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Brain Cancer

Summary

The central nervous system includes the brain and spinal cord. Brain tumors are named and grouped by which type of cells are involved and the location of the tumor. Cells from nervous, lymphatic, support, and structure tissues are some of the cells found to be involved in brain tumors. These tumors can be malignant, benign, and benign but considered malignant due to location. Studies have shown that 16,500 patients are diagnosed with malignant brain tumors yearly and 13,000 estimated die from this disease. Tumors from metastatic disease are much more common than the occurrence of primary brain tumors. Brain tumors have the ability to grow by taking over surrounding cells and /or increase in size by replication. As a brain tumor grows it takes up room in an already tight space, thereby putting pressure on the brain and skull. These two methods of growth, location, size, and stage of the tumor are the cause of brain patient signs and symptoms.

Some of the symptoms associated with brain tumors are loss of vision, seizures, headaches, memory loss, weight loss, fever, depression, change in behavior and/or personality, or problems walking (such as being off balance) and speaking. These symptoms occur differently for each patient. Patients with brain tumors are assessed on the Karnofsky scale. This scale helps to determine severity of the tumor and determine therapy.

There are a number of factors environmentally and genetically that contribute to brain tumors. Exposure to radiation and chemicals are two documented environmental causes of brain tumors. Genetic factors such as diseases from hereditary syndromes may have an effect on the potential of a patient to form brain tumors. Mutations occurring over time in tumor-suppressor genes and oncogenes contribute in the formation of brain tumors. In Glioblastoma multiforme, grade IV astrocytoma, the EGFR gene can be found to be amplified, while in Oligodendrogliomas, on chromosomes 1 and 19, DNA can be lost. Cytogenetic analysis is used to determine these deletions or amplifications and contributes to diagnosis.

Prognosis of survival depends on the type and grade of brain tumor, age of patient (prognosis decreases with increasing age), ability to function, and amount of tumor able to be surgically removed.

Brain Metastases

Lung, breast (especially ductal carcinoma), gastrointestinal tract and melanoma cancers are the most common cancers that metastasize to the brain. Germ cell tumors and thyroid cancer are less common, while prostate cancer, ovarian cancer, and Hodgkin’s Lymphoma rarely metastasize to the brain.

One form of brain metastases called Leptomeningeal metastases is commonly caused by lung, breast, melanoma, and gastrointestinal cancers; while less commonly caused by squamous cell carcinoma and some Non-Hodgkin’s Lymphoma. This occurs by travel through the bloodstream to the meninges of the brain.

An important symptom of metastases is spinal cord compression. This occurs when cancer (commonly lung, breast, and prostate) metastasizes to the bones of the body, particularly the spine. Nerves of the spinal cord and peripheral nerves are compressed by the invading cancer. Associated with this compression is back pain, pain radiating from the spine, weakness, loss of sensation, an urgent feeling of needing to urinate or loss of ability to hold urine, and sexual dysfunction in men.

Types of Brain Tumors

Brain tumors can be primary, originating in the brain, or secondary, originating from malignant cancer elsewhere in the body that has spread; such as lung, skin, kidney, breast, and colon cancer. Primary tumors are usually formed from glia support cells; they spread rarely, and occur less frequently than secondary brain tumors. The representation percentage wise of tumor types are: Glial tumors 50-60%, Meningiomas 25%, Schwannomas 10%, and other CNS tumors account for the remaining percentage.

Astrocytomas

are formed from astrocytes and are the most common type of primary tumors. They can be benign or malignant. Astrocytes are a type of supportive, glia cell in nervous tissue. These tumors characteristically spread to surrounding brain tissue, causing difficulties in surgical removal, and tend to progress in grade due to genetic mutations occurring over time. These tumors have the ability to metastasize to the spinal cord by way of CNS nerve pathways leading from the brain. Patients with tuberous sclerosis are at an increased risk of developing subependymal giant cell astrocytomas as children. Tuberous sclerosis is a genetic disorder caused by the mutation of chromosome 9 at the TSC-1 gene and/or chromosome 16 at the TSC-2 gene.

Grade I, occurring more often in children, includes juvenile pilocytic astrocytoma (most common childhood brain tumor), subependymal giant cell astrocytoma, and pleiomorphic xanthoastrocytoma. With surgical removal, this grade of astrocytoma has the highest prognosis of survival of all astrocytomas grades. Patients have a 5-6 average survival with this grade of astrocytoma.

