Brain Cancer Overview

Cancers of the brain are abnormal growths of cells in the brain.

• Although such growths are popularly called brain tumors, not all brain tumors are cancer. Cancer is a term reserved for malignant tumors.
  
  
• Malignant tumors grow and spread aggressively, overpowering healthy cells by taking their space, blood, and nutrients. (Like all cells of the body, tumor cells need blood and nutrients to survive.)
  
  
• Tumors that do not spread aggressively are called benign.
  
  
• In general, a benign tumor is less serious than a malignant tumor. But a benign tumor can still cause many problems in the brain.

Primary tumors

The brain is made up of many different types of cells.

• Some brain cancers occur when one type of cell transforms from its normal characteristics. Once transformed, the cells grow and multiply in abnormal ways.
  
  
• As these abnormal cells grow, they become a mass of cells, or tumor.
  
  
• Brain tumors that result from this transformation and abnormal growth of brain cells are called primary brain tumors because they originate in the brain.
  
  
• The most common primary brain tumors are gliomas, meningiomas, pituitary adenomas, vestibular schwannomas, and primitive neuroectodermal tumors (medulloblastomas). The term glioma includes astrocytomas, oligodendrogliomas, ependymomas, and choroid plexus papillomas.
  
  
• Most of these primary tumors are named after the part of the brain or the type of brain cell from which they arise.

Metastatic brain tumors

Metastatic brain tumors are made of cancerous cells from a tumor elsewhere in the body. The cells spread to the brain from another tumor in a process called metastasis. About 25% of tumors elsewhere in the body metastasize to the brain.

In the United States, brain tumors affect about one of every 5,000 people

Brain Cancer Causes

As with tumors elsewhere in the body, the exact cause of most brain tumors is unknown. Genetic factors, various environmental toxins, radiation, and cigarette smoking have all been linked to cancers of the brain, but in most cases, no clear cause can be shown.

The following factors have been proposed as possible risk factors for primary brain tumors. Whether these factors actually increase the risk of a brain tumor is not known for sure.

• Radiation to the head
  
  
• An inherited (genetic) risk
  
  
• HIV infection

Brain Cancer Symptoms

Not all brain tumors cause symptoms, and some (such as tumors of the pituitary gland) are found mainly after death. The symptoms of brain tumors are numerous and not specific to brain tumors, meaning they can be caused by many other illnesses as well. The only way to know for sure what is causing the symptoms is to undergo diagnostic testing.

• The symptoms are caused by the tumor pressing on or encroaching on other parts of your brain and keeping them from functioning normally.
  
  
• Some symptoms are caused by swelling in the brain caused by the tumor or surrounding inflammation.
  
  
• The symptoms of primary and metastatic brain cancers are similar.

The following symptoms are most common:

• Headache
  
  
• Weakness
  
  
• Clumsiness
  
  
• Difficulty walking
  
  
• Seizures

Other nonspecific symptoms and signs include the following:

• Altered mental status: changes in concentration, memory, attention, or alertness
  
  
• Nausea, vomiting: especially early in the morning
  
  
• Abnormalities in vision
  
  
• Difficulty with speech
  
  
• Gradual changes in intellectual or emotional capacity

In many people, the onset of these symptoms is very gradual and may be overlooked by both the person with the brain tumor and the family. Occasionally, however, these symptoms appear more rapidly. In some instances, the person acts as if he or she is having a stroke.

When to Seek Medical Care

See your health-care provider right away if you have any of the following symptoms:

• Unexplained, persistent vomiting
  
  
• Double vision or unexplained blurring of vision, especially on only one side
  
  
• Lethargy or increased sleepiness
  
  
• New seizures
  
  
• New pattern or type of headaches

Although headaches are thought to be a common symptom of brain cancer, they may not occur until late in the progression of the disease. If any significant change in your headache pattern occurs, your health-care provider may suggest that you go the hospital.

