The purpose of this study is to gain knowledge, develop skills, and to

apply the right attitudes of the student nurses in rendering and giving care to the
patient with Uterine Myoma who undergone Total Abdominal Hysterectomy
Bilateral Salphingo Oophorectomy (TAHBSO).

Specific Objectives:

 To examine condition of the patient with Uterine Myoma and undergone

TAHBSO and associate it through the introduction of the case.
 To determine the nursing history, the personal data, health history, and physical
assessment of the patient.
 To analyze the anatomy and physiology, and pathophysiology of the affected
organ or part of the body.
 To be clinically aware of the clinical manifestation in its complication.
 To develop an effective skills on how to manage a proper care in patient with
Uterine Myoma undergone TAHBSO.
 To construct drug study with regards to the patient’s condition.
 To evaluate condition of patient with Uterine Myoma undergone TAHBSO using
data gathering.
 To construct the client Nursing Care Plan and Discharge Plan to assure client’s
total wellness during her hospitalization up to the time of her hospital discharge.
Brain tumor
From Wikipedia, the free encyclopedia

Brain tumor

Classification and external resources

Brain metastasis in the right cerebral hemisphere from lung cancer shown on T1-weighted magnetic
 resonance imaging with intravenous contrast. (L=left, P=posterior, back of the head)

ICD-10 C71., D33.0-D33.2

ICD-9 191, 225.0

DiseasesDB 30781

MedlinePlus 007222 000768

eMedicine emerg/334

MeSH D001932

A brain tumor (or brain tumour) is an intracranial solid neoplasm, a tumor (defined as anabnormal growth of cells) within the brain or the

central spinal canal.

Brain tumors include all tumors inside the cranium or in the central spinal canal. They are created by an abnormal and uncontrolled cell

division, normally either in the brain itself (neurons,glial cells (astrocytes, oligodendrocytes, ependymal cells, myelin-producing Schwann

cells),lymphatic tissue, blood vessels), in the cranial nerves, in the brain envelopes (meninges), skull,pituitary and pineal gland, or spread

from cancers primarily located in other organs (metastatic tumors).

Any brain tumor is inherently serious and life-threatening because of its invasive and infiltrative character in the limited space of the

intracranial cavity. However, brain tumors (even malignant ones) do not automatically cause death. Brain tumors or intracranial neoplasms

can becancerous (malignant) or non-cancerous (benign); however, the definitions of malignant or benign neoplasms differs from those

commonly used in other types of cancerous or non-cancerous neoplasms in the body. Its threat level depends on the combination of factors

like the type of tumor, its location, its size and its state of development. Because the brain is well protected by the skull, the early detection

of a brain tumor only occurs when diagnostic tools are directed at the intracranial cavity. Usually detection occurs in advanced stages when

the presence of the tumor has side effects that cause unexplained symptoms.

Primary (true) brain tumors are commonly located in the posterior cranial fossa in children and in the anterior two-thirds of the cerebral

hemispheres in adults, although they can affect any part of the brain.

Contents

[hide]

• 1 Taxonomy of brain tumors

o 1.1 By location and origin of the neoplasm

 1.1.1 Primary brain tumors

  1.1.2 Secondary brain tumors

o 1.2 By behavior of the neoplasm

• 2 Tumor development according to tissue type

o 2.1 Basic knowledge of the anatomy of the brain needed for further reading

o 2.2 Meninges

o 2.3 Brain matter

o 2.4 Spinal cord and other tissues

• 3 In pediatrics

• 4 Prognosis

o 4.1 Glioblastoma multiforme

o 4.2 Oligodendrogliomas

• 5 Schematic overview of tumors

• 6 Characteristics of tumors

• 7 Signs and symptoms

• 8 Diagnosis

• 9 Coping with the diagnosis

• 10 Treatment

o 10.1 Surgery

o 10.2 Radiation therapy

o 10.3 Chemotherapy

o 10.4 Research to treatment with the vesicular stomatitis virus

• 11 Consequences for survivors

o 11.1 Physical consequences

o 11.2 Impact on the daily life of the family

o 11.3 Epileptic seizures

o 11.4 Psychological and behavioral consequences

o 11.5 Some practical consequences

 11.5.1 Driving

• 12 Occurrence of Brain tumors

o 12.1 Worldwide figures

o 12.2 National figures

• 13 See also
 • 14 References

• 15 External links

[edit]Taxonomy of brain tumors

[edit]By location and origin of the neoplasm

[edit]Primary brain tumors

primary neoplasms of the brain are tumors that originate in the intracranial sphere or the central spinal canal, based on the organic tissues

that make up the brain and the spinal cord. From the brain-lemma we can learn a lot of things about the composition of the brain from

different types of organic tissues. For the purpose of this article we will discuss only some types.

 The brain itself is composed of neurons and glia (that function primarily as the physical support for neurons). The neuron itself is

rarely the basis for a tumor, though tumors of the glial cells are glioma and often are of the cancerous type.

 The brain is surrounded by a system of connective tissue membranes called meninges that separate the skull from the brain.

Tumors of the meninges are meningioma and are often benign neoplasms.

 Below the brain is pituitary and pineal gland which could be the basis for its own -albeit rare- kind of benign glandular

neoplasms.

[edit]Secondary brain tumors

Secondary tumors of the brain are metastatic tumors that invaded the intracranial sphere from cancers originating in other organs. This

means that a (malignant) cancerous neoplasm has developed in another organ elsewhere in the body and that cancer cells leak from that

primary tumor. The leaked cells enter the lymphatic system and blood vessels, circulate through the bloodstream, and are deposited in the

brain. There, these cells continue growing and dividing, becoming another invasive neoplasm of the primary cancer's tissue. Secondary

tumors of the brain are very common in the terminal phases of patients with an incurable metastased cancer; the most common types of

cancers that bring about secondary tumors of the brain are lung cancer, breast cancer, malignant melanoma, kidney cancer and colon

cancer (in decreasing order of frequency).

Secondary brain tumors are the most common cause of tumors in the intracranial cavity.

The skull bone structure can also be subject to a neoplasm that by its very nature reduces the volume of the intracranial cavity, and can

damage the brain.

[edit]By behavior of the neoplasm

Brain tumors or intracanial neoplasms can be cancerous (malignant) or non-cancerous (benign). However, the definitions of malignant or

benign neoplasms differs from those commonly used in other types of cancerous or non-cancerous neoplasms in the body. In ordinary

cancers (elsewhere in the body) three malignant properties differentiate benign tumors from malignant forms of cancer : benign tumors are

self-limited and do not invade or metastasize. The malignant characteristics of tumors are :
  uncontrolled mitosis (growth by division beyond the normal limits),

 anaplasia : a term meaning that the cells in the neoplasm have an obviously different form (in size and shape). Anaplastic cells

display marked pleomorphism. The cell nuclei are characteristically extremely hyperchromatic (darkly stained) and enlarged; the

nucleus might have the same size as the cytoplasm of the cell (nuclear-cytoplasmic ratio may approach 1:1, instead of the normal 1:4

or 1:6 ratio). Giant cells that are considerably larger than their neighbors may be formed and possess either one enormous nucleus or

several nuclei (syncytia). Anaplastic nuclei are variable and bizarre in size and shape.

 invasion or infiltration : in medical literature these terms are used as synonymous equivalents. However for clarity in the articles

that follow we will adhere to a convention that they mean slightly different things (so readers should be aware that this convention is

not kept outside these articles) :

 Invasion or invasiveness is the spatial expansion of the tumor through uncontrolled mitosis, in the sense that the

neoplasm invades the space occupied by adjacent tissue, thereby pushing the other tissue aside and eventually compressing

the tissue. Often these tumors are associated with clearly outlined tumors in imaging.

 Infiltration is the behavior of the tumor either to grow (microscopic) tentacles that push into the surrounding tissue

(often making the outline of the tumor undefined or diffuse) or to have tumor cells "seeded" into the tissue beyond the

circumference of the tumorous mass; this doesn't mean that an infiltrative tumor doesn't take up space or doesn't compress the

surrounding tissue as it grows, but an infiltrating neoplasm makes it difficult to say where the tumor ends and the healthy tissue

starts.

 metastasis (spread to other locations in the body via lymph or blood).

Of the above malignant characteristics, some elements don't apply to primary neoplasms of the brain :

 Primary brain tumors rarely metastasize to other organs; some forms of primary brain tumors can metastasize but will not

spread outside the intracranial cavity or the central spinal canal. Due to the blood-brain barrier cancerous cells of a primary neoplasm

cannot enter the bloodstream and get carried to another location in the body. (Occasional isolated case reports suggest spread of

certain brain tumors outside the central nervous system, e.g. bone metastasis of glioblastoma multiforme [1].)

 Primary brain tumors generally are invasive (i.e. they will expand spatially and intrude into the space occupied by other brain

tissue and compress those brain tissues), however some of the more malignant primary brain tumors will infiltrate the surrounding

tissue.

Of numerous grading systems in use for the classification of tumor of the central nervous system, the World Health Organization (WHO)

grading system is commonly used for astrocytoma. Established in 1993 in an effort to eliminate confusion regarding diagnoses, the WHO

system established a four-tiered histologic grading guideline for astrocytomas that assigns a grade from 1 to 4, with 1 being the least

aggressive and 4 being the most aggressive.

[edit]Tumor development according to tissue type

[edit]Basic knowledge of the anatomy of the brain needed for further reading
Main anatomical regions of the vertebrate brain

When reading the human brain in the picture on the left, only a few of the areas are really of interest to us. The first type of tissue

encountered beneath the skullbone in the intracranial cavity is actually not shown on this picture : the meninges

[edit]Meninges

Human brains are surrounded by a system of connective tissue membranes called meninges that separate the skull from the brain. This

three-layered covering is composed of (from the outside in) the dura mater ("hard mother"), arachnoid mater ("spidery mother"), and pia

mater ("soft mother"). The arachnoid and pia are physically connected and thus often considered as a single layer, the pia-arachnoid.

