Brain Tumor: Treatment Options

How is it treated?

The type of treatment chosen for brain tumors depends on the type and location of the tumor. Tumors on the brain's surface can be removed more easily and with fewer lasting effects than those found deep within the brain tissue. Tumors that affect surrounding tissue often need to be treated prior to an attempt at removal. There are many different types of brain tumors and different combinations of therapy are necessary in all of these situations. Your doctor will best be able to tell you what options can best treat your particular type of brain tumor.

• Surgery: Brain tumors are most often treated with surgery.
  
  • Resection - A resection is the complete removal of the tumor from the brain. This is the most successful option if the tumor is located so that it can be reached by a surgeon.
    
  • Biopsy - If the tumor is positioned so that it cannot be removed completely, the doctor may perform a biopsy. During a biopsy, the surgeon uses a hollow needle to remove a section of the tumor. The sample is then sent to a lab where the cells can be examined. This test can tell you and your doctors' details about the type of tumor. Biopsy results also help a doctor decide what the next treatment option will be.
    
• Medication: Often it is necessary to use medication to prepare the body for surgery. Steroids are often given to a brain tumor patient in order to decrease the swelling (usually called edema) caused by the pressure on the brain. Also, anti-convulsion drugs may be given to stop seizures. These medications do not change the cancer cells, but they make surgery easier and safer.
  
• Dexamethasone (Decadron) - These are cortisone-like drugs that help to reduce the swelling that the tumor may cause. They also help to relieve headaches.
  
• Diphenylhydantoin (Dilantin) - One of the most commonly prescribed drugs, Dilantin helps to prevent seizures.
  
• Chemotherapy: Chemotherapy is the use of drugs to kill cancer cells. These drugs can be delivered either orally, in the form of pills, or intravenously, directly into the blood stream through a needle placed into a blood vessel. In chemotherapy, combinations of drugs tend to be more effective than just one type of drug itself.
  
  Chemotherapy drugs can usually be taken in a doctor's office or hospital, or even at home in some cases. Usually, the patient will go to see the doctor every day for a few weeks to receive the treatment. The patient will then have some time off from the medicine in order to build up strength and allow his or her immune system to recover. This cycle can continue until the doctor determines the cancer has stopped spreading or is beginning to go away.
  
  The dose, or amount of chemotherapy you receive, depends on several factors including your medical history, age, and severity of cancer. Studies have found that younger patients are better able to handle the side effects of higher doses of these drugs. Patients who have experienced chemotherapy in the past, or those whose bodies are no longer responding to the treatment, may not feel the benefits as strongly as others.
  
• Radiation: Another way to shrink a tumor is to expose it to high levels of radiation.
  
  • External Radiation - This type of treatment uses a large machine to aim radiation at the site of the tumor. The procedure is usually done five days per week for several weeks until further testing shows that the tumor is responding to the radiation. In order to prevent radiation exposure to surrounding tissue, the radiation can be applied to the tumor from a variety of angles and with new sophisticated computerized systems (IMRT).
    
  • Internal Radiation - Also called "interstitial radiation," this type of treatment involves the surgical implantation of radioactive chips into the brain at the site of the tumor. These chips or seeds are left in the brain for a week and then are removed with another surgery.
    

Clinical Trials

In some cases, your doctor may recommend, or you may wish to consider, participating in a Clinical Trial. Clinical Trials are carefully monitored research studies that provide patients with the opportunity to receive the most up-to-date, state-of-the-art care. In a clinical trial, new advancements in cancer treatment are compared to the current, most effective existing treatment. All participants are either treated with an existing and effective method, or with a new, innovative method. Patients in trials have access to the newest drugs, procedures, and treatments. While the side effects of Clinical Trials depend on the exact treatment used, patients who have participated in Clinical Trials in the past have found their experience to be valuable. Clinical Trials are being conducted in cities and towns across the country, and often, the Clinical Trial covers many of the costs.

