Neuro Oncology

A brain tumor is an abnormal growth of tissue in the brain. They can be either benign (non-cancerous) or malignant (cancerous). Tumors can originate in the brain itself, or come from another part of the body and travel to the brain (metastasize). Benign tumors do not contain cancer cells and when removed do not recur. Malignant tumors contain cancer cells and usually are fast growing and invade surrounding tissue. However, sometimes tumors that are not cancer are called malignant because of their size and location in the brain.

What causes brain tumors?

Most brain tumors have abnormalities of genes involved in cell cycle control, causing uncontrolled cell growth. These abnormalities are caused by alterations directly in genes, or chromosome rearrangements which change the function of a gene. Patients with neurofibromatosis, Von Hippel-Lindau syndrome, Li-Fraumeni syndrome, and retinoblastoma have an increased risk of developing tumors of the central nervous system. Also, there have been some cases of people in the same family developing brain tumors that do not have any of these genetic syndromes.

Patients who have received radiation therapy to the head as part of prior treatment for other malignancies are also at an increased risk for new brain tumors.

Symptoms of Brain Tumor

There are common symptoms for brain tumors, however each persons experience may be different and the symptoms vary depending on the size and location of the tumor. Tumors are extra tissue in the brain and can cause pressure on the brain and result in increased intracranial pressure (ICP). This may cause one or more of the ventricles that drain cerebral spinal fluid (the fluid that surrounds the brain and spinal cord) to become blocked and cause the fluid to be trapped in the brain. The 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 front of the brain include:

• Increased intracranial pressure
• Seizures
• Visual changes
• Slurred speech
• Paralysis or weakness on half of the body or face
• Drowsiness and/or confusion
• Personality changes/impaired judgment
• Gait disturbances
• Communication problems

Symptoms of brain tumors in the brainstem or base of the brain may include:

• Increased intracranial pressure (ICP)
• Seizures
• 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 walking
• Hearing loss
• Personality changes

Symptoms of brain tumors in the cerebellum or back of the brain may include:

• Increased intracranial pressure (ICP)
• Vomiting (usually in the morning without nausea)
• Headache
• Uncoordinated muscle movements
• Problems walking

Treatment of Brain Tumor

Treatment for brain tumors will be decided by your doctor based on the following characteristics:

• Your age, overall health and medical history
• Type, locations 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 for a brain tumor may rely on one or a combination of the following:

• Surgery (which is usually the first step in the treatment of brain tumors, with the goal being to remove as much of the tumor as possible while maintaining neurological function. A biopsy is done to examine the types of cells the tumor is made of for a diagnosis. This is done frequently if the tumor is in an area with sensitive structures around it that may be injured during removal.
• Chemotherapy
• Radiation therapy
• Steroids (this treats and prevents swelling especially in the brain)
• Anti-seizure medication (to treat and prevent seizures associated with intracranial pressure)
• Placement of a ventriculoperitoneal shunt (or a VP shunt) this tube 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 treatment)
• Rehabilitation (to regain lost motor skills and muscle strength, speech, physical and occupational therapists may be involved in your treatment 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)

There are also newer therapies that may be involved in your brain tumor treatment:

• Stereotactic radiosurgery. This technique 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, which is a special gene added to a virus that is injected into the brain tumor. An antiviral drug is then given which kills the cancer cells that have been infected with the altered virus.
• Chemotherapy wafers. These are wafers containing a containing a cancer-killing drug, BCNU, which is inserted directly into the area of the brain tumor during surgery.

Rehabilitation for Brain Tumors

Valley specialists will see to it that you get the continuous follow-up care that is essential for a person diagnoses with a brain tumor. One has to be on guard against the side effects of radiation and chemotherapy, as well as second malignancies which can occur in brain tumor survivors. Lost motor skills and muscle strength will be regained through rehabilitation for an extended amount of time. Valley speech therapists and physical and occupational therapist may be involved in your treatment plan.

Tumors that start in spinal tissue are called primary spinal tumors. Tumors that spread to the spine from some other place (metatastasis) are called secondary spinal tumors.

The cause of primary spinal tumors is unknown. Some primary spinal tumors occur with genetic defects. A spinal tumor is much less common than a primary brain tumor.

Spinal tumors can occur:

• Inside the cord (intramedullary)
• In the membranes (meninges) covering the spinal cord (extramedullary - intradural)
• Between the meninges and bones of the spine (extradural)

Or, tumors may extend from other locations. Most spinal tumors are extradural.

As it grows, the tumor can affect the:

• Blood vessels
• Bones of the spine
• Meninges
• Nerve roots
• Spinal cord cells

It may press on (compress) the spinal cord or nerve roots (similar to spinal cord trauma), invade normal cells, or block blood vessels and lead to a lack of oxygen (ischemia).

Symptoms of Spinal Tumors

The symptoms depend on the location, type of tumor, and your general health. Tumors that have spread to the spine from another site (metastatic tumors) often progress quickly. Primary tumors often progress slowly over weeks to years.

Tumors in the spinal cord (intramedullary) usually cause symptoms, sometimes over large portions of the body. Tumors outside the spinal cord (extramedullary) may grow for a long time before causing nerve damage.

Symptoms may include:

• Abnormal sensations, loss of sensation:
  • Especially in the legs (may be in the knee or ankle, with or without shooting pain down the leg)
  • May worsen
   
• Back pain:
  • Gets worse over time
  • In any area -- middle or low back are most common
  • Is usually severe and not relieved by pain medication
  • Is worse when lying down
  • Is worse with strain, cough, sneeze
  • May extend to the hip, leg, or feet (or arms), or all extremities
  • May stay in the spine
   
• Cold sensation of the legs, cool fingers or hands, or coolness of other areas
• Fecal incontinence
• Inability to keep from leaking urine (urinary incontinence)
• Muscle contractions or spasms (fasciculations)
• Muscle function loss
• Muscle weakness (decreased muscle strength not due to exercise):
  • Causes falls, especially in the legs
  • Makes walking difficult
  • May get worse (progressive)
   

Treatment of Spinal Tumors

The goal of treatment is to reduce or prevent nerve damage from pressure on (compression of) the spinal cord.

Treatment should be given quickly. The faster symptoms develop, the sooner treatment is needed to prevent permanent injury. Any new or unexplained back pain in a patient with cancer should be taken seriously.

Treatments include:

• Corticosteroids (dexamethasone) may be given to reduce inflammation and swelling.
• Surgery may be needed to relieve compression on the spinal cord. Some tumors can be completely removed. In other cases, part of the tumor may be removed to relieve pressure on the spinal cord.
• Radiation therapy may be used with, or instead of, surgery.
• Chemotherapy has not been proven effective against most spinal tumors, but it may be recommended in some cases.
• Physical therapy may be needed to improve muscle strength and the ability to function independently.

• Valley's Cancer Treatment & Support Team
• American Cancer Society
• CancerLifeLine