Brain Tumors

Every patient who comes to the UofL Brown Cancer Center for brain tumor treatment receives customized care from some of the nation’s top experts.

Overview

Every patient who comes to the UofL Brown Cancer Center for brain tumor treatment receives customized care from some of the nation’s top experts.

From diagnosis through treatment and follow-up, you are the focus of a team of specialists who personalize your therapy for your unique situation.

We have a level of expertise in the treatment of benign (non-cancerous) and malignant (cancer) brain tumors that can translate into more successful outcomes for many brain tumor patients.

Our team approach to care brings together highly-trained physicians from multiple areas, all dedicated to brain tumor care or research. Each team is joined by a specially trained support staff. They all work together closely to be sure you receive individualized care.

Our skilled and recognized neurosurgeons perform a large number of brain tumor surgeries each year, using the least-invasive and most advanced techniques. Like all surgeries, brain tumor surgery is most successful when it is performed by a specialist with a great deal of experience. This is especially true with brain tumors because it is crucial to remove as much of the tumor as possible while leaving intact optimum brain function.

Our Multidisciplinary Brain Tumor Clinic offers the most advanced radiation treatment methods, targeting brain tumors more precisely and delivering the maximum amount of radiation with the least damage to healthy cells.

We continue to look at new diagnostic and treatment approaches, including attacking disease on a molecular basis. We are able to offer clinical trials of target therapies in some cases. And we are studying new ways to prevent and treat brain tumors to give patients everywhere a future filled with hope.

Understanding a disease is the first step toward finding the right care. Get the facts about brain tumors, including the different types, how it starts and who’s at risk.

Brain tumors are one of the few cancer types that can strike at any age.

About 17,000 people are diagnosed with cancer that began in or next to the brain every year in the United States. These are called primary brain cancers. Another 100,000 people are diagnosed with cancer in the brain or spinal cord that spread (metastasized) from another place in the body. These are called secondary brain cancers.

Most types of brain tumors are slightly more common in men than women. Meningiomas are more common in women.

Tumor Growth

Some brain tumors grow slowly and may become quite large before causing symptoms. Others may grow quickly and cause a sudden onset of symptoms. While most types of brain cancer may spread within the brain, few spread beyond the brain. Because the skull is rigid, providing no room for the tumor to expand, brain tumors may press on parts of the brain that control movement, speech, sight or other vital functions.

Even when brain tumors are benign (not cancer), they can cause serious problems. Although non-cancerous brain tumors usually grow slower than cancerous brain tumors, they may damage and press against normal brain tissue or the spine as they grow.

Crucial Roles of the Brain

Emotions, thought, speech, vision, hearing, movement and many more important parts of everyday life begin in the brain. The brain sends messages throughout the body via the spinal cord and cranial nerves in the head. The network of the brain and spinal cord is called the central nervous system (CNS). Tumors can develop in the spinal cord and cranial nerves.

The hard, bony skull protects the brain, and the bones (vertebrae) of the spine protect the spinal cord. A liquid called cerebrospinal fluid surrounds both the brain and the spinal cord.

The brain has four main parts:

Cerebrum: The outer and largest part of the brain. The cerebrum has two halves that are called hemispheres. It is responsible for:

  • Emotions
  • Reasoning
  • Language
  • Movement of muscles
  • Senses of seeing, hearing, smelling, touch
  • Perception of pain

Basal ganglia: These are found deeper inside the brain. They play a part in muscle movement.

Cerebellum: This section is at the back of the brain. It helps control and coordinate movement, such as walking and swallowing.

Brain stem: The brain stem is at the base of the brain. Its nerve fibers carry messages between the cerebrum and the rest of the body. This small area is very important and even plays a part in breathing and heartbeat.

Brain Tumor Types

Brain tumors are classified by the types of cells within the tumor. Each type of brain tumor grows and is treated in a different way.

The main types of brain tumors are as follows. The type of cells where they begin are in parentheses.

  • Chordoma (skull and spine)
  • Craniopharyngioma (pituitary gland)
  • Dermoid cysts and epidermoid tumors
  • Germ cell tumors, including germinomas (near the pineal gland)
  • Gliomas: This is the main group of brain tumors, occurring in 65 percent of cases. It includes:
    • Glioblastoma multiforme (glial cells and oligodendrocytes), the type of brain cancer found most often in adults
    • Astrocytoma (glial cells of tissue that supports nerve cells)
    • Oligodendroglioma (oligodendrocytes in the myelin sheath around nerve fibers in the brain)
    • Ependymoma (the ventricles in tissue lining the spaces within the brain)
  • Hemangioblastoma (cells that develop into blood vessels)
  • Medulloblastoma (cerebellum)
  • Meningioma (meninges, the layers of tissue covering the brain)
  • Osteoma and osteosarcoma (bones of the skull)
  • Pinealoma (pineal gland)
  • Pituitary adenoma (pituitary gland)
  • Sarcoma (connective tissue)

Brain Metastases

Cancers that metastasize (spread) to the brain are called metastases. They may grow in one or several parts of the brain. Many types of cancer can spread to the brain. The main types are breast cancer, lung cancer, gastrointestinal cancers, malignant melanoma, leukemia and lymphoma.

