Anaplastic ependymoma is one of the most dangerous cerebral tumors. It is malignant. Most often, a neoplasm occurs in the brain, in rare cases, an ependymoma forms in the spinal canal. Each patient should be aware of the symptoms of this tumor. Such a neoplasm must be detected at an early stage, as it is prone to rapid growth and metastasis.
What is ependymoma
In the human brain is tissue - ependyma. This is a thin membrane that lines the walls of the ventricles of the brain and the spinal canal. Under the influence of various adverse factors, ependyma cells can undergo malignant changes. In this case, tumors form in the tissue called ependymomas. They are divided into several types:
- Subependymoma. This is a tumor of the 1st degree of malignancy. It grows, but very slowly.
- Myxopapillary ependymoma. Such a tumor is located in the canal of the spinal cord. She also has a tendency to slow growth.
- Ependymoma 2 degrees. This tumor is characterized by faster growth than the previous two.
- Anaplastic ependymoma of the 3rd degree. This is a malignant tumor that grows rapidly. It can metastasize from the brain to the canal of the spine. Usually, its appearance is preceded by a tumor of the 2nd degree of malignancy.
We will consider the last type of ependymoma in more detail.
Causes
Specialists cannot determine the exact cause of the development of anaplastic ependymoma of the brain and spinal cord. Only risk factors that increase the likelihood of malignant tumors can be distinguished. These include:
- contact with carcinogens;
- work in hazardous production;
- exposure to radiation;
- infection with oncogenic microorganisms (some strains of HPV, herpes virus, cytomegalovirus);
- excessive exposure to the sun;
- hereditary predisposition to cancer.
Medical scientists have discovered a special type of virus, SV40, in the cells of anaplastic ependymoma. This microorganism was in an active state. However, at present, science does not know how pathogenic this virus is and whether it plays any role in the onset of tumors.
Symptomatology
Manifestations of the disease depend on the location of the anaplastic ependymoma. If the tumor is located in the area of the spinal canal, then the following symptoms are noted:
- Various parts of the body lose sensitivity to the effects of heat and cold, as well as to pain.
- There is pain in the spine.
- The gait of the patient changes. Movement becomes awkward and awkward.
- With large neoplasms, paralysis of the limbs is possible.
If the tumor is located in the brain, then two types of symptoms can occur:
- Cerebral. These manifestations are associated with intracranial hypertension due to compression of the ependymoma of brain tissue and accumulation of cerebrospinal fluid.
- Focal. Depending on the location of the tumor, there are signs of impaired function of a particular part of the brain.
With any location of the anaplastic ependymoma of the brain, the patient has the following cerebral symptoms:
- bouts of severe headache, accompanied by vomiting;
- dizziness with sudden movements;
- intensification of pain with a change in body position and physical activity;
- bouts of seizures.
This clinical picture suggests intracranial hypertension.
Focal symptoms are diverse and depend on the location of the tumor. If anaplastic ependymoma compresses the cranial nerves, then the patient has impaired hearing and smell, slurred speech, numbness of part of the face, imbalance and coordination of movements.
If the ependymoma is located in the lateral ventricles of the brain, then in the early stages the disease can be asymptomatic for a long time. Signs of increased intracranial pressure appear already at a late stage of pathology. Also, patients experience mental disorders:
- hallucinations;
- memory impairment;
- apathy;
- depression;
- poor orientation in space.
Very often, the posterior fossa of the skull becomes the location of the tumor. The patient complains of double vision. There are signs of vestibular ataxia. It is difficult for a person to maintain balance not only when walking, but also in a sitting position. The patient is dizzy even when at rest.
Features of the disease in children
Anaplastic cerebral ependymoma in children is more common than in adults. More than half of the cases occur before the age of 5 years. In children, the pathology usually proceeds more severely than in an adult.
Anaplastic ependymoma in a child is accompanied by the following symptoms:
- movement coordination disorder;
- headache with nausea and vomiting;
- shaky gait;
- tearfulness, moodiness;
- hearing loss;
- stunted growth and development.
