| Brain cancer is a malignant tumor (or tumors) that originates from any of the cells that make up the brain (primary brain cancer) or migrates to brain cells from other cancerous parts of the body (secondary or metastatic brain cancer).
Tumors that occur in the brain can be noncancerous (benign) as well as cancerous (malignant). Unlike malignant tumors, benign tumors do not invade other tissue. However, benign tumors can be just as dangerous over time as malignant tumors when they begin to increase the amount of mass in the skull, compress vital structures, and cause serious symptoms and complications. Unlike lung, colon, and breast cancers, primary brain cancers rarely spread to other organs. Death usually occurs as a result of uncontrolled growth within the confines of the skull. As the tumor compresses vital brain centers controlling consciousness and bodily functions, the individual lapses into coma, and breathing ultimately stops (respiratory arrest).
Primary brain tumors are classified by cell type of origin and by how malignant the cells appear (histological grade). Location of the tumor and whether the tumor spreads throughout the cerebrospinal fluid bathing the brain also helps classify some brain tumors. Glial tumors originate from connecting and supporting brain cells called glia. These tumors include astrocytomas, ependymomas, oligodendroglioma, mixed tumors, medulloblastomas, and the highly malignant glioblastoma multiforme. Tumors derived from cells other than glia include pineal parenchymal tumors, germ cell tumors, craniopharyngiomas, meningiomas, and choroid plexus tumors.
Exposure to x-rays (radiation), chemicals such as vinyl chloride (associated with rubber manufacturing, dye making, and other industries), rare genetic conditions (such as neurofibromatosis), or Von Hippel-Lindau disease, may all increase the risk of brain cancer. Genetic factors may be involved, but the exact mechanism is unclear.
Individuals with a history of lung, breast, colon, kidney, or melanoma cancer are also at increased risk for brain cancer.Incidence and Prevalence: There are approximately 15 to 20 cases of brain cancer per 100,000 people each year. It is the leading cause of cancer-related death in individuals younger than age 35 and accounts for 2% to 3% of cancers reported annually. Secondary brain cancer (brain metastasis) occurs in an estimated 20% to 30% of individuals and there are about 100,000 cases of it in the US each year, with incidence rising with age ("Brain Cancer"). |
Source: Medical Disability Advisor
| History: Individuals may complain of headache, nausea, and vomiting. Other general symptoms include drowsiness, lethargy, personality changes, impaired intellectual function, impaired sense of smell, memory loss, vision loss, and seizures. Depending on the tumor location, individuals may complain of localized weakness, numbness, impaired speech, or other neurological symptoms. Physical exam: An examination using an ophthalmoscope, (an instrument used to view the inside of the eye) may reveal swelling of the optic nerve indicating increased pressure within the skull. Abnormalities are frequently seen on a neurological exam, depending on the location of the tumor. The neurological exam tests the senses (vision, smell, touch, taste, etc.), motor responses, muscle strength, coordination, reflex response, and autonomic responses (increase and decrease in pulse, breathing, sweating in response to stimuli). Abnormalities may be observed in the individual's vision if a cancerous tumor is present in the occipital lobe of the brain or in motor responses and coordination if a cancerous tumor is present in the cerebellum (a brain structure toward the back of the skull involved in coordination and movement). A neurological exam may be relatively normal when the tumor is located in the frontal lobes of the brain. Tests: CT and/or MRI are essential for locating a tumor. Use of dye injected into the vein during these procedures makes the tumor more visible. Position emission tomography (PET) may help to evaluate brain function and cell growth by producing images of chemical and physical changes in the brain. PET may also locate a tumor and determine metastatic and recurrent brain cancer at earlier stages than MRI or CT scan.
A surgical biopsy is the only method to confirm exact diagnosis and is usually performed at the time of surgery to remove the tumor. Before surgery, an arteriogram (angiogram) may be helpful to determine which blood vessels supply the tumor. In individuals with seizures, electroencephalogram (EEG) is usually indicated. After biopsy, the type of tumor may be determined by the type or types of cells seen under microscopic examination. Skull x-ray is rarely necessary except in tumors such as meningiomas that may invade or press against the bone.
