| What Is a Brain Tumor? |
A tumor is a mass or growth of abnormal cells. Tumors found in the brain typically are categorized as primary or secondary. Primary brain tumors originate in the brain and can be non-cancerous (benign) or cancerous (malignant). But they're relatively rare. About 17,000 Americans a year receive a diagnosis of a primary brain tumor. Secondary brain tumors, which are malignant, are more common, affecting some 90,000 Americans in a year. These tumors result from cancer that has started elsewhere in the body and spread (metastasized) to the brain.
Benign brain tumors are usually slower growing, easier to remove and less likely to recur than are malignant brain tumors. Malignant brain tumors can grow rapidly, crowding or destroying nearby brain tissue. However, in a small number of cases even benign brain tumors can cause serious problems or be life-threatening.
Brain tumors can be challenging to treat. In fact, brain tumors are the second leading cause of cancer death in children under age 15. But the outlook isn't necessarily bleak. Many types of brain tumors can be successfully treated with one or more treatment methods. In addition, new technology is enabling physicians to target tumors more precisely. And innovative treatments under investigation mean more hope for the future.
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| Signs and Symptoms |
The signs and symptoms of a brain tumor depend on its size, location and rate of growth. A brain tumor — primary or secondary — can cause a variety of symptoms because it can directly press on or invade brain tissue, damaging or destroying areas responsible for sight, movement, balance, speech, hearing, memory or behavior. Pressure from a brain tumor can also cause surrounding brain tissue to swell (edema), further increasing pressure and symptoms.
Signs and symptoms can include the following:
- New and aggressive headache — especially upon waking
- Unexplained nausea or vomiting
- Vision problems such as blurred vision, double vision or loss of peripheral vision
- Gradual loss of sensation or movement in an arm or a leg
- Difficulty with balance
- Speech difficulties
- Drowsiness
- Confusion in everyday matters
- Personality or behavior changes
- Seizures, especially in someone who doesn't have a history of seizures ( as with epilepsy, for
example)
- Hearing problems
- Hormonal (endocrine) disorders
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| Causes |
Physicians generally divide brain tumors into the following categories to explain where or how they originate:
- Primary. Primary brain tumors originate in the brain or close to it, such as in the skull,
brain membranes (meninges), cranial nerves, or pituitary or pineal gland. Most brain tumors in
children are primary. About 25 percent of brain tumors in adults are primary. It's not known what
causes these brain tumors. Studies are being done to determine whether heredity, environmental
factors, viruses or other factors play a role in their development.
Some common types of primary tumors — which are named after the type of brain cells from which they originate — include acoustic neuromas (schwannomas), astrocytomas, medulloblastomas, meningiomas and oligodendrogliomas. - Secondary. Secondary (metastatic) brain tumors are tumors that result from cancer that starts elsewhere in the body and then spreads (metastasizes) to the brain. Cancers of the lung, colon and breast, along with melanoma — a form of skin cancer — are most likely to spread to the brain. About 75 percent of brain tumors in adults are metastatic. Sometimes, brain metastases are the first sign of cancer elsewhere in the body.
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| Risk Factors |
Doctors don't know exactly what causes primary brain tumors, so it's difficult to pinpoint risk factors. Brain tumors sometimes strike several members of a family, suggesting heredity may be a risk factor. However, recent studies suggest that this influence is small.
Some studies show that some types of brain tumors occur more frequently in people who work in oil refining, rubber manufacturing, chemical and nuclear industries. But a definite link between exposure to chemicals and brain tumors hasn't been proved. Similarly, electromagnetic fields and the use of cell phones have been studied as causes of primary brain tumors, but no definitive medical evidence indicates that either causes brain tumors.
Although brain tumors can occur at any age, they're most common in two age groups — children ages 3 to 12 and adults ages 40 to 70. Most brain tumors in children are primary.
Doctors and researchers don't believe that head injuries increase the risk of developing a brain tumor.
| When to Seek Medical Advice |
Most headaches don't signal a serious medical condition. But if you have headaches that progressively worsen, that are always in the same location or that are worse in the morning than in the afternoon — accompanied by nausea or vomiting or by blurred or double vision — bring this to the attention of your doctor.
Brain tumors are relatively rare. But the prognosis is often better the earlier the tumors are diagnosed and treated.
| Screening and Diagnosis |
The diagnosis of brain tumors has been increasing in recent years. Experts aren't sure whether that's due to better detection methods or to an actual increase in the number of tumors.
