Neurological Cancer

Neurological cancer or brain cancer affects more than 20,000 people in the United States each year. Cancer of the brain accounts for approximately 1.4 percent of all cancers and 2.3 percent of all cancer related deaths. The majority of brain tumors have abnormalities of genes involved in a cell cycle causing uncontrolled cell growth.

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What are the symptoms of a brain tumor?

The following are the most common symptoms of a brain tumor. However, each person may experience symptoms differently. Symptoms vary depending on the size and location of tumor. Many symptoms are related to an increase in pressure in or around the brain. There is no spare space in the skull for anything except the delicate tissues of the brain and its fluid. Any tumor, extra tissue, or fluid can cause pressure on the brain and result in increased intracranial pressure (ICP), which may result from one or more of the ventricles that drain cerebral spinal fluid (CSF, the fluid that surrounds the brain and spinal cord) becoming blocked and causing the fluid to be trapped in the brain. This increased ICP may cause the following:

  • Headache
  • Vomiting (usually in the morning)
  • Nausea
  • Personality changes
  • Irritability
  • Drowsiness
  • Depression
  • Decreased cardiac and respiratory function and, eventually, coma if not treated

Symptoms of brain tumors in the cerebrum (outer part of the brain) may include:

  • Symptoms caused by increased intracranial pressure (ICP)
  • Seizures
  • Visual changes
  • Slurred speech
  • Paralysis or weakness on half of the body or face
  • Drowsiness and/or confusion
  • Personality changes/impaired judgment
  • Short-term memory loss
  • Gait disturbances
  • Communication problems

Symptoms of brain tumors in the brainstem (base of brain) may include:

  • Symptoms caused by increased intracranial pressure (ICP)
  • Endocrine problems (diabetes and/or hormone regulation)
  • Visual changes or double vision
  • Headaches
  • Paralysis of nerves/muscles of the face, or half of the body
  • Respiratory changes
  • Clumsy, uncoordinated walk
  • Hearing loss
  • Personality changes

Symptoms of brain tumors in the cerebellum (back of brain) may include:

  • Symptoms caused by increased intracranial pressure (ICP)
  • Vomiting (usually occurs in the morning without nausea)
  • Headache
  • Uncoordinated muscle movements
  • Problems walking

The symptoms of a brain tumor may resemble other conditions or medical problems. Always consult your doctor for a diagnosis.

How is a brain tumor diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for brain tumors may include the following:

  • Blood and urine tests. These include tumor markers and gene testing.
  • Neurological examination. Doctor tests reflexes, muscle strength, eye and mouth movement, coordination, and alertness.
  • Computed tomography scan (also called a CT or CAT scan). A diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs, such as the brain. CT scans are more detailed than general X-rays.
  • Magnetic resonance imaging (MRI). A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body. MRI is very helpful for looking at the brain and spinal cord. Functional MRI (fMRI) is a special kind of MRI used to determine which areas of the brain are active with specific functions. This may be done before surgery if the tumor is in a vital area of the brain.
  • X-ray. A diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
  • Arteriogram (also called an angiogram). An X-ray of the arteries and veins to detect blockage or narrowing of the vessels. (This test is used less often than in the past, as special CT or MRI angiogram techniques can now be used to look at blood vessels in the brain.)
  • Magnetic resonance arteriogram (MRA) or computed tomography arteriogram (CTA). Combinations of the above noted scans.
  • Myelogram. A procedure that uses dye injected into the spinal canal to make the structure clearly visible on X-rays.
  • Spinal tap (also called a lumbar puncture). A special needle is placed into the lower back, into the spinal canal. This is the area around the spinal cord. The pressure in the spinal canal and brain can then be measured. A small amount of cerebral spinal fluid (CSF) can be removed and sent for testing to determine if there is an infection or other problems. CSF is the fluid that bathes the brain and spinal cord.
  • Positron emission tomography (PET). A type of nuclear medicine procedure. This means that a tiny amount of a radioactive substance, called a radionuclide (radiopharmaceutical or radioactive tracer), is injected into a vein during the procedure to assist in the examination of the tissue under study. Specifically, PET studies evaluate the metabolism of a particular organ or tissue, so that information about the physiology (functionality) and anatomy (structure) of the organ or tissue is evaluated, as well as its biochemical properties. Thus, PET may detect biochemical changes in an organ or tissue that can identify the onset of a disease process before anatomical changes related to the disease can be seen with other imaging processes, such as CT or MRI.
  • Single photon emission CT scan (SPECT). Also uses an injected radionuclide to show areas of greater metabolism and blood flow.
  • Magnetic resonance spectroscopy (MRS). A procedure that produces images depicting function rather than shape. The equipment requires a special, highly complex facility.
  • Biopsy of tumor. A procedure in which a sample of tissue is removed (with a needle or during surgery) to be looked at under a microscope.
  • Diagnosis of a brain tumor depends mostly on the types of cells involved and the tumor location. Tumors are graded from I to IV based on the type of cells seen on microscopic exam, as well as the growth rate of the cells. Brain tumors are not described by stages like other body tumors, because they almost never move beyond the brain and spinal cord.

