Brain tumor

Overview

A brain tumor is an abnormal growth of tissue in the brain. The tumor can either originate in the brain itself (primary brain tumor), or come from another part of the body and travel to the brain (metastatic or secondary tumor). Brain tumors may be classified as either benign (noncancerous) or malignant (cancerous), depending on their behavior.

A benign tumor does not contain cancer cells and usually, once removed, does not recur. Most benign brain tumors have clear borders, meaning they do not invade surrounding tissue. These tumors can, however, cause symptoms similar to cancerous tumors because of their size and location in the brain.

Malignant brain tumors contain cancer cells. Malignant brain tumors are usually fast growing and invade surrounding tissue. Malignant brain tumors very rarely spread to other areas of the body, but may recur after treatment. Sometimes, brain tumors that are not cancer are called malignant because of their size and location, and the damage they can do to vital functions of the brain.

Our approach

As one of the country's most progressive cancer centers for brain tumors, Northwell Health physicians offer the most advanced treatments and services for patients with brain tumors:

  • Leading-edge surgical procedures, such as awake craniotomy, that avoid damage to critical areas
  • Unique intra-operative magnetic resonance imaging (iMRI) that guides surgery and ensures superior precision
  • Minimally invasive laser treatment —pioneering the treatment of brain tumors with lasers that are inserted through the smallest possible incisions with the highest accuracy.
  • Innovative GliaSite Radiation Therapy System —one of the few hospitals in New York State actively performing this procedure.
  • State-of-the-art Novalis® stereotactic radiosurgery (SRS) that delivers precise radiation beam shaping that targets tumors and protects healthy cells
  • Advanced chemotherapy treatment options

Multidisciplinary Brain Tumor Treatment

Each brain tumor diagnosis and treatment plan is unique, so the team meets regularly to discuss each patient’s treatment. The physicians participate in multidisciplinary conferences where brain tumor experts across multiple departments and disciplines share ideas and best practices for delivering the best possible collaborative patient care. The specialists review each treatment plan to constantly improve care and ensure treatment milestones are reached. 

Types

There are many different types of brain tumors. A tumor is usually categorized by the type of cell it begins with or the area of the brain in which it occurs. The most common types of brain tumors include the following:

