Brain cancer: It’s a diagnosis that can instill instant fear, because it evokes images of prolonged illness, cognitive impairment and eventual death. But knowledge—about the power of early diagnoses and the effectiveness of current treatments—can help bring the specter of brain cancer down to a manageable size.
Knowing your nemesis
Cancer occurs when cells in the body divide without control or order and form tumors or growths. The term “cancer” usually refers to malignant tumors, which can invade nearby tissue and spread to other parts of the body.
Brain tumors can also be benign. A benign tumor doesn’t spread, but can continue to grow and press on nearby structures, causing symptoms. In that regard, some benign tumors may act in a “malignant” fashion. This article focuses specifically on brain cancers, not benign brain tumors.
There are two general ways of categorizing malignant brain cancers. First, primary brain cancers begin in the substance of the brain. Second, secondary or metastatic brain cancers have spread from a primary tumor from another site in the body. Risk factors that increase chances of developing brain cancers include large doses of radiation, immune system dysfunction and a family history of certain types of cancer.
Reading the signs
Symptoms of brain cancer depend on the tumor’s size and location. A growing tumor will often have surrounding fluid build-up, called edema, which places additional pressure on the brain.
If you experience any of the following symptoms, you should consult immediately with your physician:
• Headaches that tend to get progressively worse over a period of weeks to months, or that intensify in the morning, cause you to wake during the night or worsen with a change of posture, straining or coughing;
• Seizures;
• Nausea or vomiting without accompanying symptoms;
• Sudden weakness or loss of sensation in arms and/or legs;
• Intense and unexplained drowsiness;
• Hearing loss or vision loss (including double vision);
• Sudden or unexplained difficulty walking, speech impairment, memory problems or personality changes.
Early detection of a malignant brain tumor provides the best chance for a successful recovery.
Tracking down a tumor
If symptoms suggest a brain tumor, your physician will take a complete medical history and do a neurologic exam to evaluate brain and spinal cord function. The exam may test your reflexes, muscle strength, eye and mouth movement, coordination, alertness and other functions.
If the results of the exam are abnormal, your physician may refer you to a neurologist or a neurosurgeon to conduct a more detailed exam and/or perform other tests, such as MRI, CT or PET scan, or one of various types of arteriograms.
Crafting a treatment strategy
Treatment of brain cancer depends on the type, size and location of the cancer, as well as your overall health.
Surgery. Surgical procedures may include biopsy—drilling a hole in the skull and retrieving a small part of the tumor, and a craniotomy—opening the skull to remove as much of the tumor as possible. A long, thin tube called a shunt may also be placed in the brain to divert build-up of fluid and diminish raised intracranial pressure to another part of the body.
Computer-assisted brain surgery. Here, the surgical team uses imaging technologies, such as MRI and CT, to permit a computer to guide the surgeon to the areas of the brain requiring treatment with the least amount of risk to surrounding tissue.
Radiation therapy. Radiation therapy kills cancer cells and shrinks tumors. It can be used in the following ways:
• Whole brain external radiation therapy, which directs radiation toward the tumor from a source outside the body.
• Internal radiation therapy, which places radioactive materials inside the body near the cancer cells.
• Stereotactic radiosurgery, such as a Gamma knife or Cyber knife, which uses focused radiation so the affected area can receive a higher—and thus more effective—dose while sparing surrounding normal brain tissue.
Chemotherapy. The use of drugs to kill cancer cells may be administered through a pill, intravenously or intra-arterially. It may also be delivered directly into the cerebrospinal fluid when cancer has spread in the body, to the covering of the brain or to the fluid surrounding the brain and spinal cord.
Regaining function and independence
Cancer treatment doesn’t end with surgery, radiation therapy or chemotherapy. It continues with therapies designed to restore the greatest degree of function and independence possible. Physical therapy helps enhance a patient’s mobility, balance and strength. Occupational therapy focuses on relearning and mastering life skills such as dressing, eating and using the toilet. Speech therapy assists the patient in regaining communication and swallowing skills.
Fostering hope
Knowing the various options available for treatment and rehabilitation of brain cancer can help mitigate, to some degree, the fear inherent in receiving such a serious diagnosis.
It’s also comforting to know that there are resources nearby that can help provide you with the newest treatments, education and rehabilitation if you need them. At a full-service neuroscience center, you’ll have an entire team—neurosurgeons, neurologists, nurses specializing in neurological disease, and physical, occupational and speech therapists—all focused on planning and carrying out a program of care based on each patient’s individualized requirements and preferences.
Jeffrey Yablon, M.D. is medical director for the Peggy Herman Neuroscience Center at Queen of the Valley Medical Center. You can reach Dr. Yablon at (707) 662-8273.
