Brain Tumors

A lot of the medical topics I know the most about are those that have affected someone close to me, or myself. Naturally I tended to do the most research on these subjects as I was trying to find helpful information for the person affected.

In the case of brain tumors, the person I knew was a good friend of mine from work. Sadly, the information I found was not helpful because the type of brain tumor my friend had was nearly always fatal.

I had known her for about two years. She joined our department as a new hire from another company. She immediately fit right into our group and she and I developed one of those work friendships where you stop into each other's cubes and talk, both about business and personal lives, go out to lunch occasionally, and enjoy each other's company during the day. We had often said we should really get together outside of work but hadn't gotten around to it. Little did I know that we would never have that opportunity. I wish we had acted on our plans.

One day at the beginning of the year 2000, January 7th, to be exact, we were both attending a goodbye party after work for a colleague and my friend mentioned she had a terrible headache. She left relatively early. It was a Friday, and I didn't think anything more about it over the weekend, as she had been prone to headaches before.

That Monday she called her manager and left a message - over the weekend her headache had become unbearable and she had gone to the emergency department of her local hospital. A CT scan revealed the bad news: she had a brain tumor.

She and her husband went for the best possible care; she had an operation at Sloan Kettering to remove the majority of the tumor. A few tendrils were not able to be removed but they hoped the radiation afterward would eliminate them.

She chose not to have chemotherapy and tried natural remedies instead, using a new juicing machine she bought. She consumed her antioxidants faithfully, grinding up vegetables and fruits in the juicer to ensure as much consumption as possible of the valuable ingredients.

Sadly, it did not help. The tumor came back that summer. By September 6th she was gone. Her tumor was a glioblastoma, the most aggressive type of brain tumor. Few people survive it more than a year.

This entry is for you, Vicki.

What types of brain tumors are there?

There are two major kinds of brain tumor: primary and metastatic. Metastatic brain tumors have spread from another part of the body and are actually made up of cells from the other cancer. Primary tumors originate in the brain. This essay will focus only on primary brain tumors. There are also brain tumors that specifically develop in children. This will just focus on those that are common in adults.

Tumors can be either benign (non-cancerous) or malignant (cancerous). However, unlike other tumors, even benign brain tumors can be dangerous.

Tumors can harm the brain in various ways: they can destroy brain cells, cause damage by producting inflammation of the brain, or cause swelling that compresses other areas of the brain and increases pressure within the skull.

Primary brain tumors can grow from within brain cells, the meninges (membranes around the brain), nerves, or glands.

The cause of primary brain tumors is unknown, although there are theories that everything from cell phone use to radiation or microwaves can cause them. There are a few inherited conditions that seem to increase the risk of brain tumors. Otherwise, the following risk factors are associated with an increased chance of developing a primary brain tumor:

• Being male (except for meningiomas)
• Being white (they are less common in other races)
  Being older (most brain tumors are in people 70 years of age or older). My friend was only 36.
• Exposure to radiation or certain chemicals at work (formaldehyde, vinyl chloride, or acrylonitrile).

In adults, gliomas and meningiomas are the most common types of tumors. Gliomas are derived from glial cells such as astrocytes, oligodendrocytes, and ependymal cells. Together they account for half of all primary brain tumors, and 90% of adult primary brain tumors. The gliomas are subdivided into 3 major types:

• Astrocytic tumors - these include astrocytomas (less malignant), anaplastic astrocytomas, and glioblastomas (most malignant). Although astrocytomas are less malignant, unfortunately they can change over time to more malignant forms.
• Oligodendroglial tumors - can also vary from low grade to very malignant. Some brain tumors are a combination of both astrocytic and oligodendrocytic tumors. These are called mixed gliomas.
• Glioblastomas - the most aggressive type of primary brain tumor. These may or may not arise from a prior lower grade primary brain tumor. This was the tumor that afflicted my friend.

Another relatively common type of brain tumor is the meningioma. This tumor arises in the meninges, the tissue surrounding the brain. You're more apt to get this type of tumor if you're a woman between 40 and 70 years old. Meningiomas are usually benign (90%) but depending on their location in the brain, can still produce devastating consequences.

