Brain Tumor

A brain tumor is a collection of cells that grow out of control. As they continue to grow, they form a mass of cells that becomes a tumor. Brain tumors form in 1 of 2 ways:

• Primary brain tumor. This starts with an abnormal brain cell and grows in the brain.
• Metastatic (secondary) tumor. This starts as a cancer in another part of the body, such as the lungs or breast. It then spreads to the brain, where it forms a new tumor. 

Doctors don't know why some cells begin to form into tumor cells. It may have something to do with a person's genes, or his or her environment, or both.

The tumors can cause local damage by growing and pushing on key areas of the brain. They can also cause problems if they block the flow of fluid around the brain. This can lead to an increase in the pressure inside the skull. Some types of tumors can spread through the spinal fluid to distant areas of the brain or the spinal cord.  

A primary brain tumor can be cancer (malignant) or noncancer (benign):

• A malignant tumor is more dangerous because it can grow quickly. It may grow into or spread to other parts of the brain or to the spinal cord. Malignant tumors are also sometimes called brain cancer. Metastatic brain tumors are always cancer. They have spread to the brain from other areas of cancer in the body.
• A benign primary brain tumor is not cancer. Benign tumors can cause damage by growing and pressing on other parts of the brain. But these tumors don't spread. In some cases, a benign tumor can turn into a malignant tumor.

Symptoms of a brain tumor depend on the size and location of the tumor, as well as other factors. They may include:

• Headache.
• Dizziness.
• Weakness or numbness in the arms, legs, or face.
• Vomiting.
• Changes in speech, vision, hearing, or personality.
• Seizures.
• Feeling drowsy.
• Problems with balance or walking.

Both the type of brain tumor and its location are important. For example, some benign brain tumors can be quite harmful. They can cause severe neurological problems if located in a key area of the brain. More than 100 types of brain tumors have been identified. They are often named by the type of brain cell or part of the brain where they begin to grow.

There are 2 main types of brain tumors:

• Primary tumor. This kind of tumor starts in the brain.
• Secondary (metastatic) tumor.This kind of tumor is from a cancer that starts in another part of the body, then spreads to the brain.
  

There are 2 types of primary brain tumors:

• Benign tumor. This kind of tumor is not cancer. It tends to grow slowly. Most benign brain tumors don’t grow into nearby tissue. Once removed, they usually don’t grow back. A benign tumor can cause symptoms like a malignant tumor, depending on its size and location in the brain.
• Malignant tumor. This kind of tumor is cancer. It usually grows fast, and grows into nearby tissue. This can make it hard to remove fully. A malignant brain tumor may grow back after treatment.

Primary brain tumors are named by the type of brain tissue where they’re found. The most common type of primary brain tumor is a glioma. This type begins in the supportive (glial) tissue of the brain. Some gliomas tend to grow slowly. Others grow and spread quickly. Some types of glioma include:

• Astrocytoma. This kind of tumor comes from small star-shaped cells called astrocytes. In adults, an astrocytoma usually grows in the cerebrum. In children, they can grow in the cerebellum, cerebrum, and brain stem. Most astrocytomas spread into nearby normal brain tissue and are hard to cure with surgery. Glioblastoma is a type of astrocytoma that tends to grow very quickly. 
• Brain stem glioma. This kind of tumor of the brain stem is more common in children than in adults. Because the brainstem controls many important functions, such as breathing and heart rate, this kind of tumor usually can’t be removed by surgery.
• Ependymoma. This kind of tumor starts in cells that line the fluid-filled spaces within the brain (ventricles). It doesn’t often grow into nearby brain tissue. This means in some cases it can be cured with surgery.
• Oligodendroglioma. This kind of tumor starts in cells that make myelin, the fatty substance that surrounds nerve cells. Like an astrocytoma, this tumor tends to spread into nearby brain tissue and is often hard to cure with surgery. 
• Optic nerve glioma. This kind of tumor grows in or around the nerve that sends messages from the eyes to the brain. This can cause vision changes. It can also cause hormone changes, due to its location near the pituitary gland. 

