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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.
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.
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.
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
Unusual changes in energy level or excessive sleepiness
Slow speech or worsening of handwriting skills
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 spectroscopy will be done along with an MRI to determine the chemical makeup of the tumor.
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.
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 start in the brain rather than spreading from another part of the body.
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.
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.
These are common symptoms of craniopharyngiomas:
Headache, including one that goes away after vomiting
Unusual changes in energy level
Slow growth or delayed puberty
Increase in thirst
Increase in head size (in infants)
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.
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.
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 is a slow-growing tumor that develops at the base of the skull.
A meningioma is a type of tumor that grows in the meninges, which are layers of tissue that cover the brain and spinal cord. Technically, a meningioma is not a brain tumor because it does not arise from brain tissue. However, it may be referred to as a brain tumor.
These tumors are usually non-cancerous (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.
Meningiomas are the most common type of brain tumors in adults and occur more often than cancerous brain tumors. They're more common in women and usually develop in the 40s or 50s. Children rarely get meningiomas.
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.
Researchers have found a chromosome abnormality in a significant percentage of meningiomas. This suggests that the tumors may be caused by genetic-related factors. The specific chromosome involved functions to suppress tumor growth.
Women are much more likely to get meningiomas than men, which has led doctors to suspect that certain hormones might play a role in the development of these tumors. Other people at higher risk include those who have received radiation treatment to the head and people with neurofibromatosis (an inherited nervous system disorder).
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:
Meningiomas often come to light because of symptoms a person is having. To diagnose meningiomas, the following tests may be done:
Not all meningiomas need to be treated right away.
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 help 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.
In many people, meningiomas don’t cause any symptoms and grow quite slowly. For this reason, doctors might recommend “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.
Tips to help you get the most from a visit to your health care provider:
Meningioma is a tumor that develops in the membranes that surround the brain and spinal cord (meninges).
The brain is part of the central nervous system (CNS). The CNS also includes the spinal cord. A tumor is an abnormal growth of tissue. An oligodendroglioma is a type of CNS tumor called a glioma. These are tumors of the glial cells, the supporting cells of the brain. There are several types of glioma, depending on the type of cells involved and the location in the brain. Oligodendroglioma is a rare tumor that starts in the oligodendrocytes. These are the cells that help to form the fatty covering (myelin) of nerve cells. Oligodendrogliomas:
Symptoms of brain tumors depend on their size and where they are in the brain. For example, if a tumor develops in the region that controls speech, your child's speech may be affected.
Symptoms of an oligodendroglioma may include:
The symptoms of oligodendroglioma can be like other health conditions. Make sure your child sees a healthcare provider for a diagnosis.
Your child's healthcare provider will ask about your child's health history and symptoms. He or she will examine your child. This will include a neurological exam. The exam tests reflexes, muscle strength, eye and mouth movement, and coordination. Your child's healthcare provider may refer your child to a cancer specialist (oncologist). Your child may have tests such as:
Part of diagnosing cancer and deciding on treatment is called grading. Grading describes how much cancer cells are different from normal cells. Most tumors are graded on a scale from I to IV. Grade I means that the cancer cells have only just started to grow. They look a lot like normal cells and are likely to grow slowly. They are called low-grade. Grade IV means that it is advanced in its growth and is likely to grow quickly. They are called high-grade. Grade 4 tumors are also called anaplastic oligodendrogliomas. Grades 2 and 3 are in between. They are called intermediate-grade.
If your child has been diagnosed with a brain tumor and time allows, you may want your child to see a different oncologist (get a second opinion) before beginning treatment. In fact, your insurance company might require a second opinion.
Treatment may include one or more of the below:
Other parts of treatment may include:
With any cancer, how well a child is expected to recover (prognosis) varies. Keep in mind:
A child may have complications from the tumor or from treatment, such as:
A child with a brain tumor needs ongoing care. Your child will be seen by oncologists and other healthcare providers to treat any late effects of treatment and to watch for signs or symptoms of the tumor returning. Your child will be checked with imaging tests and other tests. And your child may see other healthcare providers for problems from the tumor or from treatment. For example, your child may see an eye doctor (ophthalmologist) for vision problems.
Your child may need therapy to help with movement and muscle strength. This may be done by physical and occupational therapists. If your child's speech is affected, he or she may need help from a speech therapist. Your child may also need the help of other therapists for learning or emotional problems.
You can help your child manage his or her treatment in many ways. For example:
Call the healthcare provider if your child has:
Oligodendrogliomas develop in the brain and can be low grade (Grade II) or anaplastic (Grade III).
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, colon, 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.
In adults, metastatic brain tumors are more common than tumors that begin in the brain, and are treated differently from those that start in the brain.
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 of this condition can vary, depending on the size and number of tumors in the brain and where they occur. These are possible symptoms:
Changes in personality
Loss of feeling or movement on one side of the body, typically in the arm or leg
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. This test is not used much anymore and has largely been replaced with MRI and CT angiography.
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 camcer that led to brain tumor. A doctor may also remove part of the tumor in your brain or the rest of your body to examine it.
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.
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.
Limit your sun exposure.
Have regular screening exams for certain cancers, such as mammograms for breast cancer.
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 tumors are considered secondary brain tumors, and spread to the brain from another part of the body.
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