Brain Tumors Prevention Tips
What is a brain tumor?
A brain tumor is an abnormal mass of tissue in which the cells grow and multiply without restraint, apparently unregulated by the mechanisms that control normal cells. One factor that distinguishes brain tumors from other tumors is that they arise in the skull, an organ encased by bone, and there is very little room for expansion with the skull. They are also among the few types of tumors that generally do not tend to metastasize or spread to other parts of the body.
Whereas certain brain tumors occur almost exclusively during childhood and adolescence, others are predominantly tumors of adult life. The patient's age appears to correlate with the site where some tumors develop in the brain. Although most primary tumors attack member of both sexes with equal frequency, some, such as meningiomas, occur more frequently in women, while others, such as medulloblastomas, more commonly afflict boys and young men.
The prognosis for patients with a brain tumor is as individual as the patients themselves. Your doctors will help you understand the possible consequences of your specific tumor.
Tumor Types
There are several different types of brain tumors and this section describes most except the ones that are quite rare. We will help you locate the structures of the brain mentioned in these descriptions and will tell you in general terms the functional roles of each structure.
Gliomas
Astrocytoma and Glioblastoma Multiforme (GBM)
Other Gliomas
Brain Stem Glioma, Epdendymoma, Ganglioneuroma, Juvenile Pilocytic Astrocytoma, Mixed Glioma, Oligodendroglioma, and Optic Nerve Glioma
Non-gliomas
Chordoma, Craniopharyngioma, Medulloblastoma, Meningioma, Pineal Tumors, Pituitary Adenoma, Primitive Neuroectodermal Tumors (PNET), Schwannoma or Acoustic Neuroma, and Vascular Tumors
Other brain-related conditions
CNS Lymphoma, Meningeal Carcinomatosis, Neurofibromatosis, Pseudotumor Cerebri, and Tuberous Sclerosis
Metastatic brain tumors
Any tumors that spread to the brain from other parts of the body.
Facts about Brain Tumors
o Each year approximately 190,000 people in the United States and 10,000 people in Canada will be diagnosed with a primary or metastatic brain tumor.
o Brain tumors are the leading cause of SOLID TUMOR death in children under age 20 now surpassing acute lymphoblastic leukemia (ALL), and are the third leading cause of cancer death in young adults ages 20-39.*
o Brain tumor patients, including those with certain "benign" brain tumors, have poorer survival rates than breast cancer patients.
o Metastatic brain tumors (cancer that spreads from other parts of the body to the brain) occur at some point in 10 to 15% of persons with cancer and are the most common type of brain tumor. The incidence of brain tumors has been increasing as cancer patients live longer.**
o In the United States, the overall incidence of all primary brain tumors is more than 14 per 100,000 people.
o There are over 120 different types of brain tumors, making effective treatment very complicated.
o Because brain tumors are located at the control center for thought, emotion and movement, their effects on an individual's physical and cognitive abilities can be devastating.
o At present, brain tumors are treated by surgery, radiation therapy and chemotherapy used either individually or in combination.
o Only 31 percent of males and 30percent of females survive five years following the diagnosis of a primary or malignant brain tumor.
o Brain tumors in children are different from those in adults and are often treated differently. Although as many as 69 percent of children with brain tumors will survive, they are often left with long-term side effects.
o Enhancing the quality of life of people with brain tumors requires access to quality specialty care, clinical trials, follow-up care and rehabilitative services. Improving the outlook for adults and children with brain tumors requires research into the causes of and better treatments of brain tumors.
o Complete and accurate data on all primary brain tumors are needed to provide the foundation for research leading to improved diagnosis and treatment and to investigations of its causes.
o The National Cancer Institute and the National Institute for Neurological Disorders and Stroke are working together to implement the brain tumor research priorities set by the research, clinical and advocacy community, as summarized in the Brain Tumor Progress Review Group Report.
o Symptoms of a brain tumor can include headaches (headaches that wake you up in the morning), seizures in a person who does not have a history of seizures, cognitive or personality changes, eye weakness, nausea or vomiting, speech disturbances, or memory loss. While these are the most common symptoms of a brain tumor, they can also indicate other medical problems.
