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Diagnosing Brain & Spinal Cord Tumors

There are a number of diagnostic tests used to find a brain or spinal cord tumor:

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

Your field of vision will be evaluated. Any loss of vision may be a sign of a tumor affecting the parts of the brain that affect eyesight. How much you can see when looking straight ahead? How much you can see in all other directions while looking forward?

Gene Testing

If you have a family history of brain tumors, your doctor may recommend tests for an inherited syndrome.

Imaging Tests

One or more imaging test would be used to ultimately find a brain or spinal cord tumor:

  • Magnetic Resonance Imaging (MRI) – This test uses nuclear magnetic resonance to take detailed pictures of the brain. During this test a dye called gadolinium may be used. 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.
  • Magnetic Resonance Spectroscopy (MRS)-  MRS is used to identify the chemical make-up of tumor tissue. It may also be done during the MRI.
  • CT scan - This X-ray test creates detailed cross-sectional images of your brain and spinal cord. The CT scanner takes many pictures of the soft tissues in the body as it rotates around. This is usually done in emergency situations or if the patient 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 shows where the dye is found. 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 with the use of a radioactive dye (injected through a vein or inhaled through the nose). Where cancer cells are growing, there will be more chemical reactions. 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 look 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. Tissue samples are needed to name and stage the cancer, based on the World Health Organization (WHO) classification system for brain tumors.

A pathologist will grade tumors by reviewing tissue samples under a microscope. Grades range from “grade I” (benign or the least aggressive), to “grade IV” (malignant and the most aggressive).

Treatment & Rehabiliation

A team of specialists will work together to treat a brain or spinal cord tumors. This team can include a neurosurgeon, neuro-oncologist, radiation oncologist, medical oncologist, neurologist, and endocrinologist.

Primary treatment options will depend on the specifics of your tumor type, location, and if/where it has spread. After getting advice from one team, you may want to get a second opinion from another. A second opinion can help you learn more about your options and gain a better sense of what to do.

Symptoms, such as headaches, swelling around the tumor or seizures are managed as well, with medication. Often, rehabilitation is necessary to address problems from damage to brain tissue. Physical, occupational, and speech therapists are experts in this area.

Brain & Spinal Cord Tumor Treatments

Several treatments are used for brain or spinal cord tumors. These include surgery, radiation therapy, chemotherapy, immunotherapy or a wearable device. A number of experimental targeted molecular therapies, immunotherapies, and drugs are available through clinical trials.

Surgery

Surgery is often the first treatment used to remove as much of the tumor as possible. If the tumor(s) cannot be removed, at least a small sample will be used for a biopsy to diagnose and guide treatment. Surgery may be followed by radiation or chemotherapy to kill cancer cells left behind.

Radiation Therapy

Radiation is used to destroy cancer cells, keep them from growing, or relieve symptoms. The way radiation therapy is given depends on the type and location of the tumor. The types used to treat brain and spinal tumors include:

  • External beam radiation therapy (EBRT) – EBRT directs high doses of radiation to the tumor(s). To protect normal brain tissue, radiation oncologists will chose the option that will work best for you:
    • Three-dimensional conformal radiation therapy (3D-CRT): 3D-CRT focuses several radiation beams at the tumor at once. The beams are directed by a computer with details on the tumor’s location.
    • Intensity modulated radiation therapy (IMRT): IMRT also uses a computer to deliver radiation. The intensity of the radiation can be targeted to protect healthy tissue.
    • Proton beam radiation therapy: Protons are different than X-rays, and are less likely to damage healthy tissue. It is used mainly for chordomas and brain tumors in children and young adults. Most cancer centers don’t offer proton radiation.
  • Stereotactic radiosurgery - This is not surgery, but a type of radiation therapy. It is sometimes called gammaknife, X-Knife, or CyberKnife radiation. It can be given in just one or two sessions to target and destroy tumor tissue.
  • Brachytherapy - This treatment places radioactive material inside or near the tumor to kill cells.
  • Whole brain and spinal cord radiation therapy (craniospinal radiation) - This is used if the tumor has spread to the spinal cord covering (meninges) or into cerebrospinal fluid.

