Font Size

Brain Cancer (cont.)

Medical Treatment

Treatment of brain cancer is usually complex. Most treatment plans involve several consulting doctors.

The team of doctors includes neurosurgeons (surgical specialists in the brain and nervous system), oncologists, radiation oncologists (doctors who practice radiation therapy), and, of course, your primary health-care provider. Your team will also include a dietitian, a social worker, a physical therapist, and, probably, other specialists.
The treatment protocols vary widely according to the location of your tumor, its size and type, your age, and any additional medical problems that you may have.
The most widely used treatments are surgery, radiation therapy, and chemotherapy. In some cases, more than one of these is used.

Most people with a brain tumor undergo surgery.

The purposes of surgery are to confirm that the abnormality seen on the brain scan is indeed a tumor and to remove the tumor. If the tumor cannot be removed, the surgeon will take a sample of the tumor to identify its type.
In some cases, mostly in benign tumors, symptoms can be completely cured by surgical removal of the tumor. Your neurosurgeon will attempt to remove the tumor when possible.
Stereotactic surgery is a newer "knifeless" technique that destroys a brain tumor without opening the skull. CT or MRI scan is used to pinpoint the exact location of the tumor in the brain. High-energy radiation beams are trained on the tumor from different angles. The radiation destroys the tumor. This technique is sometimes called "gamma knife."
The advantages of "knifeless" procedures are that they have fewer complications and the recovery time is much shorter.

You may undergo several treatments and procedures before surgery.

You may be given a steroid drug, such as dexamethasone (Decadron), to relieve swelling.
You may be treated with an anticonvulsant drug, such as carbamazepine (Tegretol), to relieve or prevent seizures.
If you have excess cerebrospinal fluid collecting around your brain, a thin, plastic tube called a shunt may be placed to drain the fluid. One end of the shunt is placed in the cavity where fluid collects; the other is threaded under your skin to another part of the body. The fluid drains from the brain to a site from which the fluid can be easily eliminated.

Radiation therapy (also called radiotherapy) is the use of high-energy rays to kill tumor cells and stop them from growing and multiplying.

Radiation therapy is sometimes used for people who cannot undergo surgery. In other cases, it is used after surgery to kill any tumor cells that may remain.
Radiation therapy is a local therapy. This means that it affects only cells in its path. It does not harm cells elsewhere in the body or even elsewhere in the brain.

Radiation can be administered in either of two ways.

External radiation uses a high-energy beam of radiation targeted at the tumor. The beam travels through the skin, the skull, healthy brain tissue, and other tissues to get at the tumor. The treatments are usually given five days a week for about four to six weeks. Each treatment takes only a few minutes.
Internal or implant radiation uses a tiny radioactive capsule that is placed inside the tumor itself. The radiation emitted from the capsule destroys the tumor. The radioactivity of the capsule decreases a little bit each day; the amount of radioactivity of the capsule is carefully calculated to run out when the optimal dose has been given. You need to stay in the hospital for several days while receiving this treatment.

Chemotherapy is the use of powerful drugs to kill tumor cells.

A single drug or a combination may be used.
The drugs are given by mouth or through an IV line. Some medications are given through the shunt put in place to drain excess fluid from your brain.
Chemotherapy is usually given in cycles. A cycle consists of a short period of intensive treatment followed by a period of rest and recovery. Each cycle lasts a few weeks.
Most regimens are designed so that two to four cycles are completed. There is then a break in the treatment to see how your tumor has responded to the therapy.
The side effects of chemotherapy are well known and are very difficult to tolerate for some people. They include nausea and vomiting, mouth sores, loss of appetite, loss of hair, and many others. Some of these side effects can be relieved or improved by medication.

New therapies for cancer are being developed all the time. When a therapy shows promise, it is studied in laboratories and improved as much as possible. It is then tested on people with cancer; these tests are called clinical trials.

Clinical trials are available for virtually every kind of cancer.
The advantage of clinical trials is that they offer new therapies that may be more effective than existing therapies or have fewer side effects.
The disadvantage is that the therapy has not been proven to work or does not work in everyone.
Many people with cancer are eligible for participation in clinical trials.
To find out more, ask your health-care provider. A list of clinical trials is available at the Web site of the National Cancer Institute.