Some current Clinical Trials are experimenting with biological therapy in conjunction with chemotherapy. Biological therapy is a technique that manipulates the body's use of hormones and other proteins in order to reduce the growth of cancerous cells. There are many different studies with biological therapy. If you are interested, your doctor or health care provider can give you more information on Clinical Trials in your area. You may also contact the Rhode Island Cancer Council who can help you find a Clinical Trial in your area.

Possible Side Effects from Treatments

• Surgery: Immediately following surgery, you may experience pain and swelling at the site of the incision. Some people find that they have a change in personality as well as difficulty in sleeping. If may also be difficult to think clearly or to find the right words. Some of the original symptoms of the tumor may feel worse immediately after surgery. Usually, these symptoms disappear over time.
  
• Medications: The side effects experienced after taking medication depend heavily on the type of medicine prescribed. Your doctor or pharmacist can provide you with more details for your particular type of medicine. Typically, the following drugs are taken before or after surgery.
  
  • Anticonvulsants - These drugs are taken to prevent seizures. The side effects include feeling dizzy or tired. Some people develop a rash on their skin. It is important to avoid drinking alcohol while taking this medication.
    
  • Steroids - Steroids are used to reduce swelling or fluid buildup in the body. Some patients taking these drugs complain of an increased appetite, weight gain, upset stomach, and headaches.
    
• Chemotherapy: The medicine used in chemotherapy targets and kills the cancer cells in the body. Cancer cells are identified by the medicine as those cells that divide rapidly. Many times, chemotherapy not only kills these cancer cells, but it can damage or even reduce the number of normal, healthy cells in the body, in particular, those healthy cells which divide rapidly. These cells include:
  
  • The lining of the digestive tract, including the inside of the mouth and the cells in the intestines.
    
  • The immune cells located in the bone marrow.
    
  • The cells responsible for hair growth on various parts of the body (hair follicles).
    
  As a result, a chemotherapy patient may experience some side effects such as sores inside the mouth, digestive problems such as loss of appetite or nausea and vomiting. Patients also tend to experience hair loss as a result of chemotherapy. The immune system also suffers because the body is less able to fight off infection and produce blood cells. A lack of red blood cells may also result in fatigue and a decrease in platelets may result in bruising easily and prolonged bleeding. These side effects are, for the most part, temporary and will go away when the chemotherapy is stopped. Some of the permanent side effects include early menopause in women and infertility in both men and women.
  
• Radiation: Patients undergoing radiation therapy may complain of feeling tired. The radiation exposure can also cause a patient's skin to become red or dry, especially in areas that are exposed to the cold air or sun, or where clothing may rub. You should avoid using any creams or lotions unless your doctor prescribes them. Wearing loose, soft, comfortable clothing and avoiding extreme hot or cold temperatures can help this. Also, the radiation can affect various parts of the body, depending on the location of the tumor. For instance, if the digestive system is exposed to radiation because the tumor is located in the lower back, the patient may experience some digestive problems.
  
  After receiving treatment for a brain tumor, it is important to keep in touch with your doctor during recovery.
  

Follow up

It is usually recommended that a patient recovering from brain tumor treatment receive an MRI or CT scan on a 3 to 6 month basis to ensure that the tumor is not going to come back. If you undergo surgery, your doctor will also want to inspect the area of the operation to be sure that you do not develop an infection.

Following treatment, some patients may often begin to feel differently physically or emotionally. The results will vary depending on the type of brain tissue affected or removed because of the tumor. Family members may also notice a change in the patient's personality, abilities, or tolerance levels. In most cases it is helpful to speak with your doctor about the changes you are experiencing. It may also be useful to seek counseling or rehabilitation, depending on the extent of the changes.

As with all medical conditions, it is necessary that you keep your doctor informed as to your progress as well as any recurring or new symptoms.

It's easier to prevent cancer than to cure it....

Certain lifestyle and dietary habits may reduce your risk of many types of cancers. Some of these include:

• Not smoking
  
• Regular exercise
  
• Moderate, if any, consumption of alcohol
  
• Low fat diet
  

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