Adult Brain Cancer

What is brain cancer?

Adult brain cancer is a disease in which cancer grows in the tissues of the brain.  Tumors that start in the brain are called primary brain cancers.  Cancers that start elsewhere in the body, but metastasize to the brain are called secondary brain cancers.  Primary brain tumors rarely metastasize.  Brain cancers are named for the different brain tissues in which they develop.  This document will focus on primary brain cancers.  The National Cancer Institute identifies the following adult brain tumors.

• Brain stem gliomas
• Pineal Astrocytic Tumor
• Pilocytic Astrocytoma (grade I)
• Diffuse Astrocytoma (grade II)
• Anaplastic Astrocytoma (grade III)
• Glioblastoma (grade IV)
• Oligodenroglial Tumors
• Mixed Gliomas
• Ependymal Tumors
• Medulloblastoma (grade IV)
• Pineal Parenchymal Tumors
• Meningeal Tumors
• Germ Cell Tumor
• Craniopharyngioma (grade II)
• Recurrent Adult Brain Tumor
• Metastatic Brain Tumors
• Other Adult Brain Tumors
  

What are risk factors for brain cancer?

The exact cause of brain cancer is unknown.  Most people with brain cancer have no known risk factors.  The risk factors that do exist include:

• Radiation – Radiation to the head and jobs in the nuclear industry have been linked to an increase in brain cancer.
• Environmental – Exposure to vinyl chloride and acrylonitrile may increase the risk for brain cancer. 
• Family history – A small percent of people have a genetic mutation that increases their risk for brain cancer.
  

What are prevention strategies for brain cancer?

Most brain cancers have no risk factors.   Currently, there are no prevention measures for brain cancer.

Is screening available?

There are no established national screening guidelines for brain cancer.  If a person is experiencing symptoms that may indicate brain cancer, they should discuss this with their doctor.

What are the symptoms of brain cancer?

Symptoms will vary depending on the type of brain cancer and the location of the cancer in the brain.  General symptoms can include:

• Seizures
• Memory loss or changes in memory
• Headaches
• Changes in speech, hearing, vision
• Numbness or tingling in the arms and legs
• Problems with coordination such as walking or balancing
• Changes in mood, personality
• Problems with concentration
• Nausea or vomiting
  

It is important to see your healthcare professional if you have any of these symptoms.  They could indicate brain cancer as well as other diseases.

How is brain cancer diagnosed?

If brain cancer is suspected, your doctor may perform one or more of the following tests.

• Physical examination
• Neurological examination – This will give your doctor information about muscle strength, coordination, eye swelling (possibly due to tumor pressing on optic nerve) and other physical changes.
• Computed tomography (CT) scan – This is used in making an initial diagnosis and helpful in providing information about the cancer.
• Magnetic resonance imaging (MRI) – Like the CT scan, it is helpful with diagnosis and providing information
• Biopsy - This removes tissue to check for cancer.  Sometimes a biopsy is not possible due to the location of a tumor.
• Angiogram – Dye is injected into the blood stream and an x-ray is taken, which may allow the doctor to locate a tumor.
• X-ray – This may detect changes to the skull or calcium deposits due to a tumor.
• Spinal tap – A thin needle is inserted into the spinal column to remove cerebrospinal fluid.  The fluid is then checked for cancer cells.
• Myelogram – A dye is inserted into the cerebrospinal fluid and an x-ray is taken to detect tumors in the spinal cord.
  

What is staging?

There is no standard staging system for brain cancer.  Brain tumors are classified by the type of cells in which the cancer developed.  This is useful for treatment of brain cancer.  For most cancer, staging is done to help with cancer diagnosis and treatment.  Following is a description of staging.

Staging describes the extent of the cancer.  It determines if the cancer has spread and if so, what parts of the body are affected.  Staging a cancer is important to assist the doctor with determining the appropriate course of treatment and assessing an accurate prognosis. 

The most common staging system is the TNM.

• T – size of the tumor
• N – degree to which regional lymph nodes are involved
• M – the absence or presence of distant metastases

Once the TNM has been determined, then a stage of I, II, III or IV is assigned.

• Stage I – cancers are small and local and usually curable
• Stage II & III – typically these are locally advanced and could involve the lymph nodes
• Stage IV – cancer has metastasized and can be inoperable
  

What are treatment options?

There are three standard treatments (highlight and link to http://www.cancer.gov/cancertopics/pdq/treatment/adultbrain/Patient/page4)  for brain cancer.  Treatment will depend on the type and grade of the tumor along with the patient’s health, age and other factors.

• Surgery – This is used to take out the tumor.  It is not always possible to remove the tumor.
• Chemotherapy – This systemic drug is administered through the veins to kill cancer cells.  Regional chemotherapy (drugs administered directly into the organ, spinal column or body cavity) may be used.  The type and grade of brain cancer will determine the best way to administer chemotherapy.
• Radiation therapy - This uses high energy rays to kill cancer cells.  It is either administered externally or internally.  The type and grade of brain cancer will determine the best way to give radiation therapy.

Other treatments that may be used include:

• Biological therapy – This form of treatment helps the body’s immune system attack and destroy cancer cells and may help the body recover from some of the side effects of treatment.
• Hyperthermia therapy – Tissue is exposed to very high temperatures to damage and kill cancer cells.  This will make them more sensitive to radiation therapy and certain drugs.
  

What clinical trials are available?

Clinical trials are studies that seek to find better ways to prevent, screen, diagnose and treat a disease such as cancer.  Clinical trials test new approaches to treatment, such as new drugs, new approaches to surgery or radiation therapy, or a combination of treatments.

Learn more about clinical trials.

What questions should I ask my doctor?

It is often helpful to make a list of questions before an appointment.  This will help you to remember what the doctor says.  Patients and care givers can write notes or ask if they may use a tape recorder.  Sometimes it is helpful to have a family member or friend at the appointment to take notes, ask questions or just listen.  Below are a few suggested questions a patient may ask their doctor.

Will you please write down the type of cancer that I have?

What stage is my cancer and what does that mean?

What are my treatment options?

What treatment do you recommend and why?

What are the risks and benefits of each treatment?

What are possible side effects of treatment?

How will you help manage my side effects?

How will treatment affect my normal activities?

Are there specific things I must do to get ready for treatment?

Are there other things I can be doing to help with my treatment, such as diet and exercise?

What are resources that I can turn to learn more about my cancer and help me deal with it?

Make an appointment

Resources

American Cancer Society – www.cancer.org, 1-800-ACS-2345

Cancer Care, Inc. - www.cancercare.org, 1-800-813-HOPE

National Cancer Institute - www.cancer.gov, 1-800-4CANCER