- Overview Brain & Spinal Tumors
- Risk Factors, Signs & Symptoms
- Diagnosing Brain & Spinal Tumors
What are Brain & Spinal 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. (Sometimes tumors start in other parts of the body but spread, or metastasize, to the brain. These are called secondary brain tumors or brain metastases.)
Brain tumors can be benign or malignant. Benign tumors are the least aggressive type. They begin in cells within or around the brain, but they grow slowly and don’t spread. Still, they can grow back after treatment. Malignant tumors are cancerous and can have more dangerous effects. They are known to grow quickly and spread into other areas of the brain. They may also recur or grow back after treatment. Metastatic or secondary brain tumors begin in other parts of the body but spread to the brain. They are treated based on where they began, like the lung, breast, colon or skin. In any case, if a tumor grows in the brain and presses on nearby areas, it can cause trouble.
The Anatomy of the Brain and Spinal Cord
The brain has three main sections:
- The cerebrum - The largest part of the brain, at the top of the head. It controls thinking, learning, problem solving, emotions, reading, writing, and voluntary movement. In many people, the left side of the brain controls speech.
- The cerebellum - The lower back of the brain, near the middle of the back of the head. It controls movement, balance, and posture.
- The brain stem - The lowest part of the brain (just above the back of the neck). The brain stem connects the brain to the spinal cord. It controls breathing, heart rate, and the nerves and muscles used in seeing, hearing, walking, talking, and eating.
The spinal cord - Connects the brain to nerves in most parts of the body. Spinal cord nerves carry messages between the brain and the rest of the body.
There are over 120 types of brain and central nervous system tumors. The most commonly found are:
- Ependymal Tumors
- Pineal Parenchymal Tumors
- Meningeal Tumors
- Germ Cell
- Pituitary tumors
Risk Factors, Signs & Symptoms
We still don’t know why brain cancers form. Certain types of brain tumors may result from the following risk factors:
- Past radiation therapy to the scalp or brain may increase the risk of brain tumors many years later especially meningiomas, and to a lesser extent gliomas.
- Certain viruses may increase risk. For example, infection with the Epstein-Barr virus, or being HIV-positive and developing AIDS may increase the risk of primary CNS lymphoma.
- Receiving an organ transplant may increase the risk of primary CNS lymphoma.
- These genetic syndromes are known to increase risk:
- Neurofibromatosis type 1 or 2
- von Hippel-Lindau
- Tuberous Sclerosis
- Li-Fraumeni Syndrome
- Turcot Syndrome type 1 and type 2
- Klinefelter Syndrome
- Nevoid Basal Cell Carcinoma Syndrome
- Lynch Syndrome
There is no real evidence that vinyl chloride exposure or the use of cell phones will increase your risk of gliomas. A history of allergies may actually lower your risk of brain tumors.
Signs and Symptoms
Everyone with a brain or spinal cord tumor has different symptoms. What you feel depends on where the tumor forms, the functions controlled by that part of the brain, and the size of the tumor. These are the most common signs:
- Morning headache or headache that goes away when standing
- Frequent nausea and vomiting
- Vision, hearing, and speech problems
- Loss of balance and trouble walking
- Weakness on one side of the body
- Numbness on one side of the body
- Unusual sleepiness or change in activity level
- Unusual changes in personality or behavior
- Trouble with thinking and memory
Spinal Cord Tumors
- Back pain or pain that spreads from the back towards the arms or legs.
- A change in bowel habits or trouble urinating
- Weakness in the legs
- Numbness in the legs or trunk
- Trouble walking
Diagnosing Brain & Spinal Tumors
If you experience symptoms that suggest a brain or spinal cord tumor, there are a number of diagnostic tests you can take. These include:
Physical Exam - Your doctor will assess your overall health. You will be tested for fever, high blood pressure and swollen lymph nodes.
Neurological (or “neuro) Exam - You will answer questions and perform tests that check brain, spinal cord, and nerve function. Are you walking normally? How well do your muscles, senses, and reflexes work?
Visual Field Exam - This exam will check your field of vision—the total area in which you can see objects. How much you can see when looking straight ahead? How much you can see in all other directions while staring straight ahead? Any loss of vision may be a sign of a tumor affecting the parts of the brain that affect eyesight.
Gene Testing - If you have a family history of brain tumors, your doctor may recommend tests for an inherited syndrome.
Your doctor may also recommend that you have one or more imaging tests of your brain.
Imaging Tests for Brain Cancer
Commonly used scans to find a brain or spinal cord tumor:
MRI (Magnetic Resonance Imaging) – This test uses nuclear magnetic resonance to take detailed pictures of the brain. During this test a dye called gadolinium is usually injected into a vein. It collects around the cancer cells so they show up brighter in the picture.
Perfusion MRI- This test may also be done during the MRI to look at blood flow in the tumor and may help differentiate tumor from treatment effects.
Magnetic Resonance Spectroscopy - This test may also be done during the MRI. MRS is used to diagnose tumors based on their chemical make-up.
CT scan - This X-ray test creates detailed cross-sectional images of your brain and spinal cord. The CT scanner takes many pictures as it rotates around you to create detailed images of the soft tissues in the body. This is usually done in emergency situations and if the patients cannot have a MRI.
PET Scan - During this test a small amount of radioactive dye (often glucose (sugar)) is injected into a vein. The scanner rotates around the body and makes a picture of where glucose is being used. Malignant tumor cells use more glucose than normal cells since they are more active, so in the pictures they look brighter.
SPECT Scan - This test creates a 3-D picture of the brain. First, a small amount of a radioactive dye is injected into a vein or inhaled through the nose. Where cancer cells are growing, there will be increased blood flow and more chemical reactions (metabolism). These areas show the dye and look brighter in the picture. This scan may be done just before or after a CT scan.
Angiogram - This test uses X-rays to looks at blood vessels and the flow of blood in the brain. It is rarely used today.
If a tumor is found, surgery is often the next step. Surgery is used to both diagnose (with a biopsy) and treat brain cancer.
A team of specialists will work together to treat a brain or spinal cord tumor. This team can include a neurosurgeon, neuro-oncologist, radiation oncologist, medical oncologist, neurologist, and endocrinologist. These doctors will discuss your tumor and treatment options as a team. Your options will depend on the type and size of tumor, whether it is benign or malignant, its location, and how far it has spread.
After getting advice from one team, you may want to get a second opinion from another team. A second opinion can help you learn your options and gain a better sense of what to do.
Several types of treatment are used to treat brain or spinal cord tumors. These include surgery, radiation therapy, chemotherapy, or a wearable device. A number of experimental targeted molecular therapies and vaccines or drugs designed to stimulate the immune system are undergoing investigation in clinical trials. Medications may be used to manage symptoms, such as headaches, swelling around the tumor or seizures.