Brain Tumor FAQs
Q: What is a brain tumor?
A: A brain tumor is an abnormal growth of a person’s own cells inside the skull or cranium. It is important to distinguish between the two major types of brain tumors: brain metastasis vs primary brain tumors. Brain metastasis is an abnormal migration and growth of cancer cells in the brain from cancers that arise outside the brain, such as breast cancer, lung cancer or melanoma. There are many types of primary brain tumors depending on which cells they come from. Primary brain tumors come from an abnormal growth of brain cells including glial cells (supporting cells of neurons), neurons, pituitary cells (hormone secreting cells) and the brain covering meninges. There are over 50 different types of brain tumors: gliomas, meningiomas and pituitary adenomas are common brain tumors. Some are slow growing and are benign, called low grade brain tumors, while others grow faster and are malignant, called high grade brain tumors. Because there are many types of brain tumors it is important that you see a specialist team of brain tumor experts who work closely together to give you the best and most up to date information and care. At Tufts Medical Center we have a dedicated team of brain tumor specialists and nurses who work together on a daily basis providing care to our brain tumor patients.
If I Had A Brain Tumor Video Interview with Dr. Wu
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Q: I was just diagnosed with a brain tumor. What do I do?
A: There are many types of brain tumors. Treatments are complex and frequently require close consultation and coordination by specialists from neurosurgery, neuro-oncology, radiation oncology and neuroradiology and neuropathology. It is important you seek treatment delivered by these specialists that work together day in and day out. You should contact your primary care physician or your neurologist to refer you to a specialist caring for patients with brain tumors. At Tufts Medical Center our specialists work together on a daily basis with weekly group conference to determine the best treatment for each patient.
If I Had A Brain Tumor Video Interview with Dr. Wu
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Q: What is a glioma?
A: An “–oma” is latin for tumor. A glioma, the most common type of primary brain tumors, is a tumor arising from the Glial cells or supporting cells of the brain. There are many types of supportimg cells in the brain. A glioma is a broad term for many different types of brain tumors, such as astrocytoma, oligodendroglioma, oligoastrocytoma, (a glioma with mixture of astrocytoma and oligodendroglioma cells), ganglioglioma and ependymoma.
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Q: What is an astrocytoma?
A: An astrocytoma is a type of brain tumor that comes from the astrocytes, a type of supporting cell of the brain that under the microscope looks like a star and therefore the name “astro”. As a group, astrocytomas are the most common type of glioma. These tumors can have very different growth rates and are graded from I to IV by World Health Organization (WHO). Grade I astrocytoma is also called Juvenile Pilocytic Astrocytoma or JPA. This tumor is very slow growing. Grade II astrocytoma is also called the low grade astrocytoma or benign astrocytoma. Grade III astrocytoma is also called the anaplastic astrocytoma. Grade IV astrocytoma is also called glioblastoma, or glioblastoma multiforme (GBM), which is the fastest growing brain cancer and the hardest tumor to control. The term of malignant gliomas includes both anaplastic astrocytoma and glioblastoma multiforme.
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Q: What is a Juvenile Pilocytic Astrocytoma?
A: This tumor usually occurs in children in the cerebellum, a part of the brain in the back of the head that controls coordination. These tumors are usually cured by surgical removal alone. Even with partial removal many of these tumors stay stable for many years because of their very slow growth rates.
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Q: What is a low grade astrocytoma?
A: A Low grade astrocytoma or grade II astrocytoma is a slow growing tumor in the brain. The cells of this tumor usually infiltrate or invade between normal cells of the brain. They can grow into a large size before they are discovered. Frequently patients present with seizures. They may also present with headaches or mild neurologic problems such as weakness or numbness. These tumors, because they may involve critical areas of the brain, often cannot be totally removed surgically. If possible, as much of the tumor should be removed. Tumors that are deep in the brain are sometimes biopsied rather than removed (a tiny or small amount of tumor sample obtained to be analyzed by the neuropathologist). The treatment of low grade astrocytoma after biopsy or surgery remains controversial. Radiation or chemotherapy should be tailored to each individual patient by the neuro-oncologist, radiation oncologist and neurosurgeon. This group of patients generally can live more than 8-10 years without tumor recurrence.
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Q: What is an Anaplastic astrocytoma?
A: This tumor is also called a grade III astrocytoma. This tumor has acquired more genetic mutations and is growing faster. This tumor usually is treated with surgery followed by radiation and chemotherapy. Unfortunately, even with treatment, patients usually do not live more than 5 years but we anticipate significant improvement in outcomes in the near future.
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Q: What is a Glioblastoma?