Stereotactic biopsy, in which imaging tests are used to locate the tumor, may be recommended. This method provides an accurate diagnosis in over 90% of brain cancer cases ("Brain Cancer"). |
Source: Medical Disability Advisor
| Treatment depends on factors related to the cancer, such as tissue type, location and size of the tumor, and the degree of cancer spread (metastasis). Treatment also depends on the individual's overall health, age, medical history, the individual's tolerance for specific medications, procedures, therapies, and expectations for the course of the disease.
Surgery is the first choice for treatment, and is usually followed by radiation and chemotherapy. Surgical techniques have been improved to allow access to deeply embedded tumors that were previously inaccessible. For example, stereotactic and frameless stereotactic surgery often allows more precise localization of the tumor. In stereotactic surgery doctors put a needle into the skull and take 3D images of the brain and the tumor with either a CT scan or MRI. Then the needle sucks the tumor out. If the cancer is too large it can't be resected with this technique. The surgery can be done with or without a frame. If the procedure is done with a "halo shaped" frame it is screwed into the outside of the skull. It stays on the patient‘s head during the procedure. Patients, whose tumors are so large that they prevent cerebrospinal fluid from draining and cause elevated pressure in the brain, need a shunt placed to drain the fluid and decrease the pressure.
Chemotherapy may be given by mouth or by injection into the vein. To deliver chemotherapy more directly to the tumor, it has sometimes been given into an artery supplying the tumor, or more commonly into the cerebrospinal fluid through shunt tubing accessible from the skull (Ommaya reservoir). Recent trials are evaluating the safety and effectiveness of chemotherapy being applied directly to the tumor by placing a piece of plastic-like material coated with the drug against the tumor during surgery. Different methods of administering radiation therapy are also being evaluated (hyperfractionated irradiation, accelerated fraction radiation, stereotactic radiosurgery, radiosensitizers, hyperthermia, interstitial brachytherapy, intraoperative radiation therapy).
Steroids (adrenal cortical hormones or glucocorticoids) are usually given to reduce brain swelling and help increase alertness. Anticonvulsants may be needed in individuals with seizures, and are usually given around the time of surgery to prevent this complication.
Aggressive malignant tumors are often treated with a combination of surgery and radiation therapy, which slows their progress. However, this combined approach is not an option when the dosage needed to kill cancer cells risks damaging the sensitive brain tissues. Aggressive malignant tumors are also treated with a combination of surgery and anticancer drugs (chemotherapy). Brain cancer is difficult to treat with chemotherapy for two reasons: the cancer cells in the cancerous central nervous system (CNS) tend to become resistant to the anticancer drugs as the tumor grows and controversy exists over whether anticancer drugs can penetrate the blood-brain barrier, the protective barrier that keeps certain substances from entering the brain.
Since there has been limited success with radiation and chemotherapy treatments, individuals may be asked to enroll in clinical trials for experimental treatments (e.g., immunotherapy, gene therapy). |
Source: Medical Disability Advisor
| The outcome for an individual with brain cancer depends on the cell type, how malignant the cells appear under the microscope (histological grade), how soon the cancerous tumor is detected, where the tumor is located in the brain, how much of the tumor can be removed by surgery, and the individual's response to treatment.
Response to radiation and chemotherapy has met with limited success because the dosage of radiation needed to kill cancer cells in the brain also damages sensitive brain tissues, and because cancer cells in the brain can become resistant to chemotherapy drugs.
Many malignant brain tumors tend to recur within 6 to 12 months after initial diagnosis. The five-year survival rate for all people with brain cancer varies with age. For individuals aged 15 to 44, it is 55%. Individuals aged 45 to 64 have a 16% five-year survival rate, and for those over 65, it is 5% ("Detailed Guide").
For individuals with brain cancer that is the result of cancer that has spread (metastasis) from another part of the body (secondary brain cancer), (except when an isolated metastasis can be surgically removed), there is no cure, and the median survival period is less than 12 months. |
Source: Medical Disability Advisor
| Individuals with the diagnosis of brain cancer require physical and occupational therapy on an inpatient basis, as well as possibly homecare or outpatient therapy. Individuals may also require speech therapy. The extent and types of therapy necessary vary among individuals contingent upon the location of the tumor, how localized the tumor is, and the treatment required. Therapy focuses on the following areas: improving communication; maintaining range of motion; increasing strength; improving coordination; improving balance; and improving functional abilities such as gait.
