In cases where a brain tumor is suspected, a number of tests may be done to help the doctor tell if a tumor is indeed present. These tests may also be able help the doctor determine what kind of tumor it is.
Some of the tests performed to first diagnose the tumor are later used to monitor progress - to see if the tumor has disappeared, is shrinking, remains the same, or has changed in some way. Like many other medical conditions, follow-up care for a brain tumor might go on for years or even a lifetime.
Understanding these tests - what they are, why they are done, how they are done, and what they can and cannot show - may help you feel more comfortable and in control of the situation. If at any time you have questions about the tests ordered, feel free to ask. The doctors, nurses, and other professionals giving these tests can provide answers, information, instructional materials, and reassurance to help you feel more at ease.
Unfortunately, it is very common for brain tumor patients to experience symptoms associated with their tumor(s) and/or treatment(s).
People with brain tumors often suffer from:
Sensory (touch) and motor (movement control) loss
Deep venous thrombosis (DVT, or blood clot)
Behavioral and cognitive (thinking) changes
Endocrine dysfunction (hormone/gland changes)
Identifying a brain tumor usually involves a neurological examination, brain scans, and/or an analysis of the brain tissue. Doctors use the diagnostic information to classify the tumor from the least aggressive (benign) to the most aggressive (malignant). In most cases, a brain tumor is named for the cell type of origin or its location in the brain. Identifying the type of tumor helps doctors determine the most appropriate course of treatment.
A neurological examination is a series of tests to measure the function of the patient s nervous system and physical and mental alertness. If responses to the exam are not normal, the doctor may order a brain scan or refer the patient to a neurologist or neurosurgeon, who will then order a brain scan.
A brain scan is a picture of the internal structures in the brain. A specialized machine takes a scan in much the same way a digital camera takes a photograph. Using computer technology, a scan compiles an image of the brain by photographing it from various angles.
Some types of scans use a contrast agent (or contrast dye), which helps the doctor see the difference between normal and abnormal brain tissue. The contrast agent is injected into a vein and flows into brain tissue. Abnormal or diseased brain tissue absorbs more dye than normal healthy tissue. The most common scans used for diagnosis are as follows:
MRI (Magnetic Resonance Imaging) is a scanning device that uses magnetic fields and computers to capture images of the brain on film. It does not use x-rays. It provides pictures from various planes, which permit doctors to create a three-dimensional image of the tumor. The MRI detects signals emitted from normal and abnormal tissue, providing clear images of most tumors.
CT or CAT Scan (Computed Tomography) combines sophisticated x-ray and computer technology. CT can show a combination of soft tissue, bone, and blood vessels. CT images can determine some types of tumors, as well as help detect swelling, bleeding, and bone and tissue calcification. Usually, iodine is the contrast agent used during a CT scan.
PET Scan (Positron Emission Tomography) provides a picture of the brain s activity, rather than its structure, by measuring the rate at which a tumor absorbs glucose (a sugar). The patient is injected with deoxyglucose that has been labeled with radioactive markers. The PET scan measures the brain s activity and sends this information to a computer, which creates a live image. Doctors use PET scans to see the difference between scar tissue, recurring tumor cells, and necrosis (cells destroyed by radiation treatment).
There some drawbacks to these diagnostic tests, however. Please refer to What else should I know about diagnostic tests? for more information.
A biopsy is a surgical procedure in which a sample of tissue is taken from the tumor site and examined under a microscope. The biopsy will provide information on types of abnormal cells present in the tumor. The purpose of a biopsy is to discover the type and grade of a tumor. A biopsy is the most accurate method of obtaining a diagnosis.
An open biopsy is done during a craniotomy. A craniotomy involves removing a piece of the skull in order to get access to the brain. After the tumor is resected (completely removed) or debulked (partially removed), the bone is usually put back into place. A closed biopsy (also called a stereotactic or needle biopsy) may be performed when the tumor is in an area of the brain that is difficult to reach. In a closed biopsy, the neurosurgeon drills a small hole into the skull and passes a narrow hollow needle into the tumor to remove a sample of tissue.
