Diseases

Metastatic Brain Tumors (Adult Brain Tumors) Information

Brain and spinal cord biopsy

A biopsy is also used to diagnose a brain tumor. If imaging tests show there may be a brain tumor, a biopsy is usually done. One of the following types of biopsies may be used:

• Stereotactic biopsy: When imaging tests show there may be a tumor deep in the brain in a hard to reach place, a stereotactic brain biopsy may be done. This kind of biopsy uses a computer and a 3-dimensional (3-D) scanning device to find the tumor and guide the needle used to remove the tissue. A small incision is made in the scalp and a small hole is drilled through the skull. A biopsy needle is inserted through the hole to remove cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer.
• Open biopsy: When imaging tests show that there may be a tumor that can be removed by surgery, an open biopsy may be done. A part of the skull is removed in an operation called a craniotomy. A sample of brain tissue is removed and viewed under a microscope by a pathologist. If cancer cells are found, some or all of the tumor may be removed during the same surgery. Tests are done before surgery to find the areas around the tumor that are important for normal brain function. There are also ways to test brain function during surgery. The doctor will use the results of these tests to remove as much of the tumor as possible with the least damage to normal tissue in the brain.

• Immunohistochemistry: A test that uses antibodies to check for certain antigens in a sample of tissue. The antibody is usually linked to a radioactive substance or a dye that causes the tissue to light up under a microscope. This type of test may be used to tell the difference between different types of cancer.
• Light and electron microscopy: A laboratory test in which cells in a sample of tissue are viewed under regular and high-powered microscopes to look for certain changes in the cells.
• Cytogenetic analysis: A laboratory test in which cells in a sample of tissue are viewed under a microscope to look for certain changes in the chromosomes.

Brain and spinal cord tumor in adults definition and facts*

*Adult brain tumor facts medical author: Charles P. Davis, MD, PhD

• The brain is a soft mass of tissue that has three major parts, the cerebrum, cerebellum and the brain stem, all of which are effectively surrounded and protected by the bones of the skull; the brain is the tissue that controls people's voluntary and involuntary actions (that is, bodily functions, thoughts, and sensations).
• Cancer is the unregulated growth of abnormal cells in the body (cancer cells are also termed malignant cells).
• Malignant brain tumors contain cancer cells; benign brain tumors do not contain cancer cells but do contain abnormally growing and dividing cells that do not metastasize (spread to other organs) but may still cause problems, often because of their size and are regulated to grow in a specific area.
• Primary brain tumors are composed of abnormal types of brain cells with unregulated growth; the most common type is termed gliomas that arise from brain glial cells, but there are many other types (for example, astrocytomas, ependymomas, medulloblastomas and oligodendrogliomas).
• Secondary brain tumors are metastatic tumors comprised of cells from other organs where cancers have started and then spread through the bloodstream to the brain tissue.
• Symptoms of adult brain tumors, many of which are non-specific and occur in other diseases, may include headaches, nausea, vomiting, speech, hearing or vision changes, memory problems, personality changes and paresthesias (an abnormal sensation of the skin such as numbness, tingling, prickling, burning, or creeping on the skin that has no objective cause), and seizures.
• Brain tumors are diagnosed preliminarily by many methods including detailed physical exam, CT and/or MRI exams, angiograms, and X-rays; definitive diagnosis is by removing tissue from the tumor (tumor biopsy) and examining the cells microscopically.
• The grade of tumor is based on how abnormal the cancer cells look microscopically and how fast the cells grow and spread. Grade are from I to IV, with grade IV the most aggressive cancer.
• Types of adult brain cancers include:
  • Brain stem gliomas
  • Pineal astrocytic tumor
  • Pilocytic astrocytoma
  • Diffuse astrocytoma
  • Anaplastic astrocytoma
  • Glioblastoma
  • Oligodendroglial tumors
  • Mixed gliomas
  • Ependymal tumors
  • Medulloblastoma
  • Pineal parenchymal tumors
  • Meningeal tumors
  • Germ cell tumor
  • Craniopharyngioma
• Recurrent adult brain tumor is a tumor that has recurred or come back after treatment.
• Metastatic or secondary brain tumors that commonly spread to the brain are lung, breast, unknown primary site, melanoma, and colon cancers.
• You and your medical treatment team (oncologists, neurosurgeons, second opinions, etc.) will discuss your treatment options based upon the type and grade of the tumor, your age, and any existing health problems. Treatment options may include chemotherapy, radiation therapy, surgery, or a combination of these therapies. However, in some case no medical treatment is necessary. Clinical trials offer other types and/or new methods that may help some patients.
• Treatment choices for a brain tumor depends on joint decisions made by the patient and the patient's physician team (team members may include oncologists, neurosurgeons, and others the patient may choose, including other doctors who may give a second opinion); treatment methods are based on the individual's disease and may consist of surgery, chemotherapy, radiation therapy, combinations of these methods or no treatment.
• Side effects of treatments are common and numerous, but vary from patient to patient depending on the disease, method(s) used and the effectiveness of medications and other methods to reduce them; some of the most common side effects are weakness, nausea, edema, skin changes and hair loss but may include more serious problems such as infections, seizures, disabilities such as speech problems, mental changes and occasionally, death.
• Rehabilitation is frequently included in the treatment plan; specialists like physical, occupational and speech therapists can help the patient improve.
• Follow-up appointments are part of the treatment plan for brain tumors to catch any recurrent disease and to help with rehabilitation treatments.
• Support groups are available to patients with brain tumors and to patients who have and are undergoing treatments, for example, the American Cancer Society, American Brain Tumor Society.