To improve communication, speech therapists teach individuals specific lip, tongue, and facial muscle positions that result in clarifying speech. Individuals with the inability to communicate orally may learn to communicate through a variety of other methods.
Individuals may experience weakness and decreased function in their arms and/or legs, impaired fine motor coordination, or problems with balance. A comprehensive therapy program is critical to improving and maintaining functional abilities. Occupational and physical therapists instruct individuals and their family members how to safely stretch and strengthen the arms and legs to promote range of motion and increase fine motor coordination. Exercises to improve sitting and standing balance are essential in preserving the ability to walk.
Individuals with end stages brain cancer may require palliative therapy, in which the primary focus is pain control. Rehabilitation nurses, physical therapists, and occupational therapists all provide palliative care services.
Individuals diagnosed with cancer may find it beneficial to undergo psychological counseling either on an individual basis or in a support group setting. Psychological well being is essential to physical health, and counseling can help individuals deal with issues such as fear of dying and provide a forum for voicing concerns about topics such as cancer treatment and side effects, nutrition, and decreased energy levels. |
Source: Medical Disability Advisor
| Possible complications of brain cancer include neurologic impairment (deficit) such as paralysis or language disturbance, seizures, increased risk of blood clots (thromboembolic complications), brain herniation, and coma. |
Source: Medical Disability Advisor
| Possible changes in intellect, coordination, strength, vision, and other neurologic functions may necessitate specific work restrictions and accommodations. Some job requirements may be impossible for individuals with brain cancer, and permanent disability is not unusual. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Does individual complain of headache, nausea, and vomiting? Notice drowsiness, personality changes, impaired intellectual function, and seizures?
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Have CT and/or MRI confirmed the existence and location of a brain mass?
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Before surgery, would an arteriogram help determine blood supply to the tumor, facilitating removal?
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Was the specific cell type and degree of malignancy confirmed from surgically removed tissue?
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Is the brain cancer primary or metastatic? If metastatic, was the tumor of origin treated?
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Is there suspicion that the tumor has invaded cerebrospinal fluid? Is it safe to remove cerebrospinal fluid by lumbar puncture to find out or would this cause brain herniation?
Regarding treatment:
- Can the entire tumor be removed without compromising neighboring structures or should surgery be limited to biopsy?
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Was radiation or chemotherapy given? If no improvement has occurred with these measures, is individual a candidate for experimental forms of radiation or chemotherapy?
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Does the appearance of new or worsening symptoms reflect tumor growth or complications from surgery, radiation, or chemotherapy?
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Are steroids being given to relieve symptoms from brain swelling?
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Are anticonvulsants being given to individuals with seizures? Has individual responded well to the medications?
Regarding prognosis:
- What type of brain cancer does individual have?
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How malignant are the cells? Was the entire tumor removed with surgery?
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Has individual undergone radiation and/or chemotherapy treatment? What is individual's response to surgery and other treatments?
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Did individual's brain cancer result from a metastasis? Was it possible to surgically remove the metastasis? If not, how long is individual expected to live?
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Has individual experienced complications from the cancer or from surgery or other treatments? What are they? How will these complications be treated and how will they affect the individual?
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Would counseling and rehabilitation assist with emotional and physical aspects of recovery?
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Should second opinion consultations be obtained regarding diagnosis and treatment?
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Source: Medical Disability Advisor
| "Brain Cancer." OncologyChannel. 9 Mar. 2004. Healthcommunities.com. 2 Jan. 2005 <http://www.oncologychannel.com/braincancer/>. "Detailed Guide: Brain / CNS Tumors in Adults." American Cancer Society. Jan. 2005. 2 Jan. 2005 <http://www.cancer.org/docroot/CRI/CRI_2_3x.asp?rnav=cridg&dt=3>. |
Source: Medical Disability Advisor
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