- About Brain
Tumors
- Symptoms of Brain Tumors
- Diagnosis
- Orthodox Treatment
- Side Effects of Orthodox Treatment
About Brain Tumors
Each year more than 17,000 people in the United States find
out they have a brain tumor
The body is made up of many types of cells. Each type of
cell has special functions. Most cells in the body grow and
then divide in an orderly way to form new cells as they are
needed to keep the body healthy and working properly. When
cells lose the ability to control their growth, they divide
too often and without any order. The extra cells form a mass
of tissue called a tumor. Tumors are benign or malignant.
Benign brain tumors do not contain cancer cells. Usually
these tumors can be removed, and they are not likely to recur.
Benign brain tumors have clear borders. Although they do not
invade nearby tissue, they can press on sensitive areas of
the brain and cause symptoms.
Malignant brain tumors contain cancer cells. They
interfere with vital functions and are life threatening. Malignant
brain tumors are likely to grow rapidly and crowd or invade
the tissue around them. Like a plant, these tumors may put
out "roots" that grow into healthy brain tissue.
If a malignant tumor remains compact and does not have roots,
it is said to be encapsulated. When an otherwise benign tumor
is located in a vital area of the brain and interferes with
vital functions, it may be considered malignant (even though
it contains no cancer cells).
Doctors refer to some brain tumors by grade--from low grade
(grade I) to high grade (grade IV). The grade of a tumor refers
to the way the cells look under a microscope. Cells from higher
grade tumors are more abnormal looking and generally grow
faster than cells from lower grade tumors; higher grade tumors
are more malignant than lower grade tumors.
Symptoms of Brain Tumors
The symptoms of brain tumors depend mainly on
their size and their location in the brain. Symptoms are caused
by damage to vital tissue and by pressure on the brain as
the tumor grows within the limited space in the skull. They
also may be caused by swelling and a buildup of fluid around
the tumor, a condition called edema.
Symptoms may also be due to hydrocephalus, which occurs when
the tumor blocks the flow of cerebrospinal fluid and causes
it to build up in the ventricles. If a brain tumor grows very
slowly, its symptoms may appear so gradually that they are
overlooked for a long time.
The most frequent symptoms
of brain tumors include:
- Headaches that tend
to be worse in the morning and ease during the day,
- Seizures (convulsions),
- Nausea or vomiting,
- Weakness or loss
of feeling in the arms or legs,
- Stumbling or lack
of coordination in walking (ataxic gait),
- Abnormal eye movements
or changes in vision,
- Drowsiness,
- Changes in personality
or memory, and
- Changes in speech.
These symptoms may be caused by brain tumors
or by other problems. Only a doctor can make a diagnosis.
Diagnosis
To find the cause of a person's symptoms, the doctor asks
about the patient's personal and family medical history and
performs a complete physical examination. In addition to checking
general signs of health, the doctor does a neurologic exam.
This includes checks for alertness, muscle strength, coordination,
reflexes, and response to pain. The doctor also examines the
eyes to look for swelling caused by a tumor pressing on the
nerve that connects the eye and the brain.
Depending on the results of the physical and neurologic examinations,
the doctor may request one or both of the following:
- A CT (or CAT) scan is a series of detailed pictures
of the brain. The pictures are created by a computer linked
to an x-ray machine. In some cases, a special dye is injected
into a vein before the scan. The dye helps to show differences
in the tissues of the brain.
- MRI (magnetic resonance imaging) gives pictures of the
brain, using a powerful magnet linked to a computer. MRI
is especially useful in diagnosing brain tumors because
it can "see" through the bones of the skull to
the tissue underneath. A special dye may be used to enhance
the likelihood of detecting a brain tumor.
The doctor may also request other tests such as:
- A skull x-ray can show changes in the bones of the skull
caused by a tumor. It can also show calcium deposits, which
are present in some types of brain tumors.
- A brain scan reveals areas of abnormal growth in the brain
and records them on special film. A small amount of a radioactive
material is injected into a vein. This dye is absorbed by
the tumor, and the growth shows up on the film. (The radiation
leaves the body within 6 hours and is not dangerous.)
- An angiogram, or arteriogram, is a series of x-rays taken
after a special dye is injected into an artery (usually
in the area where the abdomen joins the top of the leg).
The dye, which flows through the blood vessels of the brain,
can be seen on the x-rays. These x-rays can show the tumor
and blood vessels that lead to it.
- A myelogram is an x-ray of the spine. A special dye is
injected into the cerebrospinal fluid in the spine, and
the patient is tilted to allow the dye to mix with the fluid.
This test may be done when the doctor suspects a tumor in
the spinal cord.
Orthodox Treatment
Treatment for a brain tumor depends on a number of factors.
Among these are the type, location, and size of the tumor,
as well as the patient's age and general health. Treatment
methods and schedules often vary for children and adults.
The doctor develops a treatment plan to fit each patient's
needs.
Brain tumors are treated with surgery, radiation therapy,
and chemotherapy. Depending on the patient's needs, several
methods may be used.
Before treatment begins, most patients are given steroids,
which are drugs that relieve swelling (edema). They may also
be given anticonvulsant medicine to prevent or control seizures.
If hydrocephalus is present, the patient may need a shunt
to drain the cerebrospinal fluid.
Surgery is the usual treatment for most brain tumors.
To remove a brain tumor, a neurosurgeon makes an opening in
the skull. This operation is called a craniotomy.
