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Adult Brain Tumors Treatment (PDQ®)
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Description
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What are adult brain tumors?
Adult brain tumors are diseases in which cancer (malignant) cells begin to grow
in the tissues of the brain. The brain controls memory and learning, senses
(hearing, sight, smell, taste, and touch), and emotion. It also controls other
parts of the body, including muscles, organs, and blood vessels.
Tumors that start in the brain are called primary brain tumors.
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What are metastatic brain tumors?
Often, tumors found in the brain have started somewhere else in the body and spread (metastasized) to the brain. These are called metastatic brain tumors.
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What are the symptoms of an adult brain tumor?
A doctor should be seen if the following symptoms appear:
- Frequent headaches.
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Vomiting.
- Loss of appetite.
- Changes in mood and personality.
- Changes in ability to think and learn.
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Seizures.
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What tests are used to find and diagnose adult brain tumors?
Tests that examine the brain and spinal cord are used to detect (find) adult brain tumor.
The following tests and procedures may be used:
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CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
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MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of the brain and spinal cord. A substance called gadolinium is injected into the patient through a vein. The gadolinium collects around the cancer cells so they show up brighter in the picture. This procedure is also called nuclear magnetic resonance imaging (NMRI).
Adult brain tumor is diagnosed and removed in surgery.
If a brain tumor is suspected, a biopsy is done by removing part of the skull and using a needle to remove a sample of the brain tissue. A pathologist views the tissue under a microscope to look for cancer cells. If cancer cells are found, the doctor will remove as much tumor as safely possible during the same surgery. An MRI may then be done to determine if any cancer cells remain after surgery. Tests are also done to find out the grade of the tumor.
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What is the grade of a tumor?
The grade of a tumor refers to how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. The pathologist determines the grade of the tumor using tissue removed for biopsy. The following grading system may be used for adult brain tumors:
Grade I
The tumor grows slowly, has cells that look similar to normal cells, and rarely spreads into nearby tissues. It may be possible to remove the entire tumor by surgery.
Grade II
The tumor grows slowly, but may spread into nearby tissue and may become a higher-grade tumor.
Grade III
The tumor grows quickly, is likely to spread into nearby tissue, and the tumor cells look very different from normal
cells.
Grade IV
The tumor grows very aggressively,
has cells that look very different from normal cells, and is difficult to treat successfully.
The chance of recovery (prognosis) and choice of treatment depend on the type, grade, and location of the tumor and whether cancer cells remain after surgery and/or have spread to other parts of the brain.
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Types of Adult Brain Tumor
The extent or spread of cancer is usually described as stages. There is no standard staging system for brain tumors. Primary brain tumors may spread within the central nervous system (brain and spinal cord), but they rarely spread to other parts of the body. For treatment, brain tumors are classified by the type of cell in which the tumor began, the location of the tumor in the central nervous system, and the grade of the tumor.
Types of adult brain tumors include the following:
Brain Stem Gliomas
These are tumors that form in the brain stem, the part of the brain connected to the spinal cord. They are often high-grade. Brain stem gliomas that are high-grade or spread widely throughout the brain
stem are difficult to treat successfully. To prevent damage to healthy brain tissue, brain stem
glioma is usually diagnosed without a biopsy.
(Refer to the PDQ summary on Childhood Brain Stem Glioma Treatment for more information.)
Pineal Astrocytic Tumor
Pineal tumors form in or near the pineal gland. The pineal gland
is a tiny organ in the brain that produces the hormone melatonin, a substance
that helps control our sleeping and waking cycle. There are several kinds of pineal tumors. Pineal astrocytic tumors
are astrocytomas that occur in the pineal region and may be any grade.
Pilocytic Astrocytoma (grade I)
Astrocytomas are tumors that start in brain cells called astrocytes. Pilocytic astrocytomas grow slowly and
rarely spread into the tissues around them. These tumors occur most often in children and young adults. They usually can
be treated successfully.
Diffuse Astrocytoma (grade II)
Diffuse astrocytomas grow slowly, but they often spread into nearby tissues. Some of them progress to a higher grade. They occur most often in young adults.
Anaplastic Astrocytoma (grade III)
Anaplastic astrocytomas are also called malignant astrocytomas. They grow rapidly and spread into nearby tissues. The tumor cells look different from normal
cells. The average age of patients developing anaplastic astrocytomas is 41 years.
Glioblastoma (grade IV)
Glioblastomas are malignant astrocytomas that grow and spread aggressively. The cells look very different from normal cells. Glioblastoma is
also called glioblastoma multiforme or grade IV astrocytoma. They occur most often in adults between the ages of 45 and 70 years.
Refer to the following PDQ summaries for more information on astrocytomas:
- Childhood Cerebral Astrocytoma/Malignant Glioma Treatment
- Childhood Cerebellar Astrocytoma Treatment
- Childhood Visual Pathway and Hypothalamic Glioma Treatment
Oligodendroglial Tumors
Oligodendroglial tumors begin in the brain cells called
oligodendrocytes, which support and nourish nerve cells. Grades of oligodendroglial tumors include the following:
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Oligodendroglioma (grade II): Oligodendrogliomas are slow-growing tumors
with cells that look very much like normal cells. These tumors occur most often in patients between the ages of 40 and 60 years.