There are a number of other brain tumors that are much less common than these types and I won't go into them for the purposes of this entry.

What are the symptoms?

In my friend's case, headache was her first, primary symptom. Later on when the tumor returned after surgery, she developed difficulties in thinking and speaking.The most common symptoms of a brain tumor are:

• Headaches - usually worse in the morning
• Nausea/vomiting
• Changes in speech, vision or hearing
• Problems balancing or walking
• Changes in mood, personality, or ability to concentrate
• Problems with memory
• Muscle jerking or twitching, including seizures or convulsions
• Numbness or tingling in the arms or legs

Unfortunately, many of us get headaches, including some that cause nausea or vomiting (such as those who suffer from migraines). So if you are a hypochondriac who gets migraines, you have probably been to the hospital a few times thinking you had a brain tumor.

A stroke can also cause very similar symptoms. It is very important to go to the hospital immediately if you start having any of these symptoms.

How are brain tumors diagnosed?

The following tests may be used to confirm the presence of a brain tumor and/or identify its location and type:

• CT scan or MRI of the head
• Electroencephalogram (EEG) - a test that shows the brain waves
• CT-guided biopsy (to determine the type of tumor)
• Biopsy during surgery to remove the tumor
• Examination of the cerebral spinal fluid, which may show cancerous cells

What treatments are available for brain tumors?

Treatment depends on the size and type of tumor. In some cases, the goal may only be to relieve symptoms, improve quality of life and the comfort of the patient. Other tumors may be curable.

If a tumor is accessible, surgery is usually done to either try to remove the whole tumor or at least "debulk" it. Afterward radiation and/or chemotherapy may be used to try to eliminate the rest of the tumor.

Corticosteroids may be used to reduce swelling and inflammation. Other medications may be provided to relieve specific symptoms such as seizures.

There are various methods of operating on brain tumors that are used at hospitals specializing in the treatment of brain tumors. The Gamma Knife is a non-invasive way to eliminate tumors. This link will explain more details: http://pennhealth.com/neuro/gammaknife/.

Another type of non-invasive surgery is the Cyber-Knife, described in the following link: http://www.phillycyberknife.com/cyberKnifeTechnology.html

There are also newer medications, chemotherapy and other promising treatments. Two new methods have been developed to more effectively target the brain tumor:

• Gliadel Wafers: These wafers are implanted directly at the site of the tumor during the brain surgery. They then slowly release potent chemotherapy agents (BCNU or carmustine) at the site where the tumor was removed to kill any remaining tumor cells that may still be present.
• Gliasite Radiation Therapy System: The Gliasite Radiation Therapy System is an implanted radiation delivery device consisting of a tube with a balloon and a port. The balloon is placed into the location of the tumor at the time of surgery. The balloon is filled with a liquid radiation solution by the radiation physician for a specific period of time, thus directly treating the area. More information is available on the website listed below for the Wallace Kettering Institute.

The following link has a wealth of information about brain tumors, clinical trials, and new medications that are available: http://www.virtualtrials.com/

There is also a section on survivor stories that should be inspirational to anyone who has been diagnosed with a brain tumor. Some glioblastoma patients have beaten this terrible tumor and lived many years. This site also has detailed information on treatments that are available.

One important drug, Temodar, is often used for glioblastoma patients. My friend started on it right before she passed away, when it was newly approved. Unfortunately it was too late for her, but has been found to prolong the lives of many patients.

Will you get a brain tumor?

Probably not, although they are becoming more common among adults in the past 25 years, probably due to the aging of the population.

Lifetime risk of a brain tumor:
Males have a 0.66% lifetime risk of being diagnosed with a primary malignant brain tumor and a 0.50% chance of dying from a brain tumor. Females have a 0.54% lifetime risk of being diagnosed with a primary malignant brain tumor and a 0.41% chance of dying from a brain tumor. (Data taken from the Brain Tumor Society website: http://www.tbts.org/itemDetail.asp?categoryID=383&itemID=16635)

General information for this article was taken from the MedlinePlus website, the National Cancer Institute website, and the Wallace Kettering Institute of Neuroscience website, http://www.wkni.org/index.cfm, as well as other websites specifically cited above.