Chemotherapy

Chemotherapy uses drugs to stop the growth of cancer cells. It either kills the cells or stops them from dividing. It is a “systemic” treatment, affecting cancer cells throughout your body (and some healthy cells). They tend to cause well-known side effects. Some chemotherapy types are better at going through the blood-brain barrier than others.

Chemotherapy drugs are used alone or with others, in cycles, to treat brain tumors:

  • Carboplatin
  • Carmustine (as a wafer)
  • Cisplatin
  • Cyclophosphamide
  • Etoposide
  • Irinotecan
  • Lomustine
  • Methotrexate
  • Procarbazine
  • Temozolomide
  • Vincristine

Targeted Molecular Therapies

Targeted therapy drugs are designed to work with a specific molecular target. They can find and stop specific cell signals known to help cancer cells grow and spread. These drugs work by targeting, for example, the blood supply to a tumor or by blocking a growth signal. They can destroy cancer cells with less harm to healthy cells. Some targeted therapies are used to deliver chemotherapy more directly to cancer cells.

Not all brain tumors have the same targets. Tests are used to learn which genes, proteins, or other factors may be “targeted” in your tumor.

The U.S. Food and Drug Administration (FDA) has approved two targeted drugs for brain tumor treatment: Avastin® (bevacizumab) for recurrent glioblastoma, and Afinitor® (everolimus) for subependymal giant cell astrocytoma.

Tumor Treating Fields

Tumor Treating Fields (TTF) is a new innovation for treating brain tumors. These are electrodes placed on the head to treat glioblastomas. The electrode pads are placed over a solid brain tumor with a type of “cap”. This wearable device delivers low-frequency electric currents that can block cells from dividing. It can stop or delay cancer cells from growing. It causes few side effects.

TTF is an FDA-approved wearable device for glioblastoma. Clinical trials have shown an approximately 3-month survival benefit when it is used with temozolomide chemotherapy for patients with newly-diagnosed glioblastoma.

Immunotherapy

These are vaccines or drugs that stimulate the immune system to kill cancer cells. They are being studied in clinical trials to see if they can treat primary and secondary brain tumors.

Clinical Trials

Clinical trials are research studies used to develop new treatments for brain and other tumors. They are important because they offer new options. Some clinical trials focus on treatment, others aim to improve a patient’s quality of life.

Learn More About Clinical Trials

Drugs to Help with Symptoms

Brain tumors can cause swelling, headaches, seizures and hormonal problems. To help with these problems your doctor may prescribe:

  • Corticosteroids - to reduce swelling
  • Anti-seizure medications

Rehabilitation for Physical Symptoms

Physical symptoms like weakness, difficulty speaking, stiffness, problems with movement, etc. can be relieved with rehabilitative treatment (rehab). Every person with a brain tumor deserves to function well and should be evaluated for rehab.

Try to find a physical, occupational, and speech therapist who has worked with neurological disorders (rather than only sports injuries, for example):

  • Physical therapists help patients improve walking, balance and strength. Some people experience permanent mobility problems. Physical or occupational therapists will offer exercises to support your range of motion. They make sure your body has proper positioning to help decrease pain and stiffness.
  • Occupational therapists teach patients how to manage changes and regain skills for daily activities, such as cooking, writing, and driving.
  • Speech therapists help people overcome problems with language. They teach patients how to improve their speech process and adjust how they verbalize or otherwise express ideas. Speech therapists also help with eating and swallowing caused by oral motor problems.
  • Cognitive therapists help people develop exercises and strategies to overcome problems with thinking and memory that may result from the brain tumor.

There are devices and exercises that can be prescribed. Handrails, grab bars and bath or shower chairs are some. There are also tools to help with eating, dressing, and computer access. The Americans with Disabilities Act was created, in part, to help people with a disability go back to work with reasonable accommodations.

Would you like to learn more about Coping with a Brain or Spinal Cord Tumor as a patient or caregiver?

Coping with a Brain Tumor