Whenever possible, the surgeon attempts to remove the entire
tumor. However, if the tumor cannot be completely removed
without damaging vital brain tissue, the doctor removes as
much of the tumor as possible. Partial removal helps to relieve
symptoms by reducing pressure on the brain and reduces the
amount of tumor to be treated by radiation therapy or chemotherapy.
Some tumors cannot be removed. In such cases, the doctor
may do only a biopsy. A small piece of the tumor is removed
so that a pathologist can examine it under a microscope to
determine the type of cells it contains. This helps the doctor
decide which treatment to use.
Radiation therapy (also called radiotherapy) is the
use of high-powered rays to damage cancer cells and stop them
from growing. It is often used to destroy tumor tissue that
cannot be removed with surgery or to kill cancer cells that
may remain after surgery. Radiation therapy is also used when
surgery is not possible.
Radiation therapy may be given in two ways. External radiation
comes from a large machine. Implant radiation therapy comes
from radioactive material placed directly in the tumor
External radiation may be directed just to the tumor and
the tissue close to it or, less often, to the entire brain.
(Sometimes the radiation is also directed to the spinal cord.)
When the whole brain is treated, the patient often receives
an extra dose of radiation to the area of the tumor. This
boost can come from external radiation or from an implant.
Stereotactic radiosurgery is another way to treat brain tumors.
Doctors use the techniques described in the Surgery section
to pinpoint the exact location of the tumor. Treatment is
given in just one session; high-energy rays are aimed at the
tumor from many angles. In this way, a high dose of radiation
reaches the tumor without damaging other brain tissue. (This
use of radiation therapy is sometimes called the gamma knife.)
Chemotherapy is the use of drugs to kill cancer cells.
The doctor may use just one drug or a combination, usually
giving the drugs by mouth or by injection into a blood vessel
or muscle. Intrathecal chemotherapy involves injecting the
drugs into the cerebrospinal fluid.
Chemotherapy is usually given in cycles: a treatment period
followed by a recovery period, then another treatment period,
and so on. Patients often do not need to stay in the hospital
for treatment. Most drugs can be given in the doctor's office
or the outpatient clinic of a hospital. However, depending
on the drugs used, the way they are given, and the patient's
general health, a short hospital stay may be necessary.
Side Effects of Orthodox Treatment
Cancer treatment often causes side effects.
These side effects occur because treatment to destroy cancer
cells damages some healthy cells as well.
The side effects of cancer treatment vary. They depend on
the type of treatment used and on the area being treated.
Also, each person reacts differently.
A craniotomy is a major operation. The surgery may damage
normal brain tissue, and edema may occur. Weakness, coordination
problems, personality changes, and difficulty in speaking
and thinking may result. Patients may also have seizures.
In fact, for a short time after surgery, symptoms may be worse
than before. Most of the side effects of surgery lessen or
disappear with time.
Most of the side effects of radiation therapy go away soon
after treatment is over. However, some side effects may occur
or persist long after treatment is complete.
Some patients have nausea for several hours after treatment.
Patients receiving radiation therapy may become very tired
as treatment continues. Radiation therapy to the scalp causes
most patients to lose their hair. In some cases, hair loss
is permanent.
Skin reactions in the treated area are common. The scalp
and ears may be red, itchy, or dark; these areas may look
and feel sunburned. The treated area should be exposed to
the air as much as possible but should be protected from the
sun. Patients should not wear anything on the head that might
cause irritation. Good skin care is important at this time.
Sometimes brain cells killed by radiation form a mass in
the brain. The mass may look like a tumor and may cause similar
symptoms, such as headaches, memory loss, or seizures. About
4 to 8 weeks after radiation therapy, patients may become
quite sleepy or lose their appetite. These symptoms may last
several weeks, but they usually go away on their own.
Children who have had radiation therapy for a brain tumor
may have learning problems or partial loss of eyesight. If
the pituitary gland is damaged, children may not grow or develop
normally.
The side effects of chemotherapy depend on the drugs that
are given. In general, anticancer drugs affect rapidly growing
cells, such as blood cells that fight infection, cells that
line the digestive tract, and cells in hair follicles. As
a result, patients may have a lower resistance to infection,
loss of appetite, nausea, vomiting, or mouth sores. Patients
may also have less energy and may lose their hair.
Some anticancer drugs can cause infertility. Women taking
certain anticancer drugs may have symptoms of menopause (hot
flashes and vaginal dryness; periods may be irregular or stop).
Some drugs used to treat children and teenagers may affect
their ability to have children later in life.
Certain drugs used in the treatment of brain tumors may cause
kidney damage. Patients are given large amounts of fluid while
taking these drugs. Patients may also have tingling in the
fingers, ringing in the ears, or difficulty hearing. These
problems may not clear up after treatment stops.
Treatment with steroids to reduce swelling in the brain may
cause increased appetite and weight gain. Swelling of the
face and feet is common. Steroids can also cause restlessness,
mood swings, burning indigestion, and acne. However, patients
should not stop using steroids or change their dose without
consulting the doctor. The use of steroids must be stopped
gradually to allow the body to adjust to the change.
Loss of appetite can be a problem for patients during therapy.
People may not feel hungry when they are uncomfortable or
tired. Some of the common side effects of cancer treatment,
such as nausea and vomiting, can also make it hard to eat.
Yet good nutrition is important because patients who eat well
generally feel better and have more energy.
Patients being treated for a brain tumor may develop a blood
clot and inflammation in a vein, most often in the leg. This
is called thrombophlebitis.
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