Description

What are adult brain tumors? What are metastatic brain tumors? What are the symptoms of an adult brain tumor? What tests are used to find and diagnose adult brain tumors? What is the grade of a tumor?

Types of Adult Brain Tumor

Brain Stem Gliomas Pineal Astrocytic Tumor Pilocytic Astrocytoma (grade I) Diffuse Astrocytoma (grade II) Anaplastic Astrocytoma (grade III) Glioblastoma (grade IV) Oligodendroglial Tumors Mixed Gliomas Ependymal Tumors Medulloblastoma (grade IV) Pineal Parenchymal Tumors Meningeal Tumors Germ Cell Tumor Craniopharyngioma (grade II) Other Adult Brain Tumors Recurrent Adult Brain Tumor Metastatic Brain Tumors

Treatment Option Overview

How are adult brain tumors treated? Three types of standard treatment are used. Other types of treatment are being tested in clinical trials. How are metastatic brain tumors treated? Treatment in a clinical trial

Treatment Options by Type of Adult Brain Tumor

Brain Stem Gliomas Pineal Astrocytic Tumors Pilocytic Astrocytomas Diffuse Astrocytomas Anaplastic Astrocytomas Glioblastoma Oligodendroglial Tumors Mixed Gliomas Ependymal Tumors Medulloblastoma Pineal Parenchymal Tumors Meningeal Tumors Germ Cell Tumors Craniopharyngioma Recurrent Adult Brain Tumor Metastatic Brain Tumors

To Learn More About Adult Brain Tumors
Get More Information From NCI
Changes to This Summary (09/16/2008)
About PDQ

Description

What are adult brain tumors?

Adult brain tumors are diseases in which cancer (malignant) cells begin to grow in the tissues of the brain. The brain controls memory and learning, senses (hearing, sight, smell, taste, and touch), and emotion. It also controls other parts of the body, including muscles, organs, and blood vessels. Tumors that start in the brain are called primary brain tumors.

Often, tumors found in the brain have started somewhere else in the body and spread (metastasized) to the brain. These are called metastatic brain tumors.

A doctor should be seen if the following symptoms appear:

• Frequent headaches.
• Vomiting.
• Loss of appetite.
• Changes in mood and personality.
• Changes in ability to think and learn.
• Seizures.

Tests that examine the brain and spinal cord are used to detect (find) adult brain tumor. The following tests and procedures may be used:

• CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
• MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of the brain and spinal cord. A substance called gadolinium is injected into the patient through a vein. The gadolinium collects around the cancer cells so they show up brighter in the picture. This procedure is also called nuclear magnetic resonance imaging (NMRI).

Adult brain tumor is diagnosed and removed in surgery. If a brain tumor is suspected, a biopsy is done by removing part of the skull and using a needle to remove a sample of the brain tissue. A pathologist views the tissue under a microscope to look for cancer cells. If cancer cells are found, the doctor will remove as much tumor as safely possible during the same surgery. An MRI may then be done to determine if any cancer cells remain after surgery. Tests are also done to find out the grade of the tumor.

The grade of a tumor refers to how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. The pathologist determines the grade of the tumor using tissue removed for biopsy. The following grading system may be used for adult brain tumors:

Grade I

The tumor grows slowly, has cells that look similar to normal cells, and rarely spreads into nearby tissues. It may be possible to remove the entire tumor by surgery.

Grade II

The tumor grows slowly, but may spread into nearby tissue and may become a higher-grade tumor.

Grade III

The tumor grows quickly, is likely to spread into nearby tissue, and the tumor cells look very different from normal cells.

Grade IV

The tumor grows very aggressively, has cells that look very different from normal cells, and is difficult to treat successfully.

The chance of recovery (prognosis) and choice of treatment depend on the type, grade, and location of the tumor and whether cancer cells remain after surgery and/or have spread to other parts of the brain.

Types of Adult Brain Tumor

The extent or spread of cancer is usually described as stages. There is no standard staging system for brain tumors. Primary brain tumors may spread within the central nervous system (brain and spinal cord), but they rarely spread to other parts of the body. For treatment, brain tumors are classified by the type of cell in which the tumor began, the location of the tumor in the central nervous system, and the grade of the tumor.

Types of adult brain tumors include the following:

These are tumors that form in the brain stem, the part of the brain connected to the spinal cord. They are often high-grade. Brain stem gliomas that are high-grade or spread widely throughout the brain stem are difficult to treat successfully. To prevent damage to healthy brain tissue, brain stem glioma is usually diagnosed without a biopsy.

(Refer to the PDQ summary on Childhood Brain Stem Glioma Treatment ¹ for more information.)