If you have a known brain tumor, any new symptoms or relatively sudden or rapid worsening of symptoms warrants a trip to the nearest hospital emergency department. Be on the lookout for the following new symptoms:

• Seizures
  
  
• Changes in mental status, such as excessive sleepiness, memory problems, or inability to concentrate
  
  
• Visual changes or other sensory problems
  
  
• Difficulty with speech or in expressing yourself
  
  
• Changes in behavior or personality
  
  
• Clumsiness or difficulty walking
  
  
• Nausea or vomiting (especially in middle-aged or older people)
  
  
• Sudden onset of fever, especially after chemotherapy

Exams and Tests

If findings of your medical interview and physical examination suggest to your health-care provider that you may have a problem in the brain or brain stem, additional tests may be done.

• In most cases, you will have a CT scan of the brain.
  
  
• This test is like an x-ray but shows more detail in three dimensions.
  
  
• Usually, a harmless dye is injected into your bloodstream to highlight abnormalities on the scan.

People with brain cancer often have other medical problems; therefore, routine laboratory tests may be performed.

• These include analysis of blood, electrolytes, liver function tests, and a blood coagulation profile.
  
  
• If you have mental status change as the main symptom, blood or urine tests may be done to detect drug use.

Often, the MRI scan is used instead of CT scan for suspected brain tumors.

• This is because MRI has a higher sensitivity for detecting the presence of, or changes within, a tumor.
  
  
• Currently, however, most institutions still use the CT scan as the first diagnostic test.

Skull x-rays are not widely used any longer to diagnose brain cancer.

If your scans indicate the presence of a brain tumor, you will be referred to a specialist in brain surgery. If one is available in your area, you should be referred to a specialist in brain tumors (neuro-oncologist).

The next step in diagnosis is confirmation that you have a cancer. A small sample of the tumor (a biopsy) is taken to identify the type of tumor.

• The most widely used technique for obtaining a biopsy is surgery. The skull is opened, usually with the intention of removing the whole tumor if possible. A biopsy is then taken from the tumor.
  
  
• If the surgeon is unable to remove the entire tumor, a small piece of the tumor is removed.
  
  
• In some cases, it is possible to collect a biopsy without opening the skull. The exact location of the tumor in the brain is determined stereotactically, that is, by using CT or MRI scans while the head is held still in a frame. A small hole is then made in the skull and a needle guided through the hole to the tumor. The needle collects the biopsy and is removed. This technique is called stereotaxis, or stereotactic biopsy.
  
  
• The biopsy is examined under a microscope by a pathologist (a physician who specializes in diagnosing diseases by looking at cells and tissues).

Brain Cancer Treatment

Treatment for brain tumor should be individualized for you. Your treatment regimen is based on your age and general health and the size, location, and type of your tumor.

You and your loved ones will have many questions about your tumor, the treatment you will undergo, how the treatment will affect you, and your long-term outlook. Your health-care team is the best source of this information. Don't hesitate to ask.

Self-Care at Home

Your health-care provider and the physician team in charge of your case should discuss details about home care with you and your family members.

• Home care usually includes supportive measures according to your symptoms.
  
  
• For example, if you have trouble walking, you probably should have a walker available at home when you need to walk.
  
  
• If you have mental status changes, a care plan should be directed to your individual needs.

If your prognosis is poor, it is appropriate to discuss options of hospice care, advance directives to doctors, and provisions for a living will.

• Home hospice care is a way of providing pain and symptom relief, as well as emotional and spiritual support for the patient and the family, at home rather than in the hospital. It involves a multidisciplinary approach that may include a physician or other care provider, nurses, a pharmacist, aides, a social worker, a spiritual caregiver, and counselors.
  
  
• Advance directive and living will are legal documents that spell out specifically which treatments are to be given and which are to be withheld. For example, a person with advanced brain cancer may not want to be put on a ventilator (breathing machine) if he or she stops breathing. You have the right to make these decisions for yourself as long as you are mentally competent.

Medical Treatment

Treatment of brain cancer is usually complex. Most treatment plans involve several consulting doctors.

• The team of doctors includes neurosurgeons (surgical specialists in the brain and nervous system), oncologists, radiation oncologists (doctors who practice radiation therapy), and, of course, your primary health-care provider. Your team will also include a dietitian, a social worker, a physical therapist, and, probably, other specialists.
  
  
• The treatment protocols vary widely according to the location of your tumor, its size and type, your age, and any additional medical problems that you may have.
  