Follow-up tests

Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.The following tests and procedures may be used to check whether a brain tumor has come back after treatment:

• SPECT scan (single photon emission computed tomography scan): A procedure that uses a special camera linked to a computer to make a 3-dimensional (3-D) picture of the brain. A very small amount of a radioactive substance is injected into a vein or inhaled through the nose. As the substance travels through the blood, the camera rotates around the head and takes pictures of the brain. Blood flow and metabolism are higher than normal in areas where cancer cells are growing. These areas will show up brighter in the picture. This procedure may be done just before or after a CT scan.
• PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the brain. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.

Genetic syndromes and risks

Anything that increases your chance of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn’t mean that you will not get cancer. Talk with your doctor if you think you may be at risk. There are few known risk factors for brain tumors. The following conditions may increase the risk of certain types of brain tumors:

• Being exposed to vinyl chloride may increase the risk of glioma.
• Infection with the Epstein-Barr virus, having AIDS (acquired immunodeficiency syndrome), or receiving an organ transplant may increase the risk of primary CNS lymphoma. (See the PDQ summary on Primary CNS Lymphoma for more information.)
• Having certain genetic syndromes may increase the risk brain tumors:
  • Neurofibromatosis type 1 (NF1) or 2 (NF2)
  • von Hippel-Lindau disease
  • Tuberous sclerosis
  • Li-Fraumeni syndrome
  • Turcot syndrome type 1 or 2
  • Nevoid basal cell carcinoma syndrome

Metastatic brain and spinal cord tumors in adults

Tumors that start in the brain are called primary brain tumors. Primary brain tumors may spread to other parts of the brain or to the spine. They rarely spread to other parts of the body.Often, tumors found in the brain have started somewhere else in the body and spread to one or more parts of the brain. These are called metastatic brain tumors (or brain metastases). Metastatic brain tumors are more common than primary brain tumors.Up to half of metastatic brain tumors are from lung cancer. Other types of cancer that commonly spread to the brain include:

• Melanoma
• Breast cancer
• Colon cancer
• Kidney cancer
• Nasopharyngeal cancer
• Cancer of unknown primary site