Grade II astrocytoma and Grade III anaplastic astrocytoma are considered intermediate grades due to their histological characteristics and symptoms. These higher grades of astrocytomas are seen more commonly in adults and can in time become fatal. Patients with grade III astrocytomas have an average 3 or less years of survival.

Grade IV is the most aggressive type of astrocytoma, Glioblastoma multiforme (GBM). This type has the worst prognosis of survival, less than one year.
Gliomatosis cerebri, a rare type of astrocytoma, is seen in patients that have symptoms of memory loss, changes in behavior or personality, and may have seizures.

Oligodendrogliomas

are rare, slow growing, and are formed from oligodendrocytes, which are one of the three types of glia cells. They may be benign or malignant. Oligodendrocytes and nerve cells make up the tissues found in the nervous system. These brain tumors are commonly benign. Oligodendrogliomas have a higher probability of complete surgical removal and increased response to chemotherapy treatment than astrocytomas.
Ependymomas are formed from ependymal cells. They are usually found in the spinal canal in adults, while in children they are seen within the ventricles (a cavity of the brain). As a primary tumor in the brain, they have the ability to spread to the spinal cord. Patients with Tuberous sclerosis are at an increased risk for developing ependymomas. Tuberous sclerosis is a genetic disorder caused by the mutation of chromosome 9 at the TSC-1 gene and/or chromosome 16 at the TSC-2 gene.
Myxopapillary Ependymoma is the most common type of ependymomas and is most commonly found in the lumosacral region towards the end of the spinal cord.

Medulloblastomas and Primitive Neuroectodermal tumors (PNET)

are frequently malignant and formed from cells destined to become neural cells. Medulloblastomas, a type of PNET, are the most common malignant brain tumor in children. A Primitive Neuroectodermal tumor (PNET) is the term given to those tumors that are similar to but cannot be distinguished from medulloblastomas. Metastasis to the spinal cord by way of CNS nerve pathways leading from the brain in commonly found. For the best possible prognosis surgery is required.

Primary CNS Lymphoma

is a type of B-cell Lymphoma that is found in patients with suppressed immune systems. For example, primary CNS Lymphoma can be found in patients with suppressed immune systems due to AIDS and/or receipt of organ transplants. In these immunosuppressed patients, tumor cells are commonly seen to be infected with the Epstein-Barr virus. Prognosis of survival is lower than that of a systematic lymphoma found external of the central nervous system.

Secondary CNS Lymphoma

is the metastatic spread of systematic lymphoma to the central nervous system. This disease occurs in adults with B-Cell Leukemia or B-Cell Lymphoma that has spread to the bone/bone marrow, testes, and/or the sinuses of the brain.
Meningiomas are the most common secondary, benign tumors, which can be found in the brain and along the spinal cord. Meningiomas form from arachnoidal cells of the mesoderm. They do have the ability to become malignant and metastasize to the skull and brain but this is found in rare cases. These tumors are found more often in women during their 60’s and 70’s. Prognosis is increased with surgical removal.

Hemangiopericytoma

is an aggressive form of a meningioma and often reoccurs.

Schwannomas

form from Schwann cells of nerve roots other than those pertaining to the sight and smell. Schwann cells main function is to protect and support peripheral nerves, while helping nerve signals to occur faster. These tumors grow slowly, are found on the outside of peripheral nerves, and rarely found to be malignant. A characteristic symptom of vestibular schwannoma is hearing loss. Schwannomas are seen to occur in patients with Type 1 & 2 Neurofibromatosis (NF). Neurofibromatosis is caused by genetic mutation of chromosome 17 at the NF1 gene and chromosome 22 at the NF2 gene. This genetic disorder causes skin abnormalities such as pigmented lesions.

Epidermoid tumors

are thought to form from epidermal cells in the CNS into cysts with liquid centers. They can be completely removed through surgery.

Dermoid cysts

are benign tumors that are treated by surgical removal. They are composed of sweat glands, hair follicles, and epidermis from the skin. They are thought to form from embryonic skin tissue enclosed within central nervous system during closure of the neural tube. These cysts usually become calcified over time.

Craniopharyngiomas

are thought to form from the structure that the anterior pituitary gland is formed. Due to their location, they may cause symptoms such as growth failure in children, endocrine dysfunction in adults, and/or visual loss in adults and children. Calcification of these tumors occurs in 80% of adults.

Colloid cysts

are benign tumors that form in the ventricle of the brain, where their presence can obstruct the flow of cerebral spinal fluid.

Germinomas

occur within the ventricles of the brain and are found n patients in their 20’s. These tumors may be benign but are more often aggressive and tend to take over surrounding cells.

