Coping With Lymphoma Of The Brain Or Spinal Cord
Coping with a diagnosis of cancer can be difficult, both practically and emotionally. It can be especially difficult when you have a rare cancer. Being well informed about the type of cancer you have, and its treatment can make it easier to cope.
Diagnosing Brain And Spinal Cancer
Most brain and spine tumors are diagnosed when a person visits their doctor because they are experiencing symptoms. This visit will likely involve both a discussion of the patients medical history, a physical exam, and a neurological exam to assess brain and spinal cord function by testing the patient’s reflexes, muscle strength, vision, eye movement, hearing, balance, coordination, and alertness. If a doctor detects an abnormality, they may recommend further tests to determine whether the patient has cancer or a benign tumor. Based on their findings, the doctor may also refer the patient to a specialist, such as a neurologist, medical oncologist, or neurosurgeon.
The diagnostic process may involve many steps, including all or some of the following:
Types Of Brain Tumors
According to the World Health Organization, there are more than 120 types of central nervous system tumors.
Gliomas are the most common type of brain tumor in adults. They form in the glial cells, which support the nerves in your brain and spine.
Glioblastoma is the most common type of glioma. It usually forms in your cerebrum, the largest part of your brain. It can also start in your spine. Glioblastomas make their own blood vessels, and can quickly grow and invade nearby areas. About 14,000 people in the US are diagnosed each year.
We categorize spine tumors into three groups:
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Chemotherapy For Brain And Spinal Cancer
Chemotherapy uses powerful medicine to kill tumor cells. Chemotherapy drugs are most often taken in pill form or injected into a vein. For some types of brain and spinal tumors, chemotherapy may also be delivered directly into the cerebrospinal fluid.
The chemotherapy drug used most often for patients with glioblastoma and high-grade glioma is called temozolomide , which is taken as a pill.
Patients who have surgery to remove their tumors may receive chemotherapy via Gliadel Wafers. The dissolvable wafers contain the chemotherapy drug carmustine and are placed in the area where the tumor was removed during surgery. Unlike intravenous or oral chemotherapy, which affects all areas of the body, this type of chemo concentrates the drug at the tumor site so the patient experiences fewer side effects.
Many other oral and IV chemotherapy medicines are used for pediatric brain tumors.
Spinal Cord Injury: Can Brain And Nerve Stimulation Restore Movement
In 1999, when Jason Carmel, MD, PhD, was a second-year medical student at Columbia, his identical twin brother suffered a spinal cord injury, paralyzing him from the chest down and limiting use of his hands.
Jason Carmels life changed that day, too. His brothers injury ultimately led Carmel to become a neurologist and a neuroscientist, with the goal of developing new treatments to restore movement to people living with paralysis.
Now, a nerve stimulation therapy that Carmel is developing at Columbia is showing promise in animal studies and may eventually allow people with spinal cord injuries to regain function of their arms.
The stimulation technique targets the nervous system connections spared by injury, says Carmel, a neurologist at Columbia University and NewYork-Presbyterian, enabling them to take over some of the lost function.
In recent years, some high-profile studies of spinal cord electrical stimulation have allowed a few people with incomplete paralysis to begin to stand and take steps again.
Carmels approach is different because it targets the arm and hand and because it pairs brain and spinal cord stimulation, with electrical stimulation of the brain followed by stimulation of the spinal cord. When the two signals converge at the level of the spinal cord, within about 10 milliseconds of each other, we get the strongest effect, he says, and the combination appears to enable the remaining connections in the spinal cord to take control.
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How Brain And Spinal Cord Tumors Are Classified
Several factors are important when doctors are trying to figure out how best to treat a brain or spinal cord tumor and what the prognosis is likely to be:
The type of tumor : Tumors can form in almost any type of tissue or cell in the brain or spinal cord. Some tumors have a mix of cell types. Different types of tumors tend to start in certain parts of the brain or spinal cord, and tend to grow in certain ways.
The grade of the tumor: Some types of brain and spinal cord tumors are more likely to grow into nearby brain or spinal cord tissue than are others. Brain and spinal cord tumors are typically divided into 4 grades , based largely on how the tumor cells look under a microscope:
- Lower grade tumors tend to grow more slowly and are less likely to grow into nearby tissues.
- Higher grade tumors tend to grow quickly and are more likely to grow into nearby tissues. These tumors often require more intense treatment.
Gene changes in the tumor cells: Even for a specific type of brain tumor, the changes in the genes of the tumor cells can be different. For example, many types of tumors are now divided based on whether the cells have mutations in one of the IDH genes . For a specific type of tumor, those with IDH mutations tend to have a better outlook than those without a mutation. Other gene mutations can also be important for certain types of tumors.
