Oligodendroglioma in Children

The brain and the spinal cord make up the central nervous system (CNS). A tumor is an abnormal growth of tissue. An oligodendroglioma is a type of CNS tumor called a glioma. These tumors start in the glial cells, which support other brain cells. There are many types of gliomas.

Oligodendroglioma is a very rare tumor that starts in cells called oligodendrocytes. These are the cells that help form the fatty covering (called myelin) of nerve cells. They can start anywhere in the brain or spinal cord.

Oligodendrogliomas:

• Are more common in adults than in children
• May start out growing slowly (low-grade) but tend to change over time and then grow faster (high-grade)
• Are often there for many years before they're diagnosed
• Often grow into the brain tissue, which makes them hard to remove with surgery
• May be mixed with other types of cells that also support the brain
• Rarely spread beyond the CNS to other parts of the body

Researchers don't know what causes brain tumors. Changes (mutations) in the genes (DNA) likely cause normal cells to turn into cancer. These may be passed on from parents to children (inherited). Or they may happen without a known reason.

Symptoms of brain tumors depend on their size and where they are in the CNS. For instance, if a tumor starts in the part of the brain that controls speech, your child's speech may be affected.

 Symptoms of an oligodendroglioma may include:

• Seizures (this is the most common symptom)
• Headaches, mostly when first waking up
• Trouble with thinking, memory, or concentration
• Nausea and vomiting
• Problems with vision or speech
• Weakness or numbness, often just on one side of the face or body
• Balance problems

The symptoms of oligodendroglioma can be like other health conditions. Make sure your child sees a healthcare provider for a diagnosis.

Your child's healthcare provider will ask about your child's health history and symptoms. A physical exam with a neurological exam will be done. The neuro exam tests reflexes, muscle strength, eye and mouth movement, and coordination. Your child's healthcare provider may refer your child to a pediatric cancer specialist (oncologist). Some of the tests that might be needed include:

• CT scan. A CT scan uses a series of X-rays and a computer to make detailed pictures of the inside of the body. Your child may drink a contrast dye or it may be put into a vein. The dye helps show more details.
• MRI. An MRI uses large magnets, radio waves, and a computer to make detailed pictures of the inside of your child's body. Contrast dye may be put into your child's vein to help get clear pictures.
• Biopsy. During this test, tumor cells are taken out and sent to a lab for testing. A biopsy is done to find out the type of tumor and how fast it's likely to grow. It may be done during surgery.
• Biomarker tests. Lab tests may be done to identify specific qualities of your child's tumor. This testing may help guide treatment choices. Talk with your child's oncologist to learn more.

Part of diagnosing oligodendroglioma and deciding on treatment is learning more about the tumor. This process is called grading. Grading describes how much the cancer cells look like normal cells. Most tumors are graded on a scale of I (1) to IV (4). Oligodendroglioma are grouped as either grade II (2) or III (3). Grade II means that the cancer cells look a lot like normal cells and are likely to grow slowly. Grade III means that the cancer cells look very different and are fast growing. Grade III tumors are also called anaplastic oligodendrogliomas. Talk with your child's healthcare provider about the grade of your child's tumor and what it means.

If your child has been diagnosed with a brain tumor and time allows, you may want your child to see a different oncologist to get a second opinion. This may help you better understand the treatment choices and feel good about the treatment choices you make.

It's important for your child to be treated at a center that specializes in treating cancer in children. Most children are treated in a clinical trial. These are studies that compare the best treatments available now with treatments that are thought to be even better. Your child's healthcare provider may talk to you about this choice.

Treatment may include one or more of the following:

• Surgery. This treatment removes part or all of the tumor. More surgery may be needed over time, if the tumor grows back. Chemotherapy or radiation therapy might be given after surgery.
• Chemotherapy.  These are strong medicines that kill cancer cells. One or more chemo medicines may be given at the same time. A type of chemo treatment, called targeted chemotherapy, targets the cancer's genes, proteins, and other parts of the cancer cell. Targeted chemotherapy blocks the growth and spread of the cancer cells and limits damage to normal cells.
• Radiation therapy.  These are high-energy X-rays or other types of radiation. They're aimed at the cancer cells to kill them and stop them from growing. 
• Clinical trials. A clinical trial is a way to test new treatments for cancer. Ask your child's healthcare provider if there are any treatments being tested that may work well for your child. Many new treatments are only available in clinical trials.
• Supportive care. Treatment can cause side effects. Medicines and other treatments can be used for pain, fever, infection, and nausea and vomiting. Managing side effects is an important part of cancer care.

