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Brain Cancer 

Cancer can develop within the brain or spinal cord itself (primary tumor) or can travel to the brain or spinal cord from a cancer elsewhere in the body (metastatic or secondary tumors).

There are many different types of primary brain or spinal cord tumors. They may be benign (noncancerous) or malignant (cancerous). While most cancers are described by stage, brain and spinal cord tumors are described by a grading system established by the World Health Organization. This system classifies tumors from Grade I to Grade IV. Grade I tumors occur almost exclusively in children and are considered benign. Grades II through IV describe tumors with increasingly malignant behavior. 

Astrocytoma

Astrocytoma

An astrocytoma is a type of brain tumor that develops in astrocytes. These are the star-shaped cells in the brain that hold nerve cells in place. An astrocytoma can be harmless (benign) or cancerous (malignant). Astrocytomas are most common in middle-aged men, but they can occur in children, too.

Astrocytomas in children

Locations of different tumors in the brain
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In young people, astrocytomas are usually found at the base of the brain, and they are usually low grade, which means they are slow growing. When diagnosed, a low-grade astrocytoma may not require immediate treatment. But it should be watched carefully, because it could turn into an aggressive, faster-growing tumor. Often, a biopsy or surgery is needed to confirm the pathology and staging.

Symptoms

An astrocytoma can cause physical symptoms if it begins to grow in or press on an area of the brain. These are common symptoms of an astrocytoma:

  • Morning headache or a headache that goes away after vomiting

  • Vision, hearing, or speech problems

  • Loss of balance or trouble walking

  • Seizures

  • Unusual changes in energy level or excessive sleepiness

  • Slow speech or worsening of handwriting skills

Diagnosis

Doctors can use a variety of tests to determine the presence of an astrocytoma. CT scans and MRIs can provide an image of the brain and allow doctors to check for abnormalities. Sometimes a procedure called magnetic resonance spectroscopywill be done along with an MRI to determine the chemical makeup of the tumor.

Treatment

If your child's health care provider suspects an astrocytoma, he or she may recommend a brain tissue biopsy to determine whether the tumor is cancerous. This is done as a surgical procedure.

If cancer cells are found, the surgeon may remove the tumor during the same surgery. The goal is usually to take out as much of the tumor as possible without damaging the brain. If some of the astrocytoma must remain in the brain, radiation therapy may be used to control its size. This can be done in the form of external beam radiation, which is given on the outside of the body, or through radiosurgery, which focuses the radiation directly on the tumor site. 

Another option to treat an astrocytoma is chemotherapy–giving special medications that kill tumor cells. Chemotherapy is often a better treatment for an astrocytoma than radiation therapy because it minimizes the risk for damage to a child's developing brain.

Prognosis

The outlook for people with an astrocytoma depends on the aggressiveness of the tumor, its location, and whether it has spread. The age of the child may also play a role. Overall, more than 70% of children with central nervous-system tumors will survive for 5 years or longer after diagnosis. 

Astrocytomas

Astrocytomas start in the brain rather than spreading from another part of the body.

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Craniopharyngioma

Craniopharyngioma

A craniopharyngioma is a usually benign but possibly aggressive tumor that is found near the pituitary gland, a structure connected to the brain that regulates the production of many hormones in the body. This tumor is most commonly found in boys and girls 5 to 14 years old, though it can occur in adults, too.

Locations of different tumors in the brain
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The basics

Craniopharyngiomas are usually a mixture of both solid mass and fluid-filled cysts. They are not cancerous tumors, and they do not spread to other parts of the body. As they grow, however, they may press on parts of the brain and surrounding structures, affecting hormones, vision, and other normal functions. For this reason, they require treatment.

