Brain Diseases

Management of brain tumors

Let us now discuss a few aspects regarding the management of brain tumors. First what are the tests usually carried out to detect and diagnose a brain tumor? As you can imagine the most commonly done tests are the ones that involve imaging the bain. Either a CT scan or an MRI brain is done. Usually during these tests a dye (also called contrast) is given. The dye/ contrast helps to highlight the tumor from the surrounding background and aids in visualization of the extent of its spread and the surrounding brain edema. Some tumors enhance, that is they take up the dye and look bright while others do not enhance.

If we are dealing with a primary barin tumor, by that I mean a tumor which arises from the brain itself and stays in the brain (does not spread) then nothing else may be needed. But if we are dealing with a metastatic brain tumor (for example a lung tumor which has spread to the brain), more imaging may need to be done. This includes imaging the chest, abdomen and pelvis to look for how far the tumor has spread.

Sometimes tests may be more invasive. The CT scan or MRI brain only shows the mass lesion, it does not tell what kind of tumor it is histopathologically. Remember not all masses in the brain are tumors, infections too can present with mass lesions (brain abscesses). For example a patient is noted to have a mass/ lesion on MRI brain. The doctor cannot tell what it is and may like to get a biopsy of the lesion. Biopsy means getting a small amount of the tissue and looking under the microscope to identify what it is. This procedure is carried out in the OR by a neurosurgeon.

So to summarize some of the investigations which may be carried out during the work-up of a brain lesion include:

1) blood tests

2) Chest X-ray

3) EKG (electrocardiogram)

4) CT scan of the brain with and without contrast

5) MRI of the brain with and without contrast.

6) EEG (electroencephalogram): remember some patients present with seizures and are then detected to have a brain tumor on testing.

7) CT scan of the chest, abdomen and pelvis.

Treatment of brain tumors: the treatment of brain tumors is complex and frequently involves multiple specialities like neurology, neurosurgery, neuro-oncology and radiation oncology. Simply put the treatment depends upon a number of factors. These are:

1) Location of the tumor in the brain--is it easily accessible surgically or is it deep in the brain and cannot be approached surgically?

2) Size of the brain tumor--is it small or is it large? Can it be safely removed without causing weakness, loss of memory or speech problems?

3) Number of tumors in the brain--a solitary lesion usually can be surgically removed while multiple lesions cannot.

4) Type of the brain tumor: as I stated earlier different tumors behave in different ways. Some are slow growing while others grow quite fast. Some are sensitive to radiation while others are not. Some respond to one type of chemotherapy (cancer drugs) while others do not.

The different modalities used in the treatment of brain tumors are:

1) Surgery--the neurosurgeon resects the tumor. For some tumors especially those caught early, this may be all that is needed. In others after surgery you may need radiation to the brain and/or chemotherapy.

2) Radiation--this may either be whole brain radiation (meaning that the whole brain is radiated) or radiation just to the tumor and the surrounding areas. While radiation involves no surgery, it too carries its own side-effects. Radiation may cause cognitive deficits and at times necrosis of the surrounding brain tissue.

3) Chemotherapy: different types of chemotherapy drugs are used in the treatment of brain tumors. Some of these are a group of drugs called nitrosoureas with names like BCNU and CCNU.

Other aspects of care include rehablitation--this may include physical therapy, occupational therapy and speech therapy.

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