UNDERSTANDING BRAIN TUMORS

The subject of brain tumors is one that, fortunately, is foreign to most people. A diagnosis of a brain tumor, whether the patient is you, a family member, or a friend, would most certainly illicit feelings of uncertainty and fear. Understanding what the experts know about the causes, symptoms and treatment of brain tumors can be helpful to anyone facing a diagnosis for themselves or a loved one.

What is a brain tumor?
A brain tumor is a mass in the brain caused by uncontrolled growth of abnormal cells. The reasons for this are not fully understood despite the enormous research in this particular area of neuroscience.

Types of brain tumors:
Brain tumors are divided in two main categories: primary – arising from certain brain cells and named after these cell types, and secondary – as a result of a spread of a cancer of other organs (most commonly lung and breast) to the brain. These second types of tumors are called brain metastases. Primary brain tumors can be benign or malignant (cancerous), whereas metastatic tumors are invariably malignant just like the original cancer that has caused them.

A benign brain tumor grows slowly, has distinct margins, and rarely spreads. Although its cells are not malignant, it can be considered life threatening if it grows fast and involves vital areas of the brain.

A malignant brain tumor grows quickly, has irregular margins, and spreads to nearby brain areas. Although they are sometimes called brain cancer, malignant brain tumors do not fit the exact definition of cancer because they typically do not spread to organs outside the brain and spinal cord.
Whether a brain tumor is benign, malignant, or metastatic, all are potentially life threatening. Outcomes, however, vary greatly depending on many factors.

What causes brain tumors?
What directly causes a specific primary brain tumor to form is not entirely known. What we do know is that people most at risk for brain tumors include those who have:

• cancer elsewhere in the body (lung, breast, prostate, colon, etc.)
• prolonged exposure to harmful chemicals (pesticides, industrial solvents)
• exposure to radiation
• inherited diseases, such as neurofibromatosis.
What are the symptoms?
Symptoms vary depending on the tumor’s type, size, and location in the brain. General symptoms include:
• headaches that tend to worsen in the morning
• seizures
• stumbling, dizziness, difficulty walking
• speech problems (e.g., difficulty finding the right word)
• vision problems, abnormal eye movements
• weakness on one side of the body
• increased intracranial pressure, which causes drowsiness, headaches, nausea and vomiting, sluggish responses.

Diagnosing Brain Tumors:
Diagnosis of a brain tumor typically involves a physical examination testing the patient’s mental status, cranial nerves, muscle strength, sensation, reflexes, coordination, balance and gait.

Additional testing, such as audiogram, visual testing, endocrine testing or spinal tap, is often conducted. Imaging tests such as Computed Tomography (CT scan) and Magnetic Resonance Imaging (MRI) are the most common ways to visualize and evaluate brain tumors. If diagnosis cannot be made from imaging and other testing, a biopsy would be performed. A biopsy is a surgical procedure performed by a neurosurgeon to obtain a small amount of the tumor to determine its type.

Who treats brain tumors?
The current management of brain tumors involves a team of doctors from multiple specialties: a neurosurgeon, oncologist, radiation oncologist, radiologist, neurologist, endocrinologist and neuro-ophthalmologist.

Treatment of brain tumors:
The type, location, size and spread of the tumor determine how a tumor should be managed. Typically the neurosurgeon attempts to remove all or as much of the tumor as possible without harming the patient’s neurological function. Radiation treatment in combination with chemotherapy is often used after surgery to minimize the further spread and recurrence of a malignant tumor.

Rehabilitation:
Although the brain can sometimes heal itself after the trauma of treatment, it will take time and patience. Physical therapy, occupational therapy, and speech therapy may be helpful to improve or correct lost functions following brain surgery.

Recurrence:
How well a tumor will respond to treatment, remain in remission, or recur after treatment depends on the specific tumor type and location. Periods of remission vary. In general, benign tumors recur less often than malignant ones.
Since it is impossible to predict whether or when a particular tumor may recur, lifelong monitoring with MRI or CT scans is essential for people treated for a brain tumor.

Fortunately, recent advances in surgical techniques have improved outcomes for patients facing a diagnosis of a brain tumor. Today’s best surgeons can more precisely locate tumors, avoid injury to vital brain areas and confirm the amount of tumor removal while still in the operating room. If you or a loved one has been recently diagnosed with a brain tumor, be sure the surgeon has extensive training and experience in the latest advanced surgical techniques. Seek a second opinion, ask questions, and make sure your team of doctors is ready to partner with you in all phases of treatment.