Below the arachnoid is the subarachnoid space which contains cerebrospinal fluid (CSF also called "liquor" in Latin), which circulates in the

narrow spaces between cells and through cavities called ventricles, and serves to nourish, support, and protect the brain tissue. Blood

vessels enter the central nervous system through the perivascular space above the pia mater. The cells in the blood vessel walls are joined

tightly, forming the blood-brain barrier which protects the brain from toxins that might enter through the blood. Tumors of the meninges

aremeningioma and are often benign neoplasms.

[edit]Brain matter

The brains of vertebrates (including humans) are made of very soft tissue, with a texture that has been compared to jello. Living brain tissue

is pinkish on the outside and mostly white on the inside, with subtle variations in color

 the telencephalon (cerebral hemispheres or cerebrum)

 mesencephalon (midbrain),

 cerebellum
make out the biggest volume of the brain. These areas are composed of two broad classes of cells: neurons and glia. These two types are

equally numerous in the brain as a whole, although glial cells outnumber neurons roughly 4 to 1 in the cerebral cortex. Glia come in several

types, which perform a number of critical functions, including structural support, metabolic support, insulation, and guidance of

development.

Primary tumors of the glial cells are called Glioma and often are malignant by the time they are diagnosed.

[edit]Spinal cord and other tissues

 the pink area in the picture is called the pons; it's a specific region that consists of myelinated axons much like the spinal cord;

 the yellow region is the diencephalon (thalamus and hypothalamus) which consist also of neuron and glial cell tissue with the

hypophysis (or pituitary gland) and pineal gland attached at the bottom which is glandular tissue, tumors of the pituitary and pineal

gland are often benign neoplasms;

 the turquoise region or medulla oblongata is the end of the spinal cord and is composed mainly of neuron tissue enveloped in

Schwann cells and meninges tissue. Our spinal cord is made up of bundles of these axons. Glial cells such as Schwann cells in the

periphery or, within the cord itself, oligodendrocytes, wrap themselves around the axon, thus promoting faster transmission of

electrical signals and also providing for general maintenance of the environment surrounding the cord, in part by shuttling different

compounds around, responding to injury, etc.

[edit]In pediatrics

A brainstem glioma in four year old. MRIsagittal, without contrast

In the US, about 2000 children and adolescents younger than 20 years of age are diagnosed with malignant brain tumors each year. Higher

incidence rates were reported in 1975–83 than in 1985–94. There is some debate as to the reasons; one theory is that the trend is the

result of improved diagnosis and reporting, since the jump occurred at the same time that MRIs became available widely, and there was no
coincident jump in mortality. The CNS cancer survival rate in children is approximately 60%. The rate varies with the type of cancer and the

age of onset: younger patients have higher mortality.[2]

In children under 2, about 70% of brain tumors are medulloblastoma, ependymoma, and low-gradeglioma. Less commonly, and seen

usually in infants, are teratoma and atypical teratoid rhabdoid tumor.[3] Germ cell tumors, including teratoma, make up just 3% of pediatric

primary brain tumors, but the worldwide incidence varies significantly.[4]

[edit]Prognosis

The prognosis of brain cancer varies based on the type of cancer. Medulloblastoma has a good prognosis with chemotherapy,

radiotherapy, and surgical resection while glioblastoma multiforme has a median survival of only 12 months even with

aggressive chemoradiotherapy and surgery. Brainstem gliomas have the poorest prognosis of any form of brain cancer, with most patients

dying within one year, even with therapy that typically consists of radiation to the tumor along with corticosteroids. However, one type of

brainstem glioma, a focal[5] seems open to exceptional prognosis and long-term survival has frequently been reported.

[edit]Glioblastoma multiforme

Main article: Glioblastoma multiforme

Glioblastoma multiforme is the deadliest and most common form of malignant brain tumor. Even when aggressive multimodality therapy

consisting of radiotherapy, chemotherapy, and surgical excision is used, median survival is only 12–17 months. Standard therapy for

glioblastoma multiforme consists of maximal surgical resection of the tumor, followed by radiotherapy between two and four weeks after

thesurgical procedure to remove the cancer. This is followed by chemotherapy. Most patients with glioblastoma take a corticosteroid,

typically dexamethasone, during their illness to palliate symptoms. Experimental treatments include gamma-knife radiosurgery.[6]

[edit]Oligodendrogliomas

Main article: Oligodendroglioma

Oligodendroglioma is an incurable but slowly progressive malignant brain tumor. They can be treated with surgical resection,

chemotherapy, and/or radiotherapy. For suspected low-grade oligodendrogliomas in select patients, some neuro-oncologists opt for a

course of watchful waiting, with only symptomatic therapy. Tumors with the 1p/19q co-deletion have been found to be especially

chemosensitive, and one source reports oligodendrogliomas to be "among the most chemosensitive of human solid malignancies"[7]. A

median survival of up to 16.7 years has been reported for low grade oligodendrogliomas [8].

[edit]Schematic overview of tumors

[show]
v•d•e
Nervous tissue tumors/NS neoplasm/Neuroectodermal tumor (ICD-O 9350-9589) (C70-C72/D32-D33, 191-192/225)

[edit]Characteristics of tumors

Tumors have characteristics that allow pathologists to determine how dangerous a tumor is/was for the patient, how it will evolve and it will

allow the medical team to determine the management plan for the patient.
Anaplasia: or dedifferentiation; loss of differentiation of cells and of their orientation to one another and blood vessels, a characteristic of

anaplastic tumor tissue. Anaplastic cells have lost total control of their normal functions and many have deteriorated cell structures.

Anaplastic cells often have abnormally high nuclear-to-cytoplasmic ratios, and many are multinucleated. Additionally, the nuclei of

anaplastic cells are usually unnaturally shaped or oversized nuclei. Cells can become anaplastic in two ways: neoplastic tumor cells can

dedifferentiate to become anaplasias (the dedifferentiation causes the cells to lose all of their normal structure/function), or cancer stem

cells can increase in their capacity to multiply (i.e., uncontrollable growth due to failure of differentiation).

Atypia: is an indication of abnormality of a cell (which may be indicative for malignancy). Significance of the abnormality is highly dependent

on context.

Neoplasia: is the (uncontrolled) division of cells; as such neoplasia is not problematic but its consequences are: the uncontrolled division of

cells means that the mass of a neoplasm increases in size, in a confined space such as the intracranial cavity this quickly becomes

problematic because the mass invades the space of the brain pushing it aside, leading to compression of the brain tissue and increased

intracranial pressure [9] and destruction of brain parenchyma. Increased Intracranial pressure (ICP) may be attributable to the direct mass

effect of the tumor, increased blood volume, or increased cerebrospinal fluid (CSF) volume may in turn have secondary symptoms

Necrosis: is the (premature) death of cells, caused by external factors such as infection, toxin or trauma. Necrotic cells send the wrong

chemical signals which prevents phagocytes from disposing of the dead cells, leading to a build up of dead tissue, cell debris an toxins at or

near the site of the necrotic cells [10]

Arterial and venous hypoxia or the deprivation of adequate oxygen supply to certain areas of the brain, this is due to the fact that the tumor

taps into nearby blood vessels for its supply of blood, the neoplasm enters into competition for nutrients with the surrounding brain tissue.

More generally a neoplasm may cause release of metabolic end products (e.g., free radicals, altered electrolytes, neurotransmitters),

release and recruitment of cellular mediators (e.g., cytokines) that disrupt normal parenchymal function.

[show]
v•d•e
Pathology: Tumor, Neoplasm, Cancer, and Oncology (C00-D48, 140-239)

[edit]Signs and symptoms

This section may require cleanup to meet Wikipedia's quality standards. Please improve this section if
you can. The talk page may contain suggestions. (June 2010)

The visibility of signs and symptoms of brain tumors mainly depends on two factors: tumor size (volume) and tumor location. The moment

that symptoms will become apparent, either to the person or people around him (symptom onset) is an important milestone in the course of

the diagnosis and treatment of the tumor. The symptom onset - in the timeline of the development of the neoplasm - depends in many

cases on the nature of the tumor but in many cases it's also related to the change of the neoplasms nature from "benign" (i.e. slow-

growing/late symptom onset) to more malignant (fast growing/early symptom onset) grading, and Sightly frequently with the moment for

seeking medical attention.

Symptoms of solid neoplasms of the brain (primary brain tumors and secondary tumors alike) can be divided in 3 main categories :

 Consequences of intracranial hypertension : The symptoms that often occur first are those that are the consequences of

increased intracranial pressure: Large tumors or tumors with extensive perifocal swelling (edema) inevitably lead to

elevated intracranial pressure(intracranial hypertension), which translates clinically into headaches, vomiting (sometimes

without nausea), altered state ofconsciousness (somnolence, coma), dilatation of the pupil on the side of the lesion

(anisocoria), papilledema (prominent optic disc at the funduscopic eye examination). However, even small tumors obstructing the

passage of cerebrospinal fluid (CSF) may cause early signs of increased intracranial pressure. Increased intracranial pressure may

result in herniation (i.e. displacement) of certain parts of the brain, such as the cerebellar tonsils or the temporal uncus, resulting in

lethal brainstem compression. In very young children, elevated intracranial pressure may cause an increase in the diameter of

the skull and bulging of the fontanelles.

 Dysfunction : depending on the tumor location and the damage it may have caused to surrounding brain structures, either

through compression or infiltration, any type of focal neurologic symptoms may occur, such as cognitive and behavioral impairment

(including impaired judgment, memory loss, lack of recognition, spatial orientation disorders), personality or emotional

changes, hemiparesis,hypoesthesia, aphasia, ataxia, visual field impairment, impaired sense of smell, impaired hearing, facial

paralysis, double vision, but more severe symptoms might occur too such as: paralysis on one side of the body hemiplegia or

impairment to swallow . These symptoms are not specific for brain tumors — they may be caused by a large variety of neurologic

conditions (e.g. stroke, traumatic brain injury). What counts, however, is the location of the lesion and the functional systems

(e.g. motor, sensory, visual, etc.) it affects. A bilateral temporalvisual field defect (bitemporal hemianopia—due to compression of

the optic chiasm), often associated with endocrine disfunction—eitherhypopituitarism or hyperproduction of

pituitary hormones and hyperprolactinemia is suggestive of a pituitary tumor.

