What are Brain and Spinal Cord Tumors?Overview of the brain and spinal cordWhat causes CNS tumors?Who is at risk?How are tumors graded?What are the possible symptoms?How are CNS tumors diagnosed?How are brain and spinal cord tumors treated?

NeurosurgeryRadiation TherapyRadiosurgeryChemotherapyTargeted TherapyAlternative and Complementary Therapy

What Research is Being Done?Appendix: Some CNS Tumors and Tumor-Related ConditionsWhere can I get more information?

A tumor is a mass of abnormal cells that either form into a new growth or the growth was there when you were born (congenital). Tumors occur when something goes wrong with genes that regulate cell growth, allowing cells to grow and divide out of control. Tumors can form anywhere in your body. Brain and spinal cord tumors form in the tissue inside your brain or spinal cord, which make up the central nervous system (CNS).

Depending on its type, a growing tumor may not cause any symptoms or can killor displace healthy cells or disrupt their function. A tumor can move or press on sensitive tissue and block the flow of blood and other fluid, causing pain and inflammation. A tumor can also block the normal flow of activity in the brain or signaling to and from the brain. Some tumors dont cause any changes.Tumors can be noncancerous (benign) or cancerous (malignant).

Tumors can be primary or secondary.

There are more than 120 types of brain and spinal cord tumors. Some are named by the type of normal cell they most closely resemble or by location. Brain and spinal cord tumors are not contagious or, at this time, preventable.

See theAppendix at the end of this guide for a listing of some CNS tumors and tumor-related conditions.

top

The brain has three major parts:

The brains two halves, or hemispheres, use nerve cells (neurons) to speak with each other.Each hemisphere has four sections, called lobes, which handle different neurological functions.

For more information, see General Information About Adult Central Nervous System Tumors.

The spinal cordan extension of the brainlies protected inside the bony spinal column. It contains bundles of nerves that carry messages between the brain and other parts of the body, such as instructions to move an arm or information from the skin that signals pain.

A tumor that forms on or near the spinal cord can disrupt communication between the brain and the nerves or restrict the cord's supply of blood. Because the spinal column is narrow, a tumor hereunlike a brain tumorcan cause symptoms on both sides of the body.

Spinal cord tumors, regardless of location, often cause pain, numbness, weakness or lack of coordination in the arms and legs, usually on both sides of the body. They also often cause bladder or bowel problems.

Spinal cord tumors are described based on where on the cord the tumor is located and each vertebra (part of a series of bones that form the backbone) is numbered from top to bottom. The neck region is called cervical (C), the back region is called thoracic (T), and the lower back region is called lumbar (L) or sacral/cauda equina (S). Tumors are further described by whether the tumor begins in the cells inside the spinal cord (intramedullary) or outside the spinal cord (extramedullary). Extramedullary tumors grow in the membrane surrounding the spinal cord (intradural) or outside (extradural).

top

Researchers really don't know why primary brain and spinal cord tumors develop. Possible causes include viruses, defective genes, exposure to certain chemicals and other hazardous materials, and immune system disorders. Sometimes CNS tumors may result from specific genetic diseases, such as neurofibromatosis and tuberous sclerosis, or exposure to radiation.

top

Anyone can develop a primary brain or spinal cord tumor, but the overall risk is very small. Brain tumors occur more often in males than in females and are most common in middle-aged to older persons. Although uncommon in children, brain tumors tend to occur more often in children under age 9, and some tumors tend to run in families. Most brain tumors in children are primary tumors.

Other risk factors for developing a primary brain or spinal cord tumor include race (Caucasians are more likely to develop a CNS tumor) and occupation. Workers in jobs that require repeated contact with ionizing radiation or certain chemicals, including those materials used in building supplies or plastics and textiles, have a greater chance of developing a brain tumor.

top

The grade of a tumor may be used to tell the difference between slow-growing and fast-growing types of the tumor. The World Health Organization (WHO) tumor grades are based on how abnormal the cancer cells look under the microscope and how quickly the tumor is likely to grow and spread. Some tumors change grade as they progress, usually to a higher grade. The tumor is graded by a pathologist following a biopsy or during surgery.

top

Brain and spinal cord tumors cause many different symptoms, which can make detection tricky. Symptoms depend on tumor type, location, size, and rate of growth. Certain symptoms are quite specific because they result from damage to particular areas of the brain and spinal cord. Symptoms generally develop slowly and worsen as the tumor grows.

