Neurological cancer | Chris O'Brien Lifehouse

This information has been prepared to help you understand more about brain and spinal cord tumours.  Many people feel understandably shocked and upset when they are told they have a brain or spinal cord tumour. This information is intended to help you understand the diagnosis and treatment of these types of tumours.

This information is about primary brain tumours. It does not provide information about cancer that has spread to the brain (brain metastases) from cancers that began in other sites.

We cannot advise you about the best treatment for you. You need to discuss this with your doctors. However, we hope this information will answer some of your questions and help you think about the questions you want to ask your doctors or other health carers.

The brain and spinal cord

The brain and spinal cord make up the body’s central nervous system. The central nervous system receives messages from cells called nerves, which are spread throughout the body (the peripheral nervous system). The brain interprets information and relays messages back through the nerves to muscles and organs.

The brain is the most important organ in the body, because it controls all voluntary and involuntary processes, such as learning, sensing, imagining, remembering, breathing, blood circulation and heart rate, body temperature, digestion and continence (bladder and bowel control).

There are two main sections of the brain:

  • cerebrum (the largest part)
  • cerebellum
  • brain stem

The spinal cord extends from the base of the brain to the base of the spinal column. It consists of nerve cells and bundles of nerves that connect the brain with all parts of the body through the peripheral nervous system. The brain and spinal cord are surrounded and protected by membranes called the meninges, the skull and the vertebrae bones. Inside the skull, the brain floats in fluid called cerebrospinal fluid.

Nervous tissue

The brain, spinal cord and nerves consist of billions of cells called neurons, which are cells that process and transmit information. There are three major types of neural cells:

Sensory neurons – respond to light, sound and touch
Motor neurons – cause muscle contractions
Interneurons – connect neurons within the brain and spinal cord.

Glial cells are the other main type of cell in the nervous system. There are several different types of glial cells, including astrocytes and oligodendrocytes.

Glial cells are the glue of the nervous system because they surround and insulate the neurons and hold the neurons in place. The glial cells also supply nutrients and oxygen to neurons and eliminate dead neurons and germs.

 

 

About brain or spinal cord tumours

When cells in the central nervous system grow and divide in an uncontrollable way, they can form a lump or a tumour. The lump may press on or grow into different areas of the brain or spinal cord, which can cause various symptoms such as loss of movement. A tumour can be benign or malignant.

The difference between benign and malignant tumours in the central nervous system is not always clear cut.

Benign tumours usually have slow-growing cells and clear borders (margins), and they rarely spread. However, they may be found in essential areas of the brain that control vital life functions, which can make them life-threatening.

Malignant tumours usually grow rapidly and spread within the brain and spinal cord. Malignant brain tumours can also be life-threatening. About 40% of brain and spinal cord tumours are malignant.

Types of tumours

There are more than 100 types of brain and spinal cord tumours (also called central nervous system or CNS tumours). They are usually named after the cell type they started in.

Benign tumours – most common type are meningiomas, neuromas, pituitary tumours, cranio-pharyngiomas and cystic astrocytomas. Benign tumours can cause problems by pressing on the brain and spinal cord. Most of these tumours can be removed by surgery, but if this is not possible, cancer treatments such as radiotherapy may be used.

Malignant tumours – include high-grade astrocytomas, oligodendrogliomas, ependymomas, glioblastomas and mixed gliomas. In some malignant tumours, the cells are confined to a specific area; in others, malignant cells are also found in tissue surrounding the tumour.

Metastatic brain tumours – These begin as cancer in another part of the body before spreading to the brain.

Hydrocephalus

A brain tumour can sometimes block the flow of cerebrospinal fluid around the brain and between its cavities. When this happens, fluid can build up, putting pressure on the brain. This is called hydrocephalus, and it is most common in infants and some adults. It is usually treated with a shunt.

How common are brain and spinal cord tumours?

About 450 new cases of brain cancer are diagnosed in NSW each year. Brain cancer represents about 1.4% of all cancers in males and 1.2% of all cancers in females.

Malignant spinal tumours affect about 30 people each year.

Causes of brain tumours

The causes of most brain and spinal cord tumours are unknown. However, there are a few known risk factors for malignant brain tumours:

Radiotherapy – People who have had radiation to the head, usually to treat another type of cancer, may be at an increased risk of developing a tumour. This may affect people who had radiotherapy for childhood leukaemia.