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Anaplastic oligodendroglioma (grade III): Anaplastic oligodendrogliomas grow quickly and the cells look
very different from normal cells.
Mixed Gliomas
Mixed gliomas are brain tumors that contain more than one type of cell. The prognosis is affected by the cell type with the highest grade
present in the tumor.
Ependymal Tumors
Ependymal tumors usually begin in cells that line the
spaces in the brain and
around the spinal cord. These spaces contain cerebrospinal fluid, a liquid that cushions
and protects the brain and spinal cord. Grades of ependymal
tumors include the following:
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Grade I and grade II ependymomas: These ependymomas grow slowly and have cells
that look very much like normal cells. They can often be removed completely by surgery.
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Anaplastic ependymoma (grade III): Anaplastic ependymomas grow very quickly.
(Refer to the PDQ summary on Childhood Ependymoma Treatment for more information.)
Medulloblastoma (grade IV)
Medulloblastomas are brain tumors that begin in the lower back of
the brain. They are formed from abnormal brain cells at a very early stage in development. Medulloblastomas are usually found in children or young adults between the ages of 21 and 40 years. This type
of cancer may spread from the brain to the spine through the cerebrospinal fluid.
(Refer to the PDQ summary on Childhood Medulloblastoma Treatment for more information.)
Pineal Parenchymal Tumors
Pineal parenchymal tumors form from parenchymal cells or pinocytes, the cells that make up most of the pineal gland. These differ from pineal astrocytic tumors, which are astrocytomas that form in tissue that supports the pineal gland. Grades of pineal parenchymal
tumors include the following:
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Pineocytomas (grade II): Pineocytomas are slow-growing pineal tumors that occur most often in adults aged 25 to 35.
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Pineoblastomas (grade IV): Pineoblastomas are rare and highly malignant. They usually occur in children.
(Refer to the PDQ summary on Childhood Supratentorial Primitive Neuroectodermal Tumors and Pineoblastoma
Treatment for more information.)
Meningeal Tumors
Meningeal tumors form in the meninges, thin layers of tissue that cover the
brain and spinal cord. Types of meningeal tumors include the following:
Germ Cell Tumor
Germ cell tumors arise from germ cells, cells that are meant to form sperm in the testicles or eggs in the ovaries. These cells may travel to other parts of the body and form tumors. Types of germ cell tumors
include germinomas, embryonal cell carcinomas, choriocarcinomas, and
teratomas. They can occur anywhere in the body and can be either benign or
malignant. In the brain, they usually form in the center,
near the pineal gland, and can spread to other parts of the brain and
spinal cord. Most germ cell tumors occur in children.
(Refer to the PDQ summary on Childhood Brain Tumors for more information.)
Craniopharyngioma (grade II)
Craniopharyngiomas occur in the sellar region of the brain, near the
pituitary gland. The pituitary gland is a small organ about the size of a pea, located at the base of
the brain. This gland controls many of the body's functions, especially growth.
In adults, these tumors occur most often after the age of 50 years. Craniopharyngiomas can press on vital brain tissue and cause symptoms to
appear. The tumors can also block fluid in the brain and cause swelling.
The prognosis is good for craniopharyngiomas that are completely removed in surgery.
Pituitary tumors also occur in this region. Refer to the PDQ summary on Pituitary Tumor Treatment for more information.
Other Adult Brain Tumors
For information about other types of adult brain tumors, refer to the PDQ health professional summary on Adult Brain Tumors.
Recurrent Adult Brain Tumor
Recurrent adult brain tumor is a tumor that has recurred (come back)
after it has been treated. Adult brain tumors often recur, sometimes many years
after the first tumor. The tumor may come back in the brain or in other parts
of the body.
Metastatic Brain Tumors
The types of cancer that commonly spread to the brain are cancers of the lung, breast, unknown primary site, melanoma, and colon. About half of metastatic spinal cord tumors are caused by lung cancer.
Prognosis depends on the following:
- Whether the patient is younger than 60 years.
- Whether there are fewer than 3 tumors in the brain and/or spinal cord.
- The location of the tumors in the brain and/or spinal cord.
- How well the tumor responds to treatment.
- Whether the primary tumor continues to grow or spread.
The prognosis is better for brain metastases from breast cancer than from other types of primary cancer. The prognosis is worse for brain metastases from colon cancer.
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Treatment Option Overview
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How are adult brain tumors treated?
Different types of treatment are available for patients with adult
brain tumor. Some treatments are standard (the currently used treatment), and
some are being tested in clinical
trials. Before starting treatment, patients may want to think
about taking part in a clinical trial. A treatment clinical trial is a research
study meant to help improve current treatments or obtain information on new
treatments for patients with cancer. When clinical trials show that a new
treatment is better than the standard
treatment, the new treatment may become the standard treatment.
