BRAIN NEOPLASM

Brain tumors or neoplasm can be primary, meaning the tumor originated in the brain, or secondary, meaning the tumor spread from another site to the brain. Primary brain tumors occur in 10 people per 100,000 population. Primary brain tumors can affect anyone but are commonly seen in children under 15 years of age and in middle-aged adults. Secondary brain tumors are commonly seen in adults.

Primary brain neoplasm is classified according to the cell the tumor originated from. Approximately 40% of all brain neoplasms originate from cells called glial cells, giving the name gliomas. In this category are the tumors named astrocytoma, glioblastoma, oligodendroglioma, ependymoma, and medulloblastoma. Brain neoplasm called meningioma and schwannomas originate from the brain's supporting connecting cells and account for approximately 20% of primary brain tumors. Lymphoma can be a primary brain tumor accounting for 3% of all brain tumors.

Approximately 25% of brain tumors have spread from another location. The most common cancers that spread to the brain are breast, lung, melanoma, kidney, and colon.

Primary brain tumors usually do not spread outside of the brain. The cause of primary brain tumors is unknown. Radiation, genetic damage, inheritance, defective immune system, viruses, and chemicals are being studied, but no definite data are known at this time.

Primary brain tumors, if detected early, can be cured. Computed tomography (CT) scan or magnetic resonance imaging (MRI) scan usually detects a brain neoplasm; however, the only definite way to diagnose a brain neoplasm is to obtain tissue and look at it under the microscope. This can be done either with a biopsy or at surgery if the entire tumor is going to be removed.

Headaches and seizures are the two most common symptoms described. The headaches usually occur in the early morning hours, sometimes waking the patient up, and worsen with coughing or sneezing. Headaches are the result of the expanding tumor within the brain pressing up against the skull.

New onset of seizures is another presenting symptom in patients with brain neoplasm. Other findings depend on the specific location of the brain tumor but can include change in behavior, difficulty with speech, memory, or concentration, and confusion.

Treatment depends on many factors such as the location and size of the tumor and age and coexisting medical problems of the patient. Surgical removal of primary brain tumors is the usual recommendation. Depending on the tumor type and location, this gives the best chance for a cure if the entire tumor can be removed. It is important to seek out a facility that has experience in dealing with patients with primary brain tumors. Surgery also provides the diagnosis of the type of brain cancer and relieves the pressure within the brain caused by the expanding tumor. Finally, surgery attempts to remove as much tumor as possible without interfering with vital structures that can cause permanent motor, speech, visual, or sensory losses.

Radiation is another form of treatment for primary brain tumors. Radiation therapy is performed by a radiation oncologist and is usually indicated in patients who have tumors that cannot be removed because of location, tumors that cannot be completely removed, or following surgery for any malignant brain tumor.

Chemotherapy is not commonly used in primary brain tumors, since the tumors originating from the brain are not sensitive to the currently available drugs. There are, however, many clinical investigations underway, and this option should be addressed with your physician.

An antiseizure medication, such as phenytoin, is commonly used before and after surgery for primary brain tumors to treat or prevent seizures from occurring.

If there is swelling in the brain, your physician can prescribe a steroid called dexamethasone.

• You will need a team of physicians to help manage your care; a neurosurgeon (a surgeon specializing in diseases of the brain and spinal cord), neurooncologist (a medical person who specializes in cancers of the brain and spinal cord), radiation oncologist (a physician who specializes in the administration of radiation for the treatment of cancer), and your primary care physician. In some situations a neurologist (a medical physician specializing in disorders of brain and spinal cord) may be needed, especially when seizures are difficult to control.

• Don't be afraid to ask for second opinions. Treatment for primary brain tumors is detailed and extensive and requires experience with a team approach.
• Don't miss follow-up appointments. Your physician will need to repeat computed tomography (CT) scans and blood tests to monitor for recurrence of the tumor if it has been completely removed and to maintain your seizure medication in the therapeutic range.

• If you have new onset headaches.
• If you have seizures.
• If you need a referral to a subspecialist.
• If you develop any neurologic symptoms as mentioned above.

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