  
• The most widely used treatments are surgery, radiation therapy, and chemotherapy. In some cases, more than one of these is used.

Most people with a brain tumor undergo surgery.

• The purposes of surgery are to confirm that the abnormality seen on the brain scan is indeed a tumor and to remove the tumor. If the tumor cannot be removed, the surgeon will take a sample of the tumor to identify its type.
  
  
• In some cases, mostly in benign tumors, symptoms can be completely cured by surgical removal of the tumor. Your neurosurgeon will attempt to remove the tumor when possible.
  
  
• Stereotactic surgery is a newer "knifeless" technique that destroys a brain tumor without opening the skull. CT or MRI scan is used to pinpoint the exact location of the tumor in the brain. High-energy radiation beams are trained on the tumor from different angles. The radiation destroys the tumor. This technique is sometimes called "gamma knife."
  
  
• The advantages of "knifeless" procedures are that they have fewer complications and the recovery time is much shorter.

You may undergo several treatments and procedures before surgery.

• You may be given a steroid drug, such as dexamethasone (Decadron), to relieve swelling.
  
  
• You may be treated with an anticonvulsant drug, such as carbamazepine (Tegretol), to relieve or prevent seizures.
  
  
• If you have excess cerebrospinal fluid collecting around your brain, a thin, plastic tube called a shunt may be placed to drain the fluid. One end of the shunt is placed in the cavity where fluid collects; the other is threaded under your skin to another part of the body. The fluid drains from the brain to a site from which the fluid can be easily eliminated.

Radiation therapy (also called radiotherapy) is the use of high-energy rays to kill tumor cells and stop them from growing and multiplying.

• Radiation therapy is sometimes used for people who cannot undergo surgery. In other cases, it is used after surgery to kill any tumor cells that may remain.
  
  
• Radiation therapy is a local therapy. This means that it affects only cells in its path. It does not harm cells elsewhere in the body or even elsewhere in the brain.

Radiation can be administered in either of two ways.

• External radiation uses a high-energy beam of radiation targeted at the tumor. The beam travels through the skin, the skull, healthy brain tissue, and other tissues to get at the tumor. The treatments are usually given five days a week for about four to six weeks. Each treatment takes only a few minutes.
  
  
• Internal or implant radiation uses a tiny radioactive capsule that is placed inside the tumor itself. The radiation emitted from the capsule destroys the tumor. The radioactivity of the capsule decreases a little bit each day; the amount of radioactivity of the capsule is carefully calculated to run out when the optimal dose has been given. You need to stay in the hospital for several days while receiving this treatment.

Chemotherapy is the use of powerful drugs to kill tumor cells.

• A single drug or a combination may be used.
  
  
• The drugs are given by mouth or through an IV line. Some medications are given through the shunt put in place to drain excess fluid from your brain.
  
  
• Chemotherapy is usually given in cycles. A cycle consists of a short period of intensive treatment followed by a period of rest and recovery. Each cycle lasts a few weeks.
  
  
• Most regimens are designed so that two to four cycles are completed. There is then a break in the treatment to see how your tumor has responded to the therapy.
  
  
• The side effects of chemotherapy are well known and are very difficult to tolerate for some people. They include nausea and vomiting, mouth sores, loss of appetite, loss of hair, and many others. Some of these side effects can be relieved or improved by medication.

New therapies for cancer are being developed all the time. When a therapy shows promise, it is studied in laboratories and improved as much as possible. It is then tested on people with cancer; these tests are called clinical trials.

• Clinical trials are available for virtually every kind of cancer.
  
  
• The advantage of clinical trials is that they offer new therapies that may be more effective than existing therapies or have fewer side effects.
  
  
• The disadvantage is that the therapy has not been proven to work or does not work in everyone.
  
  
• Many people with cancer are eligible for participation in clinical trials.
  
  
• To find out more, ask your health-care provider. A list of clinical trials is available at the Web site of the National Cancer Institute.

Follow-up

Once your brain tumor is diagnosed, you need to be very careful to keep all of your appointments with consultants and your primary health-care provider. In general, people with brain cancer are at increased risk for additional medical problems and, potentially, reoccurrence or worsening of their symptoms.

