Brain Tumor and Brain Cancer

Risk FactorsA risk factor is something that increases your chance of getting a disease or condition. Risk factors for primary brain cancer include: RadiationImmune system dysfunctionFamily history of rare types of cancerIn the case of metastatic brain cancer, any cancer throughout the body can ultimately spread to the brain. The following is a list of the most common tumors that may spread to the brain at some point:Lung cancerBreast cancerMalignant melanomasGastrointestinal tract cancerKidney cancer SymptomsSymptoms vary, depending on the tumor's size and location. A growing tumor is often associated with surrounding fluid buildup (called edema) which puts pressure on the brain. Symptoms may develop gradually or rapidly. Symptoms may include: HeadacheThe majority of headaches are not caused by brain tumors. Headaches associated with brain tumors tend to have the following features: Progressively worse over a period of weeks to monthsWorse in the morning or cause you to wake during the nightDifferent than a normal headacheWorsens with change of posture, straining, or coughingSeizuresNausea or vomitingWeakness in arms and/or legsLoss of sensation in arms and/or legsDifficulty walkingVision changesSpeech problemsDrowsinessMemory problemsPersonality changesNote: These symptoms may also be caused by other, less serious conditions. If you are experiencing these symptoms, see your doctor.

DiagnosisThe doctor will ask about symptoms and medical history and perform a physical exam. You will have a neurologic exam to test muscle strength, coordination, reflexes, response to stimuli, and alertness. The doctor will also look into your eyes to check for signs of brain swelling. Tests may include: MRI scan a test that uses magnetic waves to make pictures of structures inside the body CT scana type of x-ray that uses a computer to make pictures of structures inside the body PET scana test that detects the level of metabolic activity in the brain and other organs by tracking a radioactive sugar molecule that is injected into the bloodstream. PET scans are not approved to look at primary brain tumors, but can be helpful if the doctor is trying to find out if symptoms are related to a tumor or injury from treatment (surgery or radiation). Arteriographya test that uses x-rays to make pictures of blood vessels in the brain after injection of contrast material into an arteryBiopsyremoval of a sample of brain tissue to test for cancer cells. It may involve a small needle being inserted into the brain through a small hole drilled in the skull or it may involved surgery. Stereotaxisuse of a computer-assisted CT or MRI scan to locate the tumor and take a biopsy . The doctor drills a small hole in the skull, inserts a needle, and withdraws the sample tissue. TreatmentOnce cancer is found, further tests may be performed if there is concern that the cancer has spread. Treatment depends on the type, size, and location of the cancer, and your overall health. Treatments may leave you with physical or mental limitations.

Before beginning treatment, you may take medications, including: Steroids to decrease swelling and fluid buildup: Dexamethasone Anticonvulsants to prevent seizures: PhenytoinCarbamazepine According to the Food and Drug Administration (FDA), patients of Asian ancestry who have a certain gene, called HLA-B*1502, and take carbamazepine are at risk for dangerous or even fatal skin reactions. If you are of Asian descent, the FDA recommends that you get tested for this gene before taking carbamazepine. If you have been taking this medication for a few months with no skin reactions, then you are at low risk of developing these reactions. Talk to your doctor before stopping this medication. *PhenobarbitalValproic acidLevetiracetamOr other antiseizure medicationsA review of five studies found that medication does not appear to prevent seizures in patients with brain tumors who have no history of seizures. The medications included in the study were phenytoin, phenobarbital, and divalproex sodium (Depakene, Depakote).* Surgery Surgical removal of the tumor. Surgical procedures include: Craniotomyopening the skull to remove the tumor or as much of the tumor as possibleShuntimplanting a long thin tube in the brain to divert built-up fluid to another part of the body Radiation Therapy The use of radiation to kill cancer cells and shrink tumors. This is a common treatment for brain tumors, since surgical removal can often be difficult to achieve safely. Radiation may be:

External radiation therapyradiation directed at the tumor from a source outside the body. If you have a metastatic brain tumor, you will receive whole brain radiation therapy (WBRT). If you have a primary brain tumor, you will receive more focused radiation therapy. WRBT may also be used in people who have cancer in other areas of the body. The treatment is used to prevent brain cancer.Internal radiation therapyradioactive materials placed into the body near the cancer cells. This is used less frequently.Stereotactic radiosurgery (SRS) involves high doses of radiation to the brain tumor. It works the same way as traditional radiotherapy, but with higher doses that can be delivered to the affected areas of the brain, sparing nearby normal tissue. It is done using special equipment, including MRI and CT scans, to help localize the delivery of the radiation. This is most often used in metastatic brain tumors or in benign brain tumors, such as meningiomas. ChemotherapyChemotherapy is the use of drugs to kill cancer cells. Chemotherapy may be given in many forms, including pill, injection, and via a catheter. The drugs enter the bloodstream and travel through the body killing mostly cancer cells, but also some healthy cells. Chemotherapy may also be delivered directly into the cerebrospinal fluid, which bathes the brain tissue. This form of chemotherapy administration is called intrathecal. This is most often used when there is spread of cancer from elsewhere in the body to the fluid surrounding the brain and spinal cord.

Rehabilitation Therapy Rehabilitation therapy includes: Physical therapy to help with walking, balance, and building strengthOccupational therapy to help with mastering life skills, such as dressing, eating, and using the toiletSpeech therapy to help express thoughts and overcome swallowing difficulties PreventionThere are no guidelines for preventing brain cancer.At present, there is no conclusive evidence that using cell phones or living by electrical wires or power plants increases your risk of developing a brain tumor. RESOURCES: American Brain Tumor Associationhttp://www.abta.org/ American Cancer Societyhttp://www.cancer.org CANADIAN RESOURCES: BC Cancer Agencyhttp://www.bccancer.bc.ca/default.htm Cancer Care Ontariohttp://www.cancercare.on.ca/ References: Cecil Textbook of Medicine . 21st ed. WB Saunders Company; 2000. Clinical Oncology . 2nd ed. Churchill Livingstone, Inc; 2000. Conn's Current Therapy 2001 . 53rd ed. WB Saunders Company; 2001. National Cancer Institute website. Available at: http://www.cancer.gov/ . *12/20/2007 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : 2007 safety alerts for drugs, biologics, medical devices, and dietary supplements: Carbamazepine (marketed as Carbatrol, Equetro, Tegretol and generics). Medwatch. US Food and Drug Administration website. Available at: http://www.fda.gov/medwatch/safety/2007/safety07.htm#carbamazepine .

*5/28/2008 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Tremont-Lukats IW, Ratilal BO, Armstrong T, Gilbert MR. Antiepileptic drugs for preventing seizures in people with brain tumors. The Cochrane Library. 2008; DOI: 10.1002/14651858.CD004424.pub2. Last reviewed February 2008 by Rimas Lukas, MDPlease be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.