 Irritation : signs abnormal fatigue, weariness, absences and tremors, but also epileptic seizures.

The above symptoms are true for ALL types of Neoplasm of the brain (i.e. that includes secondary tumors). It is very likely that a person

might carry a primary benign neoplasme for several years and have no visible symptoms at all, or suffer no effects. Many present some

vague and intermittent symptoms like headaches and occasional vomiting, and weariness which is easily mistaken

for gastritis or gastroenteritis. It might seem strange that despite having a mass in his skull exercising pressure on the brain the patient feels

no pain, while headaches could cause an excruciating pain. If you ever suffered a concussion due to a fall you might remember that the

bump on the outside of your skull was painful but there was no pain inside your head. The brain has on his outside (in the meninges) no

nervesensors to feel and transmit pain to the brains pain center, it cannot signal pain if it doesn't get a sensory input. That is why secondary

symptoms like those described above should alert doctors to the possible diagnosis of a neoplasm of the brain.

If a person suffering from a metastasized cancer is diagnosed it will be likely that a scan of the skull will be made and a secondary tumor

discovered.
In a recent study by the Dutch GP Association [11], a list of causes of headaches [12] was published, that should alert GP's to take their

diagnosis further then to choose for symptomatic treatment of headaches with simple pain medication (note the occurrence of brain tumors

as possible cause) :

Alarm Signals Possible Cause to be investigated

first headache complaint from patient over 50 brain tumor, arteriïtis temporalis

first migraine attack in patient over 40 brain tumor

headache from patient under 6 brain tumor, hydrocephalus

senior patient with pain at temples arteriïtis temporalis

pregnancy with unknown headache pre-eclampsia

increased headaches after trauma sub/epidural hematoma

high-pitched headaches with high blood pressure malign hypertension

acute high pitched headache meningitis, CVA (Cerebrovascular accident or stroke), subarachnoïdal hemorrhage

headache and fever (with reduced consciousness) meningitis

Stiffness of the neck/neurological dysfunction meningitis, brain tumor

headache with signs of elevated intracranial pressure brain tumor

focal neurological dysfunction brain tumor

early morning vomiting or vomiting unrelated to headache brain tumor

behavioral changes or rapid decline in school results brain tumor

aura migraine always at one side brain tumor

[edit]Diagnosis

Although there is no specific or singular clinical symptom or sign for any brain tumors, the presence of a combination of symptoms and the

lack of corresponding clinical indications of infections might be an indicator to step up the diagnostic investigation to the direction of an

intracranial neoplasm.

The diagnosis will often start with an interrogation of the patient to get a clear view of his medical antecedents, and his current symptoms.

Clinical and laboratory investigations will serve to exclude infections as cause of the symptoms. Examinations in this stage may

includeophtamological, otolaryngological (or ENT) and/or Electrophysiological exams, other means such as electroencephalography (EEG)

play a role in the diagnosis of brain tumors.

Swelling, or obstructing the passage of cerebrospinal fluid (CSF) may cause (early) signs of increased intracranial pressure which

translates clinically into headaches, vomiting, or an altered state of consciousness, (and in children) changes to the diameter of

the skull and bulging of the fontanelles. More complex symptoms such as endocrine dysfunctions should alarm doctors not to exclude brain

tumors.

A bilateral temporal visual field defect (due to compression of the optic chiasm) or dilatation of the pupil, and the occurrence of either slowly

evolving or the sudden onset of focal neurologic symptoms, such as cognitive and behavioral impairment (including impaired judgment,

memory loss, lack of recognition, spatial orientation disorders), personality or emotional

changes, hemiparesis, hypoesthesia, aphasia,ataxia, visual field impairment, impaired sense of smell, impaired hearing, facial

paralysis, double vision, but also more severe symptoms might accur too such as: tremors, paralysis on one side of the body hemiplegia,

but also (epileptic) seizures in a patient with a negative history for epilepsy, impairment to swallow should raise red flags.

Micrograph of an oligodendroglioma, a type ofbrain cancer. Brain biopsy. H&E stain.

Imaging plays a central role in the diagnosis of brain tumors. Early imaging methods —invasive and sometimes dangerous— such

as pneumoencephalography and cerebralangiography, have been abandoned in recent times in favor of non-invasive, high-resolution

techniques, such as computed tomography (CT)-scans and especially magnetic resonance imaging (MRI). Neoplasms will often show as

differently colored masses (also referred to as processes) in CT or MRI results.

  Benign brain tumors often show up as hypodense (darker than brain tissue) mass lesions on cranial CT-scans. On MRI, they

appear either hypo- (darker than brain tissue) or isointense (same intensity as brain tissue) on T1-weighted scans, or hyperintense

(brighter than brain tissue) on T2-weighted MRI, although the appearance is variable.

 Contrast agent uptake, sometimes in characteristic patterns, can be demonstrated on either CT or MRI-scans in most malignant

primary and metastatic brain tumors.

 Perifocal edema , or pressure-areas, or where the brain tissue has been compressed by an invasive process also appears

hyperintense on T2-weighted MRI, they might indicate the presence a diffuse neoplasm (unclear outline)

This is because these tumors disrupt the normal functioning of the blood-brain barrier and lead to an increase in its permeability. However it

is not possible to diagnose high versus low grame gliomas based on enhancement pattern alone.

Another possible diagnostic indicator would be neurofibromatosis which can be in type one or type two.

Glioblastoma multiforme and anaplastic astrocytoma have been associated in case reports on PubMed[who?] with the genetic acute

hepaticporphyrias (PCT, AIP, HCP and VP), including positive testing associated with drug refractory seizures. Unexplained complications

associated with drug treatments with these tumors should alert physicians to an undiagnosed neurological porphyria.

The definitive diagnosis of brain tumor can only be confirmed by histological examination of tumor tissue samples obtained either by means

of brain biopsy or open surgery. The histological examination is essential for determining the appropriate treatment and the

correct prognosis. This examination, performed by a pathologist, typically has three stages: interoperative examination of fresh tissue,

preliminary microscopic examination of prepared tissues, and followup examination of prepared tissues after immunohistochemical staining

or genetic analysis.

[edit]Coping with the diagnosis

This section contains instructions, advice, or how-to content. The purpose of Wikipedia is to present
facts, not to train. Please help improve this article either by rewriting the how-to content or by moving it
to Wikiversity or Wikibooks. (June 2010)

Being diagnosed with a brain tumor can be overwhelming. As you come to terms with your diagnosis, your life will most certainly be turned

upside down with visits to doctors and surgeons as you prepare for your treatment. Some advice to help you cope :

 Learn whatever you can or want to know about your specific neoplasm. Ask your medical team where you can get more

information about it and your treatment options. Patient groups may help you get to reliable information and post treatment support.

 Make sure you verify the information comes from reliable resources including your library and online sources.

 Write down your questions so that you'll remember to ask them at your next appointment with your doctor.

 The more you know about your condition, the better prepared you'll be to make decisions about your treatment.

 Make a timetable and the questions you will need to ask at that time even if you understand them now that might not

be the case post-surgery.

 Building a support network is your most imperative task before surgery

  if you are an adult patient and you don't have family caregivers to support you, you should initiate contacts with

patient-support groups to have a volunteer come for regular visits who can support and inform you, help you talk to the doctors

and plan regular update appointments to help you through the initial recovery (until you are sufficiently advanced in cognitive

rehabilitation);

 to interface for you with the reality outside the hospital (time doesn't stop, it stops only in your head) and support you

with any assistance you will need until you have sufficiently recovered to return to some measure of independent life. Please

note that you might need to foresee a translator if you are not a native speaker of the local language or if you happen do be in a

foreign country (to help you understand doctor in you native language);

 until you come off anti-epileptica (medication that prevents epileptic seizures you should never be left alone, so if

you are a single and living alone in your house or apartment you should not return to your home, away from some form of

supervised care until you are free of epileptic seizures (neighbors don't suffice, even flatsharing singles (i.e. students) should

not depend on their flatmates;

 if you a parent of a child or an adolescent patient : both the patient and his family carers & siblings need outside

support : arrange it; as a family carer you have the pre-operative period and the initial recovery to prepare.

 Apart from you family supporting you after surgery you should also address your friends, this can scare them away because

they have difficulty giving themselves a place in your situation and life (so give them a chance in advance.

 Making contacts with patient-support groups is essential : they can provide a wide range of home-coming support, transport for

out-patient (radio-therapy) treatments, assistance with transport (patients will be unable to drive a car fo some time after surgery),

activities with other patients and their relatives.

 You may find it helps to have someone to talk to about your emotions. Other people who may provide support include social

workers and psychologists — ask your medical team for a referral if you feel that you need someone else to talk to. Talk with your

pastor, rabbi or other spiritual leader in order to pay you regular visits, you may not be able to ask for their visit when you need it,

because of your mental state (lack of initiative). Other people with similar experiences can offer a unique perspective, so consider

joining a support group — whether it's in your community or online. Ask your health care team about brain tumor support groups in

your area, or contact an organization like American Brain Tumor Association or whatever equivalent in your country of residence.

 Take care of yourself. Try to stay healthy during your treatment for a meningioma by taking care of yourself. Eat a diet rich in

fruits and vegetables and get moderate exercise daily if your doctor allows it. Get enough sleep so that you wake feeling rested.