The signs and symptoms of a brain tumor initially may be vague and come and go, making the diagnosis of a brain tumor difficult. Other diseases can cause similar signs and symptoms.
Diagnosing a brain tumor usually involves several steps. Your physician may perform a neurologic exam, which includes checking your vision, hearing, balance, coordination and reflexes, among other things. Depending on the results of that exam, your doctor may request one or more of these tests:
- Computerized tomography (CT) scan. A CT scan uses a sophisticated X-ray machine linked to a
computer to produce detailed, two-dimensional images of the brain. You lie still on a movable table
that's guided into what looks like an enormous doughnut where the images are taken. A special dye may
be injected into your bloodstream after a few CT scans are taken. The dye helps make tumors more
visible on X-rays. A CT scan is painless and generally takes less than 10 minutes.
- Magnetic resonance imaging (MRI) scan. This scan uses magnetic fields and radio waves to
generate images of the brain. You lie inside a cylindrical machine for 15 minutes to an hour. MRI
scans are particularly useful in diagnosing brain tumors because they outline soft tissues of the body
as well as bone. Sometimes a special dye is injected into your bloodstream during the procedure. The
dye sometimes makes tumors easier to distinguish from healthy tissue.
- Angiogram. This test involves injecting a special dye into your bloodstream. The dye, which
flows through the blood vessels in the brain, can be seen on X-ray. This test helps show the location
of blood vessels in and around a brain tumor.
- X-rays of the head and skull. An X-ray of the head may show alterations in skull bones that
could indicate a tumor. It may show calcium deposits, which are sometimes associated with brain
tumors. However, an X-ray is a far less sensitive test than brain scans and so is used less often.
- Other brain scans. Other tests, such as magnetic resonance spectroscopy (MRS), single-photon emission computerized tomography (SPECT) or positron emission tomography (PET) scanning, help doctors gauge brain activity by studying brain metabolism and chemistry and blood flow within the brain. These scans can be combined with MRIs to help doctors understand the effects of a tumor on brain activity and function.
In addition to brain scans and other tests, doctors usually need to perform surgery to diagnose a brain tumor and confirm its type. Surgery allows a biopsy to be performed. A biopsy involves removing a piece of the tumor so that it can be viewed under a microscope.
A biopsy can be performed as part of surgery to remove a brain tumor. A biopsy can also be performed as part of a separate diagnostic procedure.
A needle biopsy may be used for brain tumors in hard to reach areas within your brain. The surgeon drills a small hole, called a burr hole, into your skull. A narrow, thin needle is then inserted through the hole. Tumor tissue is removed using the needle, which is frequently guided by CT scanning.
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| Complications |
Depending on its size and location, a brain tumor can cause temporary or permanent brain damage. The brain is divided into different parts that are responsible for a variety of functions. For example, the front part of the brain (frontal lobe) is responsible for helping you think and managing motor skills. A brain tumor in the frontal lobe may press on or invade brain tissue in this area, resulting in learning or memory difficulties. It may also make talking or walking difficult. A brain tumor in the part of the brain called the occipital lobe — located in the back of the head — can result in vision problems because that area of the brain controls your ability to see and comprehend what you see.
Brain tumors may lead to an emergency complication known as hydrocephalus, which is the buildup of fluid in and around your brain. This occurs when a tumor blocks the flow of cerebrospinal fluid in and around your brain, causing fluid to build up within the confined spaces of your skull. This buildup can create pressure on delicate brain structures. The fluid must be drained to relieve pressure and reduce the risk of brain injury. Bleeding in the brain caused by a tumor often requires emergency medical care.
Your brain as a unit controls everything you do — including breathing and living. An aggressive tumor that destroys too much brain tissue can be deadly.
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| Treatment |
Treatment for a brain tumor — along with survival odds — depends on the type, size and location of the tumor, as well as your age and overall health. Doctors tailor treatment to fit each person's diagnosis.
Because brain tumors can be complex to treat, a team of doctors often treats them. This team may include:
- A neurosurgeon — a brain surgeon
- An oncologist — a doctor who specializes in treating cancer
- A radiologist — a doctor who specializes in reading medical images
- A radiation oncologist — a doctor who specializes in radiation therapy
- A neurologist — a doctor who specializes in the nervous system
These measures aren't often needed for benign, primary brain tumors. The main treatment methods for brain tumors include:
- Surgery. This is the mainstay of brain tumor treatment. It involves removing as much of the
tumor as possible while trying to minimize damage to healthy tissue. Some tumors can be removed
completely, and others can be removed only partially or not all. If a tumor is slow growing — usually
a benign tumor — doctors may not operate immediately but take a watch-and-wait approach.