  • Gliomas – The most common type of brain tumor. Gliomas begin from glial cells, which are supportive cells in the brain. There are several types of gliomas, categorized by where they are found and the type of cells that originated the tumor. The following are the different types of gliomas:
    • Astrocytomas - Astrocytomas are glial cell tumors that are derived from connective tissue cells called astrocytes. These cells can be found anywhere in the brain or spinal cord. Astrocytomas are the most common type of childhood brain tumor and the most common type of primary brain tumor in adults. Astrocytomas are generally subdivided into high-grade, medium-grade or low-grade tumors. High-grade astrocytomas (glioblastomas) are the most malignant of all brain tumors. Astrocytomas are further classified for presenting signs, symptoms, treatment, and prognosis based on the location of the tumor. The most common location of these tumors in children is in the cerebellum, where they are called cerebellar astrocytomas. These people usually have symptoms of increased intracranial pressure, headache, and vomiting. There can also be problems with walking and coordination as well as double vision. In adults, astrocytomas are more common in the cerebral hemispheres (cerebrum), where they commonly cause increased intracranial pressure (ICP), seizures and/or changes in behavior.
    • Brain stem gliomas - Brain stem gliomas are tumors found in the brain stem. Most brain stem tumors cannot be surgically removed because of the remote location and delicate and complex function this area controls. Brain stem gliomas occur almost exclusively in children; the group most often affected is the school-age child. Children usually do not have increased intracranial pressure (ICP) as a result of brain stem gliomas, but may have problems with double vision, movement of the face or one side of the body, or difficulty with walking and coordination.
    • Ependymomas - Ependymomas are also glial cell tumors. They usually develop in the lining of the ventricles or in the spinal cord. The most common place they are found in children is near the cerebellum. The tumor often blocks the flow of the cerebral spinal fluid, which bathes the brain and spinal cord, causing increased intracranial pressure. This type of tumor mostly occurs in children younger than 10 years of age. Ependymomas can be slow growing compared to other brain tumors but may recur after treatment is completed. Recurrence of ependymomas results in a more invasive tumor with more resistance to treatment. Two percent of brain tumors are ependymomas.
    • Optic nerve gliomas - Optic nerve gliomas are found in or around the nerves that send messages from the eyes to the brain. They are frequently found in children who have neurofibromatosis, a condition a child is born with that makes him or her more likely to develop brain tumors. People with optic nerve gliomas usually experience loss of vision and hormone problems. These are typically difficult to treat due to the surrounding sensitive brain structures.
    • Oligodendrogliomas - This type of tumor also arises from the supporting cells of the brain and is commonly found in the cerebral hemisphere (cerebrum). Seizures are a very common symptom of these tumors as well as headaches, weakness or changes in behavior or sleepiness. These tumors have a better prognosis than most other gliomas, but they can become more malignant with time. About 2 percent of brain tumors are oligodendrogliomas.
  • Metastatic tumors - In adults, metastatic brain tumors are the most common type of brain tumors. These are tumors that begin to grow in another part of the body before spreading to the brain through the bloodstream. When the tumors spread to the brain, they commonly go to the cerebral hemispheres or to the cerebellum. Often, a patient may have multiple metastatic tumors in several different areas of the brain. Lung, breast and colon cancers frequently travel to the brain, as do certain skin cancers. Metastatic brain tumors may be quite aggressive and may return even after surgery, radiation therapy, and chemotherapy.
  • Meningiomas - Meningiomas are usually benign tumors that come from the meninges, the outer coverings of the brain just under the skull. This type of tumor accounts for about one-third of brain tumors in adults. They are slow growing and may exist for years before being detected. Meningiomas are most common in older patients, with the highest rate in people in their 70s and 80s. They are commonly found in the cerebral hemispheres just under the skull, are usually separate from the brain and can often be removed entirely during surgery. They can, however, recur after surgery and certain types can be more aggressive.
  • Schwannomas - Schwannomas are usually benign tumors, similar to meningiomas, that arise from the supporting cells of the nerves leaving the brain. When schwannomas involve the nerves that control hearing and balance, they are called vestibular schwannomas or acoustic neuromas. They commonly result in a loss of hearing and, occasionally, loss of balance or problems with weakness on one side of the face. Surgery can be difficult because of the area of the brain in which they occur and the vital structures around the tumor. Occasionally, radiation (or a combination of surgery and radiation) is used to treat these tumors.
  • Pituitary tumors - The pituitary gland is a gland located at the base of the brain. It produces hormones that control many other glands in the body, including the thyroid gland, the adrenal glands, the ovaries and the testes. The pituitary gland also moderates milk production by pregnant women and fluid balance by the kidney. Tumors that occur in or around the area of the pituitary gland can affect the functioning of the gland or overproduce hormones that are sent to the other glands. This can lead to problems with thyroid functioning, impotence, milk production from the breasts, irregular menstrual periods or problems regulating the fluid balance in the body. In addition, due to the closeness of the pituitary to the nerves to the eyes, patients may experience decreased vision.
    • Tumors in the pituitary are frequently benign, and total removal makes the tumors less likely to recur. Since the pituitary is at the base of the skull, approaches for removal of a pituitary tumor may involve entry through the nose or the upper gum. Modern treatment for pituitary tumors is almost always by surgery with an endoscope which is done through the nose without any incisions. Certain types of tumors may be treated with medication which, in some cases, can shrink the tumor or stop the growth of the tumor.
  • Primitive neuroectodermal tumors (PNETs) - PNETs are much more common in children than in adults. They can occur anywhere in the brain, although the most common place is in the bottom of the brain near the cerebellum. When they occur here, they are called medulloblastomas. The symptoms depend on the PNET location in the brain, but the patient typically experiences increased intracranial pressure. These tumors are fast growing and often malignant, with occasional spreading throughout the brain or spinal cord.
  • Primary central nervous system (CNS) lymphoma - Lymphocytes are carried in lymph fluid in and out of the brain. A CNS tumor occurs when these cells turn malignant. A weakened immune system may increase the risk of this tumor.  
  • Medulloblastomas - Medulloblastomas are one type of PNET that are found near the midline of the cerebellum. This tumor is rapidly growing and often blocks drainage of the cerebral spinal fluid, causing symptoms associated with increased intracranial pressure. Medulloblastoma cells can spread, or metastasize, to other areas of the central nervous system, especially around the spinal cord. A combination of surgery, radiation, and chemotherapy is usually necessary to control these tumors.
  • Craniopharyngiomas - Craniopharyngiomas are benign tumors that occur at the base of the brain near the nerves from the eyes to the brain and the pituitary gland. These tumors are more common in children and constitute only about 1 percent of all brain tumors diagnosed in the U.S. Symptoms include headaches and problems with vision. Hormonal imbalances are also common, which may lead to poor growth in children. Symptoms of increased intracranial pressure may also be seen. Although these tumors are benign, they are hard to remove due to the sensitive brain structures that surround them.
  • Pineal region tumors - Many different tumors can arise near the pineal gland, which helps control sleep and wake cycles. Gliomas are common in this region, as are pineoblastomas (a type of PNET). In addition, germ cell tumors, another form of malignant tumor, can be found in this area. Benign pineal gland cysts are also seen in this location, which makes the diagnosis difficult between what is malignant and what is benign. Biopsy or removal of the tumor is frequently necessary to tell the different types of tumors apart. People with tumors in this region frequently experience headaches or symptoms of increased intracranial pressure. Treatment depends on the tumor type and size.