Treatment of Brain Tumor
1. Which therapies are used to treat brain tumors?
2. Which medications are used for brain tumor patients?
3. What is radiation therapy?
4. What is stereotactic radiosurgery?
5. What is chemotherapy?
6. What are the newest chemotherapy drugs?
7. What is gene therapy?
1. Which therapies are used to treat brain tumors?
Surgery is the chief form of treatment for brain tumors that lie within the membranes covering the brain or in parts of the brain that can be removed without damaging critical neurological functions. Because a tumor will recur if any tumor cells are left behind, the surgeon's goal is to remove the entire tumor whenever possible. Radiation therapy and chemotherapy, in general, are used as secondary or adjuvant treatment for tumors that cannot be cured by surgery alone.
2. Which medications are used for brain tumor patients?
Steroids and anti-convulsants (to stop seizures) are the most common medications used for brain tumor patients. Steroids are given to reduce inflammation of tissues and control swelling of the brain, particularly before and after surgery. They do not kill tumor cells, but used alone or combined with other forms of treatment, can cause remarkable improvement in a patients condition. If used for only a few days, steroids generally cause no side effects, but used over a long time or withdrawn without monitoring, steroids may produce several side effects. You should discuss monitoring of the steroid and all possible side effects with you doctor.
Other drugs commonly used with brain tumor patients are anti-convulsants. Some are used to keep seizures from happening (prophylactic) while others cut short (abort) seizures that have already started. Some of the more common drugs now used to prevent seizures are Dilantin, Tegratol, Depakote, and Phenobarbital. It is important to remember that side effects of these drugs vary greatly from person to person. But if side effects are a serious problem, there are plenty of newer drugs that can be used, either alone or in combination with others. Newer drugs include Neurontin (gabapentin), Topomax (toiramate), Lamictal (lamotrigine) and Gabitril (tiagabine).
3. What is radiation therapy?
Radiation therapy is mainly used after surgery for tumors that cannot be removed completely, as well as for cases in which surgery would involve too great a risk to the patient. It may be given in a single dose each day, usually for 30 days with weekends off, or it may be "hyper fractionated" into two or more doses daily for the recommended course of treatment.
Standard radiation therapy delivers an external beam of radiation aimed at an entire region, such as the portion of the brain containing the tumor and typically delivers a daily dose of 1.8-2.0 Gy (Gray) to a total dose of 50-60 Gy over 5-7 weeks.
4. What is stereotactic radiosurgery?
Stereotactic radiosurgery is a non-invasive therapeutic alternative for treating brain disorders. Instead of a scalpel, clinicians using stereotactic radiosurgery technology aim multiple"pencil-thin" beams or arced beams of high energy particles directly at the tumor site while sparing healthy tissue as much as possible. With stereotactic radiosurgery techniques, a higher dose of radiation is delivered to the specific site (or tumor) of 15-20 Gy and is usually given in one day. Both Gamma Knife and LINAC X Knife are types of stereotactic radiosurgery.
5. What is chemotherapy?
Chemotherapy works to destroy tumor cells with drugs that may be given either alone or in combination with other treatments. A key problem with chemotherapy has been the difficulty in delivering sufficient amounts of drug directly to the tumor while sparing normal brain cells. Another problem is the blood-brain barrier mechanism that normally serve to keep harmful substances out of the brain - unfortunately, this same blood-brain barrier can also work to keep potentially helpful drugs out of the brain. Although chemotherapy is usually given by mouth or injected in the vein, some new techniques of intratumoral chemotherapy use either small pumps or biodegradable wafers to place the drug inside the tumor.
6. What are the newest chemotherapy drugs?
There is currently a great deal of scientific activity focused on the area of the discovery of new chemotherapy drugs, many with novel or alternative mechanisms of action (how drugs work). Following is a brief list of the various categories of chemotherapies being used to treat brain tumors: Cytotoxic Agents, Anti-angiogenic drugs, Differentiating agents, Anti-invasion agents, Cell signal transduction modulators and Growth factor inhibitors.
7. What is gene therapy?
Currently for patients with malignant brain tumors who have a recurrence after surgery, radiation therapy or chemotherapy, gene therapy may provide an experimental option for treatment. Using gene therapy, researchers inject a substance into the brain tumor that changes the genetic makeup of the tumor cells.