Pineal tumors form in or near the pineal gland. The pineal gland is a tiny organ in the brain that produces the hormone melatonin, a substance that helps control our sleeping and waking cycle. There are several kinds of pineal tumors. Pineal astrocytic tumors are astrocytomas that occur in the pineal region and may be any grade.

Astrocytomas are tumors that start in brain cells called astrocytes. Pilocytic astrocytomas grow slowly and rarely spread into the tissues around them. These tumors occur most often in children and young adults. They usually can be treated successfully.

Diffuse astrocytomas grow slowly, but they often spread into nearby tissues. Some of them progress to a higher grade. They occur most often in young adults.

Anaplastic astrocytomas are also called malignant astrocytomas. They grow rapidly and spread into nearby tissues. The tumor cells look different from normal cells. The average age of patients developing anaplastic astrocytomas is 41 years.

Glioblastomas are malignant astrocytomas that grow and spread aggressively. The cells look very different from normal cells. Glioblastoma is also called glioblastoma multiforme or grade IV astrocytoma. They occur most often in adults between the ages of 45 and 70 years.

Refer to the following PDQ summaries for more information on astrocytomas:

• Childhood Cerebral Astrocytoma/Malignant Glioma Treatment ²
• Childhood Cerebellar Astrocytoma Treatment ³
• Childhood Visual Pathway and Hypothalamic Glioma Treatment ⁴

Oligodendroglial tumors begin in the brain cells called oligodendrocytes, which support and nourish nerve cells. Grades of oligodendroglial tumors include the following:

• Oligodendroglioma (grade II): Oligodendrogliomas are slow-growing tumors with cells that look very much like normal cells. These tumors occur most often in patients between the ages of 40 and 60 years.
• Anaplastic oligodendroglioma (grade III): Anaplastic oligodendrogliomas grow quickly and the cells look very different from normal cells.

Mixed gliomas are brain tumors that contain more than one type of cell. The prognosis is affected by the cell type with the highest grade present in the tumor.

• Oligoastrocytoma (grade II): Oligoastrocytomas are slow-growing tumors composed of cells that look like astrocytes and oligodendrocytes.
• Anaplastic oligoastrocytoma (grade III): These are higher-grade oligoastrocytomas. The average age of patients developing anaplastic oligoastrocytomas is 45 years.

Ependymal tumors usually begin in cells that line the spaces in the brain and around the spinal cord. These spaces contain cerebrospinal fluid, a liquid that cushions and protects the brain and spinal cord. Grades of ependymal tumors include the following:

• Grade I and grade II ependymomas: These ependymomas grow slowly and have cells that look very much like normal cells. They can often be removed completely by surgery.
• Anaplastic ependymoma (grade III): Anaplastic ependymomas grow very quickly.

(Refer to the PDQ summary on Childhood Ependymoma Treatment ⁵ for more information.)

Medulloblastomas are brain tumors that begin in the lower back of the brain. They are formed from abnormal brain cells at a very early stage in development. Medulloblastomas are usually found in children or young adults between the ages of 21 and 40 years. This type of cancer may spread from the brain to the spine through the cerebrospinal fluid.

(Refer to the PDQ summary on Childhood Medulloblastoma Treatment ⁶ for more information.)

Pineal parenchymal tumors form from parenchymal cells or pinocytes, the cells that make up most of the pineal gland. These differ from pineal astrocytic tumors, which are astrocytomas that form in tissue that supports the pineal gland. Grades of pineal parenchymal tumors include the following:

• Pineocytomas (grade II): Pineocytomas are slow-growing pineal tumors that occur most often in adults aged 25 to 35.
• Pineoblastomas (grade IV): Pineoblastomas are rare and highly malignant. They usually occur in children.

(Refer to the PDQ summary on Childhood Supratentorial Primitive Neuroectodermal Tumors and Pineoblastoma Treatment ⁷ for more information.)

Meningeal tumors form in the meninges, thin layers of tissue that cover the brain and spinal cord. Types of meningeal tumors include the following:

• Grade I meningioma: Meningiomas are the most common meningeal tumor. Grade I meningiomas are slow-growing and benign. They are found most often in women.
• Grade II and III meningiomas and hemangiopericytomas: These are rare malignant meningeal tumors. They grow quickly and are likely to spread within the brain and spinal cord. Grade III meningiomas are more common in men. Hemangiopericytomas often recur after treatment and most of them spread to other parts of the body.