After your treatment, you will be returning for follow-up visits with your cancer team. A schedule of follow-up checkups and tests will be recommended. The purpose of this follow-up is to ensure that any recurrence of your cancer or any long-term effect of the treatment is identified promptly so that it can be treated right away

Prevention

n general, there is no way to prevent brain cancers. Early diagnosis and treatment of tumors that tend to metastasize to the brain may reduce the risk of metastatic brain tumors.

The following factors have been suggested as possible risk factors for primary brain tumors. Avoiding the factors that can be avoided may reduce your risk.

• Radiation to the head
  
  
• HIV infection

For More Information

American Cancer Society
(800) ACS-2345

National Cancer Institute, Cancer Information Service
(800) 4-CANCER (422-4237)
TTY (for deaf and hearing-impaired callers) (800) 332-8615

Brain Cancer Treatment

Treatment for brain tumor should be individualized for you. Your treatment regimen is based on your age and general health and the size, location, and type of your tumor.

You and your loved ones will have many questions about your tumor, the treatment you will undergo, how the treatment will affect you, and your long-term outlook. Your health-care team is the best source of this information. Don't hesitate to ask.

For More Information

American Cancer Society
1599 Clifton Road, NE
Atlanta, GA 30329
(800) ACS-2345 (227-2345)

National Cancer Institute
NCI Public Inquiries Office
6116 Executive Boulevard
Room 3036A
Bethesda, MD 20892-8322
(800) 4-CANCER (422-6237)
cancergovstaff@mail.nih.gov

Cancer Care
National Office, 275 7th Avenue
New York, NY, 10001
(800) 813-HOPE (813-4673)

Cancer Facts

• Cancer is the second most common cause of death after heart disease.
  
  
• A significant percentage of newly diagnosed cancers can be cured.
  
  
• Cancer is more curable when detected early. Although some cancers develop completely without symptoms, the disease can be particularly devastating if you ignore symptoms because you do not think that these symptoms might represent cancer.

Cancer Symptoms (cont.)

• Unexplained anemia
  
  
  • Anemia is a condition in which you have fewer than the expected number of red blood cells in your blood. Anemia should be investigated.
    
    
  • There are many kinds of anemia, but blood loss almost always causes iron deficiency anemia. Unless there is an obvious source of ongoing blood loss, as there is for menstruating women, this anemia needs to be explained.
    
    
  • Many cancers can cause anemia, but bowel cancers most commonly cause iron deficiency anemia. Evaluation should include endoscopy or x-ray studies of your upper and lower intestinal tracts.
  
  
• Breast lump or breast discharge
  
  
  • Most breast lumps are noncancerous tumors such as fibroadenomas or cysts. But all breast lumps need to be thoroughly investigated.
    
    
    • A negative mammogram result is not sufficient to evaluate a breast lump.
      
      
    • Generally, diagnosis requires a needle aspiration or biopsy (a small tissue sample).
      
      
    • Discharge from a breast is common. But some forms of discharge may be signs of cancer. If discharge is bloody or from only 1 nipple, further evaluation is recommended.
    
    
  • Women are advised to conduct monthly breast self-examinations.
  
  
• Lumps in the testicles
  
  
  • Most men (90%) with cancer of the testicle have a painless or uncomfortable lump on a testicle.
    
    
  • Some men have an enlarged testicle.
    
    
  • Other conditions, such as infections and swollen veins, can also cause changes in your testicles, but you should have any lump evaluated.
    
    
  • Men are advised to conduct monthly testicular self-examinations.
  
  
• A change in urination
  
  
  • Urinary symptoms can include frequent urination, small amounts of urine, and slow urine flow.
    
    
  • These symptoms can be caused by urinary infections or, in men, by an enlarged prostate gland.
    
    
    • Most men will suffer from harmless prostate enlargement as they age, and will often have these urinary symptoms.
      
      
    • These symptoms may signal prostate cancer.
      
      
    • Men experiencing urinary symptoms need a bit of investigation, probably including a specific blood test called a PSA and a digital rectal exam.
    
    
  • Cancer of the bladder and pelvic tumors can also cause irritation of the bladder and urinary frequency.
  
