine and alcohol tend to dry out your digestive system.

3. Get enough exercise.
Regular exercise helps your digestive system stay active and healthy. You don’t need to become a great athlete. A 20- to 30-minute walk every day may help.

 

4. Allow yourself enough time to have a bowel movement.
Sometimes we feel so hurried that we don’t pay attention to our body’s needs. Make sure you don’t ignore the urge to have a bowel movement.

5. Use laxatives only if a doctor says you should.
Laxatives are medicines that will make you pass a stool. Most people who are mildly constipated do not need laxatives. However, if you are doing all the right things and you are still constipated, your doctor may recommend laxatives for a limited time.

Your doctor will tell you if you need a laxative and what type is best for you. Laxatives come in many forms: liquid, chewing gum, pills, and powder that you mix with water, for example.

6. Check with your doctor about any medicines you take.
Some medicines can cause constipation. They include calcium pills, pain pills with codeine in them, some antacids, iron pills, diuretics (water pills), and medicines for depression. If you take medicine for another problem, be sure to ask your doctor whether it could cause constipation.
Points to Remember
Constipation affects almost everyone at one time or another.
Many people think they’re constipated when really they aren’t.
In most cases, following these simple tips will help prevent constipation:
Eat a variety of foods, especially beans, bran, whole grains, and fresh fruits and vegetables.
Drink plenty of liquids.
Exercise regularly.
Don’t ignore the urge to have a bowel movement.
Understand that normal bowel habits are different for everyone.
If your bowel habits change, check with your doctor.
Most people with mild constipation do not need laxatives. However, doctors may recommend laxatives for a limited time for people with chronic constipation.
Medicines that you take for another problem might cause constipation.

Source: NIDDK, National Institutes of Health

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What is pregnancy?
Pregnancy is the term used to describe when a woman has a growing fetus inside of her. In most cases, the fetus grows in the uterus.
Human pregnancy lasts about 40 weeks, or just more than 9 months, from the start of the last menstrual period to childbirth

 

What are the signs of pregnancy?
The primary sign of pregnancy is missing one or more consecutive menstrual periods.  However, because many women experience menstrual irregularities that may cause missed periods, women who miss a period should see their health care provider to find out whether they are pregnant or whether there is another health problem.

 

Others signs and symptoms of pregnancy may include:

Nausea or vomiting, morning sickness
Sore breasts or nipples
Fatigue
Headaches
Food cravings or aversions
Mood swings
Frequent urination

 

How do I know I’m pregnant?
A pregnancy test is the best way to determine if you are pregnant. Home pregnancy test kits are available over-the-counter and are considered highly accurate.  A health care provider can also do a pregnancy test.

NICHD research in the 1970s found that high levels of the hormone human chorionic gonadatropin (HCG) in the urine were associated with pregnancy.  This research led to the development of the home pregnancy test that is commercially available today. 

If you think you may be pregnant, or have a positive home pregnancy test, see a health care provider.

 

What is prenatal care and why is it important?
Prenatal care is the care woman gets during a pregnancy.  Getting early and regular prenatal care is important for the health of both mother and the developing baby.

In addition, health care providers are now recommending a woman see a health care provider for preconception care, before she is even trying to get pregnant.

Health care providers recommend women take the following steps to ensure the best health outcome for mother and baby:

Getting at least 400 micrograms of folic acid every day to help prevent many types of neural tube defects.  Health care providers recommend taking folic acid both before and during pregnancy.
Being properly vaccinated for certain diseases (such as chicken pox and rubella) that could harm a developing fetus—it is important to have the vaccinations before becoming pregnant
Maintaining a healthy weight and diet and getting regular physical activity before, during, and after pregnancy
Avoiding smoking, alcohol, or drug use before, during, and after pregnancy
What is a high-risk pregnancy?
All pregnancies involve a certain degree of risk to both mother and baby.  But, factors present before pregnancy or that develop during pregnancy can place the mother and baby at higher risk for problems. Women with high-risk pregnancies may need care from specialists or a team of health care providers to help promote healthy pregnancy and birth.

Factors present before pregnancy that can increase risk may include:

Young or old maternal age
Being overweight or underweight
Having had problems in previous pregnancies, such as miscarriage, stillbirth, or preterm labor or birth
Pre-existing health conditions, such as high blood pressure, diabetes, or HIV/AIDS
During pregnancy, problems may also develop even in a woman who was previously healthy.  These may include (but are not limited to) gestational diabetes or preeclampsia/eclampsia.

Getting good prenatal care and seeing a health care provider regularly during pregnancy are important ways to promote a healthy pregnancy.

Source: National Institute of Child Health and Human Developement, National Institutes of Health

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