Once a sample is obtained, a pathologist examines the tissue under a microscope and writes a pathology report containing an analysis of the brain tissue. Sometimes the pathologist may not be able to make an exact diagnosis. This may be because more than one grade of tumor cells exists within the same tumor. In some cases, the tissue may be sent to another institution for additional analysis.
Treatment for a brain tumor depends on the type, size and location of the tumor, as well as your overall health and your preferences. Your doctor can tailor treatment to fit your particular situation.
If the brain tumor is located in a place that makes it accessible for an operation, your surgeon will work to remove as much of your brain tumor as possible. In some cases, tumors are small and easy to separate from surrounding brain tissue, which makes complete surgical removal possible. In other cases, tumors can't be separated from surrounding tissue or they're located near sensitive areas in your brain, making surgery risky. In these situations your doctor may try to remove as much of the tumor as is safe. Even removing a portion of the brain tumor may help reduce your signs and symptoms. In some cases only a small biopsy is taken to confirm the diagnosis.
Surgery to remove a brain tumor carries risks, such as infection and bleeding. Other risks may depend on the part of your brain where your tumor is located. For instance, surgery on a tumor near nerves that connect to your eyes may carry a risk of vision loss.
Radiation therapy uses high-energy beams, such as X-rays or protons, to kill tumor cells. Radiation therapy can come from a machine outside your body (external beam radiation), or, in very rare cases, radiation can be placed inside your body close to your brain tumor (brachytherapy).
External beam radiation can focus just on the area of your brain where the tumor is located, or it can be applied to your entire brain (whole brain radiation). Whole brain radiation is most often used to treat cancer that has spread to the brain from some other part of the body.
Side effects of radiation therapy depend on the type and dose of radiation you receive. In general it can cause fatigue, headaches and scalp irritation.
Stereotactic radiosurgery is not a form of surgery in the traditional sense. Instead, radiosurgery uses multiple beams of radiation to give a highly focused form of radiation treatment to kill the tumor cells in a very small area. Each beam of radiation isn't particularly powerful, but the point where all the beams meet - at the brain tumor - receives a very large dose of radiation to kill the tumor cells.
Radiosurgery is typically done in one treatment, and in most cases you can go home the same day. Side effects may include fatigue, headache and nausea.
Chemotherapy uses drugs to kill tumor cells. Chemotherapy drugs can be taken orally in pill form or injected into a vein (intravenously). The chemotherapy drug used most often to treat brain tumors is temozolomide (Temodar), which is taken as a pill. Many other chemotherapy drugs are available and may be used depending on the type of cancer.
Another type of chemotherapy can be placed during surgery. When removing all or part of the brain tumor, your surgeon may place one or more disk-shaped wafers in the space left by the tumor. These wafers slowly release a chemotherapy drug over the next several days.
Chemotherapy side effects depend on the type and dose of drugs you receive. Chemotherapy can cause nausea, vomiting and hair loss.
Targeted drug therapy
Targeted drug treatments focus on specific abnormalities present within cancer cells. By blocking these abnormalities, targeted drug treatments can cause cancer cells to die.
One targeted drug therapy used to treat a type of brain cancer called glioblastoma is bevacizumab (Avastin). This drug, given through a vein (intravenously), stops the formation of new blood vessels, cutting off blood supply to a tumor and killing the tumor cells.
The targeted drug everolimus (Afinitor) is used to treat a benign brain tumor that occurs in people with a genetic disorder called tuberous sclerosis. Everolimus blocks an enzyme in the body that plays a role in growth of cancer cells.
Rehabilitation after treatment
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. Your doctor may refer you to services that can help, such as:
Physical therapy can help you regain lost motor skills or muscle strength.
Occupational therapy can help you get back to your normal daily activities, including work, after a brain tumor or other illness.
Speech therapy with specialists in speech difficulties (speech pathologists) can help if you have difficulty speaking.
Tutoring for school-age children can help kids cope with changes in their memory and thinking after a brain tumor.
Primary brain tumors include any tumor that starts in the brain. Primary brain tumors can start from brain cells, the membranes around the brain (meninges), nerves, or glands.
Tumors can directly destroy brain cells. They can also damage cells by producing inflammation, placing pressure on other parts of the brain, and increasing pressure within the skull.
The cause of primary brain tumors is unknown. There are many possible risk factors that could play a role.
Radiation therapy to the brain, used to treat brain cancers, increases the risk for brain tumors up to 20 or 30 years afterwards.
Exposure to radiation at work or to power lines, as well as head injuries, smoking, and hormone replacement therapy have NOT been proven to be risk factors.
The risk of using cell phones is hotly debated. However, most recent studies have found that cell phones, cordless phones, and wireless devices are safe and do not increase the risk.
Some inherited conditions increase the risk of brain tumors, including neurofibromatosis, Von Hippel-Lindau syndrome, Li-Fraumeni syndrome, and Turcot syndrome.
Lymphomas that begin in the brain in people with a weakened immune system are sometimes linked to the Epstein-Barr virus.
Brain tumor treatment depends on a number of factors, including the type, location, size, and grade of the tumor, as well as the age and health of the patient. Your doctor can present your treatment options and tell you what to expect from each one.
Specialists who treat brain tumors include neurosurgeons, neurooncologists, medical oncologists, and radiation oncologists. In addition to the specialist, your treatment team may include other professionals such as a nurse, dietitian, mental health counselor, social worker, physical therapist, occupational therapist, and/or speech therapist.
Many people with brain tumors want to take an active part in making decisions about their medical care. They want to learn all they can about their disease and their treatment choices. Below are some questions you might want to ask your doctor:
1. What type of brain tumor is it?
2. Is it benign or malignant?
3. What grade is my tumor?
4. What are the treatment options? What do you recommend? Why?
5. What are the benefits of each treatment option?
6. What are the risks and possible side effects of each option?
7. What is the treatment likely to cost?
8. How will treatment affect my everyday activities?
9. Should I participate in a clinical trial/research study? If so, which one?
It is not necessary to ask all of these questions or to understand the answers all at one time. There will be other opportunities to ask your doctor to explain things that are not clear and to ask for more information.
Before starting treatment, you may want a second opinion about your diagnosis and treatment plan. Some insurance companies require a second op
Because an MRI uses magnetic fields, people who have metal implanted in their body in any form should let the doctor know about it before scheduling the procedure. An MRI may not be an option for these patients because the intense magnetic fields can damage some types of implanted medical devices. Patients should advise the doctor if they have a pacemaker, cardiac monitor, surgical clip, or facial tattoos.
In a standard MRI scan, the patient lies on a narrow table, which slides through a long, cylindrical tube with a narrow opening. Although there is enough room for the patient s body inside the cylinder, the patient will not be able to move around. The scan takes approximately 15-45 minutes. During the scan, the patient will hear loud banging sounds, caused by the electronics within the machine. Patients may request earplugs to reduce noise. Some people find the MRI claustrophobic and ask for a sedative beforehand to relax. Other people request an open MRI.
An open MRI machine does not have a cylinder, so the patient is not enclosed. The procedure lasts approximately 45 minutes. There is some discussion among doctors concerning the quality of the images of an open MRI compared to the standard or closed MRI.
Contrast agents may cause reactions in some patients. Gadolinium, the contrast agent used with an MRI, may cause temporary headaches. Patients with chronic renal disease may develop a condition called nephrogenic system fibronolysis (NSF). The FDA recommends using gadolinium only when clearly necessary in patients with stage 4 and 5 renal disease, which it defined as a glomerular filtration rate lower than 30 mL per minute per 1.73 m2. If patients with renal insufficiency receive gadolinium, then specific steps are taken to limit the possibility of NSF occurring, Patients undergoing MRI with gadolinium are screened for risk factors prior to receiving the scan.
Iodine is the contrast agent most commonly used for CT scanning. If you know you are allergic to iodine, tell your doctor. Allergic reactions can include rashes, a warm. sensation, or, in rare cases, difficulty breathing.
