Brain and Spinal Cord Tumors
What Are Brain & Spinal Cord 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. Secondary brain tumors or brain metastases begin in another part of the body but spread to the brain. If your cancer spreads to the bone, visit our bone metastases page.
Benign brain tumors begin in cells within or around the brain. They grow slowly and don’t spread. Still, they can recur (come back) after treatment. Malignant tumors are cancerous and can have more dangerous effects. They can grow quickly and spread into other areas of the brain. They may also recur after treatment. Metastatic or secondary brain tumors begin in other parts of the body like the lung, breast, colon or skin, but spread to the brain. In any case, if a tumor grows in the brain and presses on nearby areas, it can lead to unwanted signs & symptoms.
There are over 120 types of brain tumors and central nervous system tumors.
Types of Brain & Spinal Cord Tumors
Brain and spinal cord tumors are named based on where they begin and the main cell type they contain. Glial cells make up 90% of our brain cells, and they play a major role in how we think. There are many types of glial cells.
The World Health Organization (WHO) classifies brain tumors by their cell type, location, how they behave, and their molecular features. Some tumors are given a grade based on how fast they grow and spread. Grades range from “grade I” (benign or the least aggressive), to “grade IV” (malignant and the most aggressive). Tumors graded in the I-II range are usually easier to treat and manage.
- Mixed Gliomas
- Ependymal Tumors
- Pineal Parenchymal Tumors
- Meningeal Tumors
- Germ Cell
- Sellar Region
These tumors begin in brain glial cells called astrocytes, which help keep nerve cells healthy. Astrocytomas are divided into two categories: those with and without isocitrate dehydrogenase (IDH) mutations. Tumors with IDH mutations are more common and tend to grow more slowly.
- Pilocytic Astrocytoma (grade I)
- Diffuse Astrocytoma (grade II)
- Anaplastic Astrocytoma (grade III)
- Glioblastoma (grade IV)
- Brain Stem Glioma
These tumors begin in brain glial cells called oligodendrocytes. Oligodendrogliomas with IDH mutations tend to grow more slowly.
- Oligodendroglioma (grade II)
- Anaplastic oligodendroglioma (grade III)
These tumors have both oligodendrocytes and astrocytes and often start in in the cerebrum. With modern molecular testing, most of these tumors are found to be one type or the other. True oligoastrocytomas are very rare.
- Oligoastrocytoma (grade II)
- Anaplastic oligoastrocytoma (grade III)
These tumors begin in cells that line the fluid-filled spaces of the brain and spinal cord called the ependyma. Ependymal cells are a type of glial cell and ependymomas are a type of glioma.
- Ependymoma (grade I or II)
- Anaplastic ependymoma (grade III)
These tumors form in the cells that make up most of the pineal gland, which makes melatonin. These tumors are different from pineal astrocytic tumors.
- Pineocytomas (grade II)
- Pineal parenchymal tumors of intermediate differentiation (grade II or III)
- Pineoblastomas (grade IV)
This tumor forms in the meninges (thin layers of tissue that cover the brain and spinal cord). It can form from different types of brain or spinal cord cells. Most meningiomas are slow growing grade I tumors. Grade II and III meningiomas are more aggressive.
A hemangiopericytoma/solitary fibrous tumor resembles meningiomas but is different biologically. It is treated like a grade II or III meningioma.
Germ cell tumors usually form in the center of the brain, near the pineal gland. They can spread to other parts of the brain and spinal cord. These tumors impact the cells that develop into sperm in men or ova (eggs) in women. They can be either benign or malignant. Types include:
- Embryonal yolk sac carcinomas
This tumor begins underneath the center of the brain, just above the back of the nose. It can form from different types of brain or spinal cord cells.
- Pituitary Tumors
- Craniopharyngioma (grade I)
Signs & Symptoms
Symptoms are closely related to where the tumor forms and how it affects that part of the brain.
The brain has three main sections:
- 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.
- Cerebellum - The lower back of the brain, near the middle of the back of the head. It controls movement, balance, and posture.
- 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.
Most Common Signs of Brain Tumors:
- Morning headache or headache that goes away when standing
- 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
Most Common Signs of Spinal Cord Tumors:
- Back pain or pain that spreads from the back towards the arms or legs
- Weakness in the legs
- Numbness in the legs or trunk
- Trouble walking
- A change in bowel habits or trouble urinating
Diagnosis & Staging
There are many diagnostic tests used to find a brain or spinal cord tumor. The frequently used test is magnetic resonance imaging (MRI). 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. 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).
- Physical Exam - Your doctor will assess your overall health. You will be tested for fever, high blood pressure and swollen lymph nodes.
- 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.
- Neurological ("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?
- Gene Testing - If you have a family history of brain tumors, your doctor may recommend tests for an inherited syndrome.
One or more imaging test would be used to ultimately find a brain or spinal cord tumor.
- Magnetic Resonance Imaging (MRI)
- Perfusion MRI
- Magnetic Resonance Spectroscopy (MRS)
- CT Scan
- PET Scan
This test takes detailed pictures of the brain. A contrast dye is usually used to improve the visualization of the tumor. It collects around the cancer cells so they show up brighter in the picture.
This test may also be done during the MRI to look at blood flow in the tumor. It can be helpful in differentiating tumor from effects of treatment such as radiation therapy.
MRS is used to identify the chemical make-up of tumor tissue. It may also be done during the MRI.
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.
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.
This test uses X-rays to look at blood vessels and the flow of blood in the brain. It is rarely used today.
Treatments & Side Effects
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 delivering low intensity electric current. Targeted molecular therapies and vaccines or drugs designed to stimulate the immune system are being tested in clinical trials. Medications may be used to manage symptoms, such as headaches, swelling around the tumor or seizures.
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. It is important that enough of the tumor is removed for the biopsy and any additional molecular studies. Surgery may be followed by radiation or chemotherapy to kill cancer cells left behind.
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 choose 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 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. They 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 gamma knife, 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 involves the use of drugs to destroy cancer cells. It is a systemic (whole body) treatment. 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.
Targeted therapy aims to more precisely attack cancer cells. These drugs target changes in the genes or proteins of cancer cells that help them grow, divide, and spread.
Not all brain tumors have the same targets. Molecular 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 targeted drugs for recurrent glioblastoma and for subependymal giant cell astrocytoma.
Tumor Treating Fields (TTF) is a new innovation for treating brain tumors. Electrodes are placed over a solid brain tumor on the head with a type of “cap”. This wearable device delivers low-frequency electric currents. It can block or delay cancer cells from dividing and growing. It causes few side effects.
TTF is an FDA-approved wearable device used with chemotherapy. It is available for newly-diagnosed glioblastoma patients after standard surgery and radiation treatments. It may also be used for patients whose glioblastoma returns after treatment.
Coping & Managing Symptoms
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, and problems with movement 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.