Frequently Asked Questions
1. What is a brain tumor?
2. What is the difference between a primary brain tumor and a metastatic (secondary) brain tumor?
3. What is the difference between a benign brain tumor and a malignant (cancerous) brain tumor?
4. What does it mean when a brain tumor is in remission?
5. What are recurrent tumors?
6. Is a brain tumor cancer?
7. How is a brain tumor diagnosed?
8. How is a brain tumor treated?
9. What will happen to a patient with a brain tumor?
10. What are the parts of the brain?
1. What is a brain tumor?
A brain tumor is an abnormal mass of tissue in which the cells grow and multiply without restraint, apparently unregulated by the mechanisms that control normal cells. One factor that distinguishes brain tumors from other tumors is that they arise in the skull, an organ encased by bone, and there is very little room for expansion with the skull. They are also among the few types of tumors that generally do not tend to metastasize or spread to other parts of the body.
Whereas certain brain tumors occur almost exclusively during childhood and adolescence, others are predominantly tumors of adult life. The patient's age appears to correlate with the site where some tumors develop in the brain. Although most primary tumors attack member of both sexes with equal frequency, some, such as meningiomas, occur more frequently in women, while others, such as medulloblastomas, more commonly afflict boys and young men.
The prognosis for patients with a brain tumor is as individual as the patients themselves. Your doctors will help you understand the possible consequences of your specific tumor.
2. What is the difference between a primary brain tumor and a metastatic (secondary) brain tumor?
Primary brain tumors originate in the brain. The tumor cells do not travel to the brain from other parts of the body and, in most cases, primary brain tumor cells do not travel to other parts of the body either. The most common exception to this rule is the primary brain tumor of childhood called medulloblastoma, which can spread to the lymph nodes, bone marrow, lungs or other parts of the body. But even in this case, it is unusual for medulloblastoma to spread outside the nervous system. Pathologists classify primary brain tumors into two groups: the gliomas, composed of "glial" cells that invade the neural tissue surrounding them; and the nonglial tumors, which are not composed of glial cells and compress, rather than invade, the neighboring brain tissue as they grow.
Metastatic (secondary) brain tumors have spread to the brain from another part of the body. They most often metastasize from tumors of the lung or breast, but almost any tumor can spread to the brain. They arise when abnormal cells that developed elsewhere in the body are carried to the brain by the blood flow. Metastatic tumors are the most common form of brain tumor, affecting 20-40% of all cancer patients.
3. What is the difference between a benign brain tumor and a malignant (cancerous) brain tumor?
Benign brain tumors do exist, and often can be cured with surgery alone. Some primary brain tumors are called benign because their rate of growth is so slow that many years may pass before the tumor grows large enough to compress functional areas of the brain, causing symptoms that require treatment. Others are considered benign because - once the tumor is diagnosed and treated - in many cases, the patient will be cured and live a normal life span and in many others, the tumor will not grow back for many years or even decades.
We use the term benign with caution, however. Even a benign brain tumor may cause intolerable symptoms or may not be controllable because of its particular location in the brain. A tumor in the brain stem or the spinal cord, for example, is often impossible to remove with surgery. In those particular locations even a small amount of tumor growth can compress and cause very serious damage to brain or spinal structures that control functions critical to life. While such a tumor may be called "benign" because of its slow growth, the situation is far from benign.
No one is certain why, but some benign brain tumors may change over time to become malignant. The meningioma, for instance, is one type of primary brain tumor that can be cured, either with surgery alone or sometimes with surgery and radiation therapy. In such cases, meningioma is considered a benign tumor. But in rare cases, even a meningioma may have invasive features, which the pathologist can see in the tumor's cells under the microscope and which suggest that the tumor may behave more aggressively than usual. In such a case, the meningioma may not be curable. It may continue to grow despite surgery, irradiation and chemotherapy and might cause death by its uncontrolled growth. It is because of this potential for aggressive and uncontrolled growth that a tumor is considered malignant.
Malignant brain tumors behave in an aggressive manner and require aggressive treatments. They grow much more quickly than benign tumors and tend to invade normal brain tissue. The goal of treatment in some cases is to control the growth of the tumor as long as possible with the least possible side effects. But just because a tumor is considered malignant does not always mean that it cannot be cured. Many malignant tumors, including malignant primary brain tumors, are curable. Medulloblastoma, for example, is considered a malignant tumor, yet many patients are cured of medulloblastoma by surgery, radiation therapy and chemotherapy.
4. What does it mean when a brain tumor is in remission?
When a brain tumor is in remission, the tumor cells have entered a phase in which they generally have stopped growing or multiplying. This may or may not mean that these tumor cells will never grow again. After treatment, in some cases, the tumor has actually been destroyed and the area it occupied in the brain is composed only of dead tissue. In other circumstances, tumor cells remain alive, or viable, and retain the capacity to grow actively again, meaning that the tumor may recur at a later date.