Symptoms

These are common symptoms of craniopharyngiomas:

  • Headache, including one that goes away after vomiting

  • Vision changes

  • Loss of balance or trouble walking

  • Unusual changes in energy level

  • Slow growth or delayed puberty

  • Hearing loss

  • Increase in thirst

  • Increase in head size (in infants)

Diagnosis

Tests that may lead a doctor to suspect a craniopharyngioma generally include physical exams, neurological exams, and vision tests. CT and MRI scans are the primary tests used to confirm the diagnosis. Doctors may also check the blood for levels of specific hormones such as thyroid-stimulating hormone and ACTH, which are secreted by the pituitary gland. Techniques like CT scans and MRIs may also be used to take pictures of the brain and detect tumors.

Treatment

Once diagnosed, craniopharyngiomas are usually removed through surgery. The surgeon will decide if the tumor can be removed in its entirety, which can't always be determined before surgery. Sometimes, doctors are not sure whether a tumor is a craniopharyngioma until the surgery begins.

Sometimes not all of the tumor can be removed through surgery because of the risk of damaging other structures, like the optic nerve, hypothalamus, and carotid artery. When the entire craniopharyngioma can't be surgically removed, doctors will usually try to remove as much of it as possible to relieve pressure on other body parts, and then use radiation therapy to get rid of what remains. Radiation therapy is generally given by external beam therapy. Experimental chemotherapy trials can be considered if the tumor recurs after radiation.

Prognosis

The outlook for craniopharyngioma patients is good. Up to 90% of all patients have a chance of a permanent cure if the tumor can be completely removed with surgery. However, there is a chance that the tumor will recur, especially if it is not all removed. Most recurrences happen within two years of surgery.

Other health effects may remain after treatment ends. Some common side effects of craniopharyngiomas include vision loss, obesity, behavioral problems, and the need for lifelong hormone replacement.  One common side effect is loss of posterior pituitary gland function. This causes uncontrolled urination. It can be partially treated with hormonal therapy.

Craniopharyngioma

Craniopharyngioma is a slow-growing tumor that develops at the base of the skull.

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Meningioma

Meningioma

A meningioma is a type of tumor that's often discussed along with brain tumors, though it's not technically a brain tumor. This type of tumor grows in the meninges, which are layers of tissue that cover the brain and spinal cord.

These tumors are usually benign. This means that unlike cancerous tumors, they don't tend to spread to distant parts of the body. Because of their location, though, meningiomas can still cause neurological problems. As these tumors grow, they can compress the brain and spinal cord, leading to serious symptoms.

Facts about meningiomas

Meningiomas are the most common type of brain tumors in adults and occur more often than cancerous brain tumors. Children rarely get them, and they're more common in older adults. Women are also much more likely to get them than men. The underlying cause of meningiomas is not clear. Hormonal fluctuations may encourage the growth of these tumors, but more research is needed to confirm this.

Symptoms

These tumors usually grow slowly. You may not have any symptoms until the tumor has become large. The tumor can cause different symptoms, depending on where it's growing. These are possible symptoms:

  • Vision or hearing loss

  • Seizures

  • Trouble thinking clearly

  • Trouble walking

  • Loss of smell

  • Weakness in an arm or leg

  • Headache

  • Nausea

Diagnosis

Doctors often diagnose a meningioma using an MRI or CT scan. In addition, the doctor may want to remove a sample of the tumor to examine it under a microscope before making the diagnosis.

Treatment

If your meningioma is causing symptoms or is growing, your doctor will likely want to remove it with surgery. In some cases, though, trying to remove the tumor may be too risky. For example, the tumor may be too close to a vital brain structure or blood vessel.

If you do have surgery, the surgeon will try to take out as much of the tumor as possible. The surgeon may use MRI images of your brain to help guide the surgery. The surgeon may also use a special microscope during the surgery to get a better view of the tumor and the surrounding parts of your brain.

If the surgeon can't remove the tumor—or can only remove part of it—you may need radiation therapy. Depending on the areas of the brain and/or spinal cord that are involved, radiation therapy may help shrink any remaining tumor and can also prevent it from spreading to the tissues around it. Even if the tumor is completely removed during surgery, some doctors may still recommend radiation therapy to help prevent another meningioma from developing in the future. Meningiomas have a tendency to grow back after surgery.

