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The brain can be affected by many different kinds of growths, which are called tumors. Malignant (cancerous) tumors can arise within the brain itself, or they may begin in another part of the body and spread to the brain (metastasize).
Primary tumors are those that originate in the brain tissue. Secondary tumors begin as cancers in another part of the body, such as the lung, which then metastasize to the brain.
Not all growths are cancerous. Some are not malignant (that is, they are benign tumors). But because the brain is enclosed within the rigid skull, any abnormal tissue growth can cause problems. In recent years, advances in surgery, radiation and chemotherapy have improved outcomes for people with brain tumors.
Advanced diagnostic and surgical techniques, better radiation therapy technologies and other novel treatments are all being used at City of Hope to stop the growth and spread of brain tumors. And in partnership with our patients, we are continually exploring even more effective treatments through clinical trials and research, including more effective chemotherapies, gene therapies and immunotherapies.
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A glioma is a primary brain tumor that arises from glial cells, which are the supportive cells of the brain. There are many more glial cells than the neurons which they protect and support. Glial cells have three main types: astrocytes, oligodendrocytes, and ependymal cells.
While neurons cannot multiply, glial cells have the power to divide and reproduce. Sometimes this process goes out of control, resulting in a tumor called a glioma.
Types of Gliomas
Each type of glial cell creates its own type of glioma. Most gliomas come from abnormal astrocytes, and are called astrocytomas. The other types of gliomas include oligodendrogliomas and ependymomas. Sometimes, a tumor will have a combination of cell types.
Treatment
Treatment of gliomas depends on the specific type of tumor, how advanced the tumor is, and whether it is malignant or benign. Treatments may include surgery, radiation, chemotherapy, immunotherapy, or novel strategies in clinical trials.
Astrocytoma
An astrocytoma is a type of brain tumor, specifically arising from glial cells, which are the most common kind of cell in the brain. Glial cells protect and support neurons. Among glial cells, most are the kind called astrocytes, which are star-shaped; correspondingly, most gliomas arise from this type of cell, and are called astrocytomas.
Symptoms
- Symptoms of an astrocytoma may include:
- Headache (due to increased pressure in the brain), frequently worse in the morning
- Vomiting
- Seizures
- Weakness or numbness on one side
- Behavioral and cognitive changes
Grading Astrocytoma
A tumor “grade” helps doctors understand how aggressively a tumor is growing. Determining the grade provides information that can help in assessing a patient’s outlook and deciding which treatments to use.
Astrocytomas have four general grades:
Grade I: Pilocytic astrocytoma – The most benign, mainly found in children.
Grade II: Low-grade astrocytoma – Also benign, mainly found in teenagers.
Grade III: Anaplastic astrocyoma – A slow-growing malignant tumor.
Grade IV: Glioblastoma multiforme– A highly malignant brain tumor.
Pilocytic astrocytomas, the most benign variant, are rare and found almost exclusively in children. On the other end of the spectrum is the glioblastoma - one of the most malignant tumor types found in the body.
Pilocytic astrocytomas are considered benign because they do not invade the surrounding normal brain tissue. Although these are slow-growing tumors, they can become very large. These are the most commonly diagnosed brain tumors in children and teenagers, and can cause problems with balance and coordination.
Low-grade astrocytomas are rare, slow-growing tumors which occur most often in younger patients. They rarely spread to other parts of the central nervous system (CNS). The outlook with these tumors is generally better than with other brain tumors.
Anaplastic astrocytomas are fast-growing, relatively aggressive brain tumors that invade neighboring tissues. They are more common among men and women in their 30s to 50s.
Ependymoma
Ependymomas are a rare type of glioma that develop from the ependymal cells which line the ventricles (fluid-filled spaces in the brain), and from the central canal of the spinal cord. They may occur in any part of the brain or spine. Ependymomas can spread from the brain to the spinal cord via the cerebrospinal fluid (CSF) that surrounds and protects the brain and spinal cord. People of all ages can develop ependymomas, including children. Ependymomas of the spine account for the majority of adult spinal tumors.
Symptoms
Ependymomas can grow in different parts of the brain, and symptoms may differ depending on the area of the brain that is affected. Because these are often slow-growing tumors, any signs and symptoms may develop over many months.
Symptoms of an ependymoma may include:
- Headache (due to increased pressure in the brain), frequently worse in the morning
- Vomiting
- Seizures
- Vision changes
- Weakness or numbness on one side
- Problems with balance and coordination
- Behavioral and cognitive changes
- Swelling of the nerve at the back of the eye (papilloedema)
- Rapid, jerky eye movements (nystagmus)
- Neck pain and irritability
The symptoms of an ependymoma in the spinal cord can vary depending on which part of the spine is affected. Symptoms of spinal cord tumors may include neck or back pain, numbness or weakness in the limbs, and loss of bladder control.
