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Overview of Brain Tumor Treatment

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Treatment of brain tumors can vary considerably. Often, it involves a complex and multifaceted care team including a neurosurgeon, oncologist (a doctor who specializes in tumor treatments like chemotherapy), and a radiation oncologist (a doctor who specializes in using radiation to treat tumors).

Only rarely can a brain tumor go away without surgery; therefore, most brain tumors require some form of treatment. You may need only surgery to remove the tumor, with no need for chemotherapy or radiation. Some benign brain tumors can even be observed and require no intervention unless they start causing troublesome symptoms. Ultimately, the best treatment for a brain tumor depends on several factors, including the type of tumor, its location in the brain, your overall health, and your treatment goals.

Surgical Options for Brain Tumors

Surgery is often the first-line treatment for brain tumors and involves removing as much of the tumor as possible. There are several surgical options to treat brain tumors that may be used alone or in combination with other treatments. The type of surgical procedure performed depends on the size, location, and type of tumor, as well as your overall health. Surgical options to treat brain tumors include:

  • Craniotomy: A craniotomy is the most common type of brain surgery and involves removing a piece of the skull to access the brain. The surgeon then removes as much of the tumor as possible, while minimizing damage to surrounding brain tissue.
  • Endonasal endoscopic surgery: This is a minimally invasive surgical approach that uses an endoscope (a thin tube with a camera) to access the tumor through the nose and sinuses. This approach is used for tumors located in the skull base, pituitary gland, or other areas that are difficult to reach through a traditional craniotomy.
  • Stereotactic biopsy: This is a minimally invasive procedure that uses computer imaging to guide the insertion of a needle through a small hole in the skull to obtain a tissue sample for biopsy. It is used to diagnose the type of tumor before treatment is planned.
  • Laser interstitial thermal therapy (LITT): This is a minimally invasive procedure that uses a laser to destroy the tumor with heat. It is used for small tumors that are difficult to remove with surgery or for tumors located in critical areas of the brain.
  • Shunt placement: This is a surgical procedure to place a shunt (a thin, flexible tube) in the brain to drain excess fluid that may accumulate due to the tumor or the treatment.

The specific treatment plan for a brain tumor will depend on your specific case and should be determined together with your neurosurgeon and other members of your treatment team.

Nonsurgical Options for Brain Tumors

Nonsurgical treatments may be used for brain tumors for several reasons. For example, some brain tumors are located in sensitive areas of the brain that cannot be safely accessed through surgery. In other cases, a brain tumor may be too large to be completely removed with surgery, and nonsurgical treatments can be used to shrink the tumor before or after surgery. There are also types of brain tumors, like gliomas, that are more effectively treated with a combination of surgery, radiation therapy, and chemotherapy. Lastly, some patients may prefer brain tumor treatment without surgery to help control the growth of the tumor and manage symptoms. The most common nonsurgical options to treat brain tumors are:

  • Radiation therapy: Uses high-energy radiation to slow down the growth of the cancer cells and shrink tumors; can be delivered externally (external beam radiation therapy) or internally (brachytherapy), depending on the type and location of the tumor. Proton radiation therapy can be more precisely targeted to the tumor, resulting in less damage to surrounding healthy tissue.
  • Chemotherapy: Uses drugs to kill cancer cells; can be given orally or intravenously and may be used alone or in combination with radiation therapy.
  • Immunotherapy: Helps the immune system to fight cancer; can be used alone or in combination with other treatments and is delivered either intravenously or through an injection.
  • Targeted therapy: Uses drugs to target specific molecules or pathways that are involved in cancer growth; can be given orally or intravenously and may be used alone or in combination with other treatments.
  • “Watchful” waiting: Involves close monitoring of the tumor without immediate treatment; may be used for small tumors that are not causing symptoms or for patients who are not candidates for surgery or other treatments.

Often a patient will undergo surgery and then have a combination of both chemotherapy and radiation for several months. This typically occurs with “high-grade” tumors, which are fast-growing and aggressive tumors. The success rate for radiation and chemotherapy depends on the type of tumor. A combination of chemotherapy and radiation after surgery can control tumor progression and prolong survival, depending on the type of brain tumor being treated.

Side Effects of Brain Tumor Surgery

Brain tumor surgery can cause a range of side effects that vary depending on the type of surgery, location of the tumor, and your overall health. Some common side effects of brain tumor surgery include:

  • Pain and discomfort: Pain and discomfort at the site of the incision are common for a short time after brain tumor surgery. Pain medication can help manage these symptoms.
  • Nausea and vomiting: Nausea and vomiting can occur after brain surgery, especially if the surgery was extensive. Anti-nausea medications can be prescribed to help manage these symptoms.
  • Headache: Headache is common after brain tumor surgery. Pain medication, hydration, and rest can help manage headaches.
  • Fatigue: Fatigue is also common after brain surgery and can last for several weeks or months. Rest and a gradual increase in activity level can help manage fatigue.
  • Changes in cognitive function: You may experience changes in cognitive function, such as memory problems, confusion, or difficulty with attention and concentration.
  • Changes in speech or language: Changes in speech or language abilities, such as difficulty with speaking, understanding speech, or producing speech, can occur after brain tumor surgery.
  • Weakness or paralysis: Temporary or rarely permanent weakness or paralysis, depending on the location of the tumor and the extent of the surgery, may occur. Physical and occupational therapy can help improve muscle strength and coordination.
  • Seizures: Seizures can occur after brain tumor surgery, especially if the tumor was near the area of the brain responsible for controlling seizures. Anti-seizure medication can be prescribed to help manage these symptoms.