Your doctor may also recommend medications to treat the tumor. Experts are studying several drugs to see if they work against meningiomas. You may need to take part in a study in order to use these drugs.

You may also be able to use other drugs to treat symptoms caused by the meningioma, such as seizures, excessive vomiting, weakness, and vision disturbances.

Long-term management of meningiomas

In most people, meningiomas don’t cause any symptoms and grow quite slowly. For this reason, doctors will recommend using an approach called “watchful waiting.” This means you will report any new symptoms to your doctor, and your doctor will order scans on a regular basis to track even minor changes in the tumor. This may be a reasonable option for managing small tumors that aren't causing symptoms, especially in older adults who may not be able to undergo surgery or radiation therapy because of other medical conditions.

Meningioma

Meningioma is a tumor that develops in the membranes that surround the brain and spinal cord (meninges).

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Oligodendroglioma

Oligodendroglioma

Oligodendrogliomas are uncommon brain tumors. They make up about 4% of all brain tumors. They are usually found in men in their mid-30s to mid-40s, but they can develop at any age, including during childhood.

Because brain tumors are much less common in children than adults, little research has been done to explain why they happen or how best to treat them. For this reason, doctors might recommend participation in a clinical trial as part of the treatment plan.

A clinical trail tests new treatments to determine how well they work. You may also hear the term clinical study used to describe this type of research. 

Symptoms

Symptoms of brain tumors depend on where in the brain the tumor is located. For example, if a tumor develops in the region that controls speech, the child's speaking would be affected.

Locations of different tumors in the brain
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These are possible symptoms of an oligodendroglioma:

  • Seizures

  • Headaches

  • Changes in mood or personality

  • Nausea

  • Vomiting

  • Drowsiness

  • Dizziness

  • Problems with vision or speech

Complications

Oligodendrogliomas and their treatment may lead to the following complications:

  • Infection

  • Bleeding

  • Return of the cancer

  • Disabilities, such as impaired speech or vision, depending on the location of the tumor

  • Changes in development and growth, usually as a result of radiation

Diagnosis

Doctors typically take a medical history and do a physical examination that may include a neurological exam to look at vision, hearing, speech, thinking, and motor skills. The tests conducted will usually focus on a child's age-appropriate abilities.

The doctor might also want to order imaging tests to find out more about the tumor and its location. MRIs or CT scans are likely to be included.

These other tests might also be done:

  • Blood tests

  • Biopsy, which involves a laboratory examination of a small sample of the tissue in the tumor to check for signs of cancer

Grade of tumor

The tumor will be graded on a scale from I to IV. Grade I means that the cancer cells have only barely started to grow, whereas grade IV means that they are fairly advanced in their growth. Grades II and III describe progression toward advanced cancer.

Doctors may also use terms such as low grade to describe slower-growing cancer tumors or high grade (anaplastic oligodendrogliomas) to describe faster-growing tumors. Commonly, oligodendrogliomas are mixed with other types of cells. These are called oligoastrocytomas.

Treatment

Treating brain tumors is complicated because of their location. As a result, treatment may involve many different approaches:

  • Steroids, which help reduce the swelling around the tumor.

  • Anticonvulsant medication to help control any seizures.

  • Shunt to drain any fluid that has built up in or around the brain.

  • Surgery to remove part or all of the tumor.

  • Chemotherapy, a drug-based treatment to kill the cancer cells. Sometimes a combination of chemotherapy drugs is needed; currently, researchers are trying to determine if chemotherapy can help children avoid radiation. Pathologists have found that specific changes in the chromosomes of some oligodendrogliomas make them respond better to chemotherapy. 

  • Radiation, a treatment with high-energy beams often used in combination with surgery to help control the tumor and improve the surgery's chances for success. In some cases, chemotherapy may be combined with radiation for a better outcome.

Traditionally, oligodendrogliomas respond well to chemotherapy. Therefore, if your tumor requires further treatment after the surgery, it is usually a combination of chemotherapy and radiation. Imaging tests will be used after surgery and during treatment to check on the tumor's progress. After treatment, a child will need follow-up care in subsequent years to make sure the cancer has not returned. 