Germ cell tumors arise from germ cells, cells that are meant to form sperm in the testicles or eggs in the ovaries, These cells may travel to other parts of the body and form tumors. Types of germ cell tumors include germinomas, embryonal cell carcinomas, choriocarcinomas, and teratomas. They can occur anywhere in the body and can be either benign or malignant. In the brain, they usually form in the center, near the pineal gland, and can spread to other parts of the brain and spinal cord. Most germ cell tumors occur in children.

(Refer to the PDQ summary on Childhood Brain and Spinal Cord Tumors Treatment Overview ⁸ for more information.)

Craniopharyngiomas occur in the sellar region of the brain, near the pituitary gland. The pituitary gland is a small organ about the size of a pea, located at the base of the brain. This gland controls many of the body's functions, especially growth. In adults, these tumors occur most often after the age of 50 years. Craniopharyngiomas can press on vital brain tissue and cause symptoms to appear. The tumors can also block fluid in the brain and cause swelling. The prognosis is good for craniopharyngiomas that are completely removed in surgery.

Pituitary tumors also occur in this region. Refer to the PDQ summary on Pituitary Tumors Treatment ⁹ for more information.

For information about other types of adult brain tumors, refer to the PDQ health professional summary on Adult Brain Tumors ¹⁰.

Recurrent adult brain tumor is a tumor that has recurred (come back) after it has been treated. Adult brain tumors often recur, sometimes many years after the first tumor. The tumor may come back in the brain or in other parts of the body.

The types of cancer that commonly spread to the brain are melanoma and cancers of the lung, breast, unknown primary site, and colon. About half of metastatic spinal cord tumors are caused by lung cancer.

Prognosis depends on the following:

• Whether the patient is younger than 60 years.
• Whether there are fewer than 3 tumors in the brain and/or spinal cord.
• The location of the tumors in the brain and/or spinal cord.
• How well the tumor responds to treatment.
• Whether the primary tumor continues to grow or spread.

The prognosis is better for brain metastases from breast cancer than from other types of primary cancer. The prognosis is worse for brain metastases from colon cancer.

Treatment Option Overview

How are adult brain tumors treated?

Different types of treatment are available for patients with adult brain tumor. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

Surgery

Surgery is used, when possible, to treat adult brain tumor, as described in the Description ¹¹ section of this summary.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). A dissolving wafer may be used to deliver an anticancer drug directly into the brain tumor site after the tumor has been removed by surgery. The way the chemotherapy is given depends on the type and stage of the cancer being treated.

New methods of delivering radiation therapy

• Radiosensitizers: Drugs that make tumor cells more sensitive to radiation. Combining radiation with radiosensitizers may kill more tumor cells.
• Hyperfractionation: Radiation therapy given in smaller-than-usual doses two or three times a day instead of once a day.
• Stereotactic radiosurgery: A radiation therapy technique that delivers radiation directly to the tumor with less damage to healthy tissue. The doctor uses a CT scan or MRI to find the exact location of the tumor. A rigid head frame is attached to the skull and high- dose radiation is directed to the tumor through openings in the head frame, reducing the amount of radiation given to normal brain tissue. This procedure does not involve surgery. This is also called stereotaxic radiosurgery and gamma knife therapy.

Hyperthermia therapy

Hyperthermia therapy is a treatment in which body tissue is exposed to high temperatures to damage and kill cancer cells or to make cancer cells more sensitive to the effects of radiation and certain anticancer drugs.

Biologic therapy

Biologic therapy is a treatment that uses the patient’s immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.

Tumors that have spread to the brain from somewhere else in the body are usually treated with radiation therapy and/or surgery. Chemotherapy may be used if the primary tumor is the kind that responds well to chemotherapy. Clinical trials are under way to study new treatments.

For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.

Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.

Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.

Clinical trials are taking place in many parts of the country. In the following lists of treatments for the different types of brain tumors, a link to search results for current clinical trials is included for each section. These have been retrieved from NCI's clinical trials database. For some types of tumors, there may not be any trials listed. Check with your doctor for clinical trials that are not listed here but may be right for you.

Treatment Options by Type of Adult Brain Tumor

Brain Stem Gliomas

Treatment of brain stem gliomas may include the following:

1. Hyperfractionated radiation therapy.
2. A clinical trial of new anticancer drugs and/or biologic therapy.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with adult brain stem glioma ¹².

Treatment of pineal astrocytic tumors may include the following:

1. Surgery and radiation therapy, with or without chemotherapy.
2. A clinical trial of external radiation therapy plus hyperthermia therapy or new methods of delivering radiation therapy.
3. A clinical trial of new anticancer drugs and biologic therapy following radiation therapy.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with adult pineal gland astrocytoma ¹³.

Treatment of pilocytic astrocytoma is usually surgery with or without radiation therapy.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with adult pilