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Brain Tumor

What is the brain?

The brain is a soft, spongy mass of tissue. It is protected by the bones of the skull and three thin membranes called meninges. Watery fluid called cerebrospinal fluid cushions the brain. This fluid flows through spaces between the meninges and through spaces within the brain called ventricles.
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.

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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.

What are benign and malignant brain tumors?

Brain tumors can be benign or malignant:

  • Benign brain tumors do not contain cancer cells:
     
    • Usually, benign tumors can be removed, and they seldom grow back.
    • 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.
    • Unlike benign tumors in most other parts of the body, benign brain tumors are sometimes life threatening.
    • Very rarely, a benign brain tumor may become malignant.
  • Malignant brain tumors contain cancer cells:
     
    • Malignant brain tumors are generally more serious and often are life threatening.
    • They are likely to grow rapidly and crowd or invade the surrounding healthy brain tissue.
    • 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.
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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 are gliomas. They begin in glial cells. There are many types of gliomas:

  • Astrocytoma - The tumor arises from star-shaped glial cells called astrocytes. 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 a glioblastoma 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.


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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 certain risk 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:
     
    • Radiation - Workers in the nuclear industry have an increased risk of developing a brain tumor.
    • Formaldehyde - Pathologists and embalmers who work with formaldehyde have 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.
    • Vinyl chloride - Workers who make plastics may be exposed to vinyl chloride. This chemical may increase the risk of brain tumors.

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

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 health counselor, 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.
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