What is a Brain Tumor?
A brain tumor is an abnormal growth of tissue inside of the skull. Expansion inside of a closed space can cause pressure damage and can disrupt the flow of cerebrospinal fluid (CSF). Brain tumors can originate in the brain (Primary Tumors) or begin somewhere else in the body before traveling through the bloodstream to the brain (Secondary or Metastatic Tumors). Primary brain tumors may be either benign or malignant. Metastatic tumors are malignant because they have spread from other parts of the body.
Some Brain Tumors will be discovered while testing for something else and may have no symptoms at diagnosis. Other patients have persistent symptoms and seek out evaluation from their primary care physicians or a neurologist. Signs and symptoms of Brain Tumors can vary widely and will depend on the size, location and rate of growth. New onset or progressively worsening headaches may occur. There may be vision changes, speech difficulty or numbness and weakness of an arm or leg. Also there can be loss of balance, confusion, seizures, or unexplained nausea and vomiting.
Primary Brain Tumors begin in the brain or the tissues near the brain such as the cranial nerves, pituitary gland and meninges. The body is constantly repairing damaged cells but occasionally there is a mutation in the DNA that allows the cells to continue dividing. With no signal to stop growing, a mass of these mutated cells expands and forms a tumor. Primary brain tumors are named by the type of cell they originate from including:
- Meningiomas are tumors that arises from the meninges which are the delicate membranes encasing your brain and spinal cord. Meningiomas are usually benign and slow growing.
- Gliomas originate the brain or spinal cord and are usually malignant. They include astrocytomas, glioblastomas, ependymomas, oligoastrocytomas and oligodendrogliomas.
- Acoustic neuromas (schwannomas). These are tumors on the balance and hearing nerves that are slow growing and benign but because they can grow in narrow bony canals can cause disequilibrium or hearing loss when they are very small.
- Pituitary adenomas. The skull base contains a pituitary gland that secretes hormones that regulate body systems. Pituitary tumors are generally benign but can disrupt normal body functions.
- Medulloblastomas are the most common malignant brain tumors in children but also occur in young adults. A medulloblastoma will usually spread through the spinal fluid.
- Germ cell tumors come from the cells where the testicles or ovaries originate. Sometimes germ cell tumors will occur in the brain as well as other parts of the body.
- Craniopharyngiomas are rare, benign tumors originate near the pituitary gland. As the craniopharyngioma slowly grows, it can affect hormone secretion by the pituitary gland and adjacent brain tissue.
Metastatic or secondary brain tumorsresult from cancer that starts elsewhere in your body and then spreads (metastasizes) to your brain. They usually occur in patients with a known cancer of another part of the body but may be the first sign of having cancer. Metastatic brain tumors are much more common than primary brain tumors in adults. The most common secondary types of cancer are breast, colon, lung, kidney and melanoma.
Diagnosis is made by a combination of the patient’s history, examination and testing including:
- A complete physical and neurological exam which includes evaluation of hearing, vision, balance, coordination, strength and reflexes. A neurological deficit could help locate the area of the brain affected by the tumor.
- Imaging tests. Magnetic resonance imaging (MRI) uses powerful magnets to evaluate the structure of the brain. Magnetic resonance angiography (MRA) uses a dye to look at the arteries and veins in the brain. Computed axial tomography (CAT) scans use X-rays and are excellent for evaluating bony anatomy or acute bleeding of the brain.
- A whole body cancer work-up looks for sites where the cancer may have originated in the body. A CAT scan may be used to look for abnormal organ growths. A positron emission tomography (PET) scan uses radioactive tracer to look for injury and evaluate tissue function.
- A tissue biopsy can be performed with a needle or as part of an operation to remove the brain tumor. Laboratory analysis will determine the type of tumor cell which will help determine the appropriate treatment. Sometimes a stereotactic needle biopsy using 3-dimensional imaging is used to obtain a biopsy in hard to reach or more sensitive areas of the brain.
Treatment for a brain tumor depends on the type, size, prognosis, site of origin and location of the tumor. Your overall health and personal preferences also factor into the treatment that you will receive. Modalities of treatment include surgery, radiation therapy, chemotherapy, radiotherapy and therapy to assist in recovery from cancer.
Surgery can assist in removal of as much of the brain tumor as safely possible. Complete removal of the tumor may be possible depending on size, type and location of tumor. Reducing tumor size may improve or eliminate symptoms in some situations. The extent of surgery balances the goals of the surgery while attempting to limit risk to structures in and around the brain.
Radiation therapy uses high-energy beams to kill tumor cells. Radiation therapy is either generated outside your body (external beam radiation) or placed inside your body close to or inside of your brain tumor (brachytherapy). Side effects of radiation therapy can include fatigue, headaches and memory loss.
Stereotactic radiosurgery uses multiple beams of radiation that focus on a very small area of tumor. The combined effect of the multiple radiation beams increases the ability of the radiation to kill the tumor where the beams overlap. Types of stereotactic surgery include Gamma Knife and linear accelerator.
Chemotherapy uses oral or intravenous drugs to target and kill tumor cells. The chemotherapy drug used depends on the type of cancer being treated. Chemotherapy side effects include nausea, vomiting and hair loss.
Targeted drug therapy attacks specific types of cancer cells which causes the cancer cells to die. By blocking these abnormalities, targeted drug treatments can cause cancer cells to die. The type of cancer you have will determine if targeted drug therapy will be effective.
Rehabilitation after brain cancer treatment may be needed. Brain tumors can damage areas of the brain that control motor skills, speech, vision or cognition. Physical therapy can help you regain motor skills or muscle strength. Occupational therapy helps the return of normal daily activities. Speech therapy can improve the strength and quality of your ability to communicate verbally.
The neurosurgeons of Norelle Health are highly trained and skilled in the diagnosis, management, and treatment of brain tumors. Our neurosurgeons can provide the optimal treatment. Neurosurgery is considered essential by insurances and should be covered with your plan. As out-of-network providers, we will check your benefits for you and let you know what they are so there are no surprises. We use an individualized treatment plan for your concerns to provide a personalized holistic plan of care. If you would like assistance, please feel free to contact us (link to contact page) or call our office (link to phone number).