Brain Tumor

If a brain tumor is suspected, your healthcare professional may use several tests and procedures to diagnose it:

Neurological exam: Evaluates vision, hearing, balance, coordination, strength, and reflexes. Helps identify which part of the brain might be affected but cannot detect a tumor.
Head CT scan: Uses X-rays to create images of the brain. Often the first imaging test to check for brain abnormalities.
Brain MRI: Provides highly detailed images using strong magnets. Sometimes a dye is injected to enhance details. Special MRI techniques include:
- Functional MRI (fMRI): Shows brain areas controlling speaking, movement, and other tasks to aid surgical planning.
- Magnetic resonance spectroscopy: Measures chemical levels in tumor cells to understand tumor type.
- Magnetic resonance perfusion: Measures blood flow in tumor areas to determine the most active regions.
PET scan (Positron Emission Tomography): Uses a radioactive tracer to highlight rapidly dividing tumor cells. Helpful for detecting fast-growing tumors like glioblastomas.
Brain biopsy: Involves removing a tissue sample for lab testing. Can be done:
- During surgery to remove the tumor.
- Using a stereotactic needle biopsy, where a needle is guided to the tumor through a small hole in the skull. Risks include bleeding and brain tissue damage.
Lab testing of tumor tissue: Determines whether cells are cancerous or benign, the growth rate, and DNA changes to guide treatment planning.

Unlike other cancers, brain tumors do not have stages, as they rarely spread outside the brain.

Factors affecting prognosis include:

Survival rates:

All brain tumors combined: 1-year ~40%, 5-year ~19%, 10-year ~13%.
Brain metastasis: Life expectancy ~3–12 months; may reach 12–15 months with stereotactic radiosurgery.

Life expectancy by grade 4 brain cancer type:

Common causes of death: Tumor growth, pressure on critical brain areas, swelling, bleeding, or infections.

Treatment depends on tumor type, size, grade, location, overall health, and patient preferences.

Goal: Remove as much tumor as safely possible.

Craniotomy: Removing a section of the skull to access and remove the tumor.
Awake brain surgery: Patient is awake to monitor brain function during removal.
Endoscopic surgery: Uses a thin tube (endoscope) through the nose or skull to reach tumors, commonly for pituitary tumors.

Risks: Infection, bleeding, blood clots, brain injury, vision or hearing loss.

External beam radiation: Targets tumor with X-rays or protons.
Whole-brain radiation: Used for multiple tumors, especially metastases.
Proton therapy: Targets tumors precisely to protect healthy tissue, often used in children.

Side effects: Fatigue, headaches, memory loss, scalp irritation, hair loss, possible long-term cognitive issues.

Stereotactic radiosurgery (SRS): Intense radiation beams converge on the tumor without surgery.

Linear accelerator (LINAC), Gamma Knife, or Proton radiosurgery are used.
Typically one or few treatments, outpatient.

Side effects: Fatigue, scalp changes, hair loss (sometimes permanent).

Uses strong medicines to kill tumor cells, via pill, IV, or local placement during surgery.
May be combined with radiation.

Side effects: Nausea, vomiting, hair loss.

Rehabilitation may be needed for movement, speech, vision, or cognitive difficulties:

Physical therapy: Regains motor skills and strength.
Occupational therapy: Supports return to daily activities.
Speech therapy: Helps with speaking challenges.
Educational support: Assists school-age children with memory and learning changes.

Overview