Reduce stress in your life by focusing on what's important to you. These measures won't cure your meningioma, but they may help

you feel better as you recover from surgery or help you to cope during radiation therapy.[13]

[edit]Treatment

When a brain tumor is diagnosed, a medical team will be formed to assess the options of treatment presented by the leading surgeon to the

patient and his family. Given the location of primary solid neoplasms of the brain in most cases there is no "do-nothing" option,

neurosurgeons do take the time to observe the evolution of the neoplasm before proposing a management plan to the patient and his

relatives. Different types of treatment are available to the doctors and can be combined to give the best chances of survival :
  surgery : complete or partial ressection of the tumor ; objective : to remove as many tumor cells as possible

 radiotherapy

 chemotherapy

 kill as many as possible of the cells left behind

 put remaining tumor cells into a nondividing, sleeping state for as long as possible

Survival rates in primary brain tumors depend on the type of tumor, age, functional status of the patient, the extent of surgical tumor

removal, to mention just a few factors.[14]

[edit]Surgery

The primary course of action described in medical literature is surgical removal (ressection), a craniotomy(to open the skull) to best access

the tumor site, currently minimal invasive techniques are being studied but far from being common practice. The prime re mediating

objective of surgery is to remove as many tumor cells as possible, in any case surgery will reduce the tumor size and will attempt to

completely remove the neoplasm. In some cases access to the tumor is impossible and impedes surgery.

Many meningiomas, with the exception of some tumors located at the skull base, can be successfully removed surgically. Most pituitary

adenomas can be removed surgically, often using a minimally invasive approach through the nasal cavity and skull base (trans-nasal,

trans-sphenoidal approach). Large pituitary adenomas require a craniotomy (opening of the skull) for their removal. Radiotherapy,

includingstereotactic approaches, is reserved for the inoperable cases.

Although there is no generally accepted therapeutic management for primary brain tumors, a surgical attempt at tumor removal or at

leastcytoreduction (that is, removal of as much tumor as possible, in order to reduce the number of tumor cells available for proliferation) is

considered in most cases.[15] However, due to the infiltrative nature of these lesions, tumor recurrence, even following an apparently

complete surgical removal, is not uncommon. Several current research studies aim to improve the surgical removal of brain tumors by

labeling tumor cells with a chemical (5-aminolevulinic acid) that causes them to fluoresce [16]. Postoperative radiotherapy and chemotherapy

are integral parts of the therapeutic standard for malignant tumors. Radiotherapy may also be administered in cases of "low-grade"

gliomas, when a significant tumor burden reduction could not be achieved surgically.

The main treatment option for single metastatic tumors is surgical removal, followed by radiotherapy and/or chemotherapy. Multiple

metastatic tumors are generally treated with radiotherapy and chemotherapy. Stereotactic radiosurgery (SRS), such as Gamma

Knife,Cyberknife or Novalis Tx, radiosurgery, remains a viable option. However, the prognosis in such cases is determined by the primary

tumor, and it is generally poor.

[edit]Radiation therapy

The goal of radiation therapy is to selectively kill tumor cells while leaving normal brain tissue unharmed. In standard external beam

radiation therapy, multiple treatments of standard-dose "fractions" of radiation are applied to the brain. Each treatment induces damage to

both healthy and normal tissue. By the time the next treatment is given, most of the normal cells have repaired the damage, but the tumor
tissue has not. This process is repeated for a total of 10 to 30 treatments, depending on the type of tumor. This additional treatment

provides some patients with improved outcomes and longer survival rates.

Radiosurgery is a treatment method that uses computerized calculations to focus radiation at the site of the tumor while minimizing the

radiation dose to the surrounding brain. Radiosurgery may be an adjunct to other treatments, or it may represent the primary treatment

technique for some tumors.

Radiotherapy may be used if there is incomplete resection of the tumor. Forms of radiotherapy used for brain cancer include external beam

radiation therapy, brachytherapy ,and in more difficult cases, stereotactic radiosurgery, such as Gamma knife, Cyberknife or Novalis

Txradiosurgery, remains a viable option.[17]

Radiotherapy is the most common treatment for secondary cancer brain tumors. The amount of radiotherapy depends on the size of the

area of the brain affected by cancer. Conventional external beam whole brain radiotherapy treatment (WBRT) or 'whole brain irradiation'

may be suggested if there is a risk that other secondary tumors will develop in the future.[18] Stereotactic radiotherapy is usually

recommended in cases of under three small secondary brain tumors.

In 2008 a study published by the University of Texas M. D. Anderson Cancer Center indicated that cancer patients who receive stereotactic

radiosurgery (SRS) and whole brain radiation therapy (WBRT) for the treatment of metastatic brain tumors have more than twice the risk of

developing learning and memory problems than those treated with SRS alone.[19][20]

[edit]Chemotherapy

Patients undergoing chemotherapy are administered special drugs designed to kill tumor cells. Although chemotherapy may improve

overall survival in patients with the most malignant primary brain tumors, it does so in only about 20 percent of patients. Chemotherapy is

often used in young children instead of radiation, as radiation may have negative effects on the developing brain. The decision to prescribe

this treatment is based on a patient’s overall health, type of tumor, and extent of the cancer. The toxicity, the many side effects and the

uncertain outcome of chemotherapy in brain tumors puts this treatment further down the line of treatment options for medical teams.

UCLA Neuro-Oncology publishes real-time survival data for patients with this diagnosis. They are the only institution in the United States

that shows how brain tumor patients are performing on current therapies. They also show a listing of chemotherapy agents used to treat

high grade glioma tumors.

A shunt operation is used not as a cure but to relieve the symptoms. [21] The hydrocephalus caused by the blocking drainage of

thecerebrospinal fluid can be removed with this operation.

Researchers are presently investigating a number of promising new treatments including gene therapy, highly focused radiation therapy,

immunotherapy and novel chemotherapies. A number of new treatments are being made available on an investigational basis at centers

specializing in brain tumor therapies

[edit]Research to treatment with the vesicular stomatitis virus

In 2000, researchers at the University of Ottawa, led by John Bell PhD., have discovered that the vesicular stomatitis virus, or VSV, can

infect and kill cancer cells, without affecting healthy cells if coadministered with interferon.[22]
The initial discovery of the virus' oncolytic properties were limited to only a few types of cancer. Several independent studies have identified

many more types susceptible to the virus, including glioblastoma multiforme cancer cells, which account for the majority of brain tumors.

In 2008, researchers artificially engineered strains of VSV that were less cytotoxic to normal cells. This advance allows administration of the

virus without coadministration with interferon. Consequently administration of the virus can be given intravenously or through the olfactory

nerve. In the research, a human brain tumor was implanted into mice brains.

Research on virus treatment like this has been conducted for some years, but no other viruses have been shown to be as efficient or

specific as the VSV mutant strains. Future research will focus on the risks of this treatment, before it can be applied to humans.[23]

[edit]Consequences for survivors

This article's tone or style may not be appropriate for Wikipedia. Specific concerns may be found on
the talk page. See Wikipedia's guide to writing better articles for suggestions. (June 2010)

As was pointed out above the presence of a brain tumor is a very critical and life threatening situation. The discovery of a brain tumor

(except the lowgraded primary tumors) starts medically speaking a race against time.

The consequences - and chances of survival - of the treatment of secondary tumors (metastasis of other cancers) are hard to predict as it

depends on the type and evolution of the treatment of the primary tumor, and to what extend a patient responds to treatment. A

metastasized tumor is always significantly more difficult to treat because secondary tumors might grow almost anywhere.

The consequences of treatment of primary tumors however is a totally different matter. Survival of the treatment of a (solid) neoplasm of the

brain (and central nervous system) has dramatically increased over the years also for the higher graded tumors, also long term survival of

(younger) patients is on the increase.

Patients with benign gliomas may survive for many years,[24][25] while survival in most cases of glioblastoma multiforme is limited to a few

months after diagnosis if treatment is ignored (do nothing option), but cases are known of glioblastoma multiforme that have survived over

20 years and have a good quality of life after successful treatment, even after repeated treatment of early diagnosed recidive of a tumerous

process.

After surgical treatment the medical team might decide further post-operative treatment with Radiotherapy and/or Chemotherapy. There are

some adverse affects of these treatments but considering the impact of a brain tumor the loss of hair has mostly a cosmetic and

psychological effect. Nausea is a well known side effect of chemotherapy that should be mo nitored and regularly reported to the medical

team in an out-patient situation. Family members should be aware that whilst the radiotherapy is ongoing, healing of (external)surgery

wounds in the area of the therapy is strongly influenced, in such case have the nurses monitor the evolution of such wounds daily after

each radiotherapy session. Superficial infection might get hold of the wound if care is not given professionally.

[edit]Physical consequences
After surgery patients need time to recover physically. The first hurdles to take for the patient, after being released form the IC-unit and

his/her vital signs are stable, are :

 swallow reflex

 movement of limbs and detailed movements (fingers)

 being able to stand and equilibrium

Things that might go wrong in this phase of recovery is (partial) paralysis, incontinence, tremors and seizures(see below epileptic seizures),

some of these effects are temporal, and might be overcome with rehabilitation.

Its important for family members to know that patients suffer a huge loss in weight and muscular mass. Small efforts like walking to the

toilet will be an important physical effort, and walking from their hospital bed to a patient-family lounge or to the front door of the hospital will

cause the patient to be tired. Rebuilding physical strength, some basic endurance and resistance will be a process of months even years

even for previously well-trained athletes. The medical team will help you (the patient and the family) with training programs when the time is

right for such programs.

[edit]Impact on the daily life of the family

After initial surgery when the patient returns to the home situation, they shouldn't be left unsupervised at all, your medical team will advise

when the patient has regained enough independence to be left alone. Medication should be given at a strict regime nurse and your medical

team will advise on how strict/flexible this should be adhered to. Keep a medical diary and note :

 when medication is given (time, quantity)

 read fever/temperature at least twice a day (and every time fever is suspected)

 read heart rate and blood pressure every day

 note when nausea and pain is experienced

 note any situation out of the ordinary (pus coming out of a wound etc..), swelling etc.

Your life will - from the release form hospital onward - be regulated by the clock of the brain tumor patient medication and regular visits for

check-ups.

[edit]Epileptic seizures

Any person undergoing brain surgery may suffer from epileptic seizures. Seizures can vary from absences to severe tonic-clonic attacks.

Medication is prescribed and administered to minimize, eliminate the occurrence of seizures. Parents of children, family members of adults

and relatives in general of patients that have undergone surgery to remove a brain tumor, and who haven't got the benefit of medical

education or experience should be made aware of this fact. Experiences in patient-family support groups learn that they are informed but

are actually totally unprepared for the occurrence of an Tonic-clonic seizure.