Family history – It is possible to have a genetic predisposition to developing a tumour. This means that you may have a fault in your genes, passed down from your parents, that increases your risk. For example, some people have a genetic condition called neurofibromatosis, which causes nerve tissue to grow tumours.

Mobile phones – Some researchers have studied whether long-term or excessive use of mobile phones increases a person’s risk of developing a brain tumour. It is possible that there may be an increased risk of developing a glioma in people with high levels of mobile phone use (i.e. more than 30 minutes a day). However, there is insufficient scientific evidence to link regular mobile phone use to brain tumours. Research is continuing in this area.

Symptoms

People with a brain or spinal cord tumour have varying symptoms, depending on where the tumour is located. Sometimes, when a tumour grows slowly, symptoms develop gradually and are hardly noticeable. Brain tumours and spinal cord tumours may cause weakness or paralysis in parts of the body. Some people also have trouble balancing or have seizures.

Other symptoms of brain tumours include:

  • nausea and/or vomiting
  • headaches
  • drowsiness
  • difficulty speaking or remembering words
  • short-term memory problems
  • disturbed vision, hearing, smell or taste
  • loss of consciousness
  • general irritability, depression or personality changes

Spinal cord tumours

Symptoms for spinal cord tumours can include:

  • back and neck pain
  • numbness or tingling in the arms or legs
  • clumsiness or difficulty walking
  • loss of bowel or bladder control (incontinence).

Common tests used for diagnosis

Most people diagnosed with a brain or spinal cord tumour first consult their general practitioner (GP) because they are feeling unwell. The doctor will take your medical history and ask about your symptoms. After that, you will have a physical examination. Based on those results, the doctor will refer you to have one or more scans of the brain and body, and possibly some other tests, to confirm a diagnosis of a brain or spinal cord tumour.

Physical examination

Your doctor will assess your nervous system to check how different parts of your brain and body are working, including your speech, hearing, vision and movement. This is called a neurological examination and may cover:

Checking your reflexes (for example knee jerks)
test the strength in the muscles of your arms and legs, and ability to feel pinpricks
ask you to do some simple mental exercises (like arithmetic)
look into your eyes to see your optic nerve, which transmits visual information from your eyes to your brain.

CT scan

A CT (computerised tomography) scan is a procedure that uses x-ray beams to take pictures of the inside of your body. It uses a computer to compile many pictures of areas of your body.

A dye may be injected into your veins. This injection will help make the scan pictures clearer. It may make you feel flushed and hot for a few minutes. Rarely, more serious reactions occur, such as breathing difficulties or low blood pressure.

You will be asked to lie still on a table while the CT scanner, which is large and round like a doughnut, slowly rotates around you. It may take about 30 minutes to prepare for the scan, but the actual test is painless and only takes about 10 minutes. You will be able to go home when the scan is complete.

MRI

An MRI (magnetic resonance imaging) scan uses magnetism and radio waves to build up very detailed cross-section pictures of the body. A dye may be injected into your veins before the scan. As the dye may affect the kidneys, your kidney function will be checked.

You will lie on a table in a metal cylinder, which is a large and powerful magnet. Some people feel anxious lying in the narrow cylinder during the MRI. Let your health care team know if you are claustrophobic. It may help to take a mild sedative.

The MRI is painless and is usually completed in under an hour. You will be able to go home when your scan is over. People with a pacemaker or other metallic objects in their body will not be able to have an MRI due to the effect of the magnet.

Further tests

Other tests that are sometimes used to show how quickly or aggressively a tumour is growing or if the cancer has spread:

Magnetic resonance spectroscopy (MRS) scan

This scan can be conducted at the same time as a standard MRI scan. An MRS scan shows whether the brain’s neurons are working properly.

Single photon emission computerised tomography (SPECT or SPET) scan

You are injected with a small amount of radioactive fluid. You are then scanned with a machine called a gamma camera, which creates three- dimensional pictures of your body. This scan is often used to assess blood flow in the brain.

Positron emission tomography (PET) scan

You are injected with radioactive glucose solution, which may be absorbed by active cells, such as cancer cells. The scan shows where these areas of active cancer are.

Lumbar puncture (spinal tap)

A needle is inserted into the spinal column to collect cerebrospinal fluid. This fluid will be sent away for analysis to see if cancer cells are present.