Other types of primary tumors include:

• Primitive Neuroectodermal Tumor (PNET). This kind of tumor grows more often in children. It can grow anywhere in the brain in the primitive form of nerve cells. One type is the medulloblastoma. This kind of tumor is found in the cerebellum. They are more common in children than in adults. They tend to grow and spread quickly, but they can often be treated effectively. 
• Tumor of the pineal gland. This kind of tumor grows in and around the pineal gland. This is a tiny organ near the center of the brain. The tumor can be slow-growing, called pineocytoma. Or it can be fast-growing, called pineoblastoma.
• Pituitary tumor. This kind of tumor starts in the pituitary gland at the base of the brain. It is almost always benign. But it can cause serious symptoms because of its location, and because it may secrete excess hormones. 
• Craniopharyngioma. This kind of tumor starts near the pituitary gland. It is usually slow growing. But it can cause symptoms if it presses on the pituitary gland or on nearby nerves. 
• Schwannoma. This kind of tumor starts in myelin-making cells that surround certain nerves. It’s most common in the vestibular nerve in the inner ear that helps with balance. If it grows there, the tumor is called a vestibular schwannoma or acoustic neuroma. This type of tumor is usually benign. 
• Meningioma. This kind of tumor starts in the outer linings of the brain (meninges). It is more common in adults. Many meningiomas can be removed with surgery, but some may grow back.  
• Primary central nervous system lymphoma. This is an aggressive, rare type of tumor that starts in lymphocytes. This is a type of immune cell. The tumor is more common in people with a disease of the immune system, such as AIDS. But it can grow in healthy people.

A secondary brain tumor is also known as a metastatic brain tumor. This is a cancer that starts in another organ and then travels to the brain. In adults, secondary brain tumors are more common than primary brain tumors. Cancer in the brain that has spread from another part of the body is not considered brain cancer. It is still the same type of cancer as where it started. For example, lung cancer that has spread to the brain is called metastatic lung cancer. These are some of the most common types of cancer that spread to the brain:

• Lung cancer.
• Breast cancer.
• Melanoma.
• Colon cancer.
• Kidney cancer.

Along with its location, the way a tumor grows can affect the symptoms you have. A tumor may affect the brain in one or more ways. It may:

• Destroy normal brain tissue.
• Compress normal brain tissue.
• Increase pressure within the brain.
• Excite brain cells and produce seizures.
• Cause bleeding in the brain.
• Block the normal flow of cerebrospinal fluid (CSF) that bathes the brain and spinal cord.

The most common symptoms of brain tumors are:

• Headaches that may be worse in the morning.
• Trouble thinking, remembering, or talking, or changes in personality.
• Vision, speech, or hearing problems.
• Seizures or convulsions.
• Paralysis, numbness, or weakness in one part or on one side of the body.
• Loss of balance, lack of coordination, or problems walking.
• Nausea and vomiting that may be worse in the morning.
• Hormone problems (many types).
• Drowsiness.

If your healthcare provider thinks you might have a brain tumor, you will need some exams and tests to be sure. Diagnosing a brain tumor starts with your healthcare provider asking you questions. He or she will ask you about your health history, your symptoms, risk factors, and family history of disease.

Your healthcare provider will also give you a physical exam. He or she will likely examine you for possible signs of brain or spinal cord problems. The exam will test things like your reflexes, muscle strength, sensation, eye and mouth movement, vision, coordination, and alertness.

You may have one or more of the following imaging tests:

• Magnetic resonance imaging (MRI).
• Computed tomography (CT) scan.
• Computed tomography angiogram (CTA).
• Positron emission tomography (PET) scan.
• Magnetic resonance spectroscopy (MRS).
• Angiogram.
• Magnetic resonance angiography (MRA) and magnetic resonance venography (MRV).
• Diffusion tensor imaging (DTI).
• Functional magnetic resonance imaging (fMRI).
• Skull X-ray.

And you may have other tests such as:

• Lumbar puncture (spinal tap).
• Electroencephalogram (EEG).
• Brain tumor biopsy.

• Magnetic resonance imaging (MRI). An MRI scanner uses magnets and strong radio waves to make pictures of the brain. MRIs are very useful in diagnosing brain tumors because they allow your doctor to "see through" your skull. This results in clearer pictures of the brain. A technician might inject a special dye into your vein. This makes it easier to see the difference between a tumor and normal brain tissue. An MRI can show slices of the brain from many different angles. It can show smaller details better than other scans. An MRI is especially helpful in finding tumors in the back part of the brain called the posterior fossa. It is also better at finding tumors in the spinal cord.