CT scans involve exposure to ionizing radiation, which is known to cause cancer. This is a concern for people who may need multiple CT scans and for children, because they are more sensitive to radiation than adults. It is wise for people who have had frequent x-ray exams and parents of children who have brain tumors to keep a record of their x-ray history. This information can help doctors make informed decisions and minimize radiation over-exposure.
The brain is a highly specialized organ. It serves as the control center for functions of the body and allows us to cope with our environment. Words, actions, thoughts, and feelings are centered in the brain. It is so complex that some theorists believe we will never be able to fully understand it. We do, however, know that each part of the brain has a specific, important function, often a profoundly important function, and each part contributes to the healthy functioning of our body.
The location of tumors in the brain is one of the factors that determines how a brain tumor affects an individual's functioning and what symptoms the tumor causes.
Cerebrum is the largest part of the brain and is associated with conscious thought, movement and sensation. It consists of two halves, each controlling the opposite side of the body. The halves are connected by the corpus callosum, which delivers messages between them. Four lobes make up the cerebrum: the frontal, temporal, parietal, and occipital lobes.
Frontal Lobe is one of the four lobes of the cerebral hemisphere. It controls attention, behavior, abstract thinking, problem solving, creative thought, emotion, intellect, initiative, judgment, coordinated movements, muscle movements, smell, physical reactions, and personality.
Parietal Lobe is one of the four lobes of the cerebral hemisphere. It controls tactile sensation, response to internal stimuli, sensory comprehension, some language, reading, and some visual functions.
Sensory cortex is located in the front part of the parietal lobe, or in other words, the middle area of the brain. The sensory cortex receives information from the spinal cord about the sense of touch, pressure, pain, and the perception of the position of body parts and their movements.
Motor cortex is an area located in the middle, top part of the brain that helps control movement in various parts of the body.
Temporal lobe is one of the four lobes of the cerebral hemisphere of the cerebral hemisphere. It controls auditory and visual memories, language, some hearing and speech, language, plus some behavior.
Wernicke's Area is part of the temporal lobe that surrounds the auditory cortex and is thought to be essential for understanding and formulating speech. Damage in Wernicke's area causes deficits in understanding spoken language.
Occipital Lobe is one of the four lobes of the cerebral hemisphere. It is located in the back of the head and controls vision.
Broca's Area is located in the opercular and triangular sections of the inferior frontal gyrus. The function of this area is the understanding of language, speech, and the control of facial neurons.
Brain Stem is located at the bottom of the brain and connects the cerebrum to the spinal cord. The brain stem controls many vitally important functions including motor and sensory pathways, cardiac and respiratory functions, and reflexes.
Cerebellum is located at the lower back of the head and is connected to the brain stem. It is the second largest structure of the brain and is made up of two hemispheres. The cerebellum controls complex motor functions such as walking, balance, posture, and general motor coordination.
Cerebrospinal Fluid, also called CSF, is a clear substance that circulates through the brain and spinal cord. It provides nutrients and serves to cushion the brain and therefore protect it from injury. As this fluid gets absorbed, more is produced from the choroid plexus, a structure located in the ventricles. A brain tumor can cause a build-up or blockage of CSF.
Four Ventricles of the brain are connected cavities within the brain, where cerebrospinal fluid is produced.
Hypothalamus is a region of the brain in partnership with the pituitary gland that controls the hormonal processes of the body as well as temperature, mood, hunger, and thirst.
Optic Chiasm is located beneath the hypothalamus and is where the optic nerve crosses over to the opposite side of the brain.
Pineal Gland controls the response to light and dark. The exact role of the pineal gland is not certain.
Pituitary Gland is a small, bean-sized organ that is located at the base of the brain and is connected to the hypothalamus by a stalk. The pituitary gland secretes many essential hormones for growth and sexual maturation.
Meninges are the membrane covering the brain and spinal cord. A tumor arising from this tissue is called a meningioma.
Thalamus is located near the center of the brain and controls input and output to and from the brain, as well as the sensation of pain and attention.
