Brain Tumors

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• QWhat is a metastatic brain tumor?

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  A Dr. Robert A. Wascher, MD , Surgery, answered on behalf of Cancer Treatment Centers of America (CTCA)

  A metastatic brain tumor is a cancerous tumor that began in another part of the body, and has then spread (or "metastasized") to the brain.
   
   
   

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• QWhat are the risk factors for a brain tumor?

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  A Spotsylvania Regional Medical Center answered

  Studies have found the following risk factors for brain tumors:

  Ionizing radiation: Ionizing radiation from highdose x-rays (such as radiation therapy from a large machine aimed at the head) and other sources can cause cell damage that leads to a tumor. People exposed to ionizing radiation may have an increased risk of a brain tumor, such as meningioma or glioma. Family history: It is rare for brain tumors to run in a family. Only a very small number of families have several members with brain tumors.

  Researchers are studying whether using cell phones, having had a head injury, or having been exposed to certain chemicals at work or to magnetic fields are important risk factors. Studies x0060have not shown consistent links between these possible risk factors and brain tumors, but additional research is needed.

  This answer is based on source information from the National Cancer Institute.

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• QWhat chemotherapy is used for brain tumors?

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  A Dr. Simeon Jaggernauth, DO , Oncology, answered on behalf of Cancer Treatment Centers of America (CTCA)

  Some of the newer agents used to treat brain tumors involve medications that block angiogenesis. Angiogenesis is the process of overproducing blood vessels from surrounding circulation to create a network of blood supply so that the tumor may grow larger (i.e. new blood vessel formation). Brain tumors called glioblastomas multiforme (GBM) are an aggressive type of brain tumor that is highly vascularized and responds best to agents that stop angiogenesis. Bevacizumab (Avastin) is a monoclonal antibody that is FDA approved for use in GBM. Sometimes other agents are combined with Avastin to increase the response rate of the chemotherapy.
• QWhat is the treatment for a metastatic brain tumor?

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  A Dr. Vitaly Siomin, MD , Neurosurgery, answered on behalf of Baptist Health South Florida

  The treatment for a metastatic brain tumor is tailored to an individual patient. Based on the tumor's position and the type of tumor, a neurosurgeon will determine which treatment approach is best. There are many factors that will be considered including the patient's general health and the location and number of metastatic tumors.
  Surgery and radiosurgery are the standard treatments if lesions are limited in number and accessible. Both of these treatments may be followed by whole brain radiation therapy. In cases of multiple tumors (also known as lesions), whole brain radiation therapy alone may be given. Chemotherapy specific to the brain-located metastatic tumor may be used. 
• QWhat is awake brain surgery?

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  A Dr. Joshua B. Bederson, MD , Neurosurgery, answered on behalf of The Mount Sinai Health System

  Awake brain surgery is an advanced neurosurgical procedure used to remove brain tumors. During awake brain surgery, you will remain alert and responsive at various times during the surgical removal of infiltrative brain tumors, such as gliomas.
  
  Brain mapping may also be used if your surgeon is searching for the areas of the brain responsible for seizures (epilepsy). Your being awake helps the surgical team locate more precisely the boundary between the tumor and the high-functioning cortical and subcortical white matter fibers, facilitating surgical removal of the tumor.
  
  

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• QHow are brain tumors diagnosed?

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  A Spotsylvania Regional Medical Center answered

  If you have symptoms that suggest a brain tumor, your doctor will give you a physical exam and ask about your personal and family health history. You may have one or more of the following tests:

  Neurologic exam: Your doctor checks your vision, hearing, alertness, muscle strength, coordination, and reflexes. Your doctor also examines your eyes to look for swelling caused by a tumor pressing on the nerve that connects the eye and the brain. MRI: A large machine with a strong magnet linked to a computer is used to make detailed pictures of areas inside your head. Sometimes a special dye (contrast material) is injected into a blood vessel in your arm or hand to help show differences in the tissues of the brain. The pictures can show abnormal areas, such as a tumor. CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of your head. You may receive contrast material by injection into a blood vessel in your arm or hand. The contrast material makes abnormal areas easier to see.