Brain tumor

In infants, the most obvious sign of a brain tumor is a rapidly widening head or bulging crown. Other more common symptoms of a pediatric brain tumor can include:

In older children and adults, a tumor can cause a variety of symptoms, including headaches, seizures, balance problems, and personality changes.

Other symptoms may include endocrine disorders or abnormal hormonal regulation, difficulty swallowing, facial paralysis and sagging eyelids, fatigue, weakened sense of smell, or disrupted sleep and changes in sleep patterns.

Spinal cord tumors

Common symptoms of a spinal cord tumor include:

top

If you are suspected of having a brain or spinal cord tumor, your doctor (usually a neurologist, oncologist, or neuro-oncologist) will perform a neurologic exam and may order a variety of tests based on your symptoms, personal and family medical history, and results of the physical exam. Once a tumor is found on diagnostic imaging studies, surgery to obtain tissue for a biopsy or removal is often recommended. Diagnosing the type of brain or spinal cord tumor is often difficult. Some tumor types are rare and the molecular and genetic alterations of some tumors are not well understood. You may want to ask your primary care doctor or oncologist for a second opinion from a comprehensive cancer center or neuro-oncologist with experience treating your diagnosis or tumor type. Even a secondopinion that confirms the originaldiagnosis can be reassuring and help you better prepare for your care and treatment.

A neurological exam

A neurological exam can be done in your doctors office. It assesses your movement and sensory skills, hearing and speech, reflexes, vision, coordination and balance, mental status, and changes in mood or behavior.

Some advanced tests are performed and analyzed by a specialist.

Diagnostic imaging

Diagnostic imaging produces extremely detailed views of structures inside the body, including tissues, organs, bones, and nerves. Such imagingcan confirm the diagnosis and helpdoctors determine the tumor's type, treatment options, and later, whether the treatment is working.

See the NINDS publication, Neurological Diagnostic Tests and Procedures, for a more complete description of the following tests:

Usually a contrast agent (such as a dye) is injected into a vein before a CT or MRI. Many tumors become much easier to identify on the scan after the contrast is given.

Laboratory and other tests

top

A specialized team of doctors advises and assists individuals throughout treatment and rehabilitation. These doctors may include:

For more information, see: https://www.cancer.gov/rare-brain-spine-tumor/tumors/about-cns-tumors#who-treats-central-nervous-system-cns-tumors.

Your health care team will recommend a treatment plan based on the tumor's location, type, size and aggressiveness, as well as medical history, age, and general health. Malignant tumors require some form of treatment, while some small benign tumors may need onlymonitoring. Treatment for a brain or spinal tumor can include surgery, radiation therapy, chemotherapy, targeted therapy, or a combination of treatments.Initial treatment for a CNS tumor may involve a variety of drugs to treat or ease symptoms, including:

top

Surgery is usually the first treatment to both obtain tissue for diagnosis and remove as much tumor as can be done safely. Surgery may be the only treatment you need if your tumor is considered benign or low grade. Based on the type and grade (low versus high), doctors often recommend follow-up treatment, including radiation and chemotherapy, or an experimental treatment. You will be referred to the specialists above to provide guidance on this treatment.

Surgery is usually the first step in treating an accessible tumorone that can be removed without risk of neurological damage. Many low-grade tumors and secondary (metastatic) cancerous tumors can be removed entirely. Some tumors have a clearly defined shape and can be removed more easily. Your surgeon will try removing (called resecting or excising) all or as much tumor as possible. For malignant CNS tumors, this is best performed by a neurosurgeon.

An inaccessible or inoperable tumor is one that cannot be removed surgically because of the risk of severe nervous system damage during the operation. These tumors are frequently located deep within the brain or near vital structures such as the brain stem and may not have well-defined edges. In these cases, a biopsy may be performed.