From personal experience this example: We were informed both by medical staff and by leaflets from family-support associations that our

son could have epileptic seizure(s) as a consequence of the surgery, this forewarning wasn't sufficient. I had previously witnessed a few

(tonic-clonic) epileptic seizures from epilepsy-patients under medication. Those patients would fall to the ground have some muscle

spasms, and after a few minutes this would calm down, they would regain conscienceness, feel somewhat disoriented, get up and sit down

on their chair as if they returned from the bathroom. On a scale of 1-10 such an attack would scale in at about 1 or at the utmost 2. As a

bystander I just knew I had to free the throat-area from restricting clothing that would hinder respiration, and make sure the person having

the attack would not hurt himself on furniture standing around. But when my son had a tonic-clonic seizure, just weeks after his surgery, I

was totally unprepared. The first attack would be rated 4 or 5 at that scale mentionned before. Several tonic-clonic seizures, increasing in

amplitude follow each other in a rapid tempo, within 10 minutes he underwent his 3rd attack without regaining conscienceness between the

seizures, the 3rd attack could easily be rated 8. It was impossible to determine wether he had a heartbeat, or wether he was breathing, his

skin colour turned grayish. I wasn't sure if i was doing enough to make sure he could continue to breath. I called in the emergency services.

They dispatched a cardiac-ambulance unit and a emergency medical team (ER-doctor) and even with 4 staff I could still offer help (even if i

was only holding the perfusion bag at one stage). Thanks to medication (intravenous valium) the next attack was calmed down in amplitude

but continued for perhaps as long as 30 minutes. Only after more than 2 hours my son regained some form of conscienceness, enabling

him to respond to what we were saying. I think relatives should get video-based or multimedia training that prepares them to what they will

experience during epileptic seizure and how they should respond to the situation. [26]

The level of anti-epilepsy medication varies from patient to patient and depends on the severity of the lesion. So the doctors have to

experiment to determine the applicable level of medication, this could cause some more or less severe epileptic seizures, relatives in care

of people recovering form surgery might find the first aid section useful reading.

[edit]Psychological and behavioral consequences

It might be very difficult to communicate at first with the patient, and family often will see that reaction isn't forthcoming or response comes

very slow. This is perfectly normal and will wear off while the patient recovers, we might be talking weeks or months. At first family

members might have to interpret answers like "yes", "no" and the tone of patient's grunts get an idea of the patients reaction. Friends

coming to visit a patient might find him unresponsive or staring at the TV-screen. This is normal behavior, as the patient gets to grips with

his condition he will learn to talk in phrases again and to express his ideas an feelings again, but in the beginning he will have difficulty

finding the words to describe his feelings. In some cases, patients may react uninhibitedly towards some social conventions, they are not

aware of that behavior and you should seek specialist help, in order to avoid adverse reactions towards caring relatives. If the reaction is

verbal respond normally even if the reaction is negative, if the reaction is physical correct it, in any case react as if the patients action was

normal within the social convention without shaming or punishing. Don't ignore or pretend as if nothing happened but seek professional

help with your psychologist who can tell you how to respond and when its time to retrain this social conventional behavior.

[edit]Some practical consequences

[edit]Driving

A mundane and routine activity such as driving a car might be impossible after treatment of a brain tumor, that might be permanent or

temporary. In many countries it is illegal to drive a car (motorvehicle) without being medically certified fit to drive. Doing so uncertified might
invalidate your insurance. Having post-operative epileptic seizures disqualifies you for a period of time and requires you to get a medical

certification to be able to drive again.

In the UK : In some circumstances you may not be allowed to drive for a period of time. If you have had an epileptic fit, the Drivers and

Vehicle Licensing Association (DVLA) will not allow you to drive for a year after your last fit. You can then drive again provided you remain

well.

If you have a braintumor and have not had any (epileptic) seizures, the DVLA requires that you do not drive for at least six months after

surgery. Initially, your licence may only be for a short period.

If you drive some vehicles, such as a LGV (large goods vehicle) or a PCV (passenger carrying vehicle) you will not be able to drive for at

least five years after surgery. If you have had any seizures you will not be able to drive this type of vehicle until 10 years after your last fit. In

some circumstances, it will be recommended that you never drive these vehicles. You may require a medical assessment before your

driving licence is renewed.

[edit]Occurrence of Brain tumors

International The incidence of low-grade astrocytoma has not been shown to vary significantly with nationality. However, studies examining

the incidence of malignant CNS tumors have shown some variation with national origin. Since some of these high-grade lesions arise from

low-grade tumors, these trends are worth mentioning. Specifically, the incidence of CNS tumors in the United States, Israel, and the Nordic

countries is relatively high, while Japan and Asian countries have a lower incidence. These differences probably reflect some biological

differences as well as differences in pathologic diagnosis and reporting.[27]

[edit]Worldwide figures

Worldwide data on incidence of cancer can be found at the WHO (world health organisation) and is handled by the AIRC (Agency for

Interanctional Research on Cancer) located in France. [28].

Figures for incidences of cancers of the brain show a significant difference between more and less developed countries (i.e. the lesser

developed countries have less incidences of tumors of the brain) this should be explained by undiagnosed tumor-related deaths (patient in

extreme poor situations don't get diagnosed simply because they don't have access to the modern diagnostic facilities required to diagnose

a brain tumor) and by deaths caused by other poverty related causes that preempt a patients life before tumors develop or tumors become

life threatening. Nevertheless studies have been made that certain forms of primary brain tumors are more prevalent among certain groups

of the population.

[edit]National figures

From the British national statistics data about new diagnosis of maglignant neoplasms of the brain for the year 2007 (in absolute figures

and in rates per 100.000)

ICD-10 code : C71 Description : Malignant neoplasm of brain

 All 10- 15- 20- 25- 30- 35- 40- 45- 50-
Gender DASR Under 1 1-4 5-9 55-59 60-64 65-69 70-74 75-79 80-84 85+
ages 14 19 24 29 34 39 44 49 54

Absolute figures

M 2.130 7 34 39 31 37 33 48 61 87 100 116 142 242 264 258 237 193 128 73

F 1.598 7 42 39 37 28 25 37 50 42 73 87 99 140 191 166 169 158 111 97

Rates per
100.000
inhabitants

M 7,7 8,5 2,1 2,8 2,7 2,0 2,1 1,9 2,8 3,7 4,6 5,1 6,6 9,3 15,7 18,6 24,0 25,8 26,7 26,6 21,2

F 5,3 6,2 2,2 3,6 2,8 2,5 1,7 1,5 2,2 3,0 2,2 3,7 4,9 6,3 8,8 12,9 14,3 16,2 17,1 15,1 12,8

GB Office National statistics , online http://www.statistics.gov.uk/downloads/theme_health/2007cancerfirstrelease.xls

CBTRUS (Central Brain Tumor Registry of the United States), In the United States in the year 2005, it was estimated there were 43,800

new cases of brain tumors (Central Brain Tumor Registry of the United States, Primary Brain Tumors in the United States, Statistical

Report, 2005–2006),[29] which accounted for 1.4 percent of all cancers, 2.4 percent of all cancer deaths,[30] and 20–25 percent of pediatric

cancers.[30][31] Ultimately, it is estimated there are 13,000 deaths per year in the United States alone as a result of brain tumors.[29]

[edit]See also

 Craterization

 List of notable brain tumor patients

 Radiosurgery

 Stereotactic surgery

 Radiation therapy

 Grading of the tumors of the central nervous system

 Visualase Laser Technology for Tumor Ablation (LITT)

[edit]References
1. ^ Frappaz D, Mornex F, Saint-Pierre G, Ranchere-Vince D, Jouvet A, Chassagne-Clement C, Thiesse P, Mere P, Deruty R.

(1999). "Bone metastasis of glioblastoma multiforme confirmed by fine needle biopsy". Acta neurochirurgica (Wien) 141 (5): 551–

552.doi:10.1007/s007010050342. PMID 10392217.

2. ^ Gurney, James G; Smith, Malcolm A; Bunin, Greta R. "CNS and Miscellaneous Intracranial and Instraspinal

Neoplasms" (PDF).SEER Pediatric Monograph. National Cancer Institute. pp. 51–52 (incidence); pp. 56–57 (trends); p. 57 (survival).

Retrieved 4 December 2008. "[re incidence] In the US, approximately 2,200 children and adolescents younger than 20 years of age are

diagnosed with malignant central nervous system tumors each year. More than 90 percent of primary CNS malignancies in children are

located within the brain."

3. ^ Infantile Brain Tumors by Brian Rood for The Childhood Brain Tumor Foundation (accessed July 2007)

4. ^ Echevarría ME, Fangusaro J, Goldman S (June 2008). "Pediatric central nervous system germ cell tumors: a

review". Oncologist 13(6): 690–9. doi:10.1634/theoncologist.2008-0037.PMID 18586924.

5. ^ http://www.childhoodbraintumor.org/index.php/articles/34-brain-tumor-types-and-imaging/57-brain-stem-gliomas-in-

childhood.html

6. ^ http://brain.mgh.harvard.edu/patientguide.htm

7. ^ http://www.neurology.org/cgi/content/abstract/66/2/247

8. ^ http://www.neurology.org/cgi/content/abstract/54/7/1442

9. ^ http://www.helium.com/items/1354248-difference-between-metaplasia-heteroplasia-dysplasia-neoplasia-hyperplasia-

anaplasia

10. ^ http://www.nlm.nih.gov/medlineplus/ency/article/002266.htm

11. ^ http://nhg.artsennet.nl

12. ^ http://www.gezondheid.be/INDEX.cfm?fuseaction=art&art_id=2663

13. ^ Section adapted from Coping with meningioma at Mayoclinic

14. ^ Nicolato A, Gerosa MA, Fina P, Iuzzolino P, Giorgiutti F, Bricolo A (Sep 1995). "Prognostic factors in low-grade

supratentorial astrocytomas: a uni-multivariate statistical analysis in 76 surgically treated adult patients". Surg Neurol 44 (3): 208–21;

discussion 221–3. doi:10.1016/0090-3019(95)00184-0. PMID 8545771.