Clinical trials are taking place in many parts of the country.
To learn more about clinical
trials, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237);
TTY at 1-800-332-8615.
Information about ongoing clinical trials is available from the
NCI Web site. Choosing the most appropriate cancer treatment is a
decision that ideally involves the patient, family, and health care
team.
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Three types of standard treatment are used.
Surgery
Surgery is used, when possible, to treat adult brain tumor, as described in the Description section of this summary.
Radiation therapy
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.
Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). A dissolving wafer may be used to deliver an anticancer drug directly into the brain tumor site after the tumor has been removed by surgery. The way the chemotherapy is given depends on the type and stage of the cancer being treated.
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Other types of treatment are being tested in clinical trials.
New methods of delivering radiation therapy
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Radiosensitizers: Drugs that make tumor cells more sensitive to radiation. Combining radiation
with radiosensitizers may kill more tumor cells.
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Hyperfractionation: Radiation therapy given in smaller-than-usual doses two or
three times a day instead of once a day.
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Stereotactic radiosurgery: A radiation therapy technique that
delivers radiation directly to the tumor with less damage to healthy tissue. The
doctor uses a CT scan or MRI to find the exact location of the tumor. A rigid
head frame is attached to the skull and high-dose radiation is directed to the
tumor through openings in the head frame, reducing the amount of radiation
given to normal brain tissue. This procedure does not involve surgery. This is
also called stereotaxic radiosurgery and gamma knife therapy.
Hyperthermia therapy
Hyperthermia therapy is a treatment in which body tissue is exposed to
high temperatures to damage and kill cancer cells or to make cancer cells more
sensitive to the effects of radiation and certain anticancer drugs.
Biologic therapy
Biologic
therapy is a treatment that uses the patient’s immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.
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How are metastatic brain tumors treated?
Tumors that have spread to the brain from somewhere else in the body are usually treated with radiation therapy and/or surgery. Chemotherapy may be used if the primary tumor is the kind that responds well to chemotherapy. Clinical trials are under way to study new treatments.
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Treatment Options by Type of Adult Brain Tumor
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Brain Stem Gliomas
Treatment of brain stem gliomas may include the following:
Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with adult brain stem glioma.
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Pineal Astrocytic Tumors
Treatment of pineal astrocytic tumors may include the
following:
Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with adult pineal gland astrocytoma.
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Pilocytic Astrocytomas
Treatment of pilocytic astrocytoma is usually surgery with or without radiation therapy.
Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with adult pilocytic astrocytoma.
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Diffuse Astrocytomas
Treatment of diffuse astrocytoma may include the following:
Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with adult diffuse astrocytoma.
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Anaplastic Astrocytomas
Treatment of anaplastic astrocytoma may include the
following:
Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with adult anaplastic astrocytoma.
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Glioblastoma
Treatment of glioblastoma may include the
following:
Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with adult glioblastoma.
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Oligodendroglial Tumors
Treatment of oligodendrogliomas may
include the following:
Treatment of anaplastic oligodendroglioma may include the
following:
Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with adult oligodendroglial tumors.
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Mixed Gliomas
Treatment of mixed gliomas may include the following:
Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with mixed gliomas.
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Ependymal Tumors
Treatment of grade I and grade II ependymomas is usually surgery with or without radiation therapy.
Treatment of anaplastic ependymoma may include the
following:
Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with adult ependymal tumors.
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Medulloblastoma
Treatment of medulloblastomas may include the
following:
(Refer to the PDQ summary on Childhood Medulloblastoma Treatment
for more information.)
Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with adult medulloblastoma.
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Pineal Parenchymal Tumors
Treatment of pineal parenchymal tumors may include the
following:
Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with adult pineal parenchymal tumor.
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Meningeal Tumors
Treatment of meningiomas may include the following:
Treatment of malignant meningioma may include the
following:
Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with adult meningeal tumors.
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Germ Cell Tumors
Treatment of central nervous system germ cell tumors depends
on the type of cancer cells, the location of the tumor, whether the cancer can
be removed in an operation, and other factors.
Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with adult central nervous system germ cell tumor.
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Craniopharyngioma
Treatment of craniopharyngiomas may include the following:
Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with adult craniopharyngioma.
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Recurrent Adult Brain Tumor
Treatment of recurrent adult brain tumors may include the
following:
Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with recurrent adult brain tumor.
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Metastatic Brain Tumors
Treatment of a single metastatic brain tumor is usually surgery followed by radiation therapy to the brain.
Treatment of more than one metastatic brain tumor may include the following:
Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with adult tumors metastatic to brain.
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Changes to This Summary (04/02/2007)
The PDQ cancer information summaries are reviewed regularly and updated as
new information becomes available. This section describes the latest
changes made to this summary as of the date above.
Changes were made to this summary to match those made to the health professional version.
This information is provided from the PDQ® database in collaboration with the NCI.