A biopsy is sometimes performed to diagnose and help doctors determine how to treat a tumor. Biopsies can sometimes be performed by inserting a needle through a small hole in the body and taking a small piece of the tumor tissue. A pathologist will examine the tissue for certain changes that signal cancer and determine its stage or grade.

In some cases, a surgeon may need to insert a shunt into the skull to drain any dangerous buildup of CSF caused by the tumor. A shunt is a flexible plastic tube that is used to divert the flow of CSF from the central nervous system to another part of the body, where it can be absorbed as part of the normal circulatory process.

During surgery, some tools used in the operating room include a surgical microscope, the endoscope (a small viewing tube attached to a video camera), and miniature precision instruments that allow surgery to be performed through a small incision in the brain or spine. Other tools include:

For more information, see: Surgery to Treat Cancer.

top

Radiation therapy usually involvesrepeated doses of high-energy beams such as x-rays or protons to kill cancer cells or keep them from multiplying. Radiation therapy can shrink the tumor mass. It can be used to treat surgically inaccessible tumors or tumor cells that may remain following surgery.

Radiation treatment can be delivered externally, using focused beams of energy or charged particles that are directed at the tumor, or from inside the body, using a surgically implanted device. The stronger the radiation, the deeper it can penetrate to the target site. Healthy cells may also be damaged by radiation therapy, but current radiation treatment is designed to minimize injury to normal tissue.

Treatment often begins soon after surgery and may continue for several weeks. Depending on the tumor type and location, a person may be able to receive a modified form of therapy to lessen damage to healthy cells and improve the overall treatment.

Externally delivered radiation therapy poses no risk of radioactivity to the person or family and friends. Types of external radiation therapy include:

top

Radiosurgery is usually a one-time treatment using multiple, sharply focused radiation beams aimed at the brain or spinal cord tumor from multiple angles.It does not cut into the person but, like other forms of radiation therapy, harms a tumor cells ability to grow and divide. It is commonly used to treat surgically inaccessible tumors and maybe used at the end of conventional radiation treatment. Two common radiosurgery procedures are:

Side effects of radiation: Side effects of radiation therapy vary from person to person and are usually temporary. They typically begin about two weeks after treatment starts and may include fatigue, nausea, vomiting, reddened or sore skin in the treated area, headache, hearing loss, problems with sleep, and hair loss (although the hair usually grows back once the treatment has stopped). Radiation therapy in young children, particularly those age three years or younger, can cause problems with learning, processing information, thinking, and growing.

There are late side effects of radiation that may occur months to years after treatment that include shrinkage (atrophy) of the brain or spinal cord region that was treated.

top

Chemotherapy uses powerful drugs to kill cancer cells or stop them from growing or spreading. These drugs are usually given orally, intravenously, or through a catheter or port and travel through the body to the cancerous cells. Your oncologist will recommend a treatment plan based on the type of cancer, drug(s) to be used, the frequency of administration, and the number of cycles needed. Chemotherapy is given in cycles to more effectively damage and kill cancer cells and give normal cells time to recover from any damage.

Individuals might receive chemotherapy to shrink the tumor before surgery called neo-adjuvant therapy (a first step treatment to shrink a tumor before the primary treatment). Radiation therapy can also be given as neo-adjuvant therapy. After surgery, or radiation treatment if radiation is the primary treatment, chemotherapy could be called adjuvant therapy (treatment in addition to the primary treatment). Metronomic therapy involves continuous low-dose chemotherapy to block mechanisms that stimulate the growth of new blood vessels needed to feed the tumor.

Not all tumors are vulnerable to the same anticancer drugs, so a persons treatment may include a combination of drugs. Common CNS chemotherapies include temozolomide, carmustine (also called BCNU), lomustine (also called CCNU), and bevacizumab. Individuals should be sure to discuss all options with their medical team.

Side effects of chemotherapy may include hair loss, nausea, digestive problems, reduced bone marrow production, and fatigue. The treatment can also harm normal cells that are growing or dividing at the same time, but these cells usually recover and side effects often improve or stop once the treatment has ended.

