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BRAIN CANCER

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OVERVIEW Cancers of the brain are the consequence of abnormal growths of cells in the brain. Brain cancers can arise from primary brain cells, the cells that form other brain components (for example, membranes, blood vessels), or from the growth of cancer cells that develop in other organs and that have spread to the brain by the 4/22/12 bloodstream (metastatic brain

Although many growths in the brain are popularly called brain tumors, not all brain tumors are cancerous. Cancer is a term reserved for malignant tumors Malignant tumors grow and spread aggressively, overpowering healthy cells by taking their space, blood, and nutrients. Like all cells of the body, tumor cells need blood and nutrients to survive. This is especially a problem in the brain, as the added growth within the closed confines of the skull can lead to an increase in intracranial pressure or the distortion of surrounding vital structures, causing their malfunction Tumors that do not grow aggressively are called benign. Almost all tumors that begin in the brain do not spread to other parts of the body. The major difference between benign and malignant tumors is that malignant tumors can invade the brain tissues and grow rapidly. This rapid growth in the confines of the skull can quickly cause damage to nearby brain tissue. In general, a benign tumor is less serious than a malignant tumor. However, a benign tumor can still cause many 4/22/12 problems in the brain, but usually the problems progress at a

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Sometimes people confuse brain aneurysms with brain tumors. Brain aneurysms are not tumors; they are areas in the brain arteries or veins that are abnormally weak and expand to form a ballooning or expansion of the vessel wall. They seldom produce any symptoms unless they begin to leak blood into the surrounding brain tissue. Aneurysms may be congenital (present at birth) or expanded or formed in brain vessels after vessel damage (for example, trauma, atherosclerosis, high blood pressure) but are not formed from cancer cells. Unfortunately, when aneurysms produce

Primary brain tumors


The brain is made up of many different types of cells and tumors that arise from a brain cell type are termed primary brain tumors. Cancers occur when one type of cell transforms and loses its normal characteristics. Once transformed, the cells grow and multiply in abnormal ways. As these abnormal cells grow, they become a mass of cells, or tumor. Brain tumors that result from this transformation and abnormal growth of brain cells are called primary brain tumors because they originate in the brain. The most common primary brain tumors are gliomas, meningiomas, pituitary adenomas, vestibular schwannomas, primary CNS lymphomas, and primitive neuroectodermal tumors (medulloblastomas). The term glioma is an expansive one since it includes numerous subtypes, including astrocytomas, oligodendrogliomas, ependymomas, and choroid plexus papillomas. 4/22/12

Brain tumors vary in their growth rate and ability to cause symptoms. The cells in fast growing, aggressive tumors usually appear abnormal microscopically. The National Cancer Institute (NCI) uses a grading system to classify tumors. The NCI lists the following grades: Grade I: The tissue is benign. The cells look nearly like normal brain cells, and cell growth is slow. Grade II: The tissue is malignant. The cells look less like normal cells than do the cells in a grade I tumor. Grade III: The malignant tissue has cells that look very different from normal cells. The abnormal cells are actively growing. These abnormal-appearing cells are termed anaplastic. Grade IV: The malignant tissue has cells that look most abnormal and tend to grow very fast. In the United States, primary brain tumors and other 4/22/12 nervous system cancers are estimated to develop in

Metastatic brain tumors


Metastatic brain tumors are made of cancerous cells that spread through the bloodstream from a tumor located elsewhere in the body. The most common cancers that spread to the brain are those arising from cancers that originate in the lung, breast, and kidney as well as malignant melanoma, a skin cancer. The cells spread to the brain from another tumor in a process called metastasis. The process metastasis occurs when cancer cells leave the primary cancer tissue and enter either the lymphatic system to reach the blood or the bloodstream directly. These cancer cells eventually reach the brain tissue through the bloodstream where they develop into tumors.

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Metastatic brain tumors are the most common type of tumor found in the brain and are much more common than primary brain tumors. Metastatic tumors are usually named after the type of tissue from which the original cancer cells arose (for example, metastatic lung or metastatic breast cancer). Brain blood flow usually determines where the metastatic cancer cells will lodge in the brain; about 85% locate in the cerebrum (the largest portion of the brain, located in the upper part of the skull cavity). Unfortunately, the majority of metastatic brain tumors occur at more than one site in the brain tissue.