15. ^ Nakamura M, Konishi N, Tsunoda S (Feb 2000). "Analysis of prognostic and survival factors related to treatment of low-

grade astrocytomas in adults". Oncology 58 (2): 108–16.doi:10.1159/000012087. PMID 10705237.

16. ^ Clinical trials in brain tumors.. Accessed June 2000.

17. ^ Radiosurgery treatment comparisons - Cyberknife, Gamma knife, Novalis Tx

18. ^ Treating secondary brain tumours with WBRT

19. ^ Whole Brain Radiation increases risk of learning and memory problems in cancer patients with brain metastases

20. ^ IRSA - International RadioSurgery Association - Metastatic brain tumors

21. ^http://www.emedicinehealth.com/normal_pressure_hydrocephalus/page9_em.htm

22. ^ Researchers Find Cancer-Killing Virus; July 24, 2000.

 23. ^ Yale Lab Engineers Virus That Can Kill Deadly Brain Tumors; February 21, 2008.

24. ^ Janny P, Cure H, Mohr M (Apr 1994). "Low grade supratentorial astrocytomas. Management and prognostic

factors". Cancer 73 (7): 1937–45. doi:10.1002/1097-0142(19940401)73:7<1937::AID-CNCR2820730727>3.0.CO;2-G. PMID 8137221.

25. ^ Piepmeier J, Christopher S, Spencer D (May 1996). "Variations in the natural history and survival of patients with

supratentorial low-grade astrocytomas". Neurosurgery 38 (5): 872–8; discussion 878–9. doi:10.1097/00006123-199605000-

00002.PMID 8727811.

26. ^ this is an anonimised interview that relates a personal experience recorded in a patient-support group by ~~~~

27. ^ Template:Journal

28. ^ http://www-dep.iarc.fr

29. ^ a b Greenlee RT, Murray T, Bolden S, Wingo PA (2000). "Cancer statistics, 2000". CA Cancer J Clin 50 (1): 7–

33.doi:10.3322/canjclin.50.1.7. PMID 10735013.

30. ^ a b American Cancer Society. Accessed June 2000.

31. ^ Chamberlain MC, Kormanik PA (Feb 1998). "Practical guidelines for the treatment of malignant gliomas". West J

Med. 168 (2): 114–20. PMID 9499745.

[edit]External links

 American Brain Tumor Association The American Brain Tumor Association exists to eliminate brain tumors through research

and to meet the needs of brain tumor patients and their families.

 National Brain Tumor Society National Brain Tumor Society (NBTS) brings together the best of research and patient services to

be a comprehensive resource for patients, families, caregivers, researchers, and medical professionals.

 UWO Brain tumors, Approach to..

 Management Neuro-oncology disorders

 Brain Cancer Vaccine Video

 The Brain Tumor Trials Collaborative: Brain Tumor Research

 Brain and CNS cancers at the Open Directory Project

 WebMD: Brain Cancer Health Center

 Medical Image Database MR and CT Scans of Brain Tumors

 Seattle's Ivy Center for Advanced Brain Tumor Treatment

 Medical Encyclopedia MayoClinic: Brain tumor

 Brain Tumor: Definitions Neurosurgery UCLA

 Medline Plus: Brain Cancer – Interactive Health Tutorials

 Visualase Laser Technology For Thermal Tumor Ablation

 Brain Tumor Locations Differential Diagnosis

  MedPix Teaching File MR Scans of Primary Brain Lymphoma

 Brain Tumour Foundation of Canada Support, education, information and research

 Samantha Dickson Brain Tumour Trust UK charity offering support, education, information and research

Categories: Brain | Oncology | Disorders causing seizures | Nervous system neoplasms | Brain tumor

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What is the brain?

The brain is a soft, spongy mass oftissue. It is protected by the bones of the skull and three thin membranescalled meninges. Watery fluid
calledcerebrospinal fluid cushions the brain. This fluid flows through spaces between the meninges and through spaces within the brain
calledventricles.

A network of nerves carries messages back and forth between the brain and the rest of the body. Some nerves go directly from the brain to the eyes,
ears, and other parts of the head. Other nerves run through the spinal cord to connect the brain with the other parts of the body. Within the brain and
spinal cord, glial cells surround nerve cells and hold them in place.

The brain directs the things we choose to do (like walking and talking) and the things our body does without thinking (like breathing). The brain is also
in charge of our senses (sight, hearing, touch, taste, and smell), memory, emotions, and personality.

The three major parts of the brain control different activities:

• Cerebrum - The cerebrum is the largest part of the brain. It is at the top of the brain. It uses information from our senses to tell us what is
going on around us and tells our body how to respond. It controls reading, thinking, learning, speech, and emotions.

The cerebrum is divided into the left and right cerebral hemispheres, which control separate activities. The right hemisphere controls the muscles on
the left side of the body. The left hemisphere controls the muscles on the right side of the body.

• Cerebellum - The cerebellum is under the cerebrum at the back of the brain. The cerebellum controls balance and complex actions like
walking and talking.

• Brain Stem - The brain stem connects the brain with the spinal cord. It controls hunger and thirst. It also controls breathing, body
temperature, blood pressure, and other basic body functions.
 The brain and nearby structures

Major parts of the brain

What is cancer?

Cancer begins in cells, the building blocks that make up tissues. Tissues make up the organs of the body.

Normally, cells grow and divide to form new cells as the body needs them. When cells grow old, they die, and new cells take their place.

Sometimes this orderly process goes wrong. New cells form when the body does not need them, and old cells do not die when they should. These
extra cells can form a mass of tissue called a growth or tumor.

What are benign and malignant brain tumors?

Brain tumors can be benign or malignant:

• Benign brain tumors do not contain cancer cells:

o Usually, benign tumors can be removed, and they seldom grow back.

o The border or edge of a benign brain tumor can be clearly seen. Cells from benign tumors do not invade tissues around them
or spread to other parts of the body. However, benign tumors can press on sensitive areas of the brain and cause serious health problems.

o Unlike benign tumors in most other parts of the body, benign brain tumors are sometimes life threatening.

o Very rarely, a benign brain tumor may become malignant.

• Malignant brain tumors contain cancer cells:

o Malignant brain tumors are generally more serious and often are life threatening.

o They are likely to grow rapidly and crowd or invade the surrounding healthy brain tissue.

o Very rarely, cancer cells may break away from a malignant brain tumor and spread to other parts of the brain, to the spinal
cord, or even to other parts of the body. The spread of cancer is called metastasis.

o Sometimes, a malignant tumor does not extend into healthy tissue. The tumor may be contained within a layer of tissue. Or
the bones of the skull or another structure in the head may confine it. This kind of tumor is calledencapsulated.
Tumor Grade

Doctors sometimes group brain tumors by grade - from low grade (grade I) to high grade (grade IV). The grade of a tumor refers to the way the cells
look under a microscope. Cells from high-grade tumors look more abnormal and generally grow faster than cells from low-grade tumors.

What are primary brain tumors?

Tumors that begin in brain tissue are known as primary tumors of the brain. (Information about secondary brain tumors appears in the following
section.) Primary brain tumors are named according to the type of cells or the part of the brain in which they begin.

The most common primary brain tumors aregliomas. They begin in glial cells. There are many types of gliomas:

• Astrocytoma - The tumor arises from star-shaped glial cells calledastrocytes. In adults, astrocytomas most often arise in the cerebrum.
In children, they occur in the brain stem, the cerebrum, and the cerebellum. A grade III astrocytoma is sometimes called an anaplastic astrocytoma.
A grade IV astrocytoma is usually called aglioblastoma multiforme.

• Brain stem glioma - The tumor occurs in the lowest part of the brain. Brain stem gliomas most often are diagnosed in young children and
middle-aged adults.

• Ependymoma - The tumor arises from cells that line the ventricles or the central canal of the spinal cord. They are most commonly found
in children and young adults.

• Oligodendroglioma - This rare tumor arises from cells that make the fatty substance that covers and protects nerves. These tumors
usually occur in the cerebrum. They grow slowly and usually do not spread into surrounding brain tissue. They are most common in middle-aged
adults.

Some types of brain tumors do not begin in glial cells. The most common of these are:

• Medulloblastoma - This tumor usually arises in the cerebellum. It is the most common brain tumor in children. It is sometimes called
a primitive neuroectodermal tumor.

• Meningioma - This tumor arises in the meninges. It usually grows slowly.

• Schwannoma - A tumor that arises from a Schwann cell. These cells line the nerve that controls balance and hearing. This nerve is in
the inner ear. The tumor is also called an acoustic neuroma. It occurs most often in adults.

• Craniopharyngioma - The tumor grows at the base of the brain, near the pituitary gland. This type of tumor most often occurs in
children.

• Germ cell tumor of the brain - The tumor arises from a germ cell. Most germ cell tumors that arise in the brain occur in people younger
than 30. The most common type of germ cell tumor of the brain is a germinoma.

• Pineal region tumor - This rare brain tumor arises in or near the pineal gland. The pineal gland is located between the cerebrum and the
cerebellum.

What are secondary brain tumors?

When cancer spreads from its original place to another part of the body, the new tumor has the same kind of abnormal cells and the same name as
the primary tumor. Cancer that spreads to the brain from another part of the body is different from a primary brain tumor. When cancer cells spread to
the brain from another organ (such as the lung or breast), doctors may call the tumor in the brain a secondary tumor or metastatic tumor. Secondary
tumors in the brain are far more common than primary brain tumors.

What causes and who is at risk for brain tumors?

No one knows the exact causes of brain tumors. Doctors can seldom explain why one person develops a brain tumor and another does not. However,
it is clear that brain tumors are not contagious. No one can "catch" the disease from another person.
Research has shown that people with certainrisk factors are more likely than others to develop a brain tumor. A risk factor is anything that increases a
person's chance of developing a disease.

