Dr. Susan Chang provides an overview on brain tumors in adults, including the various types, symptoms, diagnosis, treatments, and current advances.
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Brain Tumors in Adults: An Introduction
What is a Brain Tumor?
Susan Chang. MD: A brain tumor is a growth that occurs in the brain. This can be a very heterogeneous group of tumors. And the way to think about it is did the tumor start in the brain? Or did it come from somewhere else? So usually we call the tumors that start in the brain primary brain cancer as opposed to metastatic. In other words, for example, if a patient had a history of lung cancer and some of those lung cancer cells spread to the brain they'd still consider it a brain tumor. But it's considered a secondary brain tumor or metastatic brain tumor.
Types of Primary Brain Tumors in Adults
Dr. Chang: So brain cancer consists of many different types of tumors.
So the major categories for adults are called gliomas and meningiomas are probably the two most common types of tumors. The meningiomas are tumors that form in the lining of the brain and the majority of those tumors are what we consider grade one or benign, but there are also components of it that are grade two or a higher grade or what we consider malignant.
The other type of tumor that's commonly found in the brain, and these are primary brain tumors, are called glioma. And the most common type is called glioblastoma
Symptoms of a Brain Tumor
Dr. Chang: Usually patients have symptom that relates to either a headache or, for example, a seizure. They might also have difficulty coordinating or writing, difficulty speaking or even the mobility. And so when those symptoms happen a lot of patients are concerned could it be a stroke or could it be a tumor. And the next step would be evaluating either with a scan called an MRI scan, which is an image of the brain.
Diagnosing a Brain Tumor in Adults
Dr. Chang: The first aspect of treatment for these tumors is making sure we have a diagnosis. There are examples where patients present with a neurological symptom, like a headache, they have a scan that shows that there is something in the brain, but there can be mimics of tumors that can look very similar to a tumor on the scan. For example, a patient could have an infection. They can have what we call a stroke or even an inflammatory process in the brain. So an MRI scan which is the most common diagnostic tool that we use can sometimes be difficult to be sure that there is a tumor.
So the next step is making a definitive diagnosis. And to do this would either encompass the surgeon taking a sample of this, which is called a biopsy, or planning an operation where you try to take out as much of the tumor as safely possible. And that's called a resection. So the first modality of treatment for some of these tumors would be an operation or surgery.
After Surgery: Treatment Approaches for Adults with a Brain Tumor
Dr. Chang: Depending on the amount of tumor that's removed and the type of tumor that you're dealing with, you may be recommended to have subsequent treatments with radiation therapy really chemotherapy. And these treatments would be administered by a specialist in the field. They will go over the side effects to be expected for these treatments and what the outcome you're expecting to have. What are you trying to do? Are you trying to improve symptoms or are we trying to improve how long you live?
So those are the types of key points that you need to understand and ask your treating doctors what are the goals of care for me and what am I to expect were I to undergo these treatments?
You will see a neurologist, a neurosurgeon, potentially then after you've had your definitive diagnosis of a brain tumor you'll also have a team of doctors, for example, medical oncologists or neuro oncologists and radiation oncologists.
So the important thing is to understand this is a team approach to taking care of you, but not only yourself but also your family.
Advances in Treatment for Brain Tumors
Dr. Chang: The biggest advance I believe in brain tumors right now is really understanding the biology of the tumors and characterizing tumors based on their molecular and cytogenetic makeup. So historically we have used a classification called the World Health Organization Pathological Classification where the pathologist will, and those are doctors who actually characterize the tumors after they've been removed from the patient and they will look at the slides or the characteristics of the cells and what the tumor actually looks like under the microscope.
And they will give us a grade, a grade one, a grade two, three or four, for example, and that tells us how aggressive the tumor is and various characteristics about the tumor. We are learning now though that within specific grades of tumor you can have very, very different outcomes. And now with the molecular characterization of tumors we will be able to classify these tumors better for patients.
And what this means is that we can now get to a point of what we call personalized medicine or precision medicine. And that's going to be key so that we can identify the appropriate patients for the appropriate treatments and spare patients treatments that are probably going to be ineffective and also associated with side effects.
The other aspects of biology of tumors that we're learning about is all of the mechanisms of growth that we could be targeting for therapies. So, for example, we know that these tumors have a lot of blood vessels that they bring into the tumor cells to nourish the tumor and we're now able to target those areas. We're learning about the immune system. There's a lot in cancer right now where the immunotherapy approaches are having fantastic positive effects and we're now exploring all of those types of therapies in brain tumors as well.
Where to Get More Information
Dr. Chang: To learn more about brain tumors not only the biology and some of the clinical aspects but also what resources might be available to you, one, a very important resource, is cancer.net. There are a number of educational features about the site that will give you information not only in terms of as I mentioned side effects of treatments and clinical trials, but also about caregiver resources that are so critical for patients with brain tumors.
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Cancer.Net®: Doctor-Approved Patient Information from ASCO®
ASCO's patient education programs are supported by Conquer Cancer Foundation of the American Society of Clinical Oncology. ConquerCancerFoundation.org
Dr. Mary Wilkinson, Dr. Raymund Cuevo, and the staff at Medical Oncology & Hematology Associates of Northern Virginia
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Hasbro Children’s Hospital
Helen F. Graham Cancer Center at Christiana Care Health System
The Adele R. Decof Comprehensive Cancer Center at The Miriam Hospital. The Miriam Hospital is a teaching hospital of The Warren Alpert Medical School of Brown University
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Moffitt Cancer Center
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