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Anatomy & Physiology


The brain is well protected by: The scalp The skull The dura A tough 3-layer sheath that surrounds the brain and spinal cord Layers include the dura mater (strongest layer), arachnoid mater (middle layer), and pia mater (closest to the brain)

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The brain is a complicated structure containing many parts. These include: The cerebrum: Made up of two cerebral hemispheres that are connected in the middle It is the largest part of the brain Each area of the cerebrum performs an important function, such as language or movement Higher thought (cognition) comes from the frontal cortex (front portion of the cerebrum) Outside of the cerebrum are blood vessels There are fluid-filled cavities and channels inside the brain The cerebellum: Located in the lower, back part of the skull Controls movement and coordination

The brainstem and pituitary gland: Responsible for involuntary functions such as breathing, body temperature, and blood pressure regulation Pituitary gland is the "master gland" that controls other endocrine glands in the body, such as the thyroid and adrenal glands Pineal gland The cranial nerves: Twelve large nerves exit the bottom of the brain to supply function to the senses such as hearing, vision, and taste The cerebral blood vessels: A complicated system that supplies oxygenated blood and nutrients to the brain

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The blood supply to the brain is divided into two main parts:

Anterior cerebral circulation: The front of the brain is supplied by the paired carotid arteries in the neck. Posterior cerebral circulation: The back portion of the brain is supplied by the paired vertebral arteries in the spine.

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PATHOPHYSIOLOGY
Tumors of the brain produce neurologic manifestations through a number of mechanisms. Small, strategically located tumors may damage specific neural pathways traversing the brain. Tumors can invade, infiltrate, and supplant normal parenchymal tissue, disrupting normal function. Because the brain dwells in the relatively restricted repository of the cranial vault, growth of intracranial tumors with accompanying edema may compress normal tissue and impair function. Tumors proximal to the third and fourth ventricles may obstruct the flow of cerebrospinal fluid, leading to hydrocephalus. In addition, tumors generate new blood vessels (ie, angiogenesis), disrupting the normal blood-brain 4/22/12

Levels of Care
Preventive In general, there is no known way to prevent brain cancers. However, early diagnosis and treatment of tumors that tend to metastasize to the brain may reduce the risk of metastatic brain tumors. Avoiding or reducing contact with radiation (especially to the head) and avoiding toxic chemicals associated with the oil and rubber industry, embalming chemicals, and other environmental toxins may help prevent brain cancers. Avoiding HIV infection is also suggested.
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The popular press and some web sites suggest that avoiding cell phone use and using a macrobiotic diet will help avoid brain cancer. Currently, there is no good evidence for these claims. In December 2010, a large study of about 59,000 cell phone users, with use times ranging over five to 10 years, claims that no substantial change in brain cancer incidence could be found in these individuals. Investigators suggest that "high usage" of cell phones over long time periods is yet to be investigated. However, for those who want to minimize any radiation dose from cell phones, the reader can consult the web for a list of phones that produce the highest and lowest radiation levels.

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Curative
Three types of standard treatment are used. 1. Surgery Surgery is used, when possible, to treat adult brain tumor. Surgery is the usual treatment for most brain tumors. To remove a brain tumor, a neurosurgeon makes an opening in the skull. This operation is called a craniotomy. Whenever possible, the surgeon attempts to remove the entire tumor. If the tumor cannot be completely removed without damaging vital brain tissue, your doctor may remove as much of the tumor as possible. Partial removal helps to relieve symptoms by reducing pressure on the brain and reduces the amount of tumor to be treated by radiation therapy or chemotherapy. Some tumors cannot be removed. In such cases, your doctor may do only a biopsy. A small piece of the tumor is removed so that a pathologist can examine it under a microscope to determine the type of cells it contains. This helps your doctor decide which treatment to use. 4/22/12

Sometimes, a biopsy is done with a needle. Doctors use a special head frame (like a halo) and CT scans or MRI to pinpoint the exact location of the tumor. The surgeon makes a small hole in the skull and then guides a needle to the tumor. Using this technique to do a biopsy or for treatment is called stereotaxis. Other advanced techniques during surgery include brain mapping to find functional pathways near tumors, endoscopy to perform biopsies and open spinal fluid pathways through a small scope and advanced frameless stereotaxic computer assisted tumor resections. Intraoperative MRI also is available to help maximize tumor removal. 2. Radiation therapy Radiation therapy is a cancer treatment that uses high-energy xrays 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 4/22/12

3. 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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REHABILITATION Once a brain tumor is diagnosed, the patient needs to be very careful to keep all appointments with consultants and the primary health-care provider. In general, people with brain cancer are at increased risk for additional medical problems and, potentially, reoccurrence or worsening of their symptoms. After treatment, patients will be returning for follow-up visits with their cancer team members. A schedule of follow-up checkups and tests will be recommended. The purpose of this follow-up is to ensure that any recurrence of cancer or any long-term effect of the treatment is identified promptly so that it can be treated right away.

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