Other treatments may include:

• Steroids. These medicines help prevent or reduce swelling in the brain.
• Antiseizure medicines. These help to prevent or control seizures.

• Hormones. The pituitary gland sits at the base of the brain and controls hormones in the body. If the pituitary is affected by the tumor or by treatments, hormone medicine may sometimes be needed to replace hormones made by the body.

• Shunt placement. A shunt is a small plastic tube. It’s put into the skull to drain any fluid that has built up in or around the brain.

With any cancer, how well a child is expected to recover (prognosis) varies. Keep in mind:                                             

• Getting medical treatment right away is important for the best outcomes. Cancer that has spread in the CNS is harder to treat.
• Ongoing follow-up care during and after treatment is needed.
• Talk with your child's healthcare provider about any concerns you have or problems you notice. Your child's treatment team wants to know as much as they can about how your child is doing.

A child may have short- and long-term problems from the tumor or from treatment. These may include things like:

• Damage to the brain or nervous system that causes problems with coordination, muscle strength, speech, hearing, or eyesight
• Problems after surgery, such as infection, bleeding, and problems with general anesthesia (the medicines used during surgery)
• Infection and bleeding from chemotherapy
• Delayed growth and development
• Learning problems
• Problems with reproduction (infertility)
• Return of the cancer (recurrence)
• Increased risk for other cancers later in life

Talk with your child's healthcare provider about what you should watch for and what can be done to help prevent problems.

A child with a brain tumor needs special care for the rest of their life. Your child will be seen by oncologists and other healthcare providers to treat any late effects of treatment and watch for symptoms of the tumor returning. Your child will be checked with imaging tests and other tests. Your child may also see other healthcare providers for problems caused by the tumor or treatment. For instance, your child may see an eye care provider (ophthalmologist) for vision problems.

Your child may need therapy to help with movement, muscle strength, and everyday activities. Your child may see physical and occupational therapists. If your child's speech is affected, your child may need help from a speech therapist. Your child may also need the help of other therapists for learning or emotional problems. 

You can help your child manage their treatment in many ways. For instance:

• Your child may have trouble eating. A dietitian may be able to help.
• Your child may be very tired. They will need to balance rest and activity. Encourage your child to get some exercise. This is good for overall health. And it may help to lessen tiredness.
• Get emotional support for your child. Find a counselor, or a child support group can help.
• Make sure your child goes to all follow-up appointments.

Your child's healthcare provider will talk with you about when to call. You may be told to call if your child has any of the below:

• New symptoms or symptoms that get worse
• Signs of an infection, such as a fever or chills
• Side effects of treatment that affect your child's daily function or don’t get better with treatment

Ask your child's healthcare provider what signs to watch for and when to call. Know how to get help after office hours and on weekends and holidays.

• Oligodendroglioma is a type of brain tumor. It’s a rare tumor that grows in the cells that make up the fatty covering of nerve cells. 
• These tumors are rare in children.
• Symptoms may include seizures, headaches, trouble with thinking, memory, or concentration, and nausea and vomiting.
• Oligodendrogliomas may be diagnosed with MRI, CT scan, or both.
• Treatment is usually surgery. It may be followed by chemotherapy, radiation therapy, or both. Other treatments may be needed to control symptoms and side effects.
• Ongoing care is important.
• Because the cancer is so rare, it's important for your child to be treated at a center that specializes in the disease.

Tips to help you get the most from a visit to your child’s healthcare provider:

• Know the reason for the visit and what you want to happen.
• Before your visit, write down questions you want answered.
• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
• Ask if your child’s condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if your child does not take the medicine or have the test or procedure.
• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your child’s healthcare provider after office hours. This is important if you have questions or need advice.