• Computed tomography (CT) scan. A CT scan is a type of X-ray that creates detailed pictures of the brain. Many images of the brain are taken as the X-ray scanner moves around your head. A computer combines these many images into a useful picture. Sometimes a technician injects a special dye into a vein before the CT scan to enhance the difference between normal and abnormal tissue. This test is not used as often as MRI to look for brain tumors, but it can be helpful in some situations. A special form of CT scan, known as CT angiography (CTA), may be used to look at the blood vessels around a tumor to help plan surgery.

• Positron emission tomography (PET) scan. For a PET scan, a technician injects a small amount of a radioactive substance into your vein. It’s usually glucose, a type of sugar. Fast-growing tissue, such as a tumor, absorbs this substance and can be seen by a special type of scanner. The radioactive material used in this test is not dangerous. It will leave your body in about 6 hours. A PET scan can help your doctor tell the difference between an active, growing tumor and damage from radiation therapy or a scar from surgery. Tumors light up while damaged tissue doesn’t.

• Magnetic resonance spectroscopy (MRS). An MRS scan can determine the metabolites inside the tumor. Sometimes, this test is used to determine if a growth is an active tumor or a mass of radiation damage (necrosis).

• Angiogram. An angiogram is a series of X-rays taken after a technician injects a special dye into one of your blood vessels. It may also be called arteriogram or venogram, depending on which type of blood vessel is used. A technician also inserts a catheter into one of your large blood vessels, usually in your groin, and then positions it with the help of an X-ray. After injection, the dye flows through the blood vessels in your brain and can be seen on X-rays. These X-rays show the tumor and the blood vessels that lead to it, which helps doctors plan surgery. This test is used less often than in the past. CT angiography and magnetic resonance (MR) angiography are now used more often to look at blood vessels in the brain.

• Magnetic resonance angiography (MRA) and magnetic resonance venography (MRV). These are special types of MRI tests that can show blood vessels in and around the brain. They are less invasive than an angiogram.

• Diffusion tensor imaging (DTI). This is a type of MRI exam that lets the doctor see the neural pathways in your brain. This is useful for surgeons to help plan tumor removal.

• Functional magnetic resonance imaging (fMRI). This is an MRI test that can help map which parts of the brain handle important functions such as movement or speech. This can be helpful before surgery.

• Skull X-ray. Certain types of tumors can leave calcium deposits. A skull X-ray is very good at seeing these. Skull X-rays will also show changes to the structure of the skull caused by tumors.

• Lumbar puncture (spinal tap). For this test, a thin, hollow needle is placed into the lower back, into the spinal canal. This is the area around the spinal cord. The fluid pressure in the spinal canal and brain can then be measured. A small amount of cerebrospinal fluid (CSF) can be removed and sent for testing to see if it contains cancer cells. CSF is the fluid that bathes the brain and spinal cord. Other tests may be done on this fluid as well.

• Electroencephalogram (EEG). An electroencephalogram (EEG) is a non-invasive test that measures the electrical activity in the brain, called brain waves.  Small round discs with wires (electrodes) are placed on your scalp. An EEG can be used to check for seizures.

• Your healthcare provider may also determine you will need formal testing of your vision and hearing.

• Brain tumor biopsy. If any of these tests suggest that a tumor might be present, a neurosurgeon will probably take a biopsy of the tumor. In most cases, this is the only way to know for sure if a tumor is benign or malignant (and to determine what type of tumor it is), although sometimes doctors can get enough information to make a diagnosis from the imaging tests alone. For a brain tumor biopsy, a doctor takes out as much of the tumor as possible through a bone "window" made in your skull. A pathologist examines this sample under a microscope to see if it is cancer. Another type of biopsy is the stereotactic biopsy. For this biopsy, the neurosurgeon removes a small piece of the tumor with a hollow needle. The needle is carefully guided and placed in the tumor with the help of an imaging test, such as an MRI or CT scan.

Most cancer centers that treat brain tumors use a grading system developed by the World Health Organization. A tumor's grade is determined by looking at cells from the tumor under a microscope. Tumor grading is important because it is one factor that helps doctors decide how to treat a tumor.

Grade I and II tumors are typically considered low grade. They look more normal under the microscope, are less likely to spread, and are easier to treat. Grade III and IV tumors are considered high grade. They grow more quickly and are harder to treat. Over time, some low-grade tumors become high-grade tumors.