Surgical biopsy

If scans show an abnormality that looks like a tumour in your brain, your doctor may decide to remove some or all of the tissue for examination. In some cases, the neurosurgeon is able to make a small opening in the skull and insert a needle to obtain a sample. In other cases, the neurosurgeon will remove part of the skull to access the tumour.

If your doctor recommends any other tests, ask him or her to explain the tests. Understanding what will happen can help you feel less worried before the test.

Staging

Staging describes the size of a tumour and if it has spread from its original location. Staging the cancer helps determine what treatment is required. Brain and spinal cord tumours are usually graded on a scale of one to four based on how quickly they are growing, as well as their ability to invade nearby tissue.

Grades 1 and 2 – are the slowest-growing tumours. They are called low-grade tumours.
Grade 3 – tumours grow at a moderate rate.
Grade 4 – are the fastest-growing tumours. They are called high-grade tumours.

Prognosis

Prognosis means the expected outcome of a disease. You will need to discuss your prognosis with your doctor, but it is not possible for any doctor to give you a 100% accurate prognosis.

It will be important to complete any tests to assess the stage of the tumour and then to observe how quickly it grows and how well you respond to treatment.

As in most types of cancer, the results of treatment are best when the cancer is found and treated early.

Which health professionals will I see?

Your GP will probably arrange the first tests to assess your symptoms. You will usually be referred to a neurologist, who will arrange further tests and advise you about treatment options.

You will be cared for by a range of health professionals who specialise in different aspects of your treatment. These include:

  • neurosurgeon and neurologist – diagnose and treat people with illnesses of the brain and nervous system
  • nurses – assist and support you through all stages of your treatment
  • medical oncologist – prescribes and coordinates chemotherapy treatment
  • radiation oncologist – prescribes and coordinates radiotherapy treatment
  • dietician – supports and educates patients about nutrition and diet
  • social worker, psychologist and pastoral worker – advise you on support services and provide emotional support
  • cognitive therapist, physiotherapist, speech therapist and occupational therapist – provide you with rehabilitative services.

Treatment

Tumours of the brain or spinal cord are usually treated with surgery, radiotherapy, chemotherapy or steroid therapy. These treatments may be used alone or in combination. The aim of treatment is to remove the tumour or to slow its growth and/or relieve symptoms by shrinking the tumour and any swelling around it. Your choice of treatment will depend on:

  • the type, size and location of your tumour
  • your age, medical history and general state of health
  • the types of symptoms and side effects you have.

Surgery

The surgeon will remove as much of the tumour as possible without damaging healthy parts of your brain. Surgery may be done as open surgery or stereotactic surgery. In open surgery, a relatively large opening needs to be made in the skull to access the tumour. In stereotactic surgery, only a small cut needs to be made.

Biopsy – A small sample of tumour tissue is removed and examined under a microscope. This is usually a diagnostic procedure but sometimes the entire tumour can be removed.

Craniotomy – The most common type of brain tumour operation. Some hair will be shaved off and you will be given a general anaesthetic. The surgeon will cut through the scalp and move it aside, then remove a piece of skull above the tumour. The bone and scalp are put back once the tumour is taken out.

Craniectomy – This is similar to a craniotomy except that the piece of skull that is removed for the operation is not replaced because the brain may swell. The bone may be replaced in the future when it won’t cause extra pressure.

Awake craniotomy – This operation is done if the tumour is near parts of the brain that control speech or movement. When the brain is exposed, the level of anaesthetic is reduced and the patient awakens (becomes conscious) so they can speak, move and respond. This is not painful because the brain itself does not feel pain, and local anaesthetic is used to numb surrounding tissues.

During the operation, the surgeon asks the patient to speak or move parts of the body so they can identify and avoid certain parts of the brain. Once the tumour is removed, the patient is given general anaesthetic again for the rest of the procedure.

Endoscopic transnasal brain surgery – This rarer type of surgery is used if the tumour is near the base of the brain, for example a pituitary gland tumour. The surgeon puts a long tube (endoscope) up the nose, then uses small tools to remove all or part of the tumour through the nostrils. This type of surgery has a faster recovery time and fewer long-term side effects than a craniotomy. You can also have further treatment, if needed.

Surgery for a spinal cord tumour
The main surgery for a spinal cord tumour is called a laminectomy. In this procedure, the surgeon makes an opening through the skin, muscle and a vertebra in the spinal column to remove the tumour that is affecting the spinal cord. Afterwards, the vertebra is replaced. You will have a general anaesthetic for this operation.

