Brain Tumors

A tumor is an abnormal growth of cells in your brain. Normal cells grow in a controlled manner as new cells replace old or damaged ones. For reasons not fully understood, tumor cells grow uncontrollably. Brain tumors are named after the type of cell from which they grow. They may be primary (starting in the brain) or secondary (spreading to the brain from another area). Treatment options vary depending on the tumor type, size and location; whether the tumor has spread; and the age and health of the person.

A Primary Brain Tumor is an abnormal growth that starts in the brain and usually does not spread to other parts of the body. Primary brain tumors may be benign or malignant.

A Benign Brain Tumor grows slowly, has distinct boundaries, and rarely spreads. Although its cells are not malignant, this tumor composed of benign cells and located in vital areas can be considered life-threatening.

A Malignant Brain Tumor grows quickly, has irregular boundaries, and spreads to nearby brain areas. Although they are sometimes called brain cancer, malignant brain tumors do not fit the definition of cancer because they do not spread to organs outside the brain and spinal cord.

Metastatic (Secondary) Brain Tumors begin as cancer elsewhere in the body and spread to the brain. They form when cancer cells are carried in the blood stream to the brain. The most common cancers that spread to the brain are lung and breast.

Whether a brain tumor is benign, malignant, or metastatic, all are potentially life-threatening. Enclosed within the bony skull, the brain cannot expand to make room for a growing mass. As a result, the tumor compresses and displaces normal brain tissue.

Brain tumors are named after the cell type from which they grow. They may be primary (starting in the brain) or secondary (spreading to the brain from another area). Treatment options vary depending on the tumor type, size and location; whether the tumor has spread; and the age and medical health of the person. Treatment options may be curative or focus on relieving symptoms. Of the more than 120 types of brain tumors, many can be successfully treated. New therapies are improving the life span and quality of life for many people.

Because there are so many kinds of brain tumors and some are complex to treat, many doctors may be involved in your care. Your team may include a neurosurgeon, oncologist, radiation oncologist, radiologist, neurologist, and neuro-ophthalmologist.

For tumors seated deep in the brain structure or those that are widespread, a guided biopsy is suggested. A CT Scan or MRI Scan enables the surgeon to maneuvre the biopsy needle in the correct direction for sample extraction. This procedure utilizes sophisticated imaging techniques, hence is completely safe. Once the specialists know about the brain tumor they are dealing with, the next operation can be planned.

What Causes Brain Tumors?

Medical science neither knows what causes brain tumors nor how to prevent primary tumors that start in the brain. People most at risk for brain tumors include those who have:

• Cancer elsewhere in the body
• Prolonged exposure to pesticides, industrial solvents, and other chemicals
• Inherited diseases, such as neurofibromatosis

What are the symptoms?

Tumors can affect the brain by destroying normal tissue, compressing normal tissue, or increasing intracranial pressure. Symptoms vary depending on the tumor’s type, size, and location in the brain. General symptoms include:

• Headaches that tend to worsen in the morning
• Seizures
• Stumbling, dizziness, difficulty walking
• Speech problems (e.g., difficulty finding the right word)
• Vision problems, abnormal eye movements
• Weakness on one side of the body
• Increased intracranial pressure, which causes drowsiness, headaches, nausea and vomiting, sluggish responses

Specific symptoms include:

Frontal lobe tumors may cause behavioral and emotional changes, impaired judgment, impaired sense of smell, memory loss, paralysis on one side of the body, reduced mental abilities, and vision loss.

Parietal lobe tumors may cause impaired speech, inability to write, lack of recognition, and spatial disorders.

Occipital lobe tumors may cause vision loss in one or both eyes.

Temporal lobe tumors may cause impaired speech and memory difficulty.

Brainstem tumors may cause behavioral and emotional changes, difficulty speaking and swallowing, drowsiness, hearing loss, muscle weakness on one side of the face (e.g., head tilt, crooked smile), muscle weakness on one side of the body, uncoordinated gait, drooping eyelid or double vision, and vomiting.

Pituitary gland tumors may cause increased secretion of hormones (Cushing’s Disease, Acromegaly), a stop in menstruation, abnormal secretion of milk, and decreased libido.

How Is A Diagnosis Made?

After checking your general health, medical history and your performance of complete physical examination the doctor also performs a neurological exam to check mental status and memory, cranial nerve function (sight, hearing, smell, tongue and facial movement), muscle strength, coordination, reflexes, and response to pain. Additional tests may include:

• Audiometry, a hearing test performed by an audiologist, detects hearing loss due to tumors near the cochlear nerve (e.g., acoustic neuroma).
• An endocrine evaluation measures hormone levels in your blood or urine to detect abnormal levels caused by pituitary tumors (e.g., Cushing’s Disease).
• A visual field acuity test is performed by a neuro-ophthalmologist to detect vision loss and missing areas in your field of view.
• A lumbar puncture (spinal tap) may be performed to examine cerebrospinal fluid for tumor cells, proteins, infection, and blood.

