[MOL] Educational Series, Brain Tumor, Adult - pls. save [02327] Medicine On Line


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[MOL] Educational Series, Brain Tumor, Adult - pls. save



Cancer Educational Series:  Brain Tumor, Adult
 
 

What is adult brain tumor?

Adult brain tumor is a disease in which cancer (malignant) cells begin to grow in the tissues of the
brain. The brain controls memory and learning, senses (hearing, sight, smell, taste, and touch), and
emotion. It also controls other parts of the body, including muscles, organs, and blood vessels.

This PDQ summary covers tumors that start in the brain (primary brain tumors). Often cancer
found in the brain has started somewhere else in the body and has spread (metastasized) to the
brain. This is called brain metastasis (see the PDQ patient information summary on brain
metastasis).

A doctor should be seen if the following symptoms appear: frequent headaches, vomiting, or
difficulty walking or speaking.

If there are symptoms, a doctor may order a computed tomographic scan, a special x-ray that
uses a computer to make a picture of the brain. A magnetic resonance imaging scan, which uses
magnetic waves to make a picture of the brain, may also be done. Often surgery is required to
determine if there is a brain tumor and to see what type of tumor it is.

The chance of recovery (prognosis) and choice of treatment depend on the type of brain tumor
and the patient's general state of health.
 
 

STAGE EXPLANATION
 

Types of adult brain tumor

Once adult brain tumor is found, more tests will be done to determine the type of tumor. A doctor
will also need to know how different the tumor cells are from the cells that are near it, which is
called the histologic grade of the tumor. To plan treatment, the doctor needs to know the type and
grade of brain tumor. The following types are used to group adult brain tumors.

Astrocytomas

Astrocytomas are tumors that start in brain cells called astrocytes. There are different kinds of
astrocytomas, which are defined by how the cancer cells look under a microscope.
 

Noninfiltrating astrocytoma

Noninfiltrating astrocytomas are tumors that grow slowly and usually do not grow into the tissues
around them.
 

Well-differentiated mildly and moderately anaplastic astrocytoma

Well-differentiated mildly and moderately anaplastic astrocytomas are slow growing, but grow
more quickly than noninfiltrating astrocytomas. They start to grow into other tissues around them.
 

Anaplastic astrocytoma

Anaplastic astrocytomas have cells that look very different from normal cells and that grow more
rapidly.
 

Glioblastoma multiforme

Glioblastoma multiformes are tumors that grow very quickly and have cells that look very different
from normal cells. Glioblastoma multiforme is also called grade IV astrocytoma.

Brain Stem Gliomas

Brain stem gliomas are tumors located in the bottom part of the brain that connects to the spinal
cord (the brain stem).

Cerebellar Astrocytoma

Cerebellar astrocytoma occurs in the area of the brain called the cerebellum, which is just above
the back of the neck. Cerebellar astrocytomas usually grow slowly and do not usually spread
from where they began to other parts of the brain or body.

Ependymal Tumors

Ependymal tumors are tumors that begin in the ependyma, the cells that line the passageways in
the brain where special fluid that protects the brain and spinal cord (called cerebrospinal fluid) is
made and stored. There are different kinds of ependymal tumors, which are defined by how the
cells look under a microscope.
 

Well-differentiated ependymoma

Well-differentiated ependymomas have cells that look very much like normal cells and grow quite
slowly.
 

Anaplastic ependymoma

Anaplastic ependymomas are ependymal tumors that do not look like normal cells and grow more
quickly than well-differentiated ependymal tumors.
 

Ependymoblastoma

Ependymoblastomas are rare cancers that usually occur in children. They may grow very quickly.

Oligodendroglial Tumors

Oligodendroglial tumors begin in the brain cells called oligodendrocytes, which provide support
and nourishment for the cells that transmit nerve impulses. There are different types of
oligodendroglial tumors, which are defined by how the cells look under a microscope.
 

Well-differentiated oligodendroglioma

Well-differentiated oligodendrogliomas are slow-growing tumors that look very much like normal
cells.
 

Anaplastic oligodendroglioma

Anaplastic oligodendrogliomas grow more quickly, and the cancer cells look very different from
normal cells.

Other Brain Tumors
 

Mixed gliomas

Mixed gliomas are brain tumors that occur in more than one type of brain cell, including cells of
astrocytes, ependymal cells, and/or oligodendrocytes.
 

Medulloblastoma

Medulloblastomas are brain tumors that begin in the lower part of the brain. They are almost
always found in children or young adults. This type of cancer may spread from the brain to the
spine.
 

Pineal parenchymal tumors

Pineal region tumors are tumors found in or around a tiny organ located near the center of the
brain (the pineal gland). The tumors can be slow growing (pineocytomas) or fast growing
(pineoblastomas). Astrocytomas may also start here.
 