For more information about chemotherapy, see: Chemotherapy to Treat Cancer .

top

Targeted therapy is a cancer treatment that uses drugs to target specific genes and proteins that are involved in tumor cell growth. This helps slow uncontrolled growth and reduce the production of tumor cells. Targeted therapies include oncogenes, growth factors, and molecules aimed at blocking gene activity.

Alternative and complementary approaches may help tumor patients better cope with their diagnosis and treatment. Some of these therapies, however, may be harmful if used during or after cancer treatment and should be discussed in advance with a doctor. Common approaches include nutritional and herbal supplements, vitamins, special diets, and mental or physical techniques to reduce stress.

top

Scientists continue to investigate ways to better understand, diagnose, and treat CNS tumors. Several of todays treatments were experimental therapies only a decade ago.Clinical studies are research studies that test or observe how well medical approaches work in people.Some clinical studies test new treatments such as a new drug or medical therapy. Treatment studies help researchers learn if a new treatment is effective or less harmful than standard treatments. Studies can be considered at any point, from the time of diagnosis through recurrence. For more information about clinical studies, see: National Cancer Institute Clinical Trials.

Current clinical studies of genetic risk factors, environmental causes, and molecular mechanisms of cancers may translate into tomorrows treatment of, or perhaps cure for, these tumors.Much of this work is supported by the National Institutes of Health (NIH), through the collaborative efforts of its National Institute of Neurological Disorders and Stroke (NINDS) and National Cancer Institute (NCI), as well as other federal agencies, nonprofit groups, pharmaceutical companies, and private institutions. Some of this research is conducted through the collaborative neuroscience and cancer research community at the NIH or through research grants to academic centers throughout the United States.

The jointly sponsored NCI-NINDS Neuro-Oncology Branch coordinates research to develop and test the effectiveness and safety of novel therapies for people with CNS tumors. These experimental treatment options may include new drugs, combination therapy, gene therapy, advanced imaging and artificial intelligence, biologic immuno-agents, surgery, and radiation. Information about these trials, and trials for other disorders, can be accessed at the federal governments database of clinical trials, ClinicalTrials.gov.

Scientists at NIH and universities across the United States are exploring a variety of approaches to treat CNS tumors. These experimental approaches include boosting the immune system to better fight tumor cells, developing therapies that target the tumor cell while sparing normal cells,making improvementsin radiation therapy, disabling the tumor using genes attached to viruses, and defining biomarkers that may predict the response of a CNS tumor to a particular treatment.

Biological therapy (also called immunotherapy)involves enhancing the bodys overall immune response to recognize and fight cancer cells. The immune system is designed to attack foreign substances in the body, but because cancer cells arent foreign, they usually do not generate much of an immune response. Researchers are using different methods to provoke a strong immune response to tumor cells, including:

Targeted therapy uses molecularly targeted drugs that seek out the cellular changes that convert normal cells into cancer. Targeted therapies include:

Biomarkersare molecules or other substances in the blood or tissue that can be used to diagnose or monitor a disorder. Some CNS tumor biomarkers have been found, such as the epithelial growth factor receptor (EGRF) gene. Researchers continue to search for additional clinical biomarkers of CNS tumors, to better assess risk from environmental toxins and other possible causes and monitor and predict the outcome of CNS tumor treatment. Identifying biomarkers may also lead to the development of new disease models and novel therapies for tumor treatment.

Radiation therapyresearch includes testing several new anticancer drugs, either independently or in combination with other drugs. Researchers are also investigating combined therapies including drugs, radiation, and radiosurgery to effectively treat CNS tumors. Research areas under investigation include radiosensitizersdrugs that make rapidly dividing tumor tissue more vulnerable to radiation.

Chemotherapeutic drugresearch focuses on ways to better deliver drugsacross the blood-brain barrier and into the site of the tumor. Since chemotherapeutic drugs work in different ways to stop tumor cells from dividing, several trials are testing whether giving more than one drug, and perhaps giving them in different ways (such as staggered delivery and low-dose, long-term treatment), may kill more tumor cells without causing damaging side effects than present therapy. Researchers are examining different levels of chemotherapeutic drugs to determine whether they are less toxic to normal tissue when combined with other cancer treatments, and ways to make cancer cells more sensitive to chemotherapy. Research areas include:

Surgery studies are ongoing to better define the potential benefits of surgery, including better response to biologic therapy and chemotherapy, improved quality of life, and prolonged survival.