If your child has been diagnosed with an oligodendroglioma tumor, you may want to consider getting a second opinion. In fact, some insurance companies require a second opinion for such diagnoses. It is very rare that the time it will take to get a second opinion will have a negative impact on your child's treatment. The peace of mind a second opinion provides may be well worth the effort. 

Oligodendrogliomas

Oligodendrogliomas develop in the brain and can be low grade (Grade II) or anaplastic (Grade III).

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Metastatic Brain Tumors

Metastatic Brain Tumors

Sometimes tumors growing in the brain begin there. These are called primary brain tumors. But other types of brain tumors begin as cancers somewhere else in the body. These can start in the lung, breast, skin, kidney, or other body parts. They may spread to the brain if the cancers are not controlled at the original site. These are called secondary or metastatic brain tumors.

Metastatic brain tumors are more common than tumors that begin in the brain, and are treated differently from those that start in the brain.

Facts about metastatic brain tumors

Cancer may spread to the brain through your lymph system or your bloodstream. Or it may travel to the brain from a nearby tissue. Metastatic brain tumors are becoming more common because people are living longer after having cancer somewhere else in their body.

In most cases, the metastatic brain tumor is found in the cerebrum. This is the outer part of the brain that controls your thoughts, emotions, and language ability. It also is involved in movement and sensing the outside world. But these tumors can appear elsewhere in the brain, too.

Metastatic brain tumors happen most commonly in lung cancer, but can occur in many other types.

Symptoms

Symptoms of this condition can vary, depending on its size and where it happens. These are possible symptoms:

  • Trouble walking

  • Mood changes

  • Unusual behaviors

  • Headaches

  • Changes in personality

  • Memory loss

  • Trouble speaking

  • Seizures

  • Trouble seeing

  • Vomiting

Diagnosis

Sometimes, your doctor will know if you already have a cancer somewhere else in your body. But in some cases, the doctor finds the metastatic brain tumor first. Doctors may diagnose this condition using:

  • MRI, CT, or PET scan. These are different ways of painlessly creating an image of your brain for the doctor to see. A PET scan is commonly performed to determine whether there are any other areas on the body with cancer. 

  • Cerebral angiography. During this test, dye will be injected through a tube put into a blood vessel. Then the doctor will take X-rays of your brain. The dye shows the path of the blood flow in your brain, which may help show if a tumor is in your brain.

  • Spinal tap. Also called a lumbar puncture, this test looks for cancer cells in the fluid found around your brain and spinal cord.

  • Other tests. Your doctor may do scans of other parts of your body to look for the tumor that started your brain cancer. A doctor may also remove part of the tumor in your brain or the rest of your body to examine it.

Treatment

A surgeon may be able to remove the tumor during brain surgery. In some cases, the surgeon may only be able to remove part of it. When more than one metastatic brain tumor occurs in the brain, surgical treatment may not always be an option. Other types of surgery may help relieve pressure on the brain and treat symptoms if the tumor can't be removed.

Doctors may be able to treat the brain tumor with radiation. Radiation therapy may involve radiation of the whole brain or more focused radiation treatment (such as with the gamma knife). Chemotherapy may also be an option. In addition, the doctor may provide medicines that relieve swelling in the brain, reduce the number of seizures, and relieve pain.

Prevention

You can take a number of steps to reduce your risk for cancers that can spread to your brain:

  • Eat a healthy diet.

  • Get regular exercise.

  • Maintain a healthy weight.

  • Avoid smoking.

  • Limit your sun exposure.

  • Have regular screening exams for certain cancers, such as mammograms for breast cancer.

Managing brain tumors

Sometimes, doctors won’t be able to cure this disease. In some cases, they will suggest methods to keep a person comfortable during his or her remaining time. These may include specific treatments and medicine to reduce pain and other symptoms.

Metastatic Brain Tumor

Metastatic brain tumors are considered secondary brain tumors, and spread to the brain from another part of the body.

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