Such manifestations should alert parents. In childhood, it is very important to diagnose the disease as early as possible, since the tumor is growing rapidly.
Diagnostics
Anaplastic ependymoma of the 3rd degree is treated by an oncologist and a neurologist. The reason for the diagnosis is the patient's complaints of headaches with vomiting and bouts of seizures. The following examinations are prescribed:
- MRI and CT of the brain or spinal cord;
- electroencephalogram;
- angiography of the vessels of the head and spine;
- myelography (study of the movement of cerebrospinal fluid using a contrast medium).
Ventriculoscopy is also performed. This is a complex endoscopic procedure that allows you to assess the condition of the 3rd and 4th ventricle. It is in these departments that anaplastic ependymoma is most often localized. Such a study is done under general anesthesia. Thin tubes are inserted into the cranial cavity, at the end of which chambers are fixed. The image is fed to the big screen. Thus, the doctor can examine in detail the state of the ventricles of the brain.
In childhood, most often do MRI and CT of the brain. These methods are not related to exposure. Infants undergo ultrasonography and neurosonography through an unclosed fontanel. Additionally, a consultation with an ophthalmologist with an examination of the fundus is prescribed. If necessary, a lumbar puncture is performed with a cerebrospinal fluid sampling for analysis. This allows you to determine the area of spread of the tumor.
Treatment
Ependymoma is not subject to conservative therapy. The tumor must be completely removed. Therefore, the patient is shown a neurosurgical operation with craniotomy. This is a rather difficult intervention.
The neoplasm is often located in such a way that it is difficult for a neurosurgeon to get close to him. If it is impossible to completely remove the tumor, then a bypass is performed. Install drainage tubes for the outflow of cerebrospinal fluid. This allows you to reduce the manifestations of intracranial hypertension.
In some cases, the Cyber-knife apparatus is used to remove the tumor. This is a non-invasive radiosurgical method. A tumor is destroyed by radiation. In this case, it is not necessary to make an incision and open the skull.
Cerebral ependymoma is prone to recurrence. Therefore, in order to prevent re-growth of the tumor, it is necessary to undergo radiation therapy sessions.
Exposure to children is contraindicated. Therefore, after removal of the tumor, they are prescribed a course of chemotherapy with cytostatics. Apply drugs "carboplatin" and "cisplatin."
The consequences of surgery and radiation therapy
Rehabilitation after tumor removal and radiation therapy is usually long and complex. In the postoperative period, patients may experience depression, convulsions, impaired memory, vision and hearing, gait changes. In children, growth and growth retardation is observed. Most patients experience nausea and hair loss. The human body is usually severely weakened by surgery and radiation.
The recovery period should take place under the supervision of a specialist. During rehabilitation, it is necessary to regularly visit an oncologist and inform him about any changes in health.
Forecast
The prognosis of anaplastic ependymoma is always very serious. The outcome of the disease largely depends on the chosen method of therapy. If treatment is limited only to surgical intervention, then immediately after surgery, about 8% of patients die. Then, during the first 5 years after removal of the tumor, about 40% of patients die.
However, the prognosis for life becomes more favorable with complex treatment. If surgery is supplemented by chemotherapy and radiation therapy, then the survival rate is about 80%.
From this we can conclude that after removing the tumor, the patient needs to undergo an additional course of chemotherapy treatment and attend radiation therapy sessions. In this case, patients may experience side effects from aggressive treatment methods, however, only an integrated approach can save the patient's life.
Prevention
Specific prophylaxis of ependymoma has not been developed. Medicine does not know the exact causes of the formation of such a tumor. You can only reduce the risk of malignancy using the following measures:
- When working in hazardous production, regularly undergo a routine inspection.
- Avoid excessive sun exposure.
- In time to detect and treat papillomatosis, herpetic diseases, cytomegaly and other pathologies caused by oncogenic viruses.
- If cerebral tumors were observed in the immediate relatives of the patient, then a person needs to be regularly examined by a neurologist, as well as an MRI of the brain.
It should be remembered that headache attacks with nausea can be a sign of a dangerous cancer. Therefore, if such symptoms occur, you should immediately consult a doctor.