Grading
A tumor “grade” helps doctors understand how aggressively a tumor is growing. Determining the grade provides information that can help in assessing a patient’s outlook and deciding which treatments to use.
There are three grades of ependymoma ranging from slow-growing (I) to more rapid and aggressive (III):
Grade I: myxo-papillary ependymoma and sub-ependymoma
Grade II: typical ependymoma (low-grade)
Grade III: anaplastic (malignant) ependymoma.
Treatment
Treatment of ependymoma depends on grade, the size and position of the tumor, and whether it has spread to other parts of the brain or the spinal cord. Treatments may include surgery, radiation, chemotherapy, immunotherapy, or novel strategies in clinical trials.
Glioblastoma, also called glioblastoma multiforme, is the most invasive type of glial tumor, which commonly spreads to nearby tissues. A rapidly growing tumor, it may be composed of several different cell types. It occurs most commonly in men and women in their 50s to 70s.
Treatment
Treatment of astrocytomas depends on the specific type, how advanced the tumor is, and whether it is malignant or benign. Treatments may include surgery, radiation, chemotherapy, immunotherapy, or novel strategies in clinical trials.
These are a type of primitive neuroectodermal tumor (PNET), which arise from undeveloped brain cells. Highly aggressive, they tend to be large and can spread throughout the central nervous system. Medulloblastomas occur most often in young children, and can cause swelling of the brain (hydrocephalus).
Treatment
Treatment options typically include surgery, and possibly radiation and chemotherapy. A shunt may be needed to drain the fluid causing hydrocephalus.
The meninges are the layers of tissue covering the brain and spinal cord. Tumors arising from these tissues, called meningiomas, compress brain tissues near them.
Symptoms
Symptoms of meningioma are often caused by the tumor’s compression of brain tissue, which can also impact cranial nerves and blood vessels. In some cases, a tumor’s growth can extend into the bones of the head and face, causing visible changes.
Common symptoms of meningiomas include:
- Headache (due to increased pressure in the brain), frequently worse in the morning
- Vomiting
- Seizures
- Weakness or numbness on one side
- Behavioral and cognitive changes
Grading Meningioma
A tumor “grade” helps doctors understand how aggressively a tumor is growing. Determining the grade provides information that can help in assessing a patient’s outlook and deciding which treatments to use.
Meningiomas have three grades which range from low (I) to high (II): the lower the grade, the lower the risk of aggressive growth and recurrence:
Grade I: Benign meningioma
Grade II: Atypical meningioma
Grade III: Malignant (anaplastic) meningioma
Most meningiomas are considered benign or low-grade tumors. However, unlike nonmalignant tumors elsewhere in the body, some meningiomas can cause disability and become life threatening. While some meningiomas grow slowly, others may grow more rapidly or have sudden growth spurts. There is no way to predict the rate of growth of a meningioma, or to know how long a specific tumor was growing before being diagnosed.
Treatment
If there has no symptoms, it may be decided to use periodic imaging tests to monitor the tumor. Otherwise, surgery is the standard treatment.
If the tumor cannot be completely removed, or if it recurs, radiation therapy may be given as well. Chemotherapy is being tested in clinical trials for inoperable, aggressive, atypical and recurrent meningiomas. With meningiomas, follow-up scans are needed indefinitely, because tumors can recur years or even decades after treatment
A metastatic or “secondary” brain tumor arises when cancer cells break away from a primary tumor elsewhere in the body, and spread through the bloodstream to the brain.
Metastastic brain tumors are more common than primary brain tumors, which originate in brain tissue. The most common cancers that metastasize to the brain include lung, breast, colon, melanoma, and kidney. In some cases, a person’s primary cancer will be discovered only after the metastatic tumor is diagnosed. However, cancers can metastasize to other parts of the body long after the primary cancer has occurred.
Diagnosing a secondary tumor will involve a biopsy to sample tumor cells. This will allow doctors to determine whether the tumor started in the brain, or spread from another location. A metastatic brain tumor that began as breast cancer, for example, will be made of breast cells, not brain cells.
Treatment depends on the type of primary cancer, the size and location of the metastasis, the patient’s age and general health, the types of treatments the patient has had in the past, and their response to those treatments.
Treatments for the secondary tumor may include surgery, radiation, chemotherapy, immunotherapy, or novel strategies in clinical trials.