5. What are recurrent tumors?
Tumor recurrence is a term that describes any of three conditions.
1. A recurrent tumor may be a tumor that still persists after primary treatment - a tumor that does not respond to surgery, radiation therapy, or chemotherapy or a combination of these therapies.
2. Alternatively, it may be a tumor that grows back some time after therapy has seemed to destroy it.
3. A new tumor that grows in the same place as the original one is also called a "recurrent" tumor because it is difficult, often impossible, to distinguish its cells from the cells of the original tumor.
Once treated, a brain tumor may remain in remission for many years, or may never recur. Unfortunately, it is not yet possible to predict whether, or when, any particular tumor may recur, which is why lifelong medical monitoring is essential for people treated for a brain tumor, even for a benign lesion.
6. Is a brain tumor cancer?
Some brain tumors are a form of cancer and some are not. The word cancer suggests a tumor that behaves aggressively and in fact, the word malignancy generally means cancer. According to this definition, most anaplastic astrocytomas as well as medulloblastomas are considered cancer, whereas meningiomas and pituitary tumors are not. In practical terms, these working definitions become blurred, however, because a benign tumor growing in the brain stem or spinal cord may cause severe injury or death whereas frequently, medulloblastoma, a form of cancer, can be cured.
7. How is a brain tumor diagnosed?
The most accurate diagnosis of a brain tumor is made with surgery, which permits the neurosurgeon to see the tumor and obtain a specimen for a pathological examination. Diagnostic surgery is not without its risks, however and there are several diagnostic procedures available today that have considerably improved the chances of detecting brain tumors without resorting to surgery. If a patient's symptoms lead the doctor to suspect a tumor, then a neurological examination, computerized tomography (CT) scans, and magnetic resonance (MR) imagings are the first diagnostic tools most often used to determine if more definitive procedures are needed. Other studies, such as X-ray films of the head and skull, an electroencephalogram (EEG) or radioisotopic brain scans, may also be done.
8. How is a brain tumor treated?
Surgery is the chief form of treatment for brain tumors that lie within the membranes covering the brain or in parts of the brain that can be removed without damaging critical neurological functions. Because a tumor will recur if any tumor cells are left behind, the surgeon's goal is to remove the entire tumor whenever possible. Radiation therapy and chemotherapy, in general, are used as secondary or adjuvant treatment for tumors that cannot be cured by surgery alone. Radiosurgery is used as both a primary and an adjunctive therapy for many brain disorders.
9. What will happen to a patient with a brain tumor?
To a large extent, what happens to you from this point forward depends on the type of tumor you have, its location, the area of the brain involved and the forms of therapy you'll have. But each patient is different, and these are not the only factors to be considered. The more you and your family know and understand each aspect of your treatment, the less uncertainty remains about what will happen. The confidence you place in yourself and your medical caretakers makes a tremendous difference. Perhaps most important of all is your outlook toward your condition and treatment and your willingness to believe in the power of healing - to be a survivor.
10. What are the parts of the brain?
The BRAINSTEM acts as the pathway for motor and sensory messages to the body and face. Tumors located in the brainstem cause cranial nerve symptoms such as inversion of the eyes and motor and sensory changes. In addition, the brainstem contains vital cardiac, respiratory and vasomotor functions.
The CEREBELLUM is one of many parts of the brain that controls motor coordination. A tumor located in this area can cause nausea and vomiting, loss of balance, double vision, difficulty walking and difficulty with fine motor skills.
The FRONTAL LOBE controls the higher cognitive functions such as judgement and emotions, and motor ability. A tumor located in this area can cause marked mood elevation or loss of initiative. Other symptoms may include hemiplegia, difficulty talking and slowing of movements.
The OPTICAL LOBE is the area of the brain that perceives vision. Tumors in this area can cause loss of vision partially or completely in one eye.
The PARIETAL LOBE is the part of the brain that controls the sensory, perceptual and speech functions. Tumors in this area can produce a decrease in perception of light touch and pressurre. Other symptoms may include impairment of right-left discrimination and visual-spacial orientation of the body.
The TEMPORAL LOBE is the area that contains speech, hearing and emotional changes. Tumors in this area can produce aggresive behavior, difficulty processing or expressing words, and memory disorders.