A pathology report contains the analysis of brain tissue taken at the time of a craniotomy or needle biopsy. A pathologist examines the tissue under a microscope. Further tests or analysis may be performed on the tumor tissue. Then the pathologist will write a pathology report, which provides the information needed to make a diagnosis of the tumor type.
Sometimes the pathologist may not be able to make an exact diagnosis. This may be because more than one grade of tumor cells exists within the same tumor. [If cells of only one grade are removed and classified during a biopsy, it is possible that the tumor grade will be misdiagnosed. This is called a sampling error.] In some cases, the tissue may be sent to another institution for additional input.
? Brain herniation (often fatal)
o Uncal herniation
o Foramen magnum herniation
Loss of ability to interact or function
Permanent, worsening, and severe loss of brain function
Return of tumor growth
Side effects of medications, including chemotherapy
Side effects of radiation treatments
Brain tumors and their treatments bring an array of possible side effects in to a patient's life. Fatigue, cognitive changes, and mood changes are just some of the things that can cause added stress.
Management of these side effects - physical, cognitive and emotional - is crucial to a patient's well-being. While patients will generally encounter many of these side effects at some point during their illness, the severity will depend on the course of treatment, type of tumor and the individual. Light or severe, side effects should not be dismissed as unimportant or incidental to treatment.
Brain tumors are classified depending on:
The location of the tumor
The type of tissue involved
Whether they are noncancerous (benign) or cancerous (malignant)
Sometimes, tumors that start out less aggressive can become more aggrssive.
Tumors may occur at any age, but many types of tumors are most common in a certain age group. In adults, gliomas and meningiomas are most common.
Gliomas come from glial cells such as astrocytes, oligodendrocytes, and ependymal cells. The gliomas are divided into three types:
Astrocytic tumors include astrocytomas (can be noncancerous), anaplastic astrocytomas, and glioblastomas.
Oligodendroglial tumors. Some primary brain tumors are made up of both astrocytic and oligodendrocytic tumors. These are called mixed gliomas.
Glioblastomas are the most aggressive type of primary brain tumor.
Meningiomas and schwannomas are two other types of brain tumor. These tumors:
Occur most often between ages 40 and 70
Are usually noncancerous, but still may cause serious complications and death from their size or location. Some are cancerous and aggressive.
Meningiomas are much more common in women. Schwannomas affect both genders equally.
Other primary brain tumors in adults are rare. These include:
Primary CNS lymphoma
Primary lymphoma of the brain
Pineal gland tumors
Primary germ cell tumors of the brain
There are over 120 types of brain tumors. The most common are listed below,
Astrocytomas are tumors that arise from astrocytes-star-shaped cells that make up the "glue-like" or supportive tissue of the brain.
Atypical Teratoid Rhaboid Tumor (ATRT).ATRTs are rare, high-grade tumors that occur most often in children age 3 and younger. They tend to be fast-growing and frequently spread through the central nervous system.
Chondroma is a rare, benign tumor that tends to arise at the base of the skull, especially in the area near the pituitary gland. These tumors are generally very slow-growing and may be present for a long time before causing any symptoms.
The malignant (cancerous) form of chondroma is chondrosarcoma. There are several different types of chondrosarcoma, including conventional, clear cell, mesenchymal, and dedifferentiated. Conventional chondrosarcoma are further subdivided into grade I, grade II, and grade III.
"Glioma" is a general term used to describe any tumor that arises from the supportive ("gluey") tissue of the brain. This tissue, called "glia," helps to keep the neurons in place and functioning well.
Ependymomas arise from the ependymal cells that line the ventricles of the brain and the center of the spinal cord.
Meningiomas are often benign tumors arising from the coverings of the brain and spinal cord. They represent about one-third of all primary brain tumors and occur most frequently in middle-aged women.
A metastatic, or secondary, brain tumor is formed by cancer cells from a primary cancer elsewhere in the body t
hat have spread to the brain.
Lymphoma is a cancer that arises from the cells of the lymphatic system. In the brain, this type of cancer is called Primary CNS Lymphoma (PCNSL).
is a fast-growing, high-grade tumor.
