Brain Cancer Overview Cancers of the brain are the consequence of abnormal growths of cells in the brain.

Brain cancers can arise from primary brain cells, the cells that form other brain components (for example, membranes, blood vessels), or from the growth of cancer cells that develop in other organs and that have spread to the brain by the bloodstream (metastatic brain cancer). Although many growths in the brain are popularly called brain tumors, not all brain tumors are cancerous. 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. This is especially a problem in the brain, as the added growth within the closed confines of the skull can lead to an increase in intracranial pressure or the distortion of surrounding vital structures, causing their malfunction. Tumors that do not grow aggressively are called benign. Almost all tumors that begin in the brain do not spread to other parts of the body. The major difference between benign and malignant tumors is that malignant tumors can invade the brain tissues and grow rapidly. This rapid growth in the confines of the skull can quickly cause damage to nearby brain tissue.

In general, a benign tumor is less serious than a malignant tumor. However, a benign tumor can still cause many problems in the brain, but usually the problems progress at a slower rate than malignant tumors. Sometimes people confuse brain aneurysms with brain tumors. Brain aneurysms are not tumors; they are areas in the brain arteries or veins that are abnormally weak and expand to form a ballooning or expansion of the vessel wall. They seldom produce any symptoms unless they begin to leak blood into the surrounding brain tissue. Aneurysms may be congenital (present at birth) or expanded or formed in brain vessels after vessel damage (for example, trauma, atherosclerosis, high blood pressure) but are not formed from cancer cells. Unfortunately, when aneurysms produce symptoms, they can resemble those produced by brain tumors. Primary brain tumors The brain is made up of many different types of cells and tumors that arise from a brain cell type are termed primary brain tumors. Cancers occur when one type of cell transforms and loses 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, primary CNS lymphomas, and primitive neuroectodermal tumors (medulloblastomas).

The term glioma is an expansive one since it includes numerous subtypes, including astrocytomas, oligodendrogliomas, ependymomas, and choroid plexus papillomas. These primary tumors are named after the part of the brain or the type of brain cell from which they arise. Brain tumors vary in their growth rate and ability to cause symptoms. The cells in fast growing, aggressive tumors usually appear abnormal microscopically. The National Cancer Institute (NCI) uses a grading system to classify tumors. The NCI lists the following grades: Grade I: The tissue is benign. The cells look nearly like normal brain cells, and cell growth is slow.

Grade II: The tissue is malignant. The cells look less like normal cells than do the cells in a grade I tumor. Grade III: The malignant tissue has cells that look very different from normal cells. The abnormal cells are actively growing. These abnormal-appearing cells are termed anaplastic.

Grade IV: The malignant tissue has cells that look most abnormal and tend to grow very fast. In the United States, primary brain tumors and other nervous system cancers are estimated to develop in about 22,000 people in 2010, according to the National Cancer Institute. Metastatic brain tumors Metastatic brain tumors are made of cancerous cells that spread through the bloodstream from a tumor located elsewhere in the body. The most common cancers that spread to the brain are those arising from cancers that originate in thelung, breast, and kidney as well as malignant melanoma, a skin cancer. The cells spread to the brain from another tumor in a process called metastasis. The process metastasis occurs when cancer cells leave the primary cancer tissue and enter either the lymphatic system to reach the blood or the bloodstream directly. These cancer cells eventually reach the brain tissue through the bloodstream where they develop into tumors. Metastatic brain tumors are the most common type of tumor found in the brain and are much more common than primary brain tumors. Metastatic tumors are usually named after the type of tissue from which the original cancer cells arose (for example, metastatic lung or metastatic breast cancer). Brain blood flow usually determines where the metastatic cancer cells will lodge in the brain; about 85% locate in the cerebrum (the largest portion of the brain, located in the upper part of the skull cavity). Unfortunately, the majority of metastatic brain tumors occur at more than one site in the brain tissue.

Brain Cancer Causes As with tumors elsewhere in the body, the exact cause of most brain tumors is unknown. The following factors have been proposed as possible risk factors for primary brain tumors, but whether these factors actually increase an individual's risk of a brain tumor is not known for sure. Radiation to the head

An inherited (genetic) risk

HIV infection Cigarette smoking Environmental toxins (for example, chemicals used in oil refineries, embalming chemicals, rubber industry chemicals)

Exams and Tests If findings of a medical interview and physical examination suggest to the health-care provider that a person may have a problem in the brain or brain stem, additional tests may be done. Many people will have a CT scan of the brain, especially if the person is seen emergently.

This test is like an X-ray but shows more detail in three dimensions.

Usually, a harmless dye is injected into the 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 the person has mental-status change as the main symptom, blood or urine tests may be done to rule out drug use. The standard way of evaluating the nature and extent of a brain tumor is an MRI scan (note that many hospitals do not have MRI scanners). This is because MRI has a higher sensitivity for detecting the presence and characteristics of a tumor. Specifically, the relationship of the tumor to the surrounding brain, the brain coverings, cerebrospinal fluid spaces, and vascular structures is assessed to come up with a provisional diagnosis of the nature of the tumor. Currently, however, many institutions that do have MRI scanners still use the CT scan as a screening test for tumors. If CT or MRI scans indicate the presence of a brain tumor, the person will be referred to a specialist in brain surgery (a neurosurgeon). If one is available in the area, the person may also be referred to a specialist in the chemotherapeutic treatment of brain tumors (a neuro-oncologist). A word of caution to readers; while radiologic examinations of the brain usually are excellent tests, they are not without any risks. People that "doctor shop" or frequent emergency centers with the main complaint of "headache" often obtain multiple brain scans in close succession. This may put the individuals at increased risk of radiation damage to cells. Patients are urged to have a primary medical caregiver to help coordinate all tests to avoid overexposure to radiation from diagnostic testing. The next step in diagnosis is confirmation that the person has cancer in the brain. A small sample of the tumor (a biopsy) is taken to identify the type of tumor and the grade of the tumor.

The most widely used technique for obtaining a biopsy is a surgical procedure called a craniotomy. 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. This process does not treat the tumor and is generally reserved for situations in which the tumor is either inaccessible or is thought to be sensitive to radiation therapy (such as CNSlymphoma or pineal germ cell tumor). The biopsy is examined under a microscope by a pathologist (a physician who specializes in diagnosing diseases by looking at cells and tissues) and usually assigned a NCI grade.

Brain Cancer Treatment Treatment for brain cancer should be individualized for each patient. Treatment regimens are based on the patient's age and general health status as well as the size, location, type, and grade of the tumor. In most cases of brain cancer, surgery, radiation, and chemotherapy are the main types of treatment. Often, more than one treatment type is used. The treatment types are further described below. The patient, family, and friends will have many questions about the tumor, the treatment, how treatment will affect the person, and the person's long-term outlook (prognosis). Members of the person's health-care team are the best source of this information. Don't hesitate to ask them any questions.

REPORTED BY: Irish P. Galura