Other diagnostic tests include:

IMAGING TESTS

Computed Tomography (CT) scan is a safe, noninvasive test that uses an X-ray beam and a computer to make 2-dimensional images of the brain. Similar to an MRI, it views the brain in slices, layer-by-layer, taking a picture of each slice. A dye (contrast agent) may be injected into your bloodstream. CT is especially useful for viewing changes in bony structures.

Magnetic Resonance Imaging (MRI) scan is a noninvasive test that uses a magnetic field and radiofrequency waves to give a detailed view of the soft tissues of the brain. It views the brain 3-dimensionally in slices that can be taken from the side or from the top as a cross-section. A dye (contrast agent) may be injected into your bloodstream. MRI is very useful to evaluate brain lesions and their effects on surrounding brain

BIOPSY

In some cases, if a diagnosis cannot be made clearly from the scans, a biopsy may be performed to determine what type of tumor is present. Biopsy is a procedure to remove a small amount of tumor to be examined by a pathologist under a microscope. A biopsy can be taken as part of an open surgical procedure to remove the tumor or as a separate diagnostic procedure, known as a needle biopsy via a small hole drilled in the skull. A hollow needle is guided into the tumor and a tissue sample is removed. A stereotactic biopsy is like a needle biopsy but is performed with the use of a stereotactic head frame and a computer to precisely locate the tumor and direct the needle. This more complex procedure is used for deep tumors in critical locations.

What Treatments Are Available?

Treatment options vary depending on the type, grade, size and location of the tumor; whether it has spread; and your age and general health.

The goal of treatment may be curative or focus on relieving symptoms. Treatments are often used in combination with one another. The goal is to remove all or as much of the tumor as possible through surgery to minimize the chance of recurrence.

Radiation therapy and chemotherapy are used to treat tumors that cannot be removed by surgery alone. For example, surgery may remove the bulk of the tumor and a small amount of residual tumor near a critical structure can later be treated with radiation.

At Salus our Surgeons offer the following treatment options:

SURGERY

• Surgery is the treatment of choice for brain tumors that can be reached without causing major injury to vital parts of the brain. Surgery can help to refine the diagnosis, remove as much of the tumor as possible, and release pressure within the skull. A neurosurgeon performs a craniotomy to open the skull and remove the tumor .Sometimes only part of the tumor is removed if it is near critical areas of the brain. A partial removal can still relieve symptoms. Radiation or chemotherapy may be used on the remaining tumor cells.
• Improvements in techniques, particularly image-guided surgery, intraoperative MRI/CT, and functional brain mapping have improved the surgeon’s ability to precisely locate the tumor, define the tumor’s borders, avoid injury to vital brain areas, and confirm the amount of tumor removal while in the operating room.

RADIATION THERAPY

• Radiation therapy uses controlled high-energy rays to treat brain tumors. Radiation works by damaging the DNA inside cells making them unable to divide and reproduce. The goal of radiation therapy is to maximize the dose to abnormal cells and minimize exposure to normal cells. The benefits of radiation are not immediate but occur over time. Aggressive tumors, whose cells divide rapidly, typically respond more quickly to radiation. There are two ways to deliver radiation, external and internal beams.
• Stereotactic Radiosurgery (SRS) delivers a high dose of radiation during a single session. Although it is called surgery, no incision is made.
• Fractionated Stereotactic Radiotherapy (FSR) delivers lower doses of radiation over many visits. Patients return daily over several weeks to receive the complete radiation dose.
• Whole brain Radiotherapy (WBRT) delivers the radiation dose to the entire brain. It is often used to treat multiple brain tumors and metastases.
• Internal radiation (brachytherapy) is delivered from inside the body by surgically placing radioactive material (sealed in catheters, seeds, or balloons) directly into the tumor. After the patient undergoes a craniotomy to remove the tumor, the radioactive material is placed inside the tumor cavity. The radiation dose is delivered to the first few millimeters of tissue that surrounded the tumor cavity where malignant cells may still remain. Patients have no risk of radiation injury to other parts of their own body or to others around them because the radiation dose is precisely delivered and short lived.

RECOVERY & PREVENTION

Rehabilitation

Because brain tumors develop in parts of the brain that control movement, speech, vision and thinking, rehabilitation may be a necessary part of recovery. A Neuropsychologist can help patients evaluate changes caused by their brain tumor and develop a plan for rehabilitation. A neuropsychological evaluation assesses the patient's emotional state, daily behavior, cognitive (mental) abilities, and personality. Physical therapy, occupational therapy, and speech therapy may be helpful to improve or correct lost functions.

Recurrence

How well a tumor will respond to treatment, remain in remission, or recur after treatment depends on the specific tumor type and location. A recurrent tumor may be a tumor that still persists after treatment, one that grows back some time after treatment destroyed it, or a new tumor that grows in the same place as the original one.

When a brain tumor is in remission, the tumor cells have stopped growing or multiplying. Periods of remission vary. In general, benign tumors recur less often than malignant ones.

Since it is impossible to predict whether or when a particular tumor may recur, lifelong monitoring with MRI or CT scans is essential for people treated for a brain tumor, even a benign lesion. Follow-up scans may be performed every 3 to 6 months or annually, depending on the type of tumor you had.