• Breast cancer
• Lung cancer
• Leukemia
• Lymphoma

New types of clinical trial treatments for brain and spinal cord tumors in adults

This summary section refers to new treatments being studied in clinical trials, but it may not mention every new treatment being studied.Proton beam radiation therapyProton beam radiation therapy is a type of high-energy, external radiation therapy that uses streams of protons (small, positively-charged pieces of matter) to make radiation. This type of radiation kills tumor cells with little damage to nearby tissues. It is used to treat cancers of the head, neck, and spine and organs such as the brain, eye, lung, and prostate. Proton beam radiation is different from x-ray radiation.Biologic therapyBiologic therapy is a treatment that uses the patient’s immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.Biologic therapy is being studied for the treatment of some types of brain tumors. Treatments may include:

• Dendritic cell vaccine therapy.
• Gene therapy.

Signs and symptoms of brain and spinal cord tumors in adults

The signs and symptoms of adult brain and spinal cord tumors are not the same in every person.Signs and symptoms depend on the following:

• Where the tumor forms in the brain or spinal cord.
• What the affected part of the brain controls.
• The size of the tumor.

• Morning headache or headache that goes away after vomiting.
• Seizures.
• Vision, hearing, and speech problems.
• Loss of appetite.
• Frequent nausea and vomiting.
• Changes in personality, mood, ability to focus, or behavior.
• Loss of balance and trouble walking.
• Weakness.
• Unusual sleepiness or change in activity level.

• Back pain or pain that spreads from the back towards the arms or legs.
• A change in bowel habits or trouble urinating.
• Weakness or numbness in the arms or legs.
• Trouble walking.

To Learn More

CallFor more information, U.S. residents may call the National Cancer Institute's (NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 9:00 a.m. to 4:30 p.m. Deaf and hard-of-hearing callers with TTY equipment may call 1-800-332-8615. The call is free and a trained Cancer Information Specialist is available to answer your questions.Web sites and OrganizationsThe NCI Web site provides online access to information on cancer, clinical trials, and other Web sites and organizations that offer support and resources for cancer patients and their families. There are also many other places where people can get materials and information about cancer treatment and services. Local hospitals may have information on local and regional agencies that offer information about finances, getting to and from treatment, receiving care at home, and dealing with problems associated with cancer treatment.PublicationsThe NCI has booklets and other materials for patients, health professionals, and the public. These publications discuss types of cancer, methods of cancer treatment, coping with cancer, and clinical trials. Some publications provide information on tests for cancer, cancer causes and prevention, cancer statistics, and NCI research activities. NCI materials on these and other topics may be ordered online or printed directly from the NCI Publications Locator. These materials can also be ordered by telephone from the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.LiveHelpThe NCI's LiveHelp service, a program available on several of the Institute's Web sites, provides Internet users with the ability to chat online with an Information Specialist. The service is available from 9:00 a.m. to 11:00 p.m. Eastern time, Monday through Friday. Information Specialists can help Internet users find information on NCI Web sites and answer questions about cancer.WriteFor more information from the NCI, please write to this address:NCI Public Inquiries OfficeSuite 3036A6116 Executive Boulevard, MSC8322Bethesda, MD 20892-8322

Types of brain tumors in adults

Astrocytic TumorsAn astrocytic tumor begins in star-shaped brain cells called astrocytes, which help keep nerve cells healthy. An astrocyte is a type of glial cell. Glial cells sometimes form tumors called gliomas. Astrocytic tumors include:

