Brain Cancer/Brain Tumor/Spinal Cord Tumor

Medical Code: SGM-FS-004
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Condition: Brain Cancer/Brain Tumor/Spinal Cord Tumor

Layman’s Definition:  Uncontrolled growth of cells in the brain

Prevalence: 78,000 new cases/year (25,000 malignant); 700,000 living with tumor or in remission   

Typical Age of Symptom Onset: 0-19 yrs and >60 yrs (median age 59)

Primary Symptoms: Symptoms of brain cancers depend on the location and type of the tumor. The most consistent symptom of cancer is a persistent headache, often with nausea. However, the headache often does not appear until the tumor has grown to considerable size, and other symptoms often appear earlier. (The headache from a brain tumor is most commonly felt as being inside of the head, as opposed to feeling like one’s head is being squeezed. See: Doctor I have a Headache.)

Changes in vision are also relatively common; the eyes are directly connected to the brain, and the retina is technically a part of the brain. Depending on the location of the tumor, individuals may experience muscle weakness, numbness, loss of vision, loss of hearing, difficulty concentrating, memory loss, poor coordination, difficulty speaking, burning shooting pain, unusual thoughts, seizures, and/or emotional instability. In addition, personality changes can be caused by tumors that release neurotransmitters or are close to emotional centers.

Secondary Symptoms: Left untreated, a growing brain or spinal cord tumor will result in increasing disability, extreme pain, and ultimately death.

Radiation treatment, commonly used to destroy central nervous system (CNS) tumors, causes blood vessels to slowly break down. This can result in the person suffering one or more bleeding type (hemorrhagic) strokes around six months to three years after radiation treatment. These strokes may be large enough to cause paralysis or even death. Deaths caused by radiation-induced breakdown of blood vessels however tend to be swift and relatively painless. The longer survival time of patients with radiation-treated tumors and the reduced suffering mean that most people will choose radiation treatment, even if the dosage necessary to destroy the tumor is also likely to be fatal.

Tissue damage caused by the tumor itself or surgery or radiation treatments can result in epileptic seizures.   

Chemotherapy treatments can result in prolonged difficulty with concentration. They can also unmask underlying tendencies towards depression and/or anxiety.

The emotional stress of coping with a cancer diagnosis can worsen underlying emotional problems and put stress on personal relationships.

Cause(s)/Risk Factor(s): Cancer is the result of damage to a cell’s DNA, which results in uncontrolled cell division and migration. Normal cells essentially commit suicide (apoptosis) if they are damaged in ways that cause them to pose a danger to the body, and they grow and divide only until they come into contact other cells. However, cancer cells continue to divide, and they push into areas occupied by normal tissue.

Certain genetic mutations increase the risk of developing cancer as does exposure to chemicals or radiation, which can damage DNA. The most controllable risk factor for all cancers is not to smoke.

There are more than 100 different histological types of brain or spinal cord cancers, each of which is treated slightly differently and has a different prognosis or likelihood of successful treatment.

Cancers of the CNS can be divided into four general classes based on the cell type of origin. The cell type of origin for the tumor cells is important because cancer cells retain some of the properties of the cells they came from. This means that some kinds of cancers are more invasive and/or faster growing than others, and some are more easily destroyed with different treatments.

Meningiomas are derived from the tissue that surrounds and protects the brain. These tumors are not protected by the blood-brain/blood-spinal cord barrier and often do not invade the brain proper. They are the most common CNS (brain and spinal cord) tumors.

Gliomas are derived from the support cells that represent 9/10 of the cells in the brain. Examples of gliomas include glioblastomas and astrocytomas.

Neuroblastomas are derived from nerve cells, also called neurons. These tumors sometimes secrete neurotransmitters.

Secondary tumors are cancers that originate elsewhere in the body and travel to the brain. Breast cancers and melanomas are examples of these.

Standard Treatment(s): Brain tumors are usually first identified with MRII imaging or a PET scan.  After a tumor has been identified, the next step is usually to obtain a sample or biopsy of the tumor, if possible. Analysis of the tissue sample can identify the type of cancer and guide treatment decisions. The tissue sample is obtained using a needle-like punch that’s guided to the precise position of the tumor seen in the MRI. Depending on the location of the tumor in the brain or spinal cord, however, it may not be possible to obtain a biopsy of the tumor without risking damage to critical parts of the brain.

Treatment options for CNS tumors tend to be extremely limited. A special structural arrangement of blood vessels, called the blood-brain and blood-spinal cord barrier, prevents chemotherapy drugs from reaching tumors within the CNS (brain and spinal cord). This is one of the reasons secondary tumors (metastatic tumors) often appear in the brain after chemotherapy treatment has successfully eliminated cancers elsewhere in the body. The barrier that protects the brain also protects the cancer.  Chemotherapy therefore cannot generally be used as a single therapy for brain cancers, as it is effective in brain tissue only if the blood-brain barrier has first been opened up by radiation treatment. Treatment options for brain cancers are therefore generally limited to surgery, radiation, surgery + radiation, or radiation + chemotherapy (with or without surgery).

Because surgery and chemotherapy both have limited usefulness in the CNS, radiation is the main tool for treating brain cancers. Radiation may be delivered to the whole brain, a portion of the brain (with the rest of the head shielded), or at very discrete localized areas using a technique called GammaKnife or CyberKnife® radiation. In these more localized treatments, beams of radiation are delivered from different angles and converge on the intended target. This technique minimizes radiation damage to cells outside the target area.  Radiation is also typically delivered in small doses, called fractions, over a period of several weeks. The recovery time allows the normal tissue to recover between treatments, minimizing damage to normal brain tissue. In each case, the goal is to deliver the lowest level of radiation to the smallest area that will reliably kill the cancer. Analyzing a tissue biopsy increases the odds of getting that dosage just right.

Anti-seizure medication may be prescribed to prevent epileptic seizures caused by brain damage form the tumor, surgery, and/or radiation treatment.

Steroid medications (corticosteroids) may be prescribed to reduce brain inflammation, and therefore the pain, nausea, and other symptoms caused by the cancer or the cancer therapies. Steroid treatments are considered to be palliative care; that is, control the symptoms but do not treat the cancer.

Because the symptoms of brain cancers and/or their treatment can be very unpleasant, a palliative care specialist may be brought into the treatment team early.  This does not mean that the person’s condition is hopeless, or that the doctors have given up on a cure.  The neurosurgeons and neuro-oncologists focus on trying to kill the cancer and save the patient.  The palliative care physicians focus on making sure that life feels like it is worth living.

After treatment, individuals may be referred to a physical therapist or speech therapist to help retrain undamaged brain tissue to take over functions of brain tissue damaged by the cancer or cancer treatments.

Occupational therapy may be recommended to help learn new strategies to optimize independence and work around any remaining disability.

Psychological counseling may be advised for the patient and/or family members to help cope with the emotional stress of a difficult diagnosis, possible loss of life, and/or the changes in lifestyle that may be necessary to adapt to any long-term disability.

For more information about brain or spinal cord cancers and clues about what to listen for when your doctor talks about a treatment plan, see: Brain Cancer. I’m Afraid That I Have Bad News

For more information about different kinds and grades of brain tumors and their treatment, see: http://nfcr.org/what-is-cancer/cancer-types/?gclid=CjwKEAjw3Nq9BRCw8OD6s4eI5HASJABsfCIaN6K2C9ZqKmKsJZ0CAVYhmwyAVx22lIrbh_x0kq4tDRoCua7w_wcB

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