Brain tumor

Brain tumors are, as the name suggests, tumors in the brain which can be benign or malignant.

The main areas of the brain and limbic system

Tumors of the brain and spinal cord

Tumors of the brain and spinal cord are abnormal growths of tissue found inside the skull or the bony spinal column.

Benign and maligant

Benign tumors are noncancerous, and malignant tumors are cancerous.

Primary and secondary

Tumors that originate in the brain or spinal cord are called primary tumors.

Primary brain tumors

Most primary tumors are caused by out-of-control growth among cells that surround and support neuron, specific genetic disease, for example, neurofibromatosis type 1 and tuberous sclerosis. They can also be caused by exposure to radiation or cancer-causing chemicals.

Secondary brain tumors

Metastatic, or secondary, tumors in the CNS are caused by cancer cells that break away from a primary tumor located in another region of the body.

Pathophysiology

As the skull is a closed space, tumors can place pressure on sensitive tissues and impair function.

• Symptoms of brain tumors include headaches, seizures, nausea and vomiting, poor vision or hearing, changes in behavior, unclear thinking, and unsteadiness.
• Spinal cord tumor symptoms include pain, numbness, and paralysis.
• Diagnosis is made after a neurological examination, special imaging techniques such as computed tomography, magnetic resonance imaging, positron emission tomography, laboratory tests, and a biopsy.

Incidence

Rate of New Cases and Deaths per 100,000: The rate of new cases of brain and other nervous system cancer was 6.4 per 100,000 men and women per year. The death rate was 4.4 per 100,000 men and women per year. These rates are age-adjusted and based on 2013–2017 cases and 2014–2018 deaths.

Life time risk

Lifetime Risk of Developing Cancer: Approximately 0.6 percent of men and women will be diagnosed with brain and other nervous system cancer at some point during their lifetime, based on 2015–2017 data.

Prevalence

Prevalence of This Cancer: In 2017, there were an estimated 168,494 people living with brain and other nervous system cancer in the United States.

Causes

Primary brain tumors include any tumor that starts in the brain. Primary brain tumors can start from brain cells, the membranes around the brain (meninges), nerves, or glands.

Tumors can directly destroy brain cells. They can also damage cells by producing inflammation, placing pressure on other parts of the brain, and increasing pressure within the skull.

Max Brodel - Cushing

The cause of primary brain tumors is unknown. There are many risk factors that could play a role:

Radiation therapy used to treat brain cancers increases the risk of brain tumors up to 20 or 30 years later. Some inherited conditions increase the risk of brain tumors, including neurofibromatosis, Von Hippel-Lindau syndrome, Li-Fraumeni syndrome, and Turcot syndrome. Lymphomas that begin in the brain in people with a weakened immune system are sometimes linked to infection by the Epstein-Barr virus. These have not proven to be risk factors:

Exposure to radiation at work, or to power lines, cell phones, cordless phones, or wireless devices

• Head injuries
• Smoking
• Hormone therapy

Classification

Brain tumors are classified depending on:

• Location of the tumor
• Type of tissue involved
• Whether they are noncancerous (benign) or cancerous (malignant)

Other factors Sometimes, tumors that start out less aggressive can change their biologic behavior and become more aggressive.

Tumors can occur at any age, but many types are most common in a certain age group.

In adults, gliomas and meningiomas are the most common.

Gliomas

Gliomas come from glial cells such as astrocytes, oligodendrocytes, and ependymal cells.

Gliomas are divided into three types:

1. Astrocytic tumors include astrocytomas (can be noncancerous),
2. anaplastic astrocytomas, and
3. glioblastomas.

The meninges lie between the skull and brain matter. Tumors originating from the meninges are meningiomas.

Oligodendroglial tumors

Some primary brain tumors are made up of both astrocytic and oligodendrocytic tumors. These are called mixed gliomas.

Glioblastomas are the most aggressive type of primary brain tumor.

Meningiomas

Meningiomas and schwannomas are two other types of brain tumors. These tumors:

Occur most often between ages 40 and 70. Are usually noncancerous, but can still cause serious complications and death from their size or location. Some are cancerous and aggressive. Other primary brain tumors in adults are rare.

Studierfenster Brain Tumor Segmentation

These include:

• Ependymomas
• Craniopharyngiomas
• Pituitary tumors
• Primary (central nervous system - CNS) CNS lymphoma
• Pineal gland tumors
• Primary germ cell tumors of the brain

Symptoms

Some tumors do not cause symptoms until they are very large. Other tumors have symptoms that develop slowly.

Symptoms depend on the tumor's size, location, how far it has spread, and whether there is brain swelling.

