Frequently Asked Questions
- What types of brain tumors are there, and who is likely to develop them?
- Does severe headache indicate the presence of a brain tumor?
- Brain tumors are sometimes described as being “Grade 1”. What does this mean?
- What is the prognosis for people with brain tumors?
- How are brain tumors diagnosed?
- What new surgical techniques are being used in the treatment of brain tumors?
- Once a tumor is removed, how soon will it be known if the mass is malignant or benign?
- If a brain tumor is benign, or noncancerous, why is it still a cause for concern?
- Why are some brain tumor patients treated with surgery alone, while others also undergo radiation or chemotherapy?
- What are some factors to consider when selecting a neurosurgeon and a hospital for treatment of a brain tumor?
- What’s the average length of hospitalization and recovery time after brain tumor surgery?
- What are some suggestions for telling family members about the diagnosis of a brain tumor?
Generally speaking, brain tumors can be categorized as benign (slow growing and noncancerous) and malignant (rapid growing and cancerous). Secondary tumors-those that originate in other parts of the body and then spread to the brain-are more common than primary tumors, which begin in the brain. Many types of brain tumors are named for the cells from which they grow or their location in the brain.
Malignant brain tumors do not commonly occur. They make up only about 1.3% of all cancers in the United States. These tumors can be found in people of all ages, but particularly in adults between 55 and 65 years of age and in children between three and 12. Men and Caucasians are at a higher risk for brain tumor than other demographic groups.
The question of why brain tumors develop remains unanswered. Some possibilities include environmental and occupational factors, a handful of inherited conditions, abnormal or missing genes, viruses, a defective immune system, and atypical fetal development.
Severe headache can usually be attributed to causes other than a brain tumor. However, headache is a common symptom of brain tumors, particularly when the patient also experiences a loss of balance; nausea and vomiting that is not associated with migraine; double vision; or numbness. The constant headache that is worse in the morning than in the afternoon may also indicate the presence of a brain tumor.
There are several other symptoms of brain tumors: seizures, loss of hearing or vision; difficulty with speech; memory loss and a general sense of confusion; inability to concentrate or reason; and even a stroke. Women of child-bearing age may find that their monthly periods have stopped, although they are not pregnant.
Because these symptoms are shared with many conditions other than brain tumor, it’s imperative that medical care be sought for an accurate diagnosis.
Once a brain tumor biopsy is examined by a pathologist, the tumor is categorized, or graded, based on its cell structure and rate of growth. There are different grading systems, but one that is commonly used has four grades. Grade I tumors are slow growing, with cells that are near-normal in appearance and are not malignant. Tumors with cells that are slightly abnormal are classified as Grade II. Grade III tumors grow quickly, contain abnormal cells, and spread to surrounding tissue. The most malignant type of brain tumors, Grade IV, contain aggressive, abnormal cells that reproduce quickly.
That depends on the type and grade of tumor and the patient: Children and young adults generally tend to fare better than older patients, and women better than men. While the diagnosis of a brain tumor is serious, there is hope on several fronts. Of all primary tumors-those that originate in the brain-about half are benign and can be treated successfully.
The Central Brain Tumor Registry, which collects data on primary brain tumors, reports a two-year survival rate for malignant brain tumors of 35.1 percent; a five-year rate of 26.6 percent; and a 10-year rate of 22.2 percent. However, those percentages are an average of several malignant brain tumors; the survival rates vary greatly depending on tumor type. For example, the five-year survival rate for patients with pilocytic astrocytoma is 86.9 percent; for patients with mixed glioma, 55.3 percent.
Still, there has been an encouraging increase in survival rates over the years. Specifically, one study published in 1998 found that the five-year survival rate rose from 40 percent to 60 percent for patients with medulloblastomas and from 45 percent to 65 percent for patients with oligodendrogliomas.
Earlier diagnosis and technological developments now being applied to brain tumor treatment have contributed to this increased survival rate. With the use of computerized tomography (CT) and magnetic resonance imaging (MRI), physicians have more accurate images of brain tumors than ever before. The technology behind stereotactic surgery, which provides a 3-D image of the brain, enables neurosurgeons to precisely map to the tumor site and remove as much of the tumor as possible. Similarly, stereotactic radiosurgery can access tumors that are not reachable with traditional craniotomy. Additionally, for certain brain tumors, chemotherapy can be directly delivered in the form of “seeds” or wafers that are surgically placed at the tumor site.
Brain tumors are diagnosed through a combination of physical exam and diagnostic tests. A neurological exam assesses both a patient’s physical condition-balance, sensory abilities, and muscle movement, for example-and his or her mental status. Next, images of the brain are captured by scanning techniques such as magnetic resonance imaging (MRI) or computed tomography (CT). In some cases, a physician may order a cerebral angiography, which is an X-ray of the brain’s blood vessels. A biopsy-where a small section of the tumor is removed and examined by a pathologist-can determine cancer cell type and/or malignancy.
