CONDITIONS

Brain Cancer

What Is Brain Cancer

The central nervous system, or CNS, is composed of the brain and the spinal cord. According to the National Cancer Institute, brain cancer, also known as an intracranial neoplasm, is the growth of abnormal cells in the tissues of the brain. Primary brain tumors start in the brain, while secondary brain tumors arise from somewhere else in the body and then metastasize, or spread, to the brain. These types of tumors are also called metastatic brain cancer.

Brain tumors may be benign (non-cancerous) or malignant (cancerous). Both benign and malignant tumors may cause symptoms as they may put pressure on nearby structures within the brain. However, benign tumors will not invade other tissues, while cancerous, or malignant, tumors will actively spread and invade nearby tissues in the brain and even elsewhere in the body. The prognosis, or chance of recovery, depends on a multitude of factors, which include the type of brain cancer, its location, its size, speed of growth, and the baseline health of the individual patient.

Brain tumors are classified by the type of brain cell from which the cancer developed. Brain cancer types include the following:

  • Adenoma or craniopharygioma – which arises from brain cells in the pituitary gland
  • Sarcoma – which arises from connective tissues within the brain
  • Pinealoma – which arises from the pineal gland in the brain
  • Osteoma and osteosarcoma – both of these arise from the bones of the skull
  • Meningioma – arise from the outside layers of the brain, or the coverings
  • Medulloblastoma – arise from the cerebellum
  • Hemangioblastoma – arise from the cells that develop the arteries and veins within the brain
  • Gliomas – arise from the glial cells, which serve as support cells for neurons, or the information carrying cells of the brain. Gliomas are the most common brain tumors and account for 65% of cases. A specific type of glioma is the glioblastoma multiforme, or GBM, which is the type of brain cancer most often found in adults. Other types of gliomas are astrocytomas, oligodendrogliomas, and ependymomas.

It is estimated that nearly 70,000 new cases of primary malignant and non-malignant brain and CNS (central nervous system) tumors will be diagnosed in the United States in 2015. More than 3,000 new cases of childhood primary malignant and non-malignant brain and CNS tumors will be diagnosed in 2015. Nearly 14,000 deaths will be attributed to primary malignant brain and CNS tumors in the US in 2015.

What Causes Brain Cancer

Primary brain tumors begin when normal cells acquire a mutation, or error, in their DNA. As the genetic code for the cell, DNA controls how a cell divides. With a specific mutation, the DNA may no longer have the normal regulatory controls inherent in other cells. A recently reported mutation in the IDH1 gene may play a pivotal role in whether surgery will prove beneficial to patients with astrocytomas, which are the most common malignant brain tumors. As a result of these mutations, these cells rapidly and uncontrollable replicate themselves, which eventually forms a mass of abnormal cells. This mass of abnormal cells, or tumor, may remain localized and cause minor symptoms, or this mass of abnormal cells may invade local tissues and spread to other sites of the body, which characterizes malignant or cancerous brain tumors.

Specific genes within the DNA of cells have functions that regulate cell division. Genes involved in cell replication or division, cellular growth, and cellular survival are called oncogenes; while those involved in limiting cell growth and division—and induce cell death when necessary—are called tumor suppressor genes (such as TP53 and RB1 genes). When cell DNA is damaged, these genes may be altered and the oncogenes turned on, while the tumor suppressor genes are turned off. As a result, there is uncontrollable cell growth and possible cancer. These types of changes to a cell’s DNA are caused by the environment, however changes or mutations to DNA can also be inherited. If these mutations in the DNA correspond to genes that are involved with effective and correct cell replication, a person’s risk for developing brain cancers and other cancers may be increased.

Patients with Von Hippel-Lindau disease, Li-Fraumeni syndrome, and neurofibromatosis (NF1 and NF2) have genetic mutations that increase their likelihood of developing brain tumors.

Risk Factors For Brain Cancer

Although the cause of brain cancer is still largely unknown, there are some genetic conditions and environmental factors, which may contribute to the development of this disease.

General risk factors include:

  • Age, as the frequency of brain cancer increases with age. Gliomas are especially common in adults, while medulloblastomas are rare.
  • Gender also plays a role in the development of some brain cancer types. For example, meningiomas are more likely to develop in women, while medulloblastomas are more common in males.
  • Finally, those with compromised immune systems have a higher likelihood of developing lymphomas in the brain.