Symptoms

Brain tumors are normally discovered in patients experiencing common symptoms such as:

  • Headache
  • Vomiting (usually in the morning)
  • Nausea
  • Personality changes
  • Irritability
  • Drowsiness

Be aware that these symptoms could be due to conditions other than a brain tumor, so it’s best to see a doctor right away.

Diagnosis

The first step in diagnosing a brain tumor is usually a thorough examination, during which your doctor will also review personal and family medical history. If a brain tumor is suspected, you will likely need additional tests.

Doctors use a variety of imaging tests and other diagnostic methods to deliver an accurate brain tumor diagnosis, including:

  • Angiogram – Catheters are inserted into the arteries and guided to the brain. After injection of a dye, X-rays obtain multiple detailed images of the brain's blood vessels to detect and potentially help treat certain types of brain tumors.
  • Bone scan - After a dye is injected and absorbed by bone tissue, X-rays are taken to detect tumors and bone abnormalities.
  • CT or CAT scan (computerized axial tomography) - This procedure uses a combination of X-rays and computer technology to produce detailed 3D images. This test is normally used to detect and monitor tumors and can be used to guide treatment procedures.  
  • MRI scan (magnetic resonance imaging) - A powerful magnet, radio waves, and computer imaging combine to create highly detailed pictures of areas to show if and where the cancer has spread.
  • fMRI scan (functional magnetic resonance imaging) - This specialized MRI for brain tumor diagnosis shows more detailed images of the brain than a regular MRI. This type of scan can be used to localized areas of the brain used for functions such as language, memory, or movement. It is also used before surgery to maximize tumor resection while minimizing the possibility of weakness, blindness or speech loss.
  • MR SPECT (magnetic resonance spectroscopy or MRS) - This specialized brain scan can diagnose whether an unexpected finding on MRI is a tumor or not.
  • Neurological exam - The physician tests reflexes, muscle strength, eye, and mouth movement, coordination and alertness.
  • Biopsy - For some patients, a surgical procedure called a biopsy — much smaller than a complete tumor removal — may be preferred to a larger operation as a way to diagnose what kind if the tumor is present.
  • Spinal tap - The physician uses a thin needle to remove fluid from the lower spine. The fluid is then checked by a pathologist for cancer cells or other problematic signs.

Staging

Once a brain tumor diagnosis has been confirmed, the doctor will conduct one or more of the diagnostic imaging tests listed above to determine the location of the cancer and whether it has spread. Unlike most other cancers, there is no standard staging system for brain and spinal cord tumors, according to the National Cancer Institute.

Brain tumors that begin in the brain may spread to other parts of the brain, but they rarely spread to other parts of the body. Treatment of brain and spinal cord tumors is based on the following:

  • The type of cell in which the tumor began
  • Where the tumor formed in the brain or spinal cord
  • The amount of cancer left after surgery

Treatment of brain tumors that have spread to the brain from other parts of the body is based on such factors as the type of tumor a patient has, how many tumors there are in the brain, and how many tumors are elsewhere in the body. Tumors that have spread are known as metastatic tumors.

Treatments

Each brain tumor diagnosis and treatment plan is unique, so our team meets regularly to discuss each patient’s treatment. Our physicians participate in multidisciplinary conferences where brain tumor experts across multiple departments and disciplines share ideas and best practices for delivering the best possible collaborative patient care. Our specialists review each treatment plan to constantly improve care and ensure treatment milestones are reached. 

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