Neurofibromas are tumors of the nerve fibers.
Glioblastomas are tumors that arise from astrocytes-the star-shaped cells that make up the "glue-like," or supportive tissue of the brain. These tumors are usually highly malignant (cancerous) because the cells reproduce quickly and they are supported by a large network of blood vessels.
Understanding Brain Tumors
o Types of Tumors
Atypical Teratoid Rhaboid Tumor (ATRT)
Bone and Connective Tissue
Juvenile Pilocytic Astrocytoma
Neuronal and Mixed Neuronal-Glial Tumors
o Risk Factors
o Brain Tumor Facts
o Anytime Learning
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A metastatic, or secondary, brain tumor is formed by cancer cells from a primary cancer elsewhere in the body that have spread to the brain.
Cancer is the general name for a group of more than 100 diseases. Although there are many kinds of cancer, all cancers start because abnormal cells grow out of control. Untreated cancers can cause serious illness and death.
Normal cells in the body
The body is made up of trillions of living cells. Normal body cells grow, divide, and die in an orderly fashion. During the early years of a person's life, normal cells divide faster to allow the person to grow. After the person becomes an adult, most cells divide only to replace worn-out or dying cells or to repair injuries.
How cancer starts
Cancer starts when cells in a part of the body start to grow out of control. Cancer cell growth is different from normal cell growth. Instead of dying, cancer cells continue to grow and form new, abnormal cells. Cancer cells can also invade (grow into) other tissues, something that normal cells cannot do. Growing out of control and invading other tissues are what makes a cell a cancer cell.
Cells become cancer cells because of DNA (deoxyribonucleic acid) damage. DNA is in every cell and it directs all the cell's actions. In a normal cell, when DNA gets damaged the cell either repairs the damage or the cell dies. In cancer cells, the damaged DNA is not repaired, and the cell doesn't die like it should. Instead, the cell goes on making new cells that the body doesn't need. These new cells all have the same abnormal DNA as the first cell does.
People can inherit abnormal DNA, but most DNA damage is caused by mistakes that happen while the normal cell is reproducing or by something in the environment. Sometimes the cause of the DNA damage may be something obvious like cigarette smoking or sun exposure. But it's rare to know exactly what caused any one person's cancer.
In most cases, the cancer cells form a tumor. Some cancers, like leukemia, rarely form tumors. Instead, these cancer cells involve the blood and blood-forming organs and circulate through other tissues where they grow.
How cancer spreads
Cancer cells often travel to other parts of the body where they begin to grow and form new tumors. This happens when the cancer cells get into the body's bloodstream or lymph vessels. Over time, the tumors replace normal tissue. The process of cancer spreading is called metastasis.
How cancers differ
No matter where a cancer may spread, it's always named for the place where it started. For example, breast cancer that has spread to the liver is called metastatic breast cancer, not liver cancer. Likewise, prostate cancer that has spread to the bone is called metastatic prostate cancer, not bone cancer.
Different types of cancer can behave very differently. For instance, lung cancer and skin cancer are very different diseases. They grow at different rates and respond to different treatments. This is why people with cancer need treatment that is aimed at their kind of cancer.
Tumors that are not cancer
Not all tumors are cancer. Tumors that aren't cancer are called benign. Benign tumors can cause problems - they can grow very large and press on healthy organs and tissues. But they cannot grow into (invade) other tissues. Because they can't invade, they also can't spread to other parts of the body (metastasize). These tumors are almost never life threatening.
How common is cancer?
Half of all men and one-third of all women in the US will develop cancer during their lifetimes.
Today, millions of people are living with cancer or have had cancer. The risk of developing many types of cancer can be reduced by changes in a person's lifestyle, for example, by staying away from tobacco, limiting time in the sun, being physically active, and healthy eating.
There are also screening tests that can be done for some types of cancers so they can be found as early as possible - while they are small and before they have spread. In general, the earlier a cancer is found and treated, the better the chances are for living for many years.