Genetic risk factors include mutations associated with:

  • Von Hippel-Lindau disease
  • Li-Fraumeni syndrome
  • neurofibromatosis (NF1 and NF2)

With regard to environmental exposure, increased risk of brain cancer is found amongst people with exposure to:

  • Oil refining
  • Rubber manufacturing
  • Drug manufacturing

In addition, exposure to radiation therapy, especially at a young age, may increase the risk of developing brain cancer.

Diagnosing Brain Cancer

According to the MD Anderson Cancer Center, if you have symptoms that may signal a brain tumor, your doctor will ask you a thorough medical history and then examine you for physical exam findings suggestive of the disease. The following diagnostic studies can help determine if you have a brain tumor, if it has spread, and how it is responding to treatment, such as surgery, chemotherapy, or radiation:

Imaging studies. Various types of imaging can help detect brain cancer, including:

  • CT (computed tomography) scans
  • MRI (magnetic resonance imaging)
  • PET (positron emission tomography) scans

Lumbar puncture. This test involves placing a small needle in the space between the vertebrae to allow the removal of a small amount of cerebrospinal fluid, or CSF, which bathes the brain and spinal cord. This fluid may help determine the cause of symptoms, especially if there is an infectious process occurring, such as a bacterial abscess or viral infection. The laboratory will usually report on the quantity of protein, glucose (sugar), and the type and quantity of red and white blood cells in the CSF.

Biopsy. While imaging studies may show a mass in the brain, a biopsy is often required for a definitive diagnosis of brain cancer. In addition, it allows for an accurate diagnosis of what type of brain cancer by identifying which type of cell the malignancy is caused by. A biopsy may be performed during surgery (referred to as a craniotomy when the skull is opened to allow for open access for surgery) when all or part of a brain tumor is being removed. Otherwise, the surgeons may elect to perform a stereotactic needle biopsy if the brain tumor is located in a difficult location to reach via craniotomy or if the mass is near vital structures, such as large blood vessels or part of the brain controlling breathing and heart rate. During a stereotactic needle biopsy, a surgeon will utilize a CT scan while slowly advancing the needle to the exact location of the brain tumor.

Symptoms of Brain Cancer

Symptoms of brain cancer are extremely variable and often are dependent on the size and location of the tumor. Possible symptoms of brain cancer include any of the following:

  • Headaches, often times worse with activity and in the morning
  • Seizures
  • Personality changes
  • Memory loss
  • Nausea
  • Vomiting
  • Fatigue
  • Loss of balance
  • Difficulty of fine motor skills
  • Changes in judgement, including loss of initiative
  • Paralysis
  • Muscle weakness
  • Partial or complete loss of vision
  • Changes in speech and hearing
  • Changes in emotional state, such as aggressiveness
  • Altered perception of touch and pressure
  • Inability to look upward
  • Abnormal lactation, which can occur in men or women secondary to growth of hormone secreting brain cells
  • Difficulty swallowing
  • Facial weakness or numbness

Prognosis

Prognosis refers to the likely course of a disease or ailment. To determine the prognosis of brain cancer, doctors seek to identify the type of brain cancer and the grade.

The grade of a cancer cell describes how similar or dissimilar the cell looks compared to a healthy cell observed under a microscope. Healthy tissue will have many different types of cells grouped together. If the tumor has many different types of cells and appears similar to healthy tissue, it is termed differentiated, or a low-grade tumor. Conversely, if the tumor appears very different from the healthy tissue, it is termed poorly differentiated, or a high-grade tumor. In general, the lower the grade of tumor, the better chance of treatment, survival, and prognosis.

The age of the patient and his or her functional status, or level of functioning, also plays a vital role in prognosis. Generally, younger and higher functioning patients will do best.

With surgery, the amount of tumor able to be removed, also known as resected, impacts prognosis. If all of the tumor is removed, prognosis improves, while if only part of the tumor is removed, prognosis will likely deteriorate. If the tumor recurs, or comes back after removal, the prognosis is worse.

