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A brain tumor is a growth that occurs in the brain.
This can be a very heterogeneous group of tumors.
And the way to think about it is did the tumor start in the brain?
Or did it come from somewhere else?
So usually we call the tumors that start in the brain primary brain cancer as opposed
to metastatic.
In other words, for example, if a patient had a history of lung cancer and some of those
lung cancer cells spread to the brain they'd still consider it a brain tumor.
But it's considered a secondary brain tumor or metastatic brain tumor.
So brain cancer consists of many different types of tumors.
So the major categories for adults are called gliomas and meningiomas are probably the two
most common types of tumors.
The meningiomas are tumors that form in the lining of the brain and the majority of those
tumors are what we consider grade one or benign, but there are also components of it that are
grade two or a higher grade or what we consider malignant.
The other type of tumor that's commonly found in the brain, and these are primary brain
tumors, are called glioma.
And the most common type is called glioblastoma
Usually patients have symptom that relates to either a headache or, for example, a seizure.
They might also have difficulty coordinating or writing, difficulty speaking or even the
mobility.
And so when those symptoms happen a lot of patients are concerned could it be a stroke
or could it be a tumor.
And the next step would be evaluating either with a scan called an MRI scan, which is an
image of the brain.
The first aspect of treatment for these tumors is making sure we have a diagnosis.
There are examples where patients present with a neurological symptom, like a headache,
they have a scan that shows that there is something in the brain, but there can be mimics
of tumors that can look very similar to a tumor on the scan.
For example, a patient could have an infection.
They can have what we call a stroke or even an inflammatory process in the brain.
So an MRI scan which is the most common diagnostic tool that we use can sometimes be difficult
to be sure that there is a tumor.
So the next step is making a definitive diagnosis.
And to do this would either encompass the surgeon taking a sample of this, which is
called a biopsy, or planning an operation where you try to take out as much of the tumor
as safely possible.
And that's called a resection.
So the first modality of treatment for some of these tumors would be an operation or surgery.
Depending on the amount of tumor that's removed and the type of tumor that you're dealing
with, you may be recommended to have subsequent treatments with radiation therapy or chemotherapy.
And these treatments would be administered by a specialist in the field.
They will go over the side effects to be expected for these treatments and what the outcome
you're expecting to have.
What are you trying to do?
Are you trying to improve symptoms or are we trying to improve how long you live?
So those are the types of key points that you need to understand and ask your treating
doctors what are the goals of care for me and what am I to expect were I to undergo
these treatments?
You will see a neurologist, a neurosurgeon, potentially then after you've had your definitive
diagnosis of a brain tumor you'll also have a team of doctors, for example, medical oncologists
or neuro oncologists and radiation oncologists.
So the important thing is to understand this is a team approach to taking care of you,
but not only yourself but also your family.
The biggest advance I believe in brain tumors right now is really understanding the biology
of the tumors and characterizing tumors based on their molecular and cytogenetic makeup.
So historically we have used a classification called the World Health Organization Pathological
Classification where the pathologist will, and those are doctors who actually characterize
the tumors after they've been removed from the patient and they will look at the slides
or the characteristics of the cells and what the tumor actually looks like under the microscope.
And they will give us a grade, a grade one, a grade two, three or four, for example, and
that tells us how aggressive the tumor is and various characteristics about the tumor.
We are learning now though that within specific grades of tumor you can have very, very different
outcomes.
And now with the molecular characterization of tumors we will be able to classify these
tumors better for patients.
And what this means is that we can now get to a point of what we call personalized medicine
or precision medicine.
And that's going to be key so that we can identify the appropriate patients for the
appropriate treatments and spare patients treatments that are probably going to be ineffective
and also associated with side effects.
The other aspects of biology of tumors that we're learning about is all of the mechanisms
of growth that we could be targeting for therapies.
So, for example, we know that these tumors have a lot of blood vessels that they bring
into the tumor cells to nourish the tumor and we're now able to target those areas.
We're learning about the immune system.
There's a lot in cancer right now where the immunotherapy approaches are having fantastic
positive effects and we're now exploring all of those types of therapies in brain tumors
as well.
To learn more about brain tumors not only the biology and some of the clinical aspects
but also what resources might be available to you, one, a very important resource, is
cancer.net.
There are a number of educational features about the site that will give you information
not only in terms of as I mentioned side effects of treatments and clinical trials, but also
about caregiver resources that are so critical for patients with brain tumors.
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