Lymphomas of the brain often are found in people who have AIDS. For unknown reasons, they are increasingly being found in people with normal immune systems.

Risk Factors

Anything that increases your chance of getting a brain tumor is a risk factor. While no definite risk factors have been found for brain tumors, some factors may put you at increased risk, including:

  • Radiation exposure
  • Family history of certain conditions including:
    • Neurofibromatosis type 1 and type 2
    • Tuberous sclerosis
    • Von Hippel-Lindau disease
    • Li-Fraumeni syndrome
  • Immune system disorders, including AIDS and lymphoma

Research is ongoing into the causes and risk factors of brain tumors. Many possibilities are being studied, including genetics and environmental exposure to certain chemicals.

Some types of brain tumors may be passed down from one generation to the next. Genetic counseling may be right for you.

Most cancers have the same symptoms as other, less serious conditions. Still, it’s important to know the signs.

Brain tumor symptoms depend on the area of the brain affected. Brain tumors can:

  • Invade and destroy brain tissue
  • Put pressure on nearby tissue
  • Take up space and increase pressure within the skull (intracranial pressure)
  • Cause fluids to accumulate in the brain
  • Block normal circulation of cerebrospinal fluid through the spaces within the brain
  • Cause bleeding

Brain tumor symptoms vary from person to person. They may include:

  • Headaches, which are often the first symptom. A headache due to a brain tumor usually becomes more frequent as time passes. It is often worse when you lie down or first awaken.
  • Seizures
  • Changes in mental function, mood or personality. You may become withdrawn, moody or inefficient at work. You may feel drowsy, confused and unable to think. Depression and anxiety, especially if either develops suddenly, may be an early symptom of a brain tumor. You may become uninhibited or behave in ways you never have before.
  • Changes in speech (trouble finding words, talking incoherently, inability to express or understand language)
  • Changes in the ability to hear, smell or see, including double or blurred vision
  • Loss of balance or coordination
  • Change in the ability to feel heat, cold, pressure, a light touch or sharp objects
  • Changes in pulse and breathing rates if brain tumor compresses the brain stem

These symptoms do not always mean you have a brain tumor. However, it is important to discuss any symptoms with your doctor, since they may signal other health problems.

Blood tests, imaging exams and even surgical procedures are used to check for cancer.

If you have a brain tumor, it is important to get the most accurate diagnosis possible. This will help your doctor pinpoint the tumor to give you the most advanced treatment with the least impact on your body.

At UofL Brown Cancer Center, we have the most modern and accurate equipment available to home in on brain tumors and find out exactly how far they may have spread.

Our specialized staff truly sets us apart. A team of neuro-oncologists, neurologists, neurosurgeons, radiation oncologists and physical medicine and rehabilitation specialists make up our Neuro-Oncology team.

Diagnostic tests

If you have symptoms that may signal a brain tumor, your doctor will examine you and ask you questions about your health, your lifestyle and your family history.

One or more of the following tests may be used to find out if you have a brain tumor and if it has spread. These tests also may be used to find out if treatment is working.

Biopsy: While imaging tests may show an area that may be a brain tumor, a biopsy is almost always needed to diagnose a brain tumor. A biopsy may be done by either of two methods.

Surgery: A biopsy may be done during surgery in which all or part of the brain tumor is removed. The operation also is called a craniotomy. If a tumor is difficult to reach, a CT (computed tomography) scan may be used for three-dimensional needle placement (stereotactic biopsy). This helps doctors precisely locate the tumor.

Sterotactic (needle) biopsy: This method may be used if the suspicious area is in a place that makes surgery too risky or difficult.

Imaging tests, which may include:

  • CT (computed tomography) scans
  • MRI (magnetic resonance imaging)
  • PET (positive emission tomography) scan

Lumbar puncture: A small amount of cerebrospinal fluid (clear liquid in and around the brain and spine) is removed with a needle and looked at with a microscope. This test may be done if:

  • Doctors suspect tumor has invaded the layers of tissue that cover the brain (meninges)
  • When the diagnosis or type of tumor is not clear

Brain tumor staging

Staging is a way of determining how much disease is in the body and where it has spread. However, staging systems are not used for brain tumors.

While primary brain tumors (that start in or next to the brain) sometimes spread (metastasize) to other parts of the brain or the spine, they usually do not spread to other places in the body.

Common cancer treatments include chemotherapy, radiation treatment and surgery. Doctors select a treatment plan based on your diagnosis and disease stage.

Some of the nation’s top experts customize your brain tumor care at UofL Brown Cancer Center. They take a team approach to deliver the most advanced therapies with the fewest possible side effects, keeping a constant eye on your quality of life. They're also actively engaged in clinical research and trials to help develop the next generation of innovative approaches for brain cancer treatment.

These highly trained physicians work together to give individualized care for malignant (cancer) and benign (non-cancer) brain tumors, collaborating and communicating frequently. Your personal team of experts may include renowned neurosurgeons, radiation oncologists and neuro-oncologists, supported by a specially trained staff.