  
• Blood in the urine
  
  
  • Hematuria or blood in the urine can be caused by urinary infection, kidney stones, or other causes.
    
    
  • For some people, it is a symptom of cancer of the bladder or kidney.
    
    
  • Any episode of blood in the urine should be investigated.
  
  
• Hoarseness
  
  
  • Hoarseness not caused by a respiratory infection or that lasts longer than 3-4 weeks should be evaluated.
    
    
  • Hoarseness can be caused by simple allergy or by vocal cord polyps, but it could also be the first sign of cancer of the throat.
  
  
• Persistent lumps or swollen glands
  
  
  • Lumps most frequently represent harmless conditions. But your doctor should examine any new lump or a lump that won't go away.
    
    
  • Lumps may represent cancer or a swollen lymph gland related to cancer.
    
    
  • Lymph nodes swell from infection and other causes and may take weeks to shrink again.
    
    
  • A lump or gland that remains swollen for 3-4 weeks should be evaluated.
  
  
• Obvious change in a wart or a mole
  
  
  • Multicolored moles that have irregular edges or bleed may be cancerous.
    
    
  • Larger moles are more worrisome.
    
    
  • Removing a mole is simple. You should remove any suspicious mole. The doctor will send it for examination under a microscope for skin cancer.
  
  
• Indigestion or difficulty swallowing
  
  
  • Most people with chronic heartburn do not have serious problems.
    
    
  • People who suffer from chronic or lasting symptoms despite using over-the-counter antacids may need to have an upper GI endoscopy.
    
    
  • A condition called Barrett esophagus, which can lead to cancer of the esophagus, can be treated with medication and then monitored by a doctor.
    
    
  • Difficulty swallowing is a common problem, especially in elderly people, and has many causes.
    
    
    • Swallowing problems need to be investigated, because nutrition is always important.
      
      
    • Difficulty swallowing solids can be seen with cancer of the esophagus.
  
  
• Unusual vaginal bleeding or discharge
  
  
  • Unusual vaginal bleeding or bloody discharge may be an early sign of cancer of the uterus. Women should be evaluated when they have bleeding after intercourse or bleeding between periods.
    
    
  • Bleeding that comes back, that lasts 2 or more days longer than expected, or that is heavier than usual also merits medical examination.
    
    
  • Postmenopausal bleeding, unless expected on hormone therapy, is also worrisome and should be evaluated.
    
    
  • Usually, the evaluation will include an endometrial biopsy, in which a doctor takes a small tissue sample from inside the uterus for testing.
  
  
• Unexpected weight loss, night sweats, or fever
  
  
  • These nonspecific symptoms might be present with several different types of cancer.
    
    
  • Various infections can lead to similar symptoms.
  
  
• Continued itching in your anus or genitals
  
  
  • Precancerous or cancerous conditions of the skin of the genital or anal areas can cause persistent itching.
    
    
  • You may notice skin color changes.
    
    
  • Several infections or skin conditions also can cause these symptoms. If itching does not stop with over-the-counter topical medications, your doctor should inspect the area.
  
  
• Nonhealing sores
  
  
  • Sores generally heal quickly. If an area fails to heal, you may have cancer and should see a doctor.
    
    
  • Nonhealing sores in your mouth or persistent white or red patches on your gums, tongue, or tonsils are also should raise concerns.
  
  
• Headaches
  
  
  • Headaches have many causes, but cancer is not a common one.
    
    
  • A severe unrelenting headache that feels different from usual can be a sign of cancer.
    
    
  • If your headache fails to improve with over-the-counter medications, see a doctor promptly.
  
  
• Back pain, pelvic pain, bloating, or indigestion
  
  
  • These are common symptoms of daily life. But they also can be seen in ovarian cancer.
    
    
  • This cancer is particularly difficult to treat, because it is frequently diagnosed late in the course of the disease.
    
    
  • The American Cancer Society and other organizations have been trying to make both patients and physicians more aware and consider this diagnosis if the classic symptoms are present.

Cancer Signs and Symptoms

Cancer gives you no symptoms or signs that exclusively indicate the disease. Every complaint for cancer can explain a harmless condition as well. If you have symptoms, however, you should see a doctor for further evaluation. Some common symptoms are as follows:

• Persistent cough or blood-tinged saliva
  
  
  • These symptoms usually represent simple infections such as bronchitis or sinusitis.
    