The most common symptoms are:

• Changes in the person's mental function
• Headaches
• Seizures (especially in older adults)
• Weakness in one part of the body

Headaches caused by brain tumors may:

• Be worse when the person wakes up in the morning, and clear up in a few hours
• Occur during sleep
• Occur with vomiting, confusion, double vision, weakness, or numbness
• Get worse with coughing or exercise, or with a change in body position

A posterior fossa tumor leading to mass effect and midline shift

Other symptoms can include:

• Change in alertness including excessive sleepiness, unconsciousness, and coma
• Changes in hearing, taste, or smell
• Changes that affect touch and the ability to feel pain, pressure, different temperatures, or other stimuli
• Confusion or memory loss
• Difficulty swallowing
• Difficulty writing or reading
• Dizziness or abnormal sensation of movement (vertigo)
• Eye problems such as eyelid drooping, pupils of different sizes, uncontrollable eye movement, vision difficulties (including decreased vision, double vision, or total loss of vision)
• Hand tremor
• Lack of control over the bladder or bowels
• Loss of balance or coordination, clumsiness, trouble walking
• Muscle weakness in the face, arm, or leg (usually on just one side)
• Numbness or tingling on one side of the body
• Personality, mood, behavior, or emotional changes
• Trouble speaking or understanding others who are speaking

Other symptoms that may occur with a pituitary tumor:

• Abnormal nipple discharge
• Absent menstruation
• Breast development in men
• Enlarged hands, feet
• Excessive body hair
• Facial changes
• Low blood pressure
• Obesity
• Sensitivity to heat or cold

Diagnosis

The following tests may confirm the presence of a brain tumor and find its location:

• CT scan of the head
• EEG (to measure the electrical activity of the brain)
• Examination of tissue removed from the tumor during surgery or CT-guided biopsy (may confirm the type of tumor)
• Examination of the cerebral spinal fluid (CSF)
• MRI of the head

CT scan of a brain tumor, with its diameters marked as an X. There is hypoattenuating (dark) peritumoral edema in the surrounding white matter, with a "finger-like" spread.

Treatment

The three most commonly used treatments are surgery, radiation, and chemotherapy. Doctors also may prescribe steroids to reduce the tumor-related swelling inside the CNS.

Treatment can involve surgery, radiation therapy, and chemotherapy.

Multispecialty approach

Brain tumors are best treated by a team that includes:

• Neuro-oncologist
• Neurosurgeon
• Medical oncologist
• Radiation oncologist

Early treatment

Early treatment often improves the chance of a good outcome.

Treatment goals

Treatment depends on the size and type of tumor and your general health. Goals of treatment may be to cure the tumor, relieve symptoms, and improve brain function or comfort.

Surgery

Surgery is often needed for most primary brain tumors. Some tumors may be completely removed. Those that are deep inside the brain or that enter brain tissue may be debulked instead of removed. Debulking is a procedure to reduce the tumor's size.

Tumors can be hard to remove completely by surgery alone. This is because the tumor invades surrounding brain tissue much like roots from a plant spread through soil. When the tumor cannot be removed, surgery may still help reduce pressure and relieve symptoms.

Radiotherapy

Radiation therapy is used for certain tumors.

Chemotherapy

Chemotherapy may be used with surgery or radiation treatment.

Other medical treatments

Other medicines used to treat primary brain tumors in children may include:

• Medicines to reduce brain swelling and pressure
• Anticonvulsants to reduce seizures
• Pain medicines
• Comfort measures, safety measures, physical therapy, and occupational therapy may be needed to improve quality of life. Counseling, support groups, and similar measures can help people cope with the disorder.

Complications

Complications that may result from brain tumors include:

• Brain herniation (often fatal)
• Loss of ability to interact or function
• Permanent, worsening, and severe loss of brain function
• Return of tumor growth
• Side effects of medicines, including chemotherapy
• Side effects of radiation treatments

Alternative Names

• Glioblastoma multiforme
• Ependymoma
• Glioma
• Astrocytoma
• Medulloblastoma
• Neuroglioma
• Oligodendroglioma
• Lymphoma
• Vestibular schwannoma (acoustic neuroma)
• Meningioma - adults;
• Cancer - brain tumor (adults)

Prognosis

Symptoms of brain and spinal cord tumors generally develop slowly and worsen over time unless they are treated.

Brain tumor score

The tumor may be classified as benign or malignant and given a numbered score that reflects its rate of malignancy. This score can help doctors determine how to treat the tumor and predict the likely outcome, or prognosis, for the individual.

Clinical trials

As brain and spinal cord tumors are an evolving field of medicine, with a lot of clinical trials and novel treatments, most patients with brain and spinal cord tumors opt for clinical trial after talking with their treatment team.

Brain tumor Resources
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External links

• American Brain Tumor Association (ABTA)
• American Cancer Society
• Child Neurology Foundation
• Childhood Brain Tumor Foundation
• Children's Brain Tumor Foundation

Medical resources

Classification	ICD-10: C71, D33, ICD-9-CM: 191, 225.0 MeSH: D001932 DiseasesDB: 30781
External resources	MedlinePlus: 007222 eMedicine: emerg/334