Clinical trials can help doctors and scientists discover whether new treatments are effective and safe for many people with spinal and brain tumors. Both healthy people and those with a disease participate in clinical trials, which increases our understanding about diseases including brain and spinal tumors. To learn more about clinical trials for CNS tumors and how to participate in them, visit http://www.clinicaltrials.gov, a database of thousands of studies, some of which include results and papers on findings.

top

There are many types of brain and spinal cord tumors. These tumors are named by their location in the body, cell of origin, rate of growth, and malignancy. Some tumor types are more prevalent in children than in adults. Here is a listing of some common benign and malignant CNS tumors.

Glioma

Glioma tumorsgrow from several types of glial cells, which support the function of neurons. Gliomasusually occur in the brains cerebral hemispheres but may also strike other areas. Gliomas are classified based on the type of normal glial cells they resemble.

Mixed gliomas contain more than one type of glial cell and are usually found in the cerebrum. These tumors can spread to other sites in the brain.Other gliomas are named after the part of the body they affect. Among them are:

ChordomaChordomas are rare congenital tumors which develop from remnants of the flexible spine-like structure that forms and dissolves early in fetal development (and is later replaced by the bones of the spine). Chordomas often occur near the top or the bottom of the spine, outside the dura mater, and can invade the spinal canal and skull cavity.

Choroid plexus papillomaThis rare, usually benign childhood tumor develops slowly and can increase the production and block the flow of CSF, causing symptoms that include headaches and increased intracranial pressure. A rarer cancerous form can spread via the cerebrospinal fluid.

Germ cell tumorsThese very rare childhood tumors may start in cells that fail to leave the CNS during development. Germ cell tumors usually form in the center of the brain and can spread elsewhere in the brain and spinal cord. Different tumors are named after the type of germ cell.

MeningiomaMeningiomas are benign tumors that develop from the thin membranes, or meninges, that cover the brain and spinal cord. Meningiomas usually grow slowly, generally do not invade surrounding normal tissue, and rarely spread to other parts of the CNS or body.

Pineal TumorsThese tumors form in the pineal gland, a small structure located between the cerebellum and the cerebrum. The three most common types of pineal region tumors are gliomas, germ cell tumors, and pineal cell tumors

Pituitary Tumors (also called pituitary adenomas)These small tumors form in the pituitary gland. Most pituitary tumors are benign and their incidence increases with age. Pituitary tumors are classified as either non-secreting or secreting (secreting tumors release unusually high levels of pituitary hormones, which can trigger neurological conditions and symptoms including Cushings syndromea harmful overproduction of the hormone cortisol).

Primitive Neuroectodermal Tumors (PNET)These malignant tumors may spring from primitive or immature cells left over from early development of the nervous system. PNETS can spread throughout the brain and spinal cord in a scattered, patchy pattern and, in rare cases, cause cancer outside the CNS. The two most common PNETs are:

Vascular TumorsThese rare, noncancerous tumors arise from the blood vessels of the brain and spinal cord. The most common vascular tumor is the hemangioblastoma, a cyst-like mass of tangled blood vessels, which does not usually spread.

For information on some rare brain and spinal cord tumors, see: https://www.cancer.gov/rare-brain-spine-tumor/tumors.

Arachnoid cystsare benign, fluid-filled masses that form within a thin membrane lining (tumors are solid tissue masses). Cysts in the CNS can cause tumor-like symptoms including headache and seizures. Some cysts occur more often in the spinal cord than in the brain, and certain cysts are seen most frequently in children.

Hydrocephalusinvolves the build-up of cerebrospinal fluid in the brain. The excessive fluidcan cause harmful pressure, headaches, and nausea.

View original post here:
Brain and Spinal Cord Tumors: Hope Through Research

Spinal Cord Stem Cells Comments Off on Brain and Spinal Cord Tumors: Hope Through Research | January 3rd, 2023