These side effects can vary greatly between individuals, and you most likely may not experience any significant side effects at all. Discuss any concerns you have about the side effects of brain tumor surgery with your medical team.

Side Effects of Radiotherapy

Radiation therapy is a common treatment option for brain tumors but does have potential side effects and complications. The specific side effects depend on the dose and duration of radiation therapy, the location of the tumor, and your health and medical history. Some common side effects of radiation therapy include:

  • Fatigue: May last for several weeks after treatment.
  • Skin changes: Redness, itching, or blistering can occur in the treatment area.
  • Hair loss: May be seen in the treatment area; may or may not grow back after treatment.
  • Cognitive changes: Memory loss, difficulty concentrating, or confusion.
  • Headaches: May be temporary or persistent.
  • Nausea and vomiting: Can be managed with medication.
  • Seizures: Risk of seizures increases; your healthcare professional can prescribe preventative medications.

There is also a very low risk of developing new tumors because of the exposure to radiation. However, there are newer radiotherapy techniques available that can reduce dose-related side effects while maximizing tumor control. Discuss all the options and risks with your medical team so you can make an informed decision before treatment.

Side Effects of Chemotherapy

Chemotherapy drugs kill rapidly dividing cancer cells, but they can also affect healthy cells in the body, leading to side effects. The specific side effects of chemotherapy to treat a brain tumor depend on the type of drugs used, the dose, and your particular response. Here are some common side effects that may occur:

  • Nausea and vomiting: Can range from mild to severe; anti-nausea medications can help manage this side effect.
  • Fatigue: May last for several weeks after treatment; it's important to get plenty of rest.
  • Hair loss: Can cause hair loss on the scalp, as well as loss of eyelashes, eyebrows, and body hair.
  • Risk of infection: May lower the number of white blood cells in the body, which can increase risk of infection; you may need to take precautions to avoid exposure to infections and take antibiotics.
  • Anemia: Can also lower the number of red blood cells in the body, leading to anemia, which can cause fatigue, shortness of breath, and other symptoms.
  • Nerve damage: May cause nerve damage, leading to numbness, tingling, and pain in the hands and feet.

Discuss the potential side effects of chemotherapy with your medical providers before treatment. There are often ways to manage side effects, and your doctors can develop a plan for minimizing and managing them.

Postoperative Recovery Period

After any treatment for brain tumors, proper recovery is essential for your complete return to health. The postoperative recovery period after brain tumor surgery can vary depending on the type, size, and location of the tumor, the surgical approach used, and your age and overall health. Recovery can be a gradual process that may take several weeks or months. Here is a general overview of what to expect:

  • Hospitalization: Patients are typically hospitalized for a few days to a week after surgery for monitoring and recovery. During this time, you may receive medications to manage pain and prevent infection.

  • Monitoring: After discharge, you will need to be monitored closely by a healthcare professional to ensure any incision site is healing properly, and there are no complications, such as infection or bleeding.
  • Rehabilitation: Some patients may need rehabilitation, such as physical therapy, speech therapy, or occupational therapy, to regain function and strength.
  • Follow-up appointments: You will have follow-up appointments with your medical team, who will monitor your recovery and adjust any medications or treatments as needed.
  • Resumption of activities: You will need to gradually resume normal activities, including work, exercise, and social activities. Your doctors will provide guidance on when it is safe to do so.

Recovery from brain tumor surgery is a gradual process, and each patient's experience is different. Your medical treatment team can offer guidance and recommendations for managing symptoms, preventing complications, and improving overall well-being.

Rehabilitation After Brain Tumor Treatment

Rehabilitation after brain tumor treatment is an important part of your recovery. Depending on the type and extent of treatment, you may experience physical, cognitive, and emotional changes. Rehabilitation can help you regain strength, improve functional abilities, and cope with any lingering side effects.

  • Physical therapy: Improves strength, flexibility, balance, and coordination; can also help with physical weakness, paralysis, or problems with walking.

  • Occupational therapy: Helps improve performance of everyday tasks, such as dressing, grooming, and eating; can also with adaptive strategies to compensate for any physical or cognitive changes.

  • Speech therapy: Improves communication skills, including speech, language, and cognitive-communication skills; can also help with any swallowing problems caused by the tumor or the treatment.

  • Cognitive rehabilitation: Helps improve cognitive skills, such as attention, memory, and problem-solving; helps with developing strategies to cope with any cognitive changes caused by the tumor or the treatment.

  • Emotional support: Counseling or psychotherapy can help with any emotional changes related to diagnosis, treatment, or recovery; can also help with coping strategies to manage anxiety, depression, or other psychological symptoms.

Treatment of brain tumors can be complex, and the length of time a person can live after brain tumor surgery or other treatment varies and depends on several factors, including the type of tumor, its location and size, the effectiveness of treatment, and your health. Consult a neurosurgeon experienced in treating brain tumors to guide you through your journey for the best outcome.

Key Takeaways

  • Brain tumors can be treated surgically or non-surgically, or with a combination of both.
  • Surgical treatment usually includes a craniotomy, which involves temporarily removing a portion of the skull to access the tumor, or endonasal endoscopic surgery, when the brain tumor is removed through the nose.
  • Nonsurgical options include radiotherapy and/or chemotherapy.
  • The treatment recovery period includes monitoring and follow-up appointments with your doctors and rehabilitation to help you regain strength, improve functional abilities, and manage any lingering side effects.