Brain Tumors: New Advances in Treatment
A diagnosis of a brain tumor sounds like a scary thing. And certainly, a brain tumor can be a serious diagnosis; life expectancies can vary widely, depending on the type of tumor, and how far advanced the disease has become. But the good news is that there are many amazing new treatments that are giving many patients much longer, more fulfilling lives than what they could have expected in decades past. Doctors have highly effective surgical as well as nonsurgical options in their toolkit.
Are all brain tumors cancer?
No. There are several types of tumors that are completely benign that aren’t cancerous. Benign tumors usually don’t spread or invade like cancerous tumors, but they can cause problems.
Some benign tumors will slow down and stop growing as the patient ages. Meningioma is a good example of that type of tumor. If a small tumor of that type is discovered in an elderly patient, we’ll usually just keep an eye on it.
Cancerous tumors, by definition, however, will usually advance and cause problems at some point.
What causes cancerous brain tumors?
Brain tumors have a diverse set of causes. Sometimes, we don’t know the exact cause. We hypothesize that somewhere deep inside one of the cells in the brain or in another part of the body, a malfunction occurs in the DNA. That causes the cell to no longer follow the rules that are dictated by the DNA of the cell. It starts to divide and form clumps of cells that are abnormal and behave in a bad way. That’s a cancerous tumor.
Both benign and cancerous brain tumors can be genetic. A specific mutation in the DNA can cause tumors, and doctors can use that information to figure out what to use against the tumor. Doctors can use what is called “targeted therapies’’ to attack this type of tumor. It’s like taking the keys out of the ignition of a car; the tumor just withers away.
My role as a neurosurgeon is to help clean out that tumor safely and effectively so that oncologists can use these targeted therapies effectively.
What are the symptoms of a brain tumor?
Sometimes, brain tumors are asymptomatic. Brain tumors can be discovered incidentally. For example, an older person might get a bump on the head and come in for a CAT scan, and a doctor discovers “Hey, there’s a tumor in there.”
Common symptoms are headaches that don’t go away, problems with speech or walking, problems with your vision, or a new onset of seizures.
Adults typically get tumors in the upper part of brain, called the cerebrum, and experience stroke-like symptoms, such as problems with balance and speech. Children more typically develop tumors in the back part of the brain, called the cerebellum, and experience nausea and vomiting, in addition to profound coordination problems. Most brain tumors occur in people age 50 and older.
How common are brain tumors?
Unfortunately, brain tumors are very common. About 200,000 people a year in the United States are diagnosed with a tumor in the brain that comes from another part of the body, most often from lung cancer or breast cancer. That’s a lot of people for one country. Sometimes, these tumors may result from melanoma and kidney cancer.
There are also tumors that originate in the brain itself that are cancerous. Most common are a type of cancerous brain tumor called gliomas. About 20,000-40,000 of those occur every year in the United States.
If we discover a cancerous tumor in the brain, we screen the rest of the body to try to determine the source. Getting the big picture helps doctors come up with a smart plan for treating the tumor.
How are brain tumors treated?
Here’s the exciting part. For people who require surgery, advancements today are amazing. Brain tumor surgeries now are guided by sophisticated computers that tell us exactly where we are in the brain with respect to the good stuff and the bad stuff. It’s kind of like a GPS for the head – it keeps you right where you need to be.
Fluorescent guidance is another newer technique. Patients are given a drink that makes their tumor glow in the operating room, allowing the surgeon to see it better. If the tumor is really close to a critical area, such as the part of the brain that controls the hands, for example, we can sometimes do the operation while you’re awake, in order to continually check in with the patient and make sure they can still move the hands as the operation proceeds. This way, we can keep patients safe and still be very thorough.
Targeted therapies are another exciting advancement in brain tumor treatment. With targeted therapy, oncologists use medications that target a tumor's specific genes, proteins or the tissue that is contributing to a tumor's growth and survival. This type of treatment blocks the growth and spread of tumor cells and limits the damage to healthy cells. Former President Jimmy Carter is a good example of someone who has benefited from this type of treatment. President Carter had melanoma and numerous cancerous growths in the brain. Things were not looking good for the president. But then, he got this new targeted therapy and his tumors all vanished. He’s still building houses for Habitat for Humanity in his mid-90s.
How long does it take to recover from brain tumor surgery?
The answer to the question is highly variable and depends a lot on how sick the patient was. Some people who have brain surgery while they’re awake might go home in 24 hours, but the average person usually stays in the hospital for three to five days.
How safe is it to come back to the hospital or clinic?
Don’t be afraid to the go the doctor during the COVID-19 pandemic. If you’re experiencing problems, make an appointment. We’ve instituted temperature checks at the entrance to all facilities, and everyone is wearing masks. We practice social distancing in our waiting areas, and we’ve added many new hand sanitizing stations. You’re in a very safe place. There’s no reason not to come to the doctor.
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