Brain Tumors – Diagnosis – Treatment

There are many kinds of brain tumors, benign and malignant, that can affect both children and adults.


The central nervous system, which consists of the brain and spinal cord, is involved in virtually every function of the body. If a tumor develops in the brain or spinal cord, many vital abilities, including speech, memory, and movement, may be affected.

The spinal cord, which runs from the lowest part of the brain, called the brain stem, down the middle of the back, is like a complex messenger service. It carries important messages back and forth between the brain and the rest of the body. For example, if you put your hand on a hot stove, your skin sends a message to the brain via the spinal cord. The message says: “Pain!” The brain then sends a message through the spinal cord to the muscles that control your hand: “Move!”

Consequently, any illness that interferes with the crucial work of the brain and spinal cord may have widespread effects.

Brain Tumor: Is it Benign or Malignant?

A “benign” spinal cord or brain tumor does not contain any cancer cells. Nevertheless, this type of tumor can be dangerous because as it enlarges it can press on the delicate tissues of the brain or spinal cord and affect their normal functioning. A benign tumor can usually be taken out with surgery and in most cases does not grow back.

When a spinal cord or brain tumor is “malignant,” it contains cancer cells. The cancerous cells may grow slowly or rapidly. They invade healthy brain tissue around the tumor. Malignant tumors are often life-threatening. Sometimes, but not often, this kind of tumor spreads to other parts of the body, in a process called metastasis.

A brain tumor might be malignant but might not invade any nearby tissue. For example, it could be surrounded by the bones of the skull and therefore could not escape. These tumors are said to be “encapsulated.”

Brain Cancer: Primary and Metastatic Brain Tumors

A tumor that starts in the spinal cord or brain is called a primary tumor. There are more than 100 kinds of primary brain tumors. Some can be cured with very little treatment; others cannot be cured even when treated very aggressively.

A tumor that initially grows in another place in the body and then spreads to the nervous system is called a metastatic, or secondary, tumor.

It is more likely that a cancer that starts in another part of the body will spread to the brain than the other way around. The most common cancers that spread to the brain are lung, breast, melanoma, and colon.

Brain Cancer in Children

After leukemia, spinal cord and brain tumors are the second most common type of cancer in children. “Certain genetic conditions cause children to be more susceptible to brain tumors,” says Andrew Sloan, MD, director of the Brain Tumor and Neuro-Oncology Center at University Hospitals Case Medical Center in Cleveland. “These include Li-Fraumeni syndrome, neurofibromatosis, and von Hippel-Lindau disease.”

There are considerable differences between a child’s brain cancer and an adult’s. They’re found in different places, have different symptoms, look different under the microscope, and have different tendencies to spread to other parts of the body.

Most adult tumors develop in what’s called the cerebral cortex, the upper area of the brain that has a role in memory, thought, and more, whereas children often develop tumors in the brain stem and cerebellum, which is located near the brain stem and affects movement and coordination.

Doctors do not know why children get primary brain tumors. There are four types common to children. These are:

  • Medulloblastomas. This is the most common type of brain cancer found in children, slightly more often in boys than girls. It is located in the cerebellum. Treatment includes surgery, usually followed by chemotherapy, and sometimes radiation.
  • Ependymomas. The tumors are found in small fluid filled cavities called ventricles. Chemotherapy, surgery, and radiation are all used to treat ependymomas.
  • Brain stem gliomas. Adults rarely get these; they are most often seen in children ages 3 to 10. Radiation is commonly used to treat these types of brain tumors.
  • Astrocytomas. These are often non-cancerous, and grow slowly. They are normally removed through surgery.

Diagnosing Spinal Cord and Brain Tumors

Imaging studies, blood tests, and spinal fluid tests are just a few of the tools used to diagnose spinal cord and brain tumors.

If your doctor suspects that you have a brain or spinal cord tumor after conducting a thorough medical and neurological exam, you will be referred to specialists who can perform imaging tests, such as X-rays and MRI scans, and laboratory tests. Understanding these tests and what the results mean will help you make a better decision about how to treat your illness.

Imaging tests used to diagnose brain tumors include:

  • CT scans
  • MRI
  • PET scans

Diagnosing Spinal Cord and Brain Tumors: CT Scans

Computerized tomography (CT) scans, also called CAT scans, use X-rays to create a computerized image of the body. For the scan, the patient lies flat on a table that slides into a doughnut-shaped scanner. The scanner circles the head or spine, allowing X-rays to penetrate from all directions. When complete, the computer transforms the thousands of thin, cross-sectional readings into an image. For better images, your doctor may choose to inject a contrast dye before scanning.

“CAT scans are one of the most common tests we use,” says Paul Graham Fisher, MD, associate professor of neurology and pediatrics and director of neuro-oncology at Packard Children’s Hospital in Palo Alto, Calif. “They are quick, easy, and readily available.”

 Diagnosing Spinal Cord and Brain Tumors: MRI Scans

Magnetic resonance image (MRI) scanners take images of the brain and spinal cord from another tunnel-shaped machine, but rather than using X-rays, they use a large magnet and radio waves to capture an image of the body. As with the CT scan, your doctor may choose to inject a contrast dye before scanning.