Germ cell tumors

Germ cell tumors arise from the sex cells. There are different kinds of germ cells, including
germinomas, embryonal carcinomas, choriocarcinomas, and teratomas.
 

Craniopharyngioma

Craniopharyngiomas are tumors that occur near the pituitary gland. The pituitary gland is a small
organ about the size of a pea; this gland is located just above the back of the nose and controls
many of the body's functions.
 

Meningioma

Meningiomas are tumors that occur in the membranes that cover and protect the brain and spinal
cord (the meninges). Meningiomas usually grow slowly.
 

Malignant meningioma

Malignant meningioma is a rare tumor that grows more quickly than other meningiomas.
 

Choroid Plexus Tumors

The choroid plexus is tissue located in the spaces inside the brain called ventricles. The choroid
plexus makes the fluid that fills the ventricles and surrounds the brain and spinal cord. Tumors of
the choroid plexus can grow slowly (choroid plexus papilloma) or grow more rapidly (anaplastic
choroid plexus papilloma). The rapidly growing tumors are more likely to spread to other places
in the brain and to the spinal cord.
 

Recurrent

Recurrent disease means that the cancer has come back (recurred) after it has been treated. It
may come back in the brain or in another part of the body.
 
 

TREATMENT OPTION OVERVIEW
 

How adult brain tumors are treated

There are treatments for all patients with an adult brain tumor. Three kinds of treatment are used:

     surgery
     radiation therapy
     chemotherapy

Surgery is the most common treatment of adult brain tumors. To take out the cancer from the
brain, a doctor will cut a part of the bone from the skull to get to the brain. This operation is called
a craniotomy. After the doctor removes the cancer, the bone will be put back or a piece of metal
or fabric will be used to cover the opening in the skull.

Radiation therapy uses x-rays produced by a machine called a linear accelerator or a cobalt
machine to kill cancer cells from the outside and shrink tumors (external-beam radiation therapy).
Radiation therapy may also be used by putting materials that produce radiation (radioisotopes)
through thin plastic tubes into the tumor to kill cancer cells from the inside (internal radiation
therapy).

Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be
put into the body by a needle in the vein or muscle. Chemotherapy is called a systemic treatment
because the drug enters the bloodstream, travels through the body, and can kill cancer cells
throughout the body.

Biological therapy (using the body's immune system to fight cancer) is also being studied in clinical
trials. Biological therapy tries to get the body to fight cancer. It uses materials made by the body
or made in a laboratory to boost, direct, or restore the body's natural defenses against disease.
Biological therapy is sometimes called biological response modifier therapy or immunotherapy.
 

Treatment by type

Treatment of adult brain tumor depends on the type and stage of the disease, and the patient's age
and overall health.

Standard treatment may be considered because of its effectiveness in past studies, or participation
in a clinical trial may be considered. Not all patients are cured with standard therapy, and some
standard treatments may have more side effects than are desired. For these reasons, clinical trials
are designed to find better ways to treat cancer patients and are based on the most up-to-date
information. Clinical trials are ongoing in most parts of the country for most types of adult brain
tumor. To learn more about clinical trials, call the Cancer Information Service at
1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.
 
 

ADULT NONINFILTRATING ASTROCYTOMA

Treatment may be one of the following:

     1. Surgery to remove the cancer.

     2. Surgery followed by external-beam radiation therapy.

     3. If anaplastic astrocytoma comes back (recurs) after surgery, treatment may be radiation
     therapy if it was not given before. If radiation therapy was given before, clinical trials of
     chemotherapy or biological therapy should be considered.
 
 

ADULT WELL-DIFFERENTIATED MILDLY AND MODERATELY
ANAPLASTIC ASTROCYTOMA

Treatment may be one of the following:

     1. Surgery followed by external-beam radiation therapy.

     2. Surgery alone.

     3. A clinical trial of surgery followed by radiation therapy and chemotherapy.
 
 

ADULT ANAPLASTIC ASTROCYTOMA

Treatment may be one of the following:

     1. Surgery followed by external-beam radiation therapy.

     2. Surgery followed by external-beam radiation therapy and chemotherapy.

     3. A clinical trial of new forms of radiation therapy, such as internal radiation, radiation
     given during surgery, or radiation given with drugs to make the cancer cells more sensitive
     to radiation.

     4. A clinical trial of chemotherapy or biological therapy following radiation therapy.

     5. A clinical trial of chemotherapy drugs, which are placed in the body during surgery.
 
 

ADULT GLIOBLASTOMA MULTIFORME

Treatment may be one of the following:

     1. Surgery followed by external-beam radiation therapy and chemotherapy.

     2. Surgery followed by external-beam radiation therapy.

     3. A clinical trial of new forms of radiation therapy, such as internal radiation, radiation
     given during surgery, or radiation given with drugs to make the cancer cells more sensitive
     to radiation.