In addition, the location of the brain tumor may impact the severity of symptoms and how effectively it can be treated. Although most brain cancers remain within the CNS, those that do metastasize, or travel to other sites in the body, carry a worse prognosis.

Finally, certain molecular markers present in the tumor cells, termed biogenetic markers, may impact the tumors responsiveness to treatment and thus impact the disease prognosis.

Taking into account the above factors, the prognosis of brain cancer varies tremendously. According to the American Cancer Society, the 5-year survival rate can vary from 4% for those aged 55-64 diagnosed with glioblastomas to 92% for those aged 22-44 diagnosed with meningiomas.

Living With Brain Cancer

People with cancer not only face physical challenges, but also mental and emotional ones. It is important to understand your illness and treatment as it can make you feel more in control. Taking care of your emotional health is also vital. Family and friends can be an important source of support for you during this challenging time.

In addition, it is helpful to consider the following:

  • Explore all treatment options. Educate yourself on potential treatment methods and ask your doctor questions. Be sure to seek out reliable sources both online and in print. See the resources section for sources of information on brain cancer.
  • Weigh the benefits and risks of each treatment options. Ask yourself what the aim of your treatment should be, and what you wish to accomplish as you live with the disease.
  • Consider palliative care, a type of medical care specialized to help patients with terminal illnesses remain comfortable while living out their disease
  • Live out your dreams and goals to help you be as happy as possible. Don’t let prognosis or statistics discourage you from accomplishing want you want to accomplish

Screening

There is no official recommendation from the U.S. Preventive Services Task Force to suggest that it is beneficial to do preventive brain cancer screenings at the current time.

Prevention

Unfortunately, aside from not working (or ceasing to work) in one of the fields with increased risk of brain cancer, there is no guaranteed preventative method to stop brain cancer from developing. However, cases of brain cancer that are diagnosed early are less likely to progress and carry a better prognosis than cases that are diagnosed at later stages.

If you experience any of symptoms of brain cancer, contact your physician immediately.

Common Treatment

According to the National Brain Tumor Society, treatment for brain cancers depends on numerous factors, which include:

  1. Your age, overall health, medial history
  2. The type, location, and size of the tumor
  3. How likely the tumor is to spread and to recur
  4. Your tolerance for specific medications, procedures, or therapies

Your treatment may include the following:

Antiseizure/antiepileptic drugs (AEDs) – these medications lower the chance of seizures for those with brain tumors leading to seizure activity. Avoiding seizures is crucial to prevent dangerous events following seizures, such as falls or problems breathing. Also, the prevention of seizures improves the quality of life for those with seizure-generating tumors. Common AEDs include carbamazepine, levetiracetam, and lamotrigine.

Steroids – help to decrease the swelling associated with brain tumors, which may help to alleviate the symptoms caused by the abnormal mass. They may also improve the patient’s state of well-being and increase appetite, which is vital for cancer patients. Although they typically do not have direct effects on cancer cells, they do inhibit the growth of a specific type of CNS cancer referred to as primary central nervous system lymphoma, or PCNSL. Brain cancer patients usually take the steroids orally, but may occasionally receive them via the intravenous (IV) route. Commonly utilized steroids include prednisone and cortisone.

Chemotherapy – uses medication via oral or intravenous routes to kill rapidly diving cells (which is characteristic of cancer cells, but other cells in the body divide quickly as well and may be killed by the chemotherapy, such as hair cells leading to baldness during chemotherapy). High-grade tumors may respond well to chemotherapy and shrink the tumor prior to a possible surgery, which makes resection easier for the surgeon. Chemotherapy may also prove helpful for tumors that are near vital brain structures, such as the brain stem, which controls the heat rate and breathing, or those tumors inaccessible to surgery. Besides the aforementioned baldness, chemotherapy may also cause loss of appetite, nausea, vomiting, weight loss, lethargy, and an increased risk of infection.

Radiation therapy – x-rays and other forms of radiation are directed at the tumor to kill cancer cells via damaging their DNA and inhibiting their ability to divide or grow. Radiation therapy is especially helpful in cases where surgery would prove difficult secondary to location of the tumor and/or involvement of nearby structures, such as the brainstem, which is involved with regulating your heart rate and breathing. Precise radiation may be targeted to the tumor with the use of multiple beams of radiation aimed only at the tumor site to allow radiation treatment even to tumor that lie in or around vital, healthy brain tissue. This may also be referred to as radiosurgery. A refinement of radiation therapy is proton therapy, which delivers high doses of radiation to the tumor cells, but limits the amount of radiation to surrounding healthy tissue.