What is the treatment for brain tumors?

Specific treatment for brain tumors will be determined by your doctor based on:

  • Your age, overall health, and medical history
  • Type, location, and size of the tumor
  • Extent of the condition
  • Your tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the condition
  • Your opinion or preference

Treatment may include (alone or in combination):

  • Surgery. Surgery is usually the first step in the treatment of brain tumors. The goal is to remove as much of the tumor as possible while maintaining neurological function. A biopsy may be done first to examine the types of cells the tumor is made of for a diagnosis. This is frequently done if the tumor is in an area with sensitive structures around it that may be injured if the whole tumor is surgically removed.
  • Chemotherapy (there are many types)
  • Radiation therapy (there are many types)
  • Steroids (to treat and prevent swelling especially in the brain)
  • Anti-seizure medication (to treat and prevent seizures associated with intracranial pressure)
  • Placement of a ventriculoperitoneal shunt (also called a VP shunt). This is a tube that is placed into the fluid filled spaces of the brain called ventricles. The other end of the tube is placed into the abdomen to help drain excess fluid that can build up in the brain and cause an increase in pressure in the brain.
  • Supportive care (to minimize the side effects of the tumor or treatment), such as pain relief and stress reduction techniques
  • Rehabilitation (to regain lost motor skills and muscle strength; speech, physical, and occupational therapists may be involved in the health care team)
  • Antibiotics (to treat and prevent infections)
  • Continuous follow-up care (to manage disease, detect recurrence of the tumor, and to manage late effects of treatment)
  • Hospice care for those who determine that continued aggressive treatment will not provide a benefit

Newer therapies that may be used to treat brain tumors include the following:

  • Stereotactic radiosurgery. A new technique that focuses high doses of radiation at the tumor site from many different angles, while sparing the surrounding normal tissue, with the use of photon beams from a linear accelerator or cobalt X-rays.
  • Gene therapy. A special gene is added to a virus that is injected into the brain tumor. An antivirus drug is then given which kills the cancer cells that have been infected with the altered virus. This is still considered an experimental treatment.
  • Chemotherapy wafers. Wafers containing a cancer-killing drug, BCNU, are inserted directly into the area of the brain tumor during surgery.
  • Targeted therapy. Newer drugs that are aimed at specific parts of tumor cells, or at other cells that help them grow. For example, a drug called bevacizumab affects a tumor's ability to make new blood vessels. It may be helpful for glioblastomas in adults. Other drugs can now target growth factors.
  • Electric field treatments. Electrodes are placed along the scalp to provide a mild electric current that may affect tumor cells more than normal brain cells.
  • Brain tumor vaccines. Cancer vaccines channel the body's own immunity against the tumor as a way of treatment. This is still considered an experimental treatment.

What are the different types of brain tumors?

There are many different types of brain tumors. They are usually categorized by the type of cell where the tumor begins, or they are also categorized by the area of the brain where they occur. The most common types of brain tumors include the following:

  • Gliomas. The following are the different types of gliomas:
    • Astrocytomas
    • Brain stem gliomas
    • Ependymomas
    • Optic nerve gliomas
    • Oligodendrogliomas
  • Metastatic tumors
  • Meningiomas
  • Schwannomas
  • Pituitary tumors
  • Primitive neuroectodermal tumors (PNETs)
  • Primary CNS lymphoma
  • Medulloblastomas
  • Craniopharyngiomas
  • Pineal region tumors

What is the long-term outlook for a person with a brain tumor?

Prognosis greatly depends on all of the following:

  • Type of tumor
  • Extent of the disease
  • Size and location of the tumor
  • Presence or absence of metastasis
  • The tumor's response to therapy
  • Your age, overall health, and medical history
  • Your tolerance of specific medications, procedures, or therapies
  • New developments in treatment

As with any cancer, prognosis and long-term survival can vary greatly from individual to individual. Prompt medical attention and aggressive therapy are important for the best prognosis. Continuous follow-up care is essential for a person diagnosed with a brain tumor. Side effects of radiation and chemotherapy, as well as second malignancies, can occur in survivors of brain tumors.

Rehabilitation for lost motor skill and muscle strength may be required for an extended amount of time. Speech therapists and physical and occupational therapists may be involved in some form of rehabilitation. More research is needed to improve treatment, decrease side effects of the treatment for this disease, and develop a cure. New methods are continually being discovered to improve treatment and to decrease side effects.

Please consult your doctor with any questions or concerns you may have regarding this condition.