     4. A clinical trial of chemotherapy or biological therapy following radiation therapy.

     5. A clinical trial of chemotherapy drugs, which are placed in the body during surgery.
 
 

ADULT BRAIN STEM GLIOMA

Treatment may be one of the following:

     1. External-beam radiation therapy.

     2. A clinical trial of chemotherapy or biological therapy.
 
 

ADULT WELL-DIFFERENTIATED EPENDYMOMA

Treatment may be one of the following:

     1. Surgery to remove the cancer.

     2. Surgery to remove the cancer followed by external-beam radiation therapy.

     3. A clinical trial of chemotherapy or biological therapy.
 
 

ADULT MALIGNANT EPENDYMOMA

Treatment may be one of the following:

     1. Surgery to remove the cancer followed by external-beam radiation therapy.

     2. A clinical trial of external-beam radiation therapy with chemotherapy.

     3. A clinical trial of chemotherapy or biological therapy.
 
 

ADULT WELL-DIFFERENTIATED OLIGODENDROGLIOMA

Treatment may be one of the following:

     1. Surgery to remove the cancer followed by external-beam radiation therapy.

     2. Surgery to remove the cancer.

     3. A clinical trial of radiation therapy plus chemotherapy.
 
 

ADULT ANAPLASTIC OLIGODENDROGLIOMA

Treatment may be one of the following:

     1. Surgery to remove the cancer followed by external-beam radiation therapy.

     2. Surgery followed by external-beam radiation therapy and chemotherapy.

     3. A clinical trial of new forms of radiation therapy, such as internal radiation, radiation
     given during surgery, or radiation given with drugs to make the cancer cells more sensitive
     to radiation.

     4. A clinical trial of chemotherapy or biological therapy following radiation therapy.
 
 

MIXED GLIOMAS

Treatment may be one of the following:

     1. Surgery followed by external-beam radiation therapy.

     2. Surgery followed by external-beam radiation therapy and chemotherapy.

     3. A clinical trial of new forms of radiation therapy, such as internal radiation, radiation
     given during surgery, or radiation given with drugs to make the cancer cells more sensitive
     to radiation.

     4. A clinical trial of chemotherapy or biological therapy following radiation therapy.
 
 

ADULT MEDULLOBLASTOMA

Treatment may be one of the following:

     1. Surgery to remove the cancer plus external-beam radiation therapy.

     2. A clinical trial of surgery plus external-beam radiation therapy and chemotherapy.

(See the PDQ patient information summary on childhood brain tumor for more information).
 
 

ADULT PINEAL PARENCHYMAL TUMOR

Treatment may be one of the following:

     1. Surgery plus external-beam radiation therapy.

     2. Surgery plus external-beam radiation therapy plus chemotherapy.

     3. A clinical trial of new forms of radiation therapy, such as internal radiation, radiation
     given during surgery, or radiation given with drugs to make the cancer cells more sensitive
     to radiation.

     4. A clinical trial of chemotherapy or biological therapy following radiation therapy.
 
 

ADULT CENTRAL NERVOUS SYSTEM GERM CELL TUMOR

Treatment depends on whether the cancer can be removed in an operation, the kind of cells, the
location of the tumor, and other factors.
 
 

ADULT CRANIOPHARYNGIOMA

Treatment may be one of the following:

     1. Surgery to remove the cancer.

     2. Surgery to remove the cancer followed by radiation therapy.
 
 

ADULT MENINGIOMA

Treatment usually consists of surgery to remove the tumor. If all of the tumor cannot be removed
in an operation, a patient may also receive external-beam radiation therapy after surgery.
 
 

ADULT MALIGNANT MENINGIOMA

Treatment may be one of the following:

     1. Surgery followed by external-beam radiation therapy.

     2. A clinical trial of new forms of radiation therapy, such as internal radiation, radiation
     given during surgery, or radiation given with drugs to make the cancer cells more sensitive
     to radiation.

     3. A clinical trial of chemotherapy or biological therapy following radiation therapy.
 
 

RECURRENT ADULT BRAIN TUMOR

Treatment may be one of the following:

     1. Surgery alone.

     2. Surgery followed by chemotherapy.

     3. External-beam radiation therapy alone, if not used during previous treatment, with or
     without chemotherapy.

     4. Internal radiation therapy.

     5. A clinical trial of chemotherapy.

     6. A clinical trial of chemotherapy drugs, which are placed in the body during surgery