A: A glioblastoma is also known as glioblastoma multiforme (GBM) or grade IV astrocytoma. This tumor is the most malignant of brain tumors that grows within the brain. Every microscopic cell of this tumor cannot be completely removed by surgery, but surgery can remove the bulk of this tumor (so called debulking surgery). Surgery frequently improves the symptoms, such as headaches or weakness for these patients. After surgery, patients will receive radiation and chemotherapy. The most common chemotherapy drug is temozolomide or Temodar, a pill that is taken with radiation and continued after radiation treatments are finished. Another treatment uses chemotherapy on a wafer that is implanted within the resected tumor cavity and will slowly release the drug in high concentration into the tumor. Unfortunately, even with these treatments most patients will have a relapse or recurrence in a year or two. When there is recurrence, new treatments or drugs available through clinical trials are being used. New drugs such as bevacizumab (Avastin), an angiogenesis inhibitor, is used to “tame” the growth of abnormal vessels in these tumors. Vaccines against the patients’ glioblastoma cells are also being tested. At Tufts Medical Center, our doctors work closely with researchers to bring new treatments to our patients.
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Q: What is an Oligodendroglioma?
A: This tumor is a cousin of the grade II astrocytoma. It instead has tumor cells that look like another supporting cell in the brain called oligodendrocytes. This tumor tends to occur in young adults. Many of them present with seizures. This tumor, if possible, should be resected. This tumor also has a faster growing variant, the anaplastic oligodendroglioma. However, many of these anaplastic oligodendrogliomas have a loss of a piece of the chromosome 1 and chromosome 19. These tumors with the chromosome losses respond very well to radiation therapy and chemotherapy including temozolomide.
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Q: What is an Ependymoma?
A: Ependymoma is a type of glioma or brain tumor that arises from the ependymal cells of the brain. The ependymal cells line the ventricles, the fluid cavities in the center of the brain. These tumors commonly are found inside the ventricles or intraventricular. Most of these tumors are low grade (grade II) and are treated with surgery. Incomplete removal usually leads to recurrence. Radiation therapy can be used for residual or recurrent anaplastic ependymoma.
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Q: What is a Meningioma?
A: Meningiomas are tumors that arise from the cells covering the brain. These tumors are within the skull but outside the brain. They produce symptoms by compressing or pushing on the surrounding brain. They can also secrete molecules or factors that cause swelling or edema of the surrounding brain, which depending on the location of the tumor, can lead to different symptoms. For example, a meningioma in the frontal lobe of the brain can cause weakness on the opposite side of the body. Surgery to remove the tumor is usually recommended if the patient has symptoms or if the tumor is observed to have grown in size on CT or MRI scans. Most meningiomas are slow growing and thus are considered benign. If these tumors can be totally resected they can be cured. However, a number of them are located in or near critical areas and cannot be totally removed. These tumors will likely grow back in time. Sometimes Gamma Knife radiation is used for treating small meningiomas or tumor residuals after surgery. There are also a small number of malignant meningiomas that grow much faster and recur despite surgery and radiation. Currently there is no effective chemotherapy for meningiomas, however there are ongoing trials for new treatments. When they are located on the base of the skull they are very difficult to remove. Special surgical techniques including skull base surgery and endoscopic surgery are used to remove these tumors. At Tufts Medical Center our skull base specialists have extensive experience in all these techniques.
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Q: What is a Ganglioglioma?
A: Ganglioglioma is a tumor that has two predominant cell types: Neurons ( ganglion) and glia (astrocytes). They are usually in the brain and frequently cause seizures in patients. These tumors generally have a somewhat better prognosis than a low grade astrocytoma. They are treated with surgery. Radiation is usually deferred for recurrence of the tumor.
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Q: What is a Pituitary Adenoma?
A: This is a tumor of the pituitary gland at the base of the brain. The pituitary gland produces hormones that control many bodily functions including tissue and bone growth, cell metabolism and lactation (breast milk production). These tumors cause problems if they are large enough to press on the optic nerve or chiasm leading to loss of vision. The other way they can cause problems is by overproduction of hormones leading to overgrowth of soft tissue and bone (acromegaly), abnormal thinning of tissue, diabetes and abnormal distribution of fat (Cushing’s disease), or loss of menstral periods, breast milk production (prolactin secreting pituitary adenoma). Except for prolactin secreting tumors (or prolactinomas) which are treated with medications, most of pituitary tumors are treated with surgery. Minimally invasive surgery through the nose without a skin incision is usually performed. At Tufts Medical Center our Neurosurgeons have been using this technique for over 10 years. The Neurosurgeons also work closely with our endocrinologist (hormone specialists) and neuro-ophthalmologist (eye specialists) for our patients.
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Q: What is an Acoustic Neuroma or Vestibular Schwannoma?
