A brain tumor is a mass or growth of abnormal cells in your brain.
Brain tumors typically are categorized as either primary or secondary. Primary brain tumors originate in your brain and can be noncancerous (benign) or cancerous (malignant). Secondary brain tumors result from cancer that began elsewhere and spread to your brain. Primary brain tumors are less common than secondary brain tumors.
Benign brain tumors are usually slower growing, easier to remove (depending on their location), and less likely to recur than are malignant brain tumors. Benign brain tumors don't invade the surrounding normal brain or other nearby structures, but they can still place pressure on sensitive areas of your brain.
Malignant brain tumors can grow more rapidly, invading or destroying nearby brain tissue. However, unlike cancers elsewhere in your body, primary malignant brain tumors rarely spread from your brain.
Brain tumors are often challenging for doctors to treat. But many types of brain tumors can be successfully treated with one or more methods. In addition, technology is enabling doctors to target tumors more precisely.
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 signs and symptoms because it can directly press on or invade brain tissue. This can damage or destroy 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:
Doctors 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, pituitary gland or pineal gland. Most brain tumors in children are primary. Slightly more than one-fourth of all brain tumors are primary. The remaining are secondary (metastatic). It's not known what causes primary brain tumors. It's possible that heredity, environmental factors, viruses or other factors play a role in their development.
Some common types of primary tumors — named after the type of brain cells from which they originate — include acoustic neuromas (schwannomas), astrocytomas, medulloblastomas, meningiomas and oligodendrogliomas.
Because doctors don't know exactly what causes primary brain tumors, it's difficult to pinpoint risk factors. In rare cases, brain tumors strike several members of a family, suggesting heredity may be a risk factor. But this accounts for only a fraction of cases.
Some types of brain tumors appear to occur more frequently in people who are exposed to radiation or certain chemicals, such as those who work in oil refining, rubber manufacturing, and 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 evidence indicates that either causes brain tumors.
Although brain tumors can occur at any age, they're most common in people older than 65. In children, those younger than 8 appear to be at a higher risk of brain tumors than are older children.
Overall, males and whites are more likely to develop a brain tumor.
Doctors and researchers don't believe that head injuries increase the risk of developing a brain tumor.
Most headaches don't signal a serious medical condition. But if you have headaches that progressively worsen, are particularly severe, are always in the same location or are accompanied by nausea or vomiting or by blurred or double vision — talk to your doctor. Brain tumors are rare. But the prognosis is often better the earlier the tumors are diagnosed and treated.
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 doctor will likely perform a neurological exam, which among other things includes checking your vision, hearing, balance, coordination and reflexes. Depending on the results of that exam, your doctor may request one or more of the following tests:
If your doctor sees what appears to be a brain tumor on a brain scan, especially if there are multiple tumors, he or she may test for cancer elsewhere in your body before making a definitive diagnosis. Letting your doctor know of a prior history of cancer, even many years earlier, is important.
Testing a tissue sample
The only test that can absolutely make a diagnosis of a brain tumor is a biopsy. This can be done as part of an operation to remove the tumor, or can be done in a separate procedure where only a small sample of tissue is obtained. 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. Tissue is removed using the needle, which is frequently guided by CT scanning.
The tissue is then viewed under a microscope to determine if it is a tumor, and if so, what type of tumor. Additional tests on the tissue are often done to help determine the exact type of tumor, which may help in guiding treatment.
Your brain is divided into different parts that are responsible for a variety of functions. Depending on its size and location, a brain tumor can cause temporary or permanent brain damage.
The front part of your 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 your brain called the occipital lobe — located in the back of your head — can result in vision problems because that area of your 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.
Another emergency situation that can be caused by brain tumors is bleeding in your brain. This might cause an extremely severe headache with an abrupt onset. If this occurs, seek emergency medical treatment.
Your brain as a unit controls everything you do. An aggressive tumor that destroys too much brain tissue can be deadly.
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. Your doctor will tailor treatment to fit your particular situation.
Because brain tumors can be complex to treat, a team of doctors often treats them. This team may include:
Initial treatment of a brain tumor may include steroid medications to reduce swelling and inflammation of brain tissue. Anticonvulsant medications may help prevent or control seizures.
If the tumor has resulted in a buildup of fluid in your brain (hydrocephalus), your doctor may surgically insert a shunt. A shunt is a long, thin tube that's placed in your brain and then threaded under your skin to another part of your body, usually your abdomen. The tube allows excess fluid to be removed from your brain.
These measures aren't often needed for benign, primary brain tumors.
The main treatment methods for brain tumors include:
Doctors treat many brain tumors with a combination of therapies. Because a tumor may recur if any tumor cells are left behind, the goal is to remove as much, if not all, of the tumor as possible through surgery. Radiation therapy and chemotherapy are used to treat tumors that can't be removed by surgery alone. Brain tumor treatments do carry side effects, such as hair loss and nausea. Ask your doctor about possible side effects and how best to cope with them.
Once treated, a brain tumor may remain in remission for years, or may never recur. When a brain tumor is in remission, it means that tests do not show any signs of the cancer. Sometimes this means the cancer will never return, but in other cases the cancer may be too small for tests to detect, and it may recur at a later date.
As part of follow-up for brain tumor treatment, you'll probably need to be monitored on a regular basis for tumor recurrence with MRI or CT scans. The type of tumor you had determines how often you'll need scans or other tests.
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.
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 are identified, the earlier they can be addressed with strategies that provide the most benefits to the child.
Emerging treatments
Technology is evolving and helping to make the treatment of brain tumors more precise.
Clinical trials
Many of the 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 the National Cancer Institute at (800) 4-CANCER, or (800) 422-6237, or visit their Web sites.
Getting a second opinion
Decisions about brain tumors are usually 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 can also request a consultation with specialists from the National Cancer Institute's Neuro-Oncology Branch by calling (301) 402-6298. 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.
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.
Surgery, radiation and chemotherapy are used to treat a tumor. But your spiritual well-being may benefit from complementary therapies, such as meditation, yoga, imagery, prayer, massage, relaxation and humor.
You can explore these therapies on your own or ask your medical care team for suggestions. However, don't take any herbal products or dietary supplements without consulting your doctor.
May 15, 2006