- Radiation. High-energy radiation can be used to destroy tumor cells in your brain.
- Chemotherapy. These drugs, taken by mouth or intravenously, can help kill cancerous tumor cells. Although chemotherapy is highly effective in treating some cancers, it's less successful in treating brain tumors.
Once treated, a brain tumor may remain in remission for many years, or may never recur. When a brain tumor is in remission, it means that the tumor cells have stopped growing or multiplying.
As part of follow-up for brain tumor treatment, you're usually monitored on a regular basis for tumor recurrence with MRI or CT scans. You may be asked to return to your doctor for a scan every 3 to 6 months or annually, depending on the type of tumor you had.
New and experimental treatments
In addition to current brain tumor treatments, new technology is evolving and helping to make the treatment of brain tumors more precise. One of the most important advances is stereotactic localization. This technique utilizes a MRI scan to map a tumor's exact location within the brain.
New techniques utilizing lasers and ultrasound also make removal of the tumor more precise, reducing the risk that cancer cells will be left behind and that healthy tissue will be harmed.
Some of the most intriguing new methods in brain tumor treatment involve the use of radiation. A treatment that precisely focuses radiation beams to a tumor is called stereotactic radiosurgery. No scalpels are involved. Gamma knife stereotactic radiosurgery delivers radiation beams in the exact size and shape of the tumor, with the aid of brain imaging techniques.
Researchers also are studying new ways to deliver cancer-fighting drugs to brain tumors. For instance, biodegradable wafers containing cancer-fighting drugs are being implanted in some tumors during surgery. In addition, gene therapy, drugs that cut off a tumor's blood supply and agents that may be able to interrupt tumor growth or to seek out and kill brain cancer cells are all under investigation.
Many of these newer treatments for brain tumors are being tested in clinical research trials. If you have a brain tumor, particularly a malignant brain tumor, participating in a clinical trial can help you have access to the newest experimental treatments and take part in helping to define the role of these new treatments. To find out about clinical trials under way, contact the American Brain Tumor Association (ABTA) at 800-886-2282 or or the National Cancer Institute at 800-4-CANCER (800-422-6237) or visit their Web sites.
Decisions about brain tumors can be complex. Before starting any treatment, you may want to get a second opinion. To find brain tumor specialists, ask your doctor for recommendations. You can also try calling local hospitals, cancer centers, medical schools or medical societies for recommendations. The ABTA provides lists of brain tumor specialists. You may not be able to get a consensus on treatment for your tumor, but the more information you gather, the more prepared you and your family are to make decisions.
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Rehabilitation
Because brain tumors can develop in parts of the brain that control motor skills, speech, vision and thinking, rehabilitation may be a necessary part of recovery. The brain can sometimes heal itself after trauma from a brain tumor or treatment of a brain tumor — but this can take time and patience.
Cognitive rehabilitation helps people with brain tumors cope with or regain lost cognitive abilities. Physical therapy can help them regain lost motor skills or muscle strength. Vocational therapy — helping people get back to work after a brain tumor or other illness — may also be beneficial. Specialists in speech difficulties (speech pathologists) are just one of many types of therapists who can help a person with a brain tumor recover as fully as possible.
School-age children with brain tumors may especially benefit from tutoring as a part of their overall treatment plan. A brain tumor can cause changes in the brain that affect thinking and learning. The earlier these problems can be identified, the earlier they can be addressed with strategies that maximize the benefit to the child.
| Coping Skills |
It's natural for you and your family to have many questions throughout your diagnosis and treatment. But a diagnosis of a brain tumor can be overwhelming — and frightening. That's why it might help to write down your questions and bring them with you to your appointments. As your doctor answers your questions, take notes or ask a family member to accompany you and take notes. The more you and your family know and understand about each aspect of your care, the better.
You also might find it helpful to share your feelings with others in similar situations. Check to see if local support groups for people with brain tumors and their families are available in your area. Hospitals often sponsor these groups. Your doctors and nurses also may be able to make recommendations on where to find the emotional support you might need.
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| Complementary and Alternative Medicine |
Surgery, radiation and chemotherapy are used to treat a tumor. But your spiritual well-being may benefit from complementary therapies such as meditation, imagery, prayer, massage, relaxation and humor. You can explore these therapies on your own or ask your medical care team for suggestions. Many books and other sources of information are specifically geared toward helping people with brain tumors and cancer cope with the physical and emotional stresses that accompany their condition.
— August 16, 2002 —