Surgery – when a surgeon opens the skull to perform surgery, it is termed a craniotomy. For low grade and easily removed tumors, a craniotomy may prove curative for some tumors, such as meningiomas. When all of the tumor is removed, it is termed total resection. If less of the tumor is removed, it is referred to as subtotal resection and when only part of the tumor is removed, it is termed partial resection. Even when the entire tumor is not removed, the mass that is removed may improve symptoms and improve prognosis, although it may not be completely curative. Recent advances in image-guided surgery, which may use real-time MRI to allow careful resection of tumors in difficult or tenuous locations, have allowed previously inoperable brain tumors to be surgically treated.

Tumor treating fields – which is a wearable device that delivers electric fields to the brain tumor to disrupt the rapid cell division.

Complementary and Alternative Treatment

As the definitive treatment for brain cancer remains chemotherapy, radiation, and surgery, alternative treatments for this condition should only be considered after traditional interventions have been initiated or completed.

Complementary medicine, which refers to interventions performed in addition to traditional or standard treatment, are numerous and may provide additional symptom relief and improved quality of life for many patients. According to the National Center for Complementary and Integrative Health, these include:

Acupuncture – is particularly effective in alleviating treatment-related nausea and vomiting in cancer patients. It may even help control cancer pain. Although complications from acupuncture are rare, it is important to ensure that the needles are properly sterilized. Many cancer patients have weakened immune systems and more prone to infections.

Ginger – may help to control nausea secondary to cancer chemotherapy, especially when used along with standard anti-nausea medications.

Massage therapy – may help to alleviate symptoms experienced by many cancer patients, such as pain, nausea, anxiety, and depression. However, the massage therapist should be careful to avoid deep or too rigorous massage prior to physician approval, especially directly over a tumor or around sensitive skin, which is common following radiation treatments.

Mindfulness-based Stress Reduction – as a type of meditation, mindfulness-based stress reduction can help cancer patients by relieving anxiety, stress, fatigue, and general mood and sleep disturbances. As a result, this can lead to an overall improvement in quality of life.

Yoga – preliminary studies suggest that yoga may improve anxiety, depression, and stress in patients with cancer. It may also alleviate fatigue in breast cancer patients. However, additional studies need to be completed for better evidence and conclusions.

Hypnosis, relaxation therapies, and biofeedback – various studies are currently assessing the benefits of these activities in cancer patients.

Herbal supplements – a 2008 review of research regarding herbal supplements and cancer concluded that the scientific evidence is limited and many clinical trials were not well designed. Furthermore, there are specific concerns regarding some herbal supplements in terms of medication interactions. Thus, any use of herbal medications should be discussed thoroughly with your physician.

When To Contact A Doctor

If you are experiencing any of the signs or symptoms of brain cancer (see above), you should seek medical attention as soon as possible. The earlier a diagnosis can be made, the earlier treatment can begin, which generally leads to improved outcomes and better prognosis.

Unless the symptoms are life-threatening, you can make an appointment within a reasonable time period and do not need to visit the emergency department.

Questions For Your Doctor

Your medical team may consist of several healthcare professionals, including your primary care physician, a neurologist, oncologist, and neurosurgeon.

The National Cancer Institute offers a Web site where you can find a cancer center near you at http://www.cancer.gov/researchandfunding/extramural/cancercenters/find-a-cancer-center

Questions For A Doctor

When you go to see your doctor, it’s good to have a list of the questions you’d like to have answered. Take a moment to write down some of the things you want to know. Your questions for your doctor might include some of these:

  • How far advanced is my cancer?
  • What are my options for treatment?
  • What is my prognosis?
  • What treatment would you recommend, and why?
  • What are the possible side effects?
  • Does my insurance cover these treatments?
  • What changes will I need to make in my day-to-day life?
  • Is there anything else I should know about my cancer?

Resources

Other useful resources to help you learn about brain cancer can be found at:

The National Cancer Institute

American Brain Tumor Association

National Brain Tumor Society