The following risk factors are associated with an increased chance of developing a primary brain tumor:

• Being male - In general, brain tumors are more common in males than females. However, meningiomas are more common in females.

• Race - Brain tumors occur more often among white people than among people of other races.

• Age - Most brain tumors are detected in people who are 70 years old or older. However, brain tumors are the second most common
cancer in children. (Leukemia is the most common childhood cancer.) Brain tumors are more common in children younger than 8 years old than in
older children.

• Family history - People with family members who have gliomas may be more likely to develop this disease.

• Being exposed to radiation or certain chemicals at work:

o Radiation - Workers in the nuclear industry have an increased risk of developing a brain tumor.

o Formaldehyde - Pathologists and embalmers who work with formaldehydehave an increased risk of developing brain
cancer. Scientists have not found an increased risk of brain cancer among other types of workers exposed to formaldehyde.

o Vinyl chloride - Workers who make plastics may be exposed to vinyl chloride. This chemical may increase the risk of brain
tumors.

o Acrylonitrile - People who make textiles and plastics may be exposed to acrylonitrile. This exposure may increase the risk of
brain cancer.

Scientists are investigating whether cell phones may cause brain tumors. Studies thus far have not found an increased risk of brain tumors among
people who use cell phones.

Scientists also continue to study whether head injuries are a risk factor for brain tumors. So far, these studies have not found an increased risk among
people who have had head injuries.

Most people who have known risk factors do not get brain cancer. On the other hand, many who do get the disease have none of these risk factors.
People who think they may be at risk should discuss this concern with their doctor. The doctor may be able to suggest ways to reduce the risk and can
plan an appropriate schedule for checkups

What are symptoms of brain tumors?

The symptoms of brain tumors depend on tumor size, type, and location. Symptoms may be caused when a tumor presses on a nerve or damages a
certain area of the brain. They also may be caused when the brain swells or fluid builds up within the skull.

These are the most common symptoms of brain tumors:

• Headaches (usually worse in the morning)

• Nausea or 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 (seizures or convulsions)

• Numbness or tingling in the arms or legs

These symptoms are not sure signs of a brain tumor. Other conditions also could cause these problems. Anyone with these symptoms should see a
doctor as soon as possible. Only a doctor can diagnose and treat the problem.

How are brain tumors diagnosed?

If a person has symptoms that suggest a brain tumor, the doctor may perform one or more of the following procedures:

• Physical exam - The doctor checks general signs of health.

• Neurologic exam - The doctor checks for alertness, muscle strength, coordination, reflexes, and response to pain. The doctor also
examines the eyes to look for swelling caused by a tumor pressing on the nerve that connects the eye and brain.

• CT scan - An x-ray machine linked to a computer takes a series of detailed pictures of the head. The patient may receive an injection of a
special dye so the brain shows up clearly in the pictures. The pictures can show tumors in the brain.

• MRI - A powerful magnet linked to a computer makes detailed pictures of areas inside the body. These pictures are viewed on a monitor
and can also be printed. Sometimes a special dye is injected to help show differences in the tissues of the brain. The pictures can show a tumor or
other problem in the brain.
The doctor may ask for other tests:

• Angiogram - Dye injected into the bloodstream flows into the blood vessels in the brain to make them show up on an x-ray. If a tumor is
present, the doctor may be able to see it on the x-ray.

• Skull x-ray - Some types of brain tumors cause calcium deposits in the brain or changes in the bones of the skull. With an x-ray, the
doctor can check for these changes.

• Spinal tap - The doctor may remove a sample of cerebrospinal fluid (the fluid that fills the spaces in and around the brain and spinal
cord). This procedure is performed with local anesthesia. The doctor uses a long, thin needle to remove fluid from the spinal column. A spinal tap
takes about 30 minutes. The patient must lie flat for several hours afterward to keep from getting a headache. A laboratory checks the fluid for
cancer cells or other signs of problems.

• Myelogram - This is an x-ray of the spine. A spinal tap is performed to inject a special dye into the cerebrospinal fluid. The patient is tilted
to allow the dye to mix with the fluid. This test helps the doctor detect a tumor in the spinal cord.

• Biopsy - The removal of tissue to look for tumor cells is called a biopsy. A pathologist looks at the cells under a microscope to check for
abnormal cells. A biopsy can show cancer, tissue changes that may lead to cancer, and other conditions. A biopsy is the only sure way to diagnose
a brain tumor.

• Surgeons can obtain tissue to look for tumor cells in three ways:

o Needle biopsy - The surgeon makes a small incision in the scalp and drills a small hole into the skull. This is called a burr
hole. The doctor passes a needle through the burr hole and removes a sample of tissue from the brain tumor.

o Stereotactic biopsy - An imaging device, such as CT or MRI, guides the needle through the burr hole to the location of the
tumor. The surgeon withdraws a sample of tissue with the needle.

o Biopsy at the same time as treatment - Sometimes the surgeon takes a tissue sample when the patient has surgery to
remove the tumor.
Sometimes a biopsy is not possible. If the tumor is in the brain stem or certain other areas, the surgeon may not be able to remove tissue from the
tumor without damaging normal brain tissue. The doctor uses MRI, CT, or other imaging tests instead.

A person who needs a biopsy may want to ask the doctor the following questions:

• Why do I need a biopsy? How will the biopsy affect my treatment plan?

• What kind of biopsy will I have?

• How long will it take? Will I be awake? Will it hurt?

• What are the chances of infection or bleeding after the biopsy? Are there any other risks?
 • How soon will I know the results?

• If I do have a brain tumor, who will talk to me about treatment? When?

What is the treatment for brain tumors?

Many people with brain tumors want to take an active part in making decisions about their medical care. They want to learn all they can about their
disease and their treatment choices. However, shock and stress after a diagnosis of a brain tumor can make it hard to think of everything to ask the
doctor. It often helps to make a list of questions before an appointment. To help remember what the doctor says, patients may take notes or ask
whether they may use a tape recorder. Some also want to have a family member or friend with them when they talk to the doctor - to take part in the
discussion, to take notes, or just to listen.

The doctor may refer the patient to a specialist, or the patient may ask for a referral. Specialists who treat brain tumors include neurosurgeons,
neurooncologists, medical oncologists, and radiation oncologists. The patient may be referred to other health care professionals who work together as
a team. The medical team may include a nurse, dietitian, mental healthcounselor, social worker, physical therapist, occupational therapist, and speech
therapist. Children may need tutors to help with schoolwork. (The section on "Rehabilitation" has more information about therapists and tutors.)

Getting a second opinion

Before starting treatment, the patient might want a second opinion about the diagnosis and the treatment plan. Some insurance companies require a
second opinion; others may cover a second opinion if the patient or doctor requests it.

There are a number of ways to find a doctor for a second opinion:

• The patient's doctor may refer the patient to one or more specialists. At cancer centers, several specialists often work together as a
team.

• The Cancer Information Service, at 1-800-4-CANCER, can tell callers about nearby treatment centers.

• A person with a brain tumor can request a consultation with a team of specialists in NCI's Neuro-Oncology Branch of the Warren Grant
Magnuson Clinical Center at the National Institutes of Health in Bethesda, Maryland (301-402-6298).

• A local or state medical society, a nearby hospital, or a medical school can usually provide the names of specialists.

• The American Board of Medical Specialties (ABMS) has a list of doctors who have met certain education and training requirements and
have passed specialty examinations. The Official ABMS Directory of Board Certified Medical Specialists lists doctors' names along with their
specialty and their educational background. The directory is available in most public libraries. Also, ABMS offers this information on the Internet at
http://www.abms.org. (Click on "Who's Certified.")

Preparing for Treatment

The doctor can describe treatment choices and discuss the results expected with each treatment option. The doctor and patient can work together to
develop a treatment plan that fits the patient's needs.

Treatment depends on a number of factors, including the type, location, size, and grade of the tumor. For some types of brain cancer, the doctor also
needs to know whether cancer cells were found in the cerebrospinal fluid.

These are some questions a person may want to ask the doctor before treatment begins:

• What type of brain tumor do I have?

• Is it benign or malignant?

• What is the grade of the tumor?

• What are my treatment choices? Which do you recommend for me? Why?

• What are the benefits of each kind of treatment?

• What are the risks and possible side effects of each treatment?
 • What is the treatment likely to cost?

• How will treatment affect my normal activities?

• Would a clinical trial (research study) be appropriate for me? Can you help me find one?

People do not need to ask all of their questions or understand all of the answers at one time. They will have other chances to ask the doctor to explain
things that are not clear and to ask for more information.

• Methods of treatment

Methods of Treatment

People with brain tumors have several treatment options. Depending on the tumor type and stage, patients may be treated with surgery, radiation therapy, or chemotherapy. Some pa

In addition, at any stage of disease, patients may have treatment to control pain and other symptoms of the cancer, to relieve the side effects of therapy, and to ease emotional proble
palliative care.

The doctor is the best person to describe the treatment choices and discuss the expected results.

A patient may want to talk to the doctor about taking part in a clinical trial, which is a research study of new treatment methods. The section on "The Promise of Cancer Research" has

Surgery is the usual treatment for most brain tumors. Surgery to open the skull is called a craniotomy. It is performed under general anesthesia. Before surgery begins, the scalp is sh
type of saw to remove a piece of bone from the skull. After removing part or all of the tumor, the surgeon covers the opening in the skull with that piece of bone or with a piece of meta

These are some questions a person may want to ask the doctor before having surgery:

• How will I feel after the operation?

• What will you do for me if I have pain?

• How long will I be in the hospital?

• Will I have any long-term effects? Will my hair grow back? Are there any side effects from using metal or fabric to replace the bone in the skull?

• When can I get back to my normal activities?

• What is my chance of a full recovery?

Sometimes surgery is not possible. If the tumor is in the brain stem or certain other areas, the surgeon may not be able to remove the tumor without damaging normal brain tissue. Pa

Radiation therapy

Radiation therapy (also called radiotherapy) uses high-energy rays to kill tumor cells. The radiation may come from x-rays, gamma rays, or protons. A large machine aims radiation at
to the entire brain or to the spinal cord.