• Brain stem glioma (usually high grade): A brain stem glioma forms in the brain stem, which is the part of the brain connected to the spinal cord. It is often a high-grade tumor, which spreads widely through the brain stem and is hard to cure. Brain stem gliomas are rare in adults.
• Pineal astrocytic tumor (any grade): A pineal astrocytic tumor forms in tissue around the pineal gland and may be any grade. The pineal gland is a tiny organ in the brain that makes melatonin, a hormone that helps control the sleeping and waking cycle.
• Pilocytic astrocytoma (grade I): A pilocytic astrocytoma grows slowly in the brain or spinal cord. It may be in the form of a cyst and rarely spreads into nearby tissues. Pilocytic astrocytomas can often be cured.
• Diffuse astrocytoma (grade II): A diffuse astrocytoma grows slowly, but often spreads into nearby tissues. The tumor cells look something like normal cells. In some cases, a diffuse astrocytoma can be cured. It is also called a low-grade diffuse astrocytoma.
• Anaplastic astrocytoma (grade III): An anaplastic astrocytoma grows quickly and spreads into nearby tissues. The tumor cells look different from normal cells. This type of tumor usually cannot be cured. An anaplastic astrocytoma is also called a malignant astrocytoma or high-grade astrocytoma.
• Glioblastoma (grade IV): A glioblastoma grows and spreads very quickly. The tumor cells look very different from normal cells. This type of tumor usually cannot be cured. It is also called glioblastoma multiforme.

• Oligodendroglioma (grade II): An oligodendroglioma grows slowly, but often spreads into nearby tissues. The tumor cells look something like normal cells. In some cases, an oligodendroglioma can be cured.
• Anaplastic oligodendroglioma (grade III): An anaplastic oligodendroglioma grows quickly and spreads into nearby tissues. The tumor cells look different from normal cells. This type of tumor usually cannot be cured.

• Oligoastrocytoma (grade II): An oligoastrocytoma is a slow-growing tumor. The tumor cells look something like normal cells. In some cases, an oligoastrocytoma can be cured.
• Anaplastic oligoastrocytoma (grade III): An anaplastic oligoastrocytoma grows quickly and spreads into nearby tissues. The tumor cells look different from normal cells. This type of tumor has a worse prognosis than oligoastrocytoma (grade II).

• Ependymoma (grade I or II): A grade I or II ependymoma grows slowly and has cells that look something like normal cells. There are two types of grade I ependymoma - myxopapillary ependymoma and subependymoma. A grade II ependymoma grows in a ventricle (fluid-filled space in the brain) and its connecting paths or in the spinal cord. In some cases, a grade I or II ependymoma can be cured.
• Anaplastic ependymoma (grade III): An anaplastic ependymoma grows quickly and spreads into nearby tissues. The tumor cells look different from normal cells. This type of tumor usually has a worse prognosis than a grade I or II ependymoma.

• Pineocytoma (grade II): A pineocytoma is a slow-growing pineal tumor.
• Pineoblastoma (grade IV): A pineoblastoma is a rare tumor that is very likely to spread.

• Meningioma (grade I): A grade I meningioma is the most common type of meningeal tumor. A grade I meningioma is a slow-growing tumor. It forms most often in the dura mater. A grade I meningioma can be cured if it is completely removed by surgery.
• Meningioma (grade II and III): This is a rare meningeal tumor. It grows quickly and is likely to spread within the brain and spinal cord. The prognosis is worse than a grade I meningioma because the tumor usually cannot be completely removed by surgery.

WHO Tumor Grading System

• Grade I (low-grade) — The tumor cells look more like normal cells under a microscope and grow and spread more slowly than grade II, III, and IV tumor cells. They rarely spread into nearby tissues. Grade I brain tumors may be cured if they are completely removed by surgery.
• Grade II - The tumor cells grow and spread more slowly than grade III and IV tumor cells. They may spread into nearby tissue and may recur (come back). Some tumors may become a higher-grade tumor.
• Grade III - The tumor cells look very different from normal cells under a microscope and grow more quickly than grade I and II tumor cells. They are likely to spread into nearby tissue.
• Grade IV (high-grade) - The tumor cells do not look like normal cells under a microscope and grow and spread very quickly. There may be areas of dead cells in the tumor. Grade IV tumors usually cannot be cured.