Common questions about brain tumors
Ask a question:
- What are the common tests used to diagnose brain tumors?
- How are brain tumors treated?
- What is a craniotomy?
- Do you use neuronavigation or awake craniotomy?
- Do you use a minimally invasive approach?
- What types of radiation are used to treat brain tumors?
- What are the risks and side effects of radiation?
- What is chemotherapy?
- What are the possible side effects of chemotherapy?
- What other medications are used to treat tumors?
What are the tests used to diagnose brain tumors?
A neurological examination followed by a magnetic resonance imaging (MRI) is the most sensitive and best method of detecting brain tumors. CT scans can also be used. Once a mass is detected by any of the imaging techniques, the diagnosis needs to be confirmed with a biopsy. Samples of tumor are tested at the time of a large operation to remove the tumor (craniotomy), or during a minimally invasive biopsy procedure in which a special needle is inserted through a small hole in the skull (burrhole). The surgeon, patient, and family decide which procedure is appropriate. The biopsy can identify they type of brain tumor, and also differentiate a tumor from other types of masses, such as infection or stroke. The microscopic structure of the tumor will be important in determining the type and grade of the tumor, guiding the brain tumor team in delivering the most effective therapy.
Treatment depends on the brain tumor type, location and size. Treatment may involve surgery (at the minimum to obtain a biopsy), and sometimes radiation therapy chemotherapy. Radiation and chemotherapy are used as secondary or adjuvant treatment for more aggressive tumors that cannot be treated by surgery alone. Sometimes, however, when the appearance of the tumor looks benign, when the tumor is very small, or when the symptoms are minimal, a decision to monitor the tumor with MRI or CT scans might be made (surveillance).
The neurosurgeon makes an incision in the scalp and removes a part of the skull bone. The location of the craniotomy is determined by the location of the tumor, and type of procedure (standard versus minimally invasive). As much of the tumor is removed as is safely possible. The bone usually replaced after the tumor has been removed. The skin incision is closed with sutures or staples. The tumor is sent to pathology for a preliminary reading. The final pathology report relies on special processing of the tumor sample, and usually takes 4-5 days, sometimes longer if a second opinion is requested.
Yes, we do. Sometimes brain tumors involve important areas of the brain that control speech, vision, and the ability to move your arms and legs. We call these areas eloquent areas. Every attempt is made to avoid brain damage to this area during surgery. This involves a careful knowledge of the anatomy using intraoperative neuronavigation techniques coupled with intraoperative monitoring to assess critical areas of the brain during surgery. Neuronavigation systems work like a brain GPS which allows us to target only abnormal tissue for removal while preserving normal brain. If the tumor is located in an eloquent area, sometimes we perform surgery with the patient awake during sections of the surgery to limit any injury to important areas. Because the brain does not have any sensors for pain, patients remain pain free and usually do not recall this portion of the surgery.
Yes, we do. A minimally invasive approach uses natural corridors or carefully targeted small openings for the removal of brain tumors. Minimally invasive neurosurgery requires advanced technological instruments and specialized surgeons who create small windows into the brain to remove tumors without disfiguring scars. This technique offers a number of advantages including a shorter recovery period with less post-operative pain. Our department includes faculty with specialized fellowship training in Minimally Invasive Neurosurgery.
We develop an individualized treatment plan for each patient and risks vary from patient to patient. Common risks and complications of brain surgery can include bleeding, infection, brain swelling, seizures, clots in the leg and neurological deficits (such as double vision or stroke).
Focused radiation (IMRT), whole brain radiation, and stereotactic radiosurgery ( e.g. Gamma Knife) are all types of radiation that treat tumors. Even if there was a "gross total resection" of the tumor at the time of surgery we know that microscopic cells often remain in the surrounding brain tissue. The goal of radiation is to reduce the size of the residual tumor and stop its progression. Radiation therapy uses high-energy x-ray or other types of ionizing radiation to stop cells from dividing. Ionizing radiation damages the basic building material in cells (DNA). Normal healthy cells can repair the damage better than tumor cells. Over time, irradiated tumor cells die.
The most common short-term side effects of radiation therapy are fatigue, loss of appetite, nausea and short-term memory loss. Brain edema may occur and may be treated with steroids. Skin reactions (rash, redness, or irritation) and hair loss may occur in the area where the radiation is focused. Some patients may experience delayed side effects such as memory loss, coordination problems and difficulty with cognition. The dead tumor cells may form a mass in the brain. This is called radiation necrosis. Surgery and/or steroids may be necessary to treat necrosis.
Chemotherapy is a very general term that is used to describe any medicines that are used to treat cancer. These medicines have a toxic effect on tumor cells as they divide. Chemotherapy might be given in cycles, which consist of "on" and "off" days of treatment followed by periods of time between treatments. The rest period allows the body to build healthy cells. Chemotherapy for brain tumors may be administered as pills, by IV, or sometimes as a wafer implanted in the brain at the time of surgery.
Side effects from chemotherapy can range from minimal to none, to severe. Temozolomide is a pill commonly used to treat malignant brain tumors, and the side effects are often relatively mild. Chemotherapy is designed to affect fast-growing cells, rapidly dividing normal cells such as hair follicles, bone marrow and stomach cells are often affected with side effects. These side effects can sometimes include baldness, nausea/vomiting, diarrhea or constipation, depending on the medicine given. Chemotherapy can also cause fatigue due to anemia, as well as fever and infection, because the immune system is weakened by the drugs.
What other medications are used for brain tumor patients?
Steroids and anti-convulsants are the most common medications given, aside from chemotherapy.. Steroids are used to decrease the edema (swelling) around the brain tumor. Anti-convulsants are used to treat seizures or to prevent seizures from occurring.