Here is more specific information on tumor grades:

• Grade I. These tumors are considered to be benign and slow growing. They may be treated with surgery and they rarely come back. You can often expect long-term survival.
• Grade II. These tumors are considered to be cancer, but they grow slowly. They are less likely to spread. But they may come back after treatment.
• Grade III. These tumors are cancer and tend to spread to other parts of the brain. They may come back as grade IV after treatment.
• Grade IV. These are the most malignant tumors. They grow and spread most rapidly. They are least likely to be cured.

If you or a loved one has been diagnosed with a brain tumor, keep in mind that many new treatments are available. These are leading to longer survival and better quality of life. Treatment will depend on a person's age, overall health, and the tumor type, grade, location, and other factors. Learn as much as you can about brain tumors and work closely with your medical team to find the best treatment.

You may have questions and concerns about your treatment options. You may also want to know how you’ll feel and function after treatment, and if you’ll have to change your normal activities. Your healthcare provider is the best person to answer your questions. He or she can tell you what your treatment choices are, the goals of these treatments, how successful they’re expected to be, and what the risks and side effects are.

Your healthcare provider may advise a specific treatment. Or he or she may offer more than 1, and ask you to decide which 1 you’d like to use. It can be hard to make this decision. It is important to take the time you need to make the best decision.

Deciding on the best plan may take some time. Talk with your healthcare provider about how much time you can take to explore your options. You may want to get another opinion before deciding on your treatment plan. In addition, you may want to include your family and friends in this process.

Treatment may control or cure the brain tumor. It may also improve your quality of life by helping to control the symptoms of the disease. The goal of brain tumor treatment is to do 1 or more of these things:

• Remove or destroy the brain tumor.
• Stop or slow the growth or spread of brain tumor cells.
• Prevent or delay the tumor's return.
• Ease symptoms caused by the tumor, such as headaches or seizures.

Ask your healthcare provider what the goals of your treatment are.

Different types of brain tumor treatments have different goals. The types of treatment and their goals include:

• Surgery. The goal of surgery is to remove the tumor while leaving as much of the brain as possible intact. It is often the first step in treatment for most brain tumors. Removing the tumor (resection) is usually done if the tumor can be removed safely. Surgery also gives the healthcare team an exact diagnosis. It also reduces the tumor size. In some cases, the surgeon can’t remove the whole tumor. This may be because it’s near vital parts of the brain. Or it may be growing into the brain like fingers of a glove. If the tumor is in an area of the brain that can’t be reached safely, a small amount of tissue is taken. This is called a biopsy. 
• Radiation therapy. The goal of radiation is to kill cancer cells. This is done using X-rays, gamma rays, or proton beams. This may be done to shrink a tumor before surgery. Or it may be done to kill any cancer cells left after surgery. Radiation therapy may also be used as the main treatment if surgery is not an option. It can also help relieve symptoms caused by a tumor. 
• Chemotherapy. Chemotherapy may be used after surgery or biopsy. Its goal is to reduce the chance that the cancer will grow and spread. This is called adjuvant chemotherapy. In most cases, chemotherapy medicines are taken by mouth as pills. But they may also be given as into a vein (IV) or into the cerebrospinal fluid (CSF) in and around the brain. If you can’t have surgery, your healthcare provider may still give you chemotherapy. You may also have it with radiation therapy. You may also have chemotherapy if your cancer returns after treatment.  
• Targeted therapy. Newer medicines target different parts of tumor cells or nearby blood vessels. They work differently from standard chemotherapy medicines. Some of these targeted medicines are now used to help treat certain brain tumors. They are usually used when surgery is not an option.
• Other medicines. Other medicines might be used to help relieve symptoms caused by the tumor or its treatment. For example, you might be given medicines to help prevent seizures, or to help control swelling in the brain.

Researchers are also finding new ways to treat brain tumors. These new methods are tested in clinical trials. Before beginning treatment, ask your healthcare team if there are any clinical trials you should consider.

Your healthcare team will help you make a treatment plan. It may take time to choose the best plan. Ask your healthcare provider how much time you can take to explore your options. You may want to get a second opinion from another healthcare provider before deciding on treatment. A second opinion can give peace of mind and help you make sure you’re making the best choices for treatment. You may also want to talk with your family and friends.