When Should I See My Healthcare Provider About My Brain Tumor
If youve been diagnosed with a brain tumor, youll need to see your healthcare team regularly to receive treatment and monitor your symptoms.
You should see your healthcare provider if your brain tumor symptoms get worse or you have new symptoms.
Even after brain tumor treatment, you should follow up with your healthcare provider regularly.
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Brain And Spinal Cord Tumors
Cancers that begin in brain tissue or the spinal cord are known as central nervous system cancers. Primary brain tumors develop in the brain. Secondary brain tumors or brain metastases begin in another part of the body but spread to the brain. If your cancer spreads to the bone, visit our bone metastases page.
Benign brain tumors begin in cells within or around the brain. They grow slowly and dont spread. Still, they can recur after treatment. Malignant tumors are cancerous and can have more dangerous effects. They can grow quickly and spread into other areas of the brain. They may also recur after treatment. Metastatic or secondary brain tumors begin in other parts of the body like the lung, breast, colon or skin, but spread to the brain. In any case, if a tumor grows in the brain and presses on nearby areas, it can lead to unwanted signs & symptoms.
There are over 120 types of brain tumors and central nervous system tumors.
How Are They Categorized
Because the brain and spinal cord make up the central nervous system, these tumors are also called CNS tumors. CNS tumors are very complex. The World Health Organization recognizes more than 150 types.
The field is also evolving as researchers at OHSU and beyond identify ways to fight tumors at the molecular level.² Here are some other ways these tumors are categorized:
Benign: Not cancer. These tumors grow slowly, are generally not invasive and typically have clear edges that make them easier to remove. They still pose serious health threats in the brain and spinal cord, though, because they can press on vital structures.
Malignant: Cancer. These tumors contain abnormal, rapidly dividing cells that can invade normal tissue. Brain and spinal cord tumors rarely spread outside the central nervous system, but they are particularly concerning because they can damage essential functions.
Primary tumor: A tumor discovered where it developed.
Secondary tumor: A tumor that spread from elsewhere in the body. These are also called metastatic brain tumors because they metastasized from elsewhere. They are treated differently than primary tumors.
New: This is a tumor that’s newly discovered and unrelated to any previous tumor.
Brain tumors are graded on a scale of one to four. The lower the grade, the less aggressive the tumor and the easier it is to treat.
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Surgery For Brain And Spinal Cancer
Surgery is a primary treatment for brain and spinal tumors and is often the only treatment needed for a low-grade tumor.
A craniotomy is the most common surgical approach to treat brain tumors. During this procedure, a neurosurgeon, often guided by MRI or CT scans, makes an incision in the scalp and then uses a drill to remove the piece of skull covering the tumor. The surgeon may also need to cut into the brain itself to reach the tumor. Once they locate the tumor, the neurosurgeon will remove the tumor in one of a few different ways, depending on how hard or soft it is and the number of blood vessels it contains. Many tumors can be excised with a scalpel or special scissors, while soft tumors are often removed with a suction device. In other cases, a handheld ultrasonic aspirator is used to break up the tumor and suction it out. Afterward, the piece of skull is put back in place and attached with titanium screws and plates, wires, or special stitches.
During a craniotomy, the patient may be under general anesthesia or may be awake for at least part of the procedure if the surgeon needs to assess brain function during the operation.
A Childhood Brain Or Spinal Cord Tumor Is A Disease In Which Abnormal Cells Form In The Tissues Of The Brain Or Spinal Cord
There are many types of childhood brain and spinal cord tumors. The tumors are formed by the abnormal growth of cells and may begin in different areas of the brain or spinal cord.
The tumors may be benign or malignant . Benign brain tumors may grow and press on nearby areas of the brain. They rarely spread into other brain tissue. Malignant brain tumors may be low grade or high grade. High-grade tumors are likely to grow quickly and spread into other brain tissue. Low-grade tumors tend to grow and spread more slowly than high-grade tumors. When a tumor grows into or presses on an area of the brain, it may stop that part of the brain from working the way it should. Both benign and malignant brain tumors can cause signs or symptoms, need treatment, and can recur .
Together, the brain and spinal cord make up the central nervous system .
This summary is about primary benign and malignant brain and spinal cord tumors.
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Who Is More Likely To Get Brain And Spinal Cord Tumors
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.
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 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.
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 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.
Treatment Of Brain And Spinal Tumors
Surgery is a main treatment for tumors of the brain and spinal cord. Additional treatments for brain and spinal tumors include chemotherapy, radiation therapy, and targeted therapy.
Treatments depend on the type of tumor, where it is located, the age of the child, and how much of the tumor can be removed with surgery.
