Brain Tumor Frequently Asked Questions

A Q&A about brain cancers with Ania Pollack, MD, neurosurgeon and neuro-oncologist, Premier Health Neuroscience Institute.

What is a brain tumor?

A brain tumor is an abnormal growth of tissue in the brain or central nervous system that can disrupt proper brain function on occasion. There are two different types. Primary brain tumors start in the brain or a structure of the brain. They may grow into other parts of the brain or into the spine, but rarely to other organs. Metastatic, or secondary, tumors begin in another part of the body, such as the breast or lung, and then spread to the brain. Metastatic tumors are much more common than primary brain tumors and are named by the location where they originate. For example, when lung cancer spreads to the brain, physicians consider it lung cancer in the brain — not brain cancer.

What is the difference between a benign tumor and a malignant tumor?

Primary brain tumors are categorized in one of two ways: benign and malignant. The less aggressive type of brain tumor is called benign. These tumors grow slowly and typically have clear borders that do not invade surrounding tissue. Meningiomas are an example brain tumors that are usually benign. Benign tumors can disrupt proper brain function by growing to a size where they are pressing on surrounding tissues. The other category is malignant brain tumors. Malignant brain tumors grow more rapidly, have uneven borders, and invade surrounding tissue. The majority of primary malignant brain tumors are a type of tumor known as a glioma. All secondary brain tumors are considered malignant.

What is the difference between grades and stages?

In the brain, tumors are graded, not staged as in other types of cancers. A stage tells you where a tumor is in relationship to the organ of origin, but stages don’t apply to brain tumors because they stay within the central nervous system. There are three to four grades of gliomas. Grade I glioma is usually a disease of childhood and can typically be cured by surgical removal. Grades II to IV are called called brain cancer. Lower grades can progress to a more aggressive grade, so they are all considered to be malignant.

How many different types of brain tumors are there?

Classification of brain tumors is complex. There are more than 120 types of brain and nervous system tumors that develop from different cell types. They can form in different areas including brain tissue, cranial nerves, meninges (or tissue that covers the brain), peripheral (may need to define difference in cranial and peripheral) nerves (the nerves outside of the brain and spinal cord that connect the central nervous system to the rest of the body, such as limbs and organs), and more.

What are the symptoms of a brain tumor?

Symptoms depend on where the tumor is located and how quickly it’s growing. For example, the tumor may affect fine motor skills (like the ability to hold a pencil), sensory skills or speech if it’s compressing the parts of the brain that control those functions.

What’s the role of surgery in treating a brain tumor?

If the tumor can be removed or resected (removed) without affecting normal brain function, surgery is usually the first line of treatment. For example, Grade I meningiomas don’t typically invade the brain, so they are much more likely to be resected successfully. On the other hand, high grade gliomas mix with (or infiltrate (mix with)) normal brain cells, so these gliomas are less likely to be resectable. If a tumor is located deep in the brain and surrounds critical structures like blood vessels it is more challenging to remove and requires a multidisciplinary team with specialists in multiple neuroscience disciplines to treat it, like the team we have here at Premier Health.

How do neurosurgeons ensure accuracy when removing a brain tumor?

The good news is that there is so much advancement in technology and in our understanding of the brain that often previously inoperable brain tumors can now be removed surgically. Neurosurgeons can map and understand an individual’s brain, which is different in every person. Very often before surgery, a functional MRI is completed to identify speech or motor areas in the brain. This also which can improves the surgical outcome.

Our team also can perform surgery while a patient is awake (need some mention of the fact that this is relatively painless) in order to map the tumor and the brain and structures around it, so we can avoid damaging healthy tissue while removing as much of the tumor as possible. This interaction is relatively painless for the patient, as the brain doesn’t have pain receptors, and is the most reliable way to ensure that the doctor does not damage healthy tissue while removing as much of the tumor as possible. The neurosurgeon will ask the patient to answer questions and perform simple tasks to make sure motor and speech function remains intact.

If a brain tumor can’t be removed by surgery, how is it treated?

A multidisciplinary approach is provided for primary brain tumors that require more than just surgery. First, surgery is done if possible, then chemotherapy and/or radiation therapy may be used, based on tissue diagnosis. Although the tumor may shrink as a result, the main goal of treatment is to stop tumor growth and protect the patient’s condition from worsening.

For many years, brain tumors were considered not to respond favorably to chemotherapy due to the blood-brain barrier that protects the brain. There is now a chemotherapeutic agent that crosses the blood-brain barrier, called temozolomide  (are there any others?), which has been widely used to treat primary brain cancers, as well as external beam radiation.

What is stereotactic radiosurgery?

Stereotactic radiosurgery is a type of radiation where the radiation field is shaped to match the exact size and shape of the tumor. With precise planning, we locate the tumor and radiate just the tumor and not the tissue around it. Stereotactic radiosurgery is called surgery because the radiation is so precise, not because it involves cutting.

How does the genetic makeup of the tumor affect treatment?

Genetic makeup can predict how a tumor may respond to treatment. We check for specific tumor markers to determine each tumor’s response. If testing indicates a sensitivity to a certain type of treatment, we will formulate a more aggressive treatment plan because we know the patient will respond better. We offer genetic testing to help guide your treatment based on how your tumor would best respond.

Are there risk factors for getting primary brain tumors?

A great deal of research is currently underway to answer this question. Risk factors may include:

  • Exposure to large doses of radiation, such as exposure to low electromagnetic fields or certain chemicals
  • Your family history and genetic conditions

What can I do to avoid brain tumors?

Lifestyle, environment, and genes can all affect the likelihood of getting cancer. Living a healthy lifestyle by doing things like exercising, eating well, and avoiding tobacco use can help to prevent cancer. However, some brain tumors also occur spontaneously, so stay aware of your health and wellness – if something doesn’t seem right, talk to your doctor.

What’s on the horizon for the treatment of brain tumors?

A lot of research is underway, with new treatment options coming to market every day. One exciting area of study is cancer vaccines that encourage the immune system to attack cancer cells; another is the use of viruses to damage cancer cells. There is so much research going on right now that I hope that one day we will have the answers to better treat all brain tumors effectively. There are new clinical trials to in which Premier Health participates - please check out our website for more information on current and past clinical trials. There is a tremendous amount of research happening around brain tumors right now and our team wants to lead the way.

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Content Updated: August 3, 2018

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