Adenoma
An adenoma is a tumor of glandular origin. Adenomas can arise in many different organs, including the colon, breast, adrenals and pituitary (the “master” endocrine gland, found in the brain). Although adenomas are benign, they can on rare occasion progress into malignant tumors called adenocarcinomas. They can also cause serious health complications by pressing on other structures as they grow, and by producing large quantities of hormones in an uncontrolled manner.
Types of Pituitary Adenomas
A large percentage of pituitary tumors are adenomas. These are called microadenomas when they are less than 1 cm in diameter, or macroadenomas when the diameter is larger than 1 cm.
Pituitary adenomas are also classified by the hormones that they secrete:
Prolactin-(PRL) producing adenomas, also called lactotroph, adenomas, causing hyperprolactinemia.
ACTH-producing adenomas, also called corticotroph adenomas, associated with Cushing or Nelson syndromes.
Growth hormone (GH-producing) adenomas, also called somatotroph adenomas, associated with acromegaly and/or gigantism.
Rare thyrotropin TSH-producing tumors, also called thyotroph adenomas..
Endocrine-inactive (clinically nonfunctioning) adenomas.
Mixed adenomas that secrete both GH and PRL.
Signs and Symptoms
Signs and symptoms of pituitary adenomas are specific to each type, as follows:
Prolactinomas
Headache
Visual problems
Oligomenorrhea or amenorrhea (reduction or cessation of menstrual periods)
Reduced fertility
Loss of libido
Erectile dysfunction
Galactorrhea (spontaneous flow of milk from the female breast)
Corticotroph adenomas
Headache
Visual problems
Proximal myopathy (muscle weakness)
Centripetal (abdominal) fat distribution
Behavioral and cognitive changes
Bruising easily, skin thinning, stretch marks
Hirsutism (growth of body hair)
Osteopenia (thinning of the bone)
Somatotroph adenomas
Headache
Visual problems
Growth of hands and feet
Coarsening of facial features
Carpal tunnel syndrome
Snoring and obstructive sleep apnea
Growth of lower face and jaw (prognathism)
Osteoarthritis and joint pain
Excessive sweating
Thyrotroph adenomas
Palpitations
Tremor
Weight loss
Insomnia
Hyperdefecation (frequent nondiarrheal bowel movements)
Excessive sweating
Nonfunctioning adenomas (typically gonadotroph adenomas)
Headache
Visual problems
Pituitary insufficiency due to compression of the pituitary stalk or destruction of normal pituitary tissue by the tumor, mainly seen as secondary hypogonadism
Ovarian overstimulation, testicular enlargement or raised testosterone levels (rare)
Treatment
Treatment of adenomas depends on the specific type of tumor, how advanced the tumor is, and the symptoms of its hormonal activity. Treatments may include surgery, radiation, chemotherapy and medications to address hormonal problems.
For more information about the Pituitary gland, click here.. Schwannomas are benign, slow-growing tumors that affect the myelin sheath surrounding peripheral nerves (produced by Schwann cells).
Although the tumor cells stay on the outside of the nerve, the tumor mass may either push the nerve aside or press it against a bony structure, causing damage.
One type of schwannoma, called the vestibular schwannoma or acoustic neuroma, develops from the balance and hearing nerves supplying the inner ear.
When vestibular schwannomas affect both ears, they are usually associated with a genetic disorder called neurofibromatosis type 2 (NF2). Patients with NF2 typically develop multiple brain- and spinal cord-related tumors. They also can develop tumors of the nerves involved in swallowing, speech, eye and facial movement, and facial sensation.
Signs and Symptoms
- Hearing loss
- Tinnitus or ringing of the hear
- Stiff neck
- Hydrocephalus (accumulation of fluid in the brain)
- Uncoordinated movement or ataxia in one or both arms
Depending on the location of the tumor, a schwannoma may also have the following symptoms:
Cranial Nerve (CN) V -- Paralysis of facial muscle, especially in the same side of the hearing loss
Cranial Nerve (CN) V -- Loss of corneal reflex or the reflex to close the eyelids when the cornea is touched
CN VI -- Double vision
CN VII -- Bell's palsy or sudden onset facial paralysis, characterized by muscle weakness and distorted facial expression
CN X -- Weakness of the palate, tongue and nerve muscle on the same side as the tumor
Treatment
Treatments for schwannoma may include surgery and radiation.
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City of Hope’s Division of Neurosurgery focuses on surgical treatment of both benign and malignant brain, spine and pituitary tumors. Our physicians are nationally-recognized experts in neurosurgery and neuro-oncology, and employ today’s leading edge therapies.
For questions or additional information, please contact Greta Manila, N.P., or Roger Harthrong, N.P. at 626-471-7100. If you prefer, you may e-mail us at: gmanila@coh.org, rharthrong@coh.org, or neurosurgery@coh.org. |
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