  Your doctor may ask for other tests:

  Angiogram: Dye injected into the bloodstream makes blood vessels in the brain show up on an x-ray. If a tumor is present, the x-ray may show the tumor or blood vessels that are feeding into the tumor. Spinal tap: Your doctor may remove a sample of cerebrospinal fluid (the fluid that fills the spaces in and around the brain and spinal cord). This procedure is performed with local anesthesia. The doctor uses a long, thin needle to remove fluid from the lower part of the spinal column. A spinal tap takes about 30 minutes. You must lie flat for several hours afterward to keep from getting a headache. A laboratory checks the fluid for cancer cells or other signs of problems. Biopsy: The removal of tissue to look for tumor cells is called a biopsy. A pathologist looks at the cells under a microscope to check for abnormal cells. A biopsy can show cancer, tissue changes that may lead to cancer, and other conditions. A biopsy is the only sure way to diagnose a brain tumor, learn what grade it is, and plan treatment.

  This answer is based on source information from the National Cancer Institute.

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• QHow are brain tumors treated?

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  A Spotsylvania Regional Medical Center answered

  People with brain tumors have several treatment options. The options are surgery, radiation therapy, and chemotherapy. Many people get a combination of treatments.

  The choice of treatment depends mainly on the following:

  The type and grade of brain tumor Its location in the brain Its size Your age and general health

  For some types of brain cancer, the doctor also needs to know whether cancer cells were found in the cerebrospinal fluid.

  Surgery

  Surgery is the usual first treatment for most brain tumors. Before surgery begins, you may be given general anesthesia, and your scalp is shaved. You probably won't need your entire head shaved.

  Surgery to open the skull is called a craniotomy. The surgeon makes an incision in your scalp and uses a special type of saw to remove a piece of bone from the skull.

  Radiation Therapy

  Radiation therapy kills brain tumor cells with high-energy x-rays, gamma rays, or protons.

  Radiation therapy usually follows surgery. The radiation kills tumor cells that may remain in the area. Sometimes, people who can't have surgery have radiation therapy instead.

  Chemotherapy

  Chemotherapy, the use of drugs to kill cancer cells, is sometimes used to treat brain tumors.

  This answer is based on source information from the National Cancer Institute.

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• QWho is not a candidate for stereotactic radiosurgery for brain tumors?

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  A Dr. Nader Pouratian, MD , Neurosurgery, answered on behalf of UCLA Health

  Stereotactic radiosurgery (SRS) is particularly useful for people with metastatic brain tumors (brain tumors that spread to the brain from somewhere else) who cannot safely have surgery due to the risks associated with anesthesia.
  
  SRS may not be recommended in some instances. You may not be a candidate for stereotactic radiosurgery if you have:

  • multiple tumors
  • tumors that too large for radiosurgery
  • excessive brain swelling

  In these cases, doctors will discuss other treatment options with you, including surgery, fractionated stereotactic radiation therapy, whole-brain radiation therapy or a combination of these options.
  
  This content originally appeared online at UCLA Health.
• QWhat are the advantages of brain surgery?

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  A Dr. Vitaly Siomin, MD , Neurosurgery, answered on behalf of Baptist Health South Florida

  Brain surgery in some patients may be the best treatment for tumors, especially when the tumor can be removed without damaging the surrounding brain tissue.
  The primary purpose of surgery is to confirm that the abnormality seen during testing is actually a tumor, and to remove the tumor.
  When dealing with sensitive parts of the brain, a tumor may only be partially removed, but that could be enough to alleviate certain symptoms and allows for other treatments to proceed.
  In mostly the cases of benign tumors, symptoms can be completely cured by surgical removal of the tumor. The neurosurgeon will attempt to remove the entire tumor when possible.
  Stereotactic radiosurgery is a newer "knifeless" procedure that destroys a brain tumor without opening the skull. A CT or MRI scan is used to pinpoint the exact location of the tumor in the brain.

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• QWhat is targeted chemotherapy?

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  A Dr. Daniel A. Nader, DO , Pulmonary Disease, answered on behalf of Cancer Treatment Centers of America (CTCA)

  Targeted chemotherapy is treatment that’s specific to a molecular mutation in the tumor. An example of a targeted chemotherapy agent is Tarceva (Erlotinib). This drug is targeted for a specific mutation that's found in lung cancer called epidermal growth factor receptor. If tumors are found to have this receptor, these targeted drugs can be very helpful in reducing the size and more effectively managing that particular cancer.