“This is another common test,” says Dr. Fisher. “If the case is a ‘need to know now,’ an MRI is the test I would use.” MRIs are the most sensitive imaging test currently available in standard medical practice, providing clearer pictures of soft-tissue areas than CT scans.

Diagnosing Spinal Cord and Brain Tumors: PET Scans

PET scans, or positron emission tomography scans, are taken after tiny amounts of a radioactive material, called a tracer, are inhaled, swallowed, or injected in the body. Rather than reveal the structure of the brain or spinal cord, they show how the tissues are working. PET scans and MRIs are sometimes combined to produce detailed views of the body, called image fusion or co-registration. PET scans are not routinely used to diagnose primary brain tumors, or brain tumors that started in the brain, but can be used to diagnose low-grade tumors and check for tumor recurrence.

Other Tests Used to Diagnose Spinal Cord and Brain Tumors

  • Magnetic Resonance Spectroscopy. An MRS lets doctors take a chemical snapshot of tissue using an MRI scanner. Like PET scanning, it is useful in diagnosing low-grade tumors and tumors that reoccur following treatment.
  • Arteriography. Also called angiography, an arteriography is an X-ray that outlines the inside of the arteries using a contrast dye. It is generally used for brain and spinal cord tumors only to determine their actual location for surgery.
  • Biopsy. With this test, the doctor removes a tiny piece of tissue from the spine or brain for examination under a microscope. For brain tumors, a small, narrow hole is drilled into the skull so that a needle can be inserted to withdraw tissue.
  • Lumbar puncture. Also called a spinal tap, a lumbar puncture is a test in which the doctor inserts a thin needle between the bones of the spine to withdraw spinal fluid. Examining the fluid determines whether cancer cells are present.
  • Blood and urine. These tests are routinely conducted before other tests to determine how well your body is functioning.

If you recieve a spinal cord tumor or brain tumor diagnosis, these same tests may be used throughout your treatment and follow-up care to monitor your progress.


Treatment of Spinal Cord and Brain Tumors

Treatment depends on many factors, including the tumor type, its speed of growth, its location, and the patient’s overall health.

Since no tumor is exactly alike, treatment for spinal cord and brain tumors often differs from patient to patient. To begin, treatment “depends on what type of tumor you are dealing with,” says Elizabeth Gerstner, MD, neuro-oncologist at the Stephen E. and Catherine Pappas Center for Neuro-oncology and assistant professor of neurology at Massachusetts General Hospital.

There are many different types of spinal cord and brain tumors, some highly curable by surgery and others very hard to cure. Doctors put tumors into categories. These categories are determined by how quickly the tumor grows, and how likely it is to spread. So your tumor’s category, or grade, will help determine your treatment options. Tumor grades range from I to IV, with grade I being slower-growing and less likely to spread, and grade IV being faster-growing and likely to spread.

The spinal cord and brain are very complex, and the location of your tumor often dictates whether a neurosurgeon will be able to remove it without causing severe damage. Some types of spinal cord or brain tumor treatments are only recommended for people who have good overall health.

Spinal Cord and Brain Tumors: Treatment Options

There are many ways to treat a spinal cord or brain tumor. Treatment may include:

  • Watchful waiting. “In rare cases we’ll not do anything and just follow patients with MRI [magnetic resonance imaging] scans,” says Dr. Gerstner. Watchful waiting, or observing the tumor until it needs treatment, is sometimes recommended for smaller tumors that are not causing major problems.
  • Surgery. Most spinal cord and brain tumors are treated surgically. Surgery can be very effective in removing all or part of your tumor and relieving your symptoms. It will take several weeks or months to recover from brain or spinal cord surgery, and risks of surgery include infection, bleeding, blood clots, unstable blood pressure, cognitive damage, coma, and death.
  • Radiation therapy. Radiation therapy is often used along with surgery to treat spinal cord and brain tumors, usually to help kill any remaining tumor cells after surgery. A session of radiation therapy generally takes 30 minutes to two hours. Common side effects include fatigue, hair loss, skin changes and swelling at the radiation entry site, and sometimes difficulties with mental tasks, like focused thinking.
  • Chemotherapy. Although not usually used to treat spinal cord tumors, chemotherapy can be beneficial in treating certain types of malignant (cancerous) brain tumors. Chemotherapy can be given through a vein to circulate throughout the entire body, or it can be surgically placed directly in the brain. The length of time you need to be on chemotherapy depends on your tumor and response to treatment. Since chemotherapy kills healthy cells as well as cancerous ones, common side effects include mouth sores, gastrointestinal problems, and hair loss.
  • Steroids. If you have a brain tumor that is causing significant swelling in your brain, your doctor may prescribe corticosteroid medications to reduce swelling and temporarily relieve some of your symptoms. Steroids can be used at any point during your treatment. Your dose may need to be increased over time, and your doctor will need to be informed of adverse effects such as weight gain, infection, mood swings, or high blood sugar levels.

Work with your treatment team to carefully weigh the benefits and risks of each treatment option when devising a plan that is right for you.

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