Surgical expertise

Like all surgeries, brain tumor surgery is most successful when it is performed by a specialist with a great deal of experience in the particular procedure. This is especially true with brain tumors because it is crucial to remove as much of the tumor as possible while leaving intact as much brain function as possible.

UofL Brown Cancer Center neurosurgeons are among the most skilled and recognized in the world. They perform a large number of brain tumor surgeries each year, using the least-invasive and most advanced techniques.

We have the most modern technology available to treat brain tumors, including:

Our treatments

If you are diagnosed with a brain tumor, your doctor will discuss the best options to treat it. This depends on several factors, including the location and type of the cancer and your general health.

Your treatment for a brain tumor will be customized to your particular needs. One or more of the following therapies may be recommended to treat the cancer or help relieve symptoms.

Surgery

Surgery usually is the first treatment for brain tumors. Even when complete removal is not possible surgery may be able to:

  • Help reduce the tumor’s size
  • Relieve symptoms
  • Help doctors decide what other treatments are needed

The most common surgery for brain tumors is craniotomy, which involves opening the skull. Some brain tumors can be removed with little or no damage to the brain. However, many grow in areas that make them difficult or impossible to remove without destroying important parts of the brain.

Radiation therapy

Radiation therapy may be able to stop or slow the growth of brain tumors that cannot be removed with surgery. It may be used:

  • Alone
  • With chemotherapy to help the radiation work better or lessen effect on normal parts of the brain
  • With targeted therapies to destroy remaining cancer cells

New radiation therapy techniques and remarkable skill allow UofL Brown Cancer Center doctors to target brain tumors more precisely, delivering the maximum amount of radiation with the least damage to healthy cells.

The UofL Brown Cancer Center uses the most advanced radiation treatment methods, including:

  • Cyberknife radiosurgery, which is not really surgery. It delivers a pinpoint dose of radiation from hundreds of angles.
  • Focused radiation therapy, which is aimed directly at the tumor and immediately surrounding area
  • Whole-brain radiation therapy, which may be needed if you have two or more brain tumors in different locations.
  • Intensity-modulated radiotherapy (IMRT), which shapes the radiation beam to the shape of the brain tumor and lessens exposure to the rest of the brain.

Laser interstitial thermal therapy

Laser interstitial thermal therapy (LITT) is performed by implanting a laser catheter into the tumor and heating it to temperatures high enough to kill the tumor.

The treatment is minimally invasive, often requiring little more than a 2-millimeter incision in the scalp, and takes just a few minutes to perform. Most patients can go home the day after treatment and can quickly return to normal activities.

LITT is currently being used to treat patients with primary and metastatic brain tumors, but can also help patients who do not respond to stereotactic radiosurgery or have radiation necrosis (tissue death caused by radiation treatment).

Chemotherapy

We offer the most up-to-date and advanced chemotherapy options for brain tumors. These drugs may be taken orally or by injection. They may be given alone or with other treatments.

Chemotherapy often is not as effective for brain cancer as some other types of cancer. This is because of the blood-brain barrier, small blood vessels in the brain and spinal cord that protect the brain from harmful substances. They also may act as a shield against chemotherapy drugs.

Targeted therapies

These new drugs target the specific gene changes that cause cancer. We are at the forefront of discovering these agents. Many of our brain tumor clinical trials include analysis of the molecular profiles of patients' tumors.

Research

At UofL Brown Cancer Center, we are working on developing and evaluating new approaches to brain cancer diagnosis and treatment. Patients benefit from the most advanced brain tumor research, translated into clinical trials as quickly as possible.

Current treatments for both primary brain tumors and brain metastases (cancer that has spread to the brain from another place in the body) are low in number and short on effectiveness. Because brain tumors contain an unusually diverse mix of cells, our plan of attack is diverse as well.

We’re building on biological therapies and testing methods that use the body’s own cells to deliver these therapies more effectively. With advanced models, we’re also screening existing drugs to find targeted combinations that can penetrate the blood-brain barrier. In the cutting-edge field of immunotherapy, our team is working on approaches using T cells, natural killer cells, signaling pathways and checkpoint inhibitors to unleash the immune system to fight brain cancer.

Existing brain tumor treatments are often toxic, threatening neurological function and quality of life. Our scientists are also investigating regenerative medicine approaches to protect and repair the brain during and after treatment. We aim to find better, safer solutions to treat both primary brain tumors and brain metastases.

Research Groups

  • Neuro-oncology Department
  • Neurosurgery Department
  • Brain Tumor Research Program

Our doctors at UofL Brown Cancer Center are proudly part of UofL Physicians and the UofL School of Medicine.

We believe knowledge comes from questioning the status quo, discovering more about disease and using that knowledge to improve the health of our community. Our physicians are the teachers and researchers at the UofL School of Medicine, involved in the research and development of new treatments and cures for cancer. This means you receive the most advanced and appropriate treatment, even for complex or rare conditions.

To learn more about the physicians who make the academic difference in treatment for brain tumors, visit the UofL Physicians web site here.