Most patients who have brain surgery will receive steroid medications to reduce swelling of the brain. Some patients may receive anti-seizure medications.
In some cases, a shunt is placed in the brain to prevent fluid from building up . A shunt is a small tube that drains cerebrospinal fluid so that it can be removed from the brain. The shunt may be temporary or permanent.
Post-surgery rehabilitation and supportive care including help with vision, speech, hearing, strength, and movement may facilitate recovery. Psychology and school support services can help with emotional, social, developmental, and learning needs.
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Sometimes brain tumors can block the normal flow of cerebrospinal fluid . Hydrocephalus occurs when too much CSF builds up in the ventricles.
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A shunt is a small tube that drains cerebrospinal fluid to prevent the build-up of fluid.
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Types Of Brain And Spinal Cord Cancer We Treat
We specialize in evaluating and treating both cancerous and noncancerous brain and spinal cord tumors. We also diagnose and treat rare neurologic complications of cancer, such as paraneoplastic neurologic disorders, which affect the nervous system in those with cancer.
Some brain tumors grow slowly and may not cause symptoms until they become large. Others can grow quickly. And not all brain and spinal cord tumors are cancerous. Some are benign but still cause major problems. Our team has expertise in diagnosing and treating all types of brain and spinal cord tumors, including:
The Central Nervous System
To understand brain and spinal cord tumors, it helps to know about the normal structure and function of the central nervous system , which is the medical name for the brain and spinal cord.
The brain is the center of thought, feeling, memory, speech, vision, hearing, movement, breathing, and much more. The spinal cord and special nerves in the head called cranial nerves help carry messages between the brain and the rest of the body. These messages tell our muscles how to move, transmit information gathered by our senses, and help coordinate the functions of our internal organs.
The brain is protected by the skull. Likewise, the spinal cord is protected by the bones of the spinal column.
The brain and spinal cord are surrounded and cushioned by a special liquid, called cerebrospinal fluid . Cerebrospinal fluid is made by the choroid plexus, which is found in spaces within the brain called ventricles. The ventricles and the spaces around the brain and spinal cord are filled with CSF.
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Expert Review And References
- Detailed guide: CNS tumors in children. American Cancer Society. American Cancer Society . Atlanta, GA: American Cancer Society 2008.
- American Society of Clinical Oncology. Central Nervous System Tumors – Childhood – Overview. 2014.
- Central nervous system – childhood. American Society of Clinical Oncology . People Living with Cancer. Alexandria, VA.: American Society of Clinical Oncology 2008.
- Brain tumours in children. Cancerbackup. Cancerbackup. London, UK: Cancerbackup 2008.
- Brain tumours. Hospital for Sick Children. AboutKidsHealth. Toronto, ON: Hospital for Sick Children 2004.
- The Hospital for Sick Children . AboutKidsHealth: An Overview of the Brain. 2009: .
Life After Brain And Spinal Tumors
The impact of a brain tumor on a childs quality of life varies widely. Some children with brain tumors show minimal lasting effects on health and function after treatment. Other children may experience long-term problems in various areas of physical, cognitive, and emotional functioning.
Sometimes, problems are the result of injury to the brain from the tumor and/or surgery. Other changes may be due to long-term or late effects of chemotherapy and/or radiation.
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Who Do Brain Tumors Affect
Brain tumors affect children and adults and can develop at any age. Theyre slightly more common in people assigned male at birth than people assigned female at birth .
Meningioma, which is usually benign, is the only type of brain tumor thats more common in people AFAB.
The most serious type of brain tumor, glioblastoma, is becoming more common among people who are as the general population ages.
Imaging Tests For Brain And Spinal Cancer
Imaging tests can show where the tumor is located and whether it has spread from the original site. The images are reviewed by a radiologist, a doctor who specializes in interpreting imaging tests.
Magnetic resonance imaging and computed tomography scans are the imaging tests doctors use most often to look for brain and spinal cancer. These scans will almost always reveal a tumor, if one is present, as well as giving the doctor an idea about what type of tumor it might be.
Special types of MRIs for brain tumors and spine tumors include magnetic resonance angiography and magnetic resonance venography , which are used to look at the blood vessels in the brain. Magnetic resonance spectroscopy can be performed during an MRI to measure biochemical changes in an area of the brain and can be helpful in determining the type of tumor. During magnetic resonance perfusion, also known as perfusion MRI, a contrast dye is injected into a vein to show the amount of blood going through different parts of the brain and tumor. After diagnosis, doctors may use a functional MRI to look for tiny blood flow changes in an active part of the brain. This test can be used to discover what part of the brain handles functions such as speech, thought, sensation, or movement, telling them which parts of the brain to avoid during surgery or radiation therapy.
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