Pituitary adenomas

occur in the pituitary gland and often remain undiagnosed until found upon autopsy. They are found when a patient presents with vision problems or upon finding of increased hormone production.

Screening

Your doctor will evaluate your condition and discuss it with you. Because there are many types of brain tumors, some of the treatments that are included here may not be right for you. Be sure to read the information that applies to your own treatment plan.

Diagnostic Process & Tests

Your doctor will test how well your nervous system is working including checking:

• Thinking/memory skills
• Vision, hearing, talking, and swallowing
• Muscle strength, gait, coordination, and reflexes
• Ability to feel and sense of touch

Imaging tests provides images of your brain. A special contrast medium may be injected during the test to make a tumor easier to see. These tests can include a CT Scan and MRI.

A Computerized Tomography Scan (CT) is a fast, painless test that creates an image of the brain. It shows if any blood has leaked around or into the brain. In some cases, CT angiography may be done to produce an enhanced image that shows an aneurysm.

For the test, a contrast dye is injected into a vein. This dye travels to the brain arteries, the CT scan is done to locate bleeding or other problems

A Magnetic Resonance Image (MRI) uses strong magnets and radio waves to form a sharp image. You lie on a long, narrow table, the table slides into a tunnel that contains a magnet. You should expect to hear a loud banging sound during the test.

Treatments

You and your doctor will discuss the best treatment. Throughout your treatment, your doctor will check your condition to see how well you are responding.

Your treatment plan is determined by the type, size, growth or changes, and location of your tumor, health history and age, and you may also have a biopsy. This is surgery to remove a sample of the tumor, which is then examined under a microscope. This allows your doctor to find out if the tumor is benign or malignant. Even a benign tumor can be a threat to your health.

Treatment may include surgery, radiation therapy, Gamma Knife, chemotherapy, craniotomy, or other medications. Treatment may be less involved for certain benign tumors, such as a pituitary tumor.

Sometimes a tumor doesn’t require treatment yet, but needs to be watched. In this case, it’s important to follow-up with your doctor.

For more information, visit www.universityneurosurgery.com.

Clinical Trials

We are actively participating in clinical trials and research for our cancer patients. Newly developed treatments or investigational drugs may reduce tumor size and eliminate symptoms better than treatments currently available.

Patients are asked if they would like to participate in our clinical trials to evaluate new cancer prevention and treatment choices. Participation is completely voluntary. Ask the doctor about clinical trials at your visit.

See the patient information on Clinical Trials at the Feist-Weiller Cancer Center. Additional information is available for medical professionals.  For more information about ongoing clinical trials at the Feist-Weiller Cancer Center, please call us toll-free at 1-866-LSU-FWCC (578-3922) or (318) 813-1410.

Cancer Support Group

The Feist Weiller Cancer Center offers two patient support groups, meeting once a week, for all types of cancer. For more information about these two support groups, please call:

Jo Ann Stewart, RN at (318) 813-1409
Susie Wiggins, RN at (318) 813-1417
Ron Nierman at (318) 470-6180

Genetic Testing and Counseling 

Almost all of us have known someone with cancer, be it a colleague, friend, or family member. For many, these acquaintances are few, and family occurrences sporadic, but for some families, cancer appears to have a much higher prevalence and may be passed throughout many generations. Our expanding knowledge regarding the hereditary aspect of cancer has enabled genetic counselors, nurses, and physicians to provide risk counseling to patients; and advances in genetics have allowed us to develop tests that help to pinpoint this hereditary risk. 

At the Feist-Weiller Cancer Center, the Hereditary Cancer Risk Assesment Program performs an initial cancer risk assessment for all patients by recording a complete family history and creating a pedigree in which all affected relatives are shown. If the patient has a positive family history of cancer, he or she is referred for genetic counseling in order to determine if genetic testing is the next appropriate step. Once genetic testing is completed, patients receive an additional counseling session in which results are disclosed and discussed. If a patient tests positively for a given mutation, specific surveillance and preventive options, as well as additional genetic testing for other family members, are discussed.

If a genetic mutation is detected in at-risk individual, which predisposes him to development of a hereditary cancer syndrome, this information is crucial in guiding the future medical and surgical management of this individual. In addition, certain hereditary cancers have unique behaviors at both a clinical and molecular level, and detection of specific mutations may help to guide therapy for these types of cancer. Discovery of a mutation specific for a hereditary cancer syndrome is not only helpful in guiding future management of that individual, but it also provides useful information about disease risk in other family members, and also the risk of the affected individual passing the mutation to his or her unborn offspring.