Gross total resection — surgical removal of the entire tumour.

Partial resection — surgical removal of part of the tumour. This may be an option if a tumour is more spread out, is near major blood vessels, or cannot be removed without damaging other important parts of the brain or spinal cord.

Removing all or part of the tumour often improves your condition, which may allow you to lead an active life for some time.

Sometimes tumours can’t be removed because it would be too dangerous, so you may have another type of treatment to ease your symptoms.

Radiotherapy
Radiotherapy is a type of treatment that uses high-energy x-ray beams to kill or damage cancer cells. The radiation is specifically targeted at the treatment site to minimise damage to healthy cells.

A personalised plastic face mask is often worn during treatment to assist the targeting of the radiotherapy. You will be able to see and breathe through the mask, but it will immobilise you so that the radiation beams always treat the same areas of your brain. You will only wear the mask for about 10 minutes at a time. Let your doctor know if you are claustrophobic.

Radiotherapy treatment is usually given once daily, Monday to Friday, for several weeks. However, the course of your treatment will depend on the size and type of tumour.

Stereotactic radiosurgery
Stereotactic radiosurgery is a type of radiation therapy, not a type of surgery. It is a non-invasive treatment that uses high doses of precisely targeted radiation to treat a brain tumour in a single hospital visit. The treatment is so accurate that surrounding areas of healthy brain tissue are not affected. The patient is usually able to return home the same day as treatment.

Radiosurgery may be offered when traditional surgery is not suitable. It is most commonly used for some meningiomas and pituitary tumours, and a type of neuroma known as an acoustic neuroma. It is also used for metastatic cancers that have spread from another part of the body. It is not usually used for gliomas.

Chemotherapy
Chemotherapy is the use of cytotoxic drugs to treat cancer. Cytotoxic drugs damage or destroy rapidly dividing cells such as cancer cells while causing the least possible damage to healthy cells. Your doctor will determine your treatment schedule and dose.

Chemotherapy is delivered either through an oral capsule or an intravenous drip. It can be difficult to treat brain tumours this way because the body has a natural defence mechanism called the blood-brain barrier that only allows certain substances from the blood into the brain. Only certain drugs can get through this barrier.

Some patients who have a craniotomy have small, dissolvable chemotherapy wafers inserted into their brain during surgery. The wafers release drugs into the brain over a couple of weeks. As the drug is placed directly at the tumour site, it doesn’t affect other areas of the body and so reduces the chance of side effects.

Chemotherapy is often combined with radiotherapy for treatment of some types of brain tumours, such as gliomas. The combination of treatments enhances the effects of radiotherapy treatment.

Other therapies

Some types of treatment are used to make you more comfortable or reduce your symptoms or side effects. Steroids are used is to reduce swelling in the brain. They may be given before, during or after surgery, or during radiotherapy.

Steroids given for a short time may cause increased appetite, weight gain, insomnia, restlessness and mood swings. If you have trouble sleeping, it may help to take the drugs in the morning.

If taken for several months, steroids can cause puffy skin (fluid retention or oedema) in the feet, hands or face; high blood pressure; unstable blood sugar levels; diabetes; or muscle weakness. You are also more likely to get infections.

Your medical team will monitor your treatment, and will change your dose when required. If you are worried about side effects, talk to your doctor.

Anti-convulsants
There are many types of anti-convulsant drugs, which are used to prevent seizures. You may have blood- and liver-function tests while you are taking them. This is to check whether the dose is effective and how your liver is coping with the medication.

Grapefruit, Seville oranges and certain herbal medicines may change the way some anti-convulsants work. You should also limit your alcohol intake. Talk to your doctor about these risks.

Shunts
Some people experience fluid build-up in their brain (hydrocephalus), either as a result of surgery or as a symptom of a tumour.

If this is a problem, the surgeon may insert a small permanent tube, called a shunt, just beneath the skin in your head. The shunt will drain the extra fluid from the brain into the abdomen, where it is safely absorbed into your bloodstream.

Sometimes a shunt may be inserted to relieve symptoms of hydrocephalus before surgery.

Palliative treatment

Palliative treatment helps to improve quality of life by alleviating symptoms of cancer without trying to cure the disease.

Often treatment is concerned with pain relief and stopping the spread of cancer, but it can also involve the management of other physical and emotional symptoms.

Treatment may include surgery, radiotherapy, chemotherapy and other medication.

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