A: This is a benign tumor arising from the insulation cells or Schwann cells of the vestibular nerve (balance nerve). Patients often first notice they cannot hear well in one ear. Occasionally there is ringing in the ear and dizziness. These tumors grow slowly. When they grow to a large size, they compress the nerves next to it including the facial nerve (which moves the muscles of the face) and the trigeminal nerve (which senses sensation on the face). They also can compress the adjacent brain and can cause weakness of the arm and leg. These tumors are treated by surgery especially when they are large, or Gamma Knife radiosurgery. At Tufts Medical Center our specialist team includes a skull base neurosurgeon, neuro-otologist (a specialist in ear surgery) and the Gamma Knife team working together to bring our patients the best treatment not only in removing the tumor but also in preserving their hearing and facial nerves.
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Q: What is the Gamma Knife?
A: Gamma Knife is “brain surgery without the knife”. In other words, it is brain surgery without the need to open the skull. By applying extremely precise and focused radiation beams to a target --in our case the brain tumor, while the surrounding brain is spared the high doses of radiation. Gamma Knife is used to treat many conditions including brain metastases from all types of cancers, meningiomas, acoustic neuroma (vestibular schwannoma), pituitary adenomas, chordomas, chondrosarcomas, some gliomas. Gamma Knife is also used to treat other conditions like trigeminal neuralgia also called tic douloureax and arteriovenous malformation (AVM). The Gamma Knife is done as an outpatient procedure—the patient comes in the morning of the procedure and usually leaves in the afternoon. At Tufts Medical Center we have the only Gamma Knife unit in Massachussetts and Northern New England. For more information please visit our web site --http://160.109.101.132/gammaknife/index.html or call the Boston Gamma Knife Center at 617-636-4266.
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Q: What is Stereotactic Surgery?
A: Stereotactic surgery is performed either with a frame or without one. When a frame is used—a special lightweight metal ring is attached to the head with 4 small pins after the skin is anesthetized. The patient then gets an MRI scan in the frame. The MRI images are then sent to a special computer that will, under the surgeon’s direction, determine the exact location or coordinates of the tumor. Most often this is used for a needle biopsy of a brain lesion where high precision is required. The frameless stereotactic surgery is performed without a frame. A high resolution MRI is obtained and loaded onto a computer navigation system in the operating room. In the operating room the patient’s head is then matched with the MRI. Once this is done a wireless pen is then used to very accurately localize any structure on or in the patient’s head. With this the neurosurgeon can design a small incision and skull opening (craniotomy) right where it needs to be and find the shortest and safest route to remove the brain tumor with the least amount of brain disruption. At Tufts Medical Center, we have over 2 decades of experience with stereotactic surgery of the brain.
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Q: What is a multidisciplinary brain tumor team?
A: This is team of specialists from neurosurgery, neuro-oncology, neurology, oncology, radiation oncology, neuroradiology, neuropathology, social worker and nursing that work side by side, to treat and care for patients with brain tumors. The treatment of brain tumors has become very complex and requires close interaction and coordination of many specialists. The multidisciplinary brain tumor team at Tufts Medical Center is dedicated to providing this high level of care with the most up to date technology and treatment regimens for our brain tumor patients. Our group meets formally once every week to discuss active patient issues. We also have weekly Brain Tumor Clinic to see new and follow-up patients. Our Brain Tumor Clinic can be reached by calling 617-636-2694 or fax 617-636-2342
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Q: What can I do to increase the chances of success of fighting against my brain tumor?
A: In addition to surgery, radiation therapy and chemotherapy, we encourage each patient to keep a positive attitude, eat a balanced diet, exercise regularly within tolerable range, communicate your questions, fears (if any) and even financial issues to your family members, physicians and social workers. Excessive vitamins or many herbal medications have not been proven to be as effective as claimed. Be cautious when receiving claims or using medications other than those prescribed by your doctors. It is always a good idea to share the information with your doctor and ask your doctor’s opinions. On June 17, 2008, FDA issued a warning letter to the public regarding false claim of effective anti-cancer therapies on the internet and listed 125 fake anti-cancer cures which you can review for detail by visiting the web site: http://www.fda.gov/cder/news/fakecancercures.htm.
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Q: I live far away from Tufts Medical Center and I have to come to the hospital for treatments. I don’t know how I can manage this.
A: Tufts Medical Center is located near downtown Boston next to the Theater district and Chinatown. It is on the Orange line MBTA Chinatown stop and a few blocks away from South station. It is easily accessible via route 93 and the MassPike. More detailed directions on the web: http://www.tuftsmedicalcenter.org/AboutUs/Directions There are a number of hotels nearby with discounts for our patients and family. For a list of these hotels please call 617-636-4500. The Neely House is a special place within the Tufts Medical Center designed and donated by the Cam Neely Foundation for Cancer Care for cancer patients and their families to stay during their treatments. For more information visit the web site:
http://www.camneelyfoundation.org/index.php
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