    
  • They could be symptoms of cancer of your lung, head, and neck. Anyone with a cough that lasts more than a month or with blood in the mucus that is coughed up should see a doctor.
    
    
• A change in bowel habits
  
  
  • Doctors sometimes see pencil-thin stools with colon cancer.
    
    
  • Occasionally, cancer exhibits continuous diarrhea.
    
    
  • Some people with cancer feel as if they need to have a bowel movement and still feel that way after they have had a bowel movement. If any of these abnormal bowel complaints last more than a few days, they require evaluation.
  
  
• Blood in your stool
  
  
  • A doctor always should investigate blood in your stool.
    
    
  • Hemorrhoids frequently cause rectal bleeding, but because hemorrhoids are so common, they may exist with cancer. Therefore, even when you have hemorrhoids, you should have a doctor examine your entire intestinal tract when you have blood in your bowel movements.

* Cancer Symptoms Introduction

Cancer often has no specific symptoms, so it is important that you limit your risk factors and undergo appropriate cancer screening.

Nevertheless, you need to know which symptoms might point to cancer. You do not want to ignore a warning that might lead to early diagnosis and possibly to a cure

Endometrial Cancer

Definition of endometrial cancer: Cancer that forms in the tissue lining the uterus (the small, hollow, pear-shaped organ in a woman's pelvis in which a baby grows). Most endometrial cancers are adenocarcinomas (cancers that begin in cells that make and release mucus and other fluids).

Estimated new cases and deaths from endometrial (uterine corpus) cancer in the United States in 2008:

	New cases: 40,100
	Deaths: 7,470

See the online booklet What You Need To Know About™ Cancer of the Uterus to learn about endometrial cancer symptoms, diagnosis, treatment, and questions to ask the doctor.

Colon and Rectal Cancer

Definition of colon cancer: Cancer that forms in the tissues of the colon (the longest part of the large intestine). Most colon cancers are adenocarcinomas (cancers that begin in cells that make and release mucus and other fluids).

Definition of rectal cancer: Cancer that forms in the tissues of the rectum (the last several inches of the large intestine closest to the anus).

Estimated new cases and deaths from colon and rectal cancer in the United States in 2008:

	New cases: 108,070 (colon); 40,740 (rectal)
	Deaths: 49,960 (colon and rectal combined)

See the online booklet What You Need To Know About™ Cancer of the Colon and Rectum to learn about colon and rectal cancer symptoms, diagnosis, treatment, and questions to ask the doctor.

For an overview of research advances, see Cancer Advances In Focus: Colorectal Cancer.

Breast Cancer

Definition of breast cancer: Cancer that forms in tissues of the breast, usually the ducts (tubes that carry milk to the nipple) and lobules (glands that make milk). It occurs in both men and women, although male breast cancer is rare.

Estimated new cases and deaths from breast cancer in the United States in 2008:

	New cases: 182,460 (female); 1,990 (male)
	Deaths: 40,480 (female); 450 (male)

See the online booklet What You Need To Know About™ Breast Cancer to learn about breast cancer symptoms, diagnosis, treatment, and questions to ask the doctor.

For an overview of research advances, see Cancer Advances In Focus: Breast Cancer.

Bladder Cancer

Definition of bladder cancer: Cancer that forms in tissues of the bladder (the organ that stores urine). Most bladder cancers are transitional cell carcinomas (cancer that begins in cells that normally make up the inner lining of the bladder). Other types include squamous cell carcinoma (cancer that begins in thin, flat cells) and adenocarcinoma (cancer that begins in cells that make and release mucus and other fluids). The cells that form squamous cell carcinoma and adenocarcinoma develop in the inner lining of the bladder as a result of chronic irritation and inflammation.

Estimated new cases and deaths from bladder cancer in the United States in 2008:

	New cases: 68,810
	Deaths: 14,100

See the online booklet What You Need To Know About™ Bladder Cancer to learn about bladder cancer symptoms, diagnosis, treatment, and questions to ask the doctor.