Radiation therapy usually follows surgery. The radiation kills tumor cells that may remain in the area. Sometimes, patients who cannot have surgery have radiation therapy instead.

The patient goes to a hospital or clinic for radiation therapy. The treatment schedule depends on the type and size of the tumor and the age of the patient. Each treatment lasts only a

Doctors take steps to protect the healthy tissue around the brain tumor:

• Fractionation - Radiation therapy usually is given five days a week for several weeks. Giving the total dose of radiation over an extended period helps to protect healthy t

• Hyperfractionation - The patient gets smaller doses of radiation two or three times a day instead of a larger amount once a day.

• Stereotactic radiation therapy - Narrow beams of radiation are directed at the tumor from different angles. For this procedure, the patient wears a rigid head frame. An M
 a computer to decide on the dose of radiation needed, as well as the sizes and angles of the radiation beams. The therapy may be given during a single visit or over several visits.

• 3-dimensional conformal radiation therapy - A computer creates a 3-dimensional image of the tumor and nearby brain tissue. The doctor aims multiple radiation beam
protects normal brain tissue.

• Proton beam radiation therapy - The source of radiation is protons rather than x-rays. The doctor aims the proton beams at the tumor. Protons can pass through healthy

These are some questions a person may want to ask the doctor before having radiation therapy:

• Why do I need this treatment?

• When will the treatments begin? When will they end?

• How will I feel during therapy? Are there side effects?

• What can I do to take care of myself during therapy?

• How will we know if the radiation is working?

• Will I be able to continue my normal activities during treatment?

Chemotherapy

Chemotherapy, the use of drugs to kill cancer cells, is sometimes used to treat brain tumors. The drugs may be given by mouth or by injection. Either way, the drugs enter the bloodst
that a recovery period follows each treatment period.

Chemotherapy may be given in an outpatient part of the hospital, at the doctor's office, or at home. Rarely, the patient may need to stay in the hospital.

Children are more likely than adults to have chemotherapy. However, adults may have chemotherapy after surgery and radiation therapy.

For some patients with recurrent cancer of the brain, the surgeon removes the tumor and implants several wafers that contain chemotherapy. Each wafer is about the size of a dime. O
drug kills cancer cells.

Patients may want to ask these questions about chemotherapy:

• Why do I need this treatment?

• What will it do?

• Will I have side effects? What can I do about them?

• When will treatment start? When will it end?

• How often will I need checkups?

/

What are the side effects of treatment for brain tumors?

Because treatment may damage healthy cells and tissues, unwanted side effects are common. These side effects depend on many factors, including
the location of the tumor and the type and extent of the treatment. Side effects may not be the same for each person, and they may even change from
one treatment session to the next. Before treatment starts, the health care team will explain possible side effects and suggest ways to help the patient
manage them.

Surgery

Patients often have a headache or are uncomfortable for the first few days after surgery. However, medicine can usually control their pain. Patients
should feel free to discuss pain relief with the doctor or nurse.

It is also common for patients to feel tired or weak. The length of time it takes to recover from an operation varies for each patient.
Other, less common, problems may occur. Cerebrospinal fluid or blood may build up in the brain. This swelling is called edema. The health care team
monitors the patient for signs of these problems. The patient may receive steroids to help relieve swelling. A second surgery may be needed to drain
the fluid. The surgeon may place a long, thin tube (shunt) in a ventricle of the brain. The tube is threaded under the skin to another part of the body,
usually the abdomen. Excess fluid is carried from the brain and drained into the abdomen. Sometimes the fluid is drained into the heart instead.

Infection is another problem that may develop after surgery. If this happens, the health care team gives the patient an antibiotic.

Brain surgery may damage normal tissue. Brain damage can be a serious problem. The patient may have problems thinking, seeing, or speaking. The
patient also may have personality changes or seizures. Most of these problems lessen or disappear with time. But sometimes damage to the brain is
permanent. The patient may need physical therapy, speech therapy, or occupational therapy.

Radiation Therapy

Some patients have nausea for several hours after treatment. The health care team can suggest ways to help patients cope with this problem.
Radiation therapy also may cause patients to become very tired as treatment continues. Resting is important, but doctors usually advise patients to try
to stay as active as they can.

In addition, radiation therapy commonly causes hair loss. Hair usually grows back within a few months. Radiation therapy also may affect the skin in
the treated area. The scalp and ears may become red, dry, and tender. The health care team can suggest ways to relieve these problems.

Sometimes radiation therapy causes brain tissue to swell. Patients may get a headache or feel pressure. The health care team watches for signs of
this problem. They can provide medicine to reduce the discomfort.

Radiation sometimes kills healthy brain tissue. This side effect is called radiation necrosis. Necrosis can cause headaches, seizures, or even the
patient's death.

In children, radiation may damage the pituitary gland and other areas of the brain. This could cause learning problems or slow down growth and
development. In addition, radiation during childhood increases the risk of secondary tumors later in life. Researchers are studying whether
chemotherapy may be used instead of radiation therapy in young children with brain tumors.

Side effects may be worse if chemotherapy and radiation therapy are given at the same time. The doctor can suggest ways to ease these problems.

Chemotherapy

The side effects of chemotherapy depend mainly on the drugs that are used. The most common side effects include fever and chills, nausea and
vomiting, loss of appetite, andweakness. Some side effects may be relieved with medicine.

Patients who receive an implant (a wafer) that contains a drug are monitored by the health care team for signs of infection after surgery. An infection
can be treated with an antibiotic.

Supportive Care

At any stage of disease, people with brain tumors receive supportive care to prevent or control problems and to improve their comfort and quality of
life during treatment. Patients may have treatment to control pain and other symptoms of a brain tumor, to relieve the side effects of therapy, and to
ease emotional problems.

These are common types of supportive care for people with brain tumors:

• Steroids - Most patients with brain tumors need steroids to help relieve swelling of the brain.

• Anticonvulsant medicine - Brain tumors can cause seizures. Patients may take an anticonvulsant medicine to prevent or control seizures.

• Shunt - If fluid builds up in the brain, the surgeon may place a shunt to drain the fluid. Information about shunts is under "Surgery" in the
"Side Effects" section.

Many people with brain tumors receive supportive care along with treatments intended to slow the progress of the disease. Some decide not to have
antitumor treatment and receive only supportive care to manage their symptoms.

What about rehabilitation after treatment for brain tumors?

Rehabilitation can be a very important part of the treatment plan. The goals of rehabilitation depend on the person's needs and how the tumor has
affected daily activities. The health care team makes every effort to help the patient return to normal activities as soon as possible. Several types of
therapists can help:

• Physical therapists - Brain tumors and their treatment may cause paralysis. They may also cause weakness and problems with balance.
Physical therapists help patients regain strength and balance.
 • Speech therapists - Speech therapists help patients who have trouble speaking, expressing thoughts, or swallowing.

• Occupational therapists - Occupational therapists help patients learn to manage activities of daily living, such as eating, using the toilet,
bathing, and dressing.

Children with brain tumors may have special needs. Sometimes children have tutors in the hospital or at home. Children who have problems learning
or remembering what they learn may need tutors or special classes when they return to school.

What happens after treatment for brain tumors?

Regular followup is very important after treatment for a brain tumor. The doctor checks closely to make sure that the tumor has not returned.
Checkups may include careful physical and neurologic exams. From time to time, the patient may have MRI or CT scans. If the patient has a shunt,
the doctor checks to see that it is working well. The doctor can explain the followup plan - how often the patient must visit the doctor and what tests
will be needed.

What support is available to patients with brain tumors?

Living with a serious disease such as a brain tumor is not easy. Some people find they need help coping with the emotional and practical aspects of
their disease. Support groups can help. In these groups, patients or their family members get together to share what they have learned about coping
with the disease and the effects of treatment. Patients may want to talk with a member of their health care team about finding a support group. Groups
may offer support in person, over the telephone, or on the Internet.

People living with a brain tumor may worry about caring for their families, keeping their jobs, or continuing daily activities. Concerns about treatments
and managing side effects, hospital stays, and medical bills are also common. Doctors, nurses, and other members of the health care team can
answer questions about treatment, working, or other activities. Meeting with a social worker, counselor, or member of the clergy can be helpful to
those who want to talk about their feelings or discuss their concerns. Often, a social worker can suggest resources for financial aid, transportation,
home care, or emotional support.

The Cancer Information Service can provide information to help patients and their families locate programs, services, and publications.

The promise of cancer research

Doctors all over the country are conducting many types of clinical trials. These are research studies in which people take part voluntarily. Studies
include new ways to treat brain tumors. Research has already led to advances, and researchers continue to search for more effective approaches.

Patients who join these studies have the first chance to benefit from treatments that have shown promise in earlier research. They also make an
important contribution to medical science by helping doctors learn more about the disease. Although clinical trials may pose some risks, researchers
take very careful steps to protect their patients.

Researchers are testing new anticancer drugs, doses, and treatment schedules. They are working with various drugs and drug combinations, as well
as combinations of drugs and radiation therapy. They also are testing new methods and schedules of radiation therapy.

Patients who are interested in being part of a clinical trial should talk with their doctor. NCI's Web site includes a section on clinical trials at
http://www.cancer.gov/clinicaltrials. This section of the Web site provides general information about clinical trials. It also offers detailed information
about ongoing studies of treatment for brain tumors. The Cancer Information Service at 1-800-4-CANCER can answer questions and provide
information about clinical trials

Brain Tumor At A Glance

• Brain tumors can be either malignant or benign.

• The causes of brain tumors are not known.

• Brain tumors can occur at any age.

• Primary brain tumors initially form in the brain tissue.

• Secondary brain tumors are cancers that have spread to the brain tissue from tissue elsewhere in the body.

• The symptoms of brain tumors depend on their size and their location in the brain.
• Brain tumors are diagnosed by the doctor based on the results of a medical history and physical examination and results of a variety of
specialized tests of the brain and nervous system.

• Treatment of a brain tumor depends on the type, location, and size of the tumor, as well as the age and health of the patient.