Technology and computers, when used by a highly trained and skilled neurosurgical team, have revolutionized the approach to brain tumor surgery.
During a traditional craniotomy, where the patient’s skull is opened to expose the tumor area, the neurosurgeon is guided by pre-operative scans and what he or she is able to see at the time of the operation. Sometimes, in an attempt to remove as much of the tumor as possible, healthy tissue surrounding the mass is removed.
However, new techniques and tools are tools are enabling brain tumor surgery to be less invasive and more precise. At present, the Program is pioneering what is expected to be one of the most significant advances in image-guided neurosurgery: the use of intraoperative MRI scans to confirm the location of lesions, plan and reconfirm the optimal surgical approach, and verify complete lesion removal prior to closure. University Hospital is the second hospital in the world to utilize a compact OR-based MRI system to obtain the most precise image possible to minimize the risk of harming healthy and/or eloquent areas of the brain. MRI images obtained during surgery provides the surgical team with a navigation route that adjusts for brain shift during the procedure. Furthermore, it provides the surgeon with the opportunity to safely expand the operative area if necessary for maximum lesion removal.
Other techniques employed in the treatment of brain tumors include stereotactic surgery, which uses computer-based technology and MRI scanning to produce a three-dimensional image of the patient’s brain. A metal frame is attached to the patient’s skull to create a fixed reference point or system of coordinates. These components enable precise mapping of and navigation to the tumor site. Then, optimal tumor resection is possible using a variety of surgical devices attached to the frame. “Frameless” stereotactic surgery provides the same precision but uses a reference system created by “wands,” plastic guides, or infrared markers instead of the metal frame.
Another relatively new surgical technique, Functional Image-Guided Surgery (FIGS), combines Functional MRI (fMRI) scanning with frameless stereotactic surgery to optimize the safety and efficacy of treatment for patients with tumors located in the cerebral hemispheres. While the MRI is scanning, the patient performs a series of activities and movements, such as reading a list or tapping fingers. The areas of the brain that correlate to those movements “light up” on the scan and create an image. This information is sent to a computer located in the operating room. Neurosurgeons use a special pointer positioned on the patient’s head to guide incisions and skull openings based on corresponding points of the MRI image.
During surgery, a section of the tumor is quick-frozen and then examined by the neurosurgeon. This “frozen-section” method gives the doctor some idea of whether the tumor is cancerous or not, but it is not the definitive word. A detailed pathological report may take up to two days or longer if the sample is sent to another laboratory for further examination.
There’s a sense of relief when a tumor is benign, and about half of all primary brain tumors are of this type. Meningiomas, benign tumors found in the brain’s membrane lining and the spinal cord, account for between 15 % and 20 % of all primary brain tumors. However, cancerous or not, a tumor can create pressure on vital areas in the brain. Most benign brain tumors are treatable with surgery or radiation.
There is no one-size-fits-all treatment for brain tumors. It’s true that some low-grade tumors can be completely removed and cured by surgery. However, high-grade tumors (those that are the most malignant) tend to grow and spread very rapidly. Radiotherapy is used to slow the growth or reduce the size of tumors. While radiation can be delivered conventionally-that is, by using external beams aimed at the tumor-there are other techniques. Brachytherapy refers to radioactive “seeds” that are placed at the tumor site. Stereotactic radiosurgery can deliver high-dose beams to a very precise location on the tumor.
Chemotherapeutic drugs destroy cancer cells and are used to treat certain types of brain tumors. Chemotherapy often is preferred over radiation in treatment of young children with brain tumors, as radiation may have adverse affects on the developing brain.
The referring doctor may give the patient the names of a few neurosurgeons, and the insurance company also may have some input based on which doctors are in its coverage network. One critical question the patient should ask is whether the doctor is board certified in neurosurgery. To be board certified, the doctor must have successfully completed an accredited residency program as well as written and oral examinations. To narrow the choice further, the patient may wish to contact a local brain tumor support group and speak with people who have gone through brain tumor treatment.
Selecting the facility where treatment will be given is also important. Hospitals in an academic setting, by design, have access to the latest technology, something that is very important to the way brain tumors are treated today. Some facilities, like University Hospital, have specialized brain tumor programs that emphasize a multidisciplinary approach to treatment.
A. Length of stay and recuperation depend on the type of surgery being performed and the patient’s condition prior to the operation. Generally speaking, however, a routine procedure involving the upper section of the brain may require a three- to four-day hospital stay; when the lower brain is operated on, the stay may be a day or two longer. Patients are encouraged to resume their regular activities as soon as possible; many are back at work within two to three weeks after they are discharged from the hospital.
It is important that family members be told so they can be informed and supportive during treatment and recovery. Even young children should receive a simple, honest explanation; otherwise, they may form a conclusion that is worse than the actual situation.
Telling the family is not something the patient has to do alone or without help. Some patients may wish to have a family conference with a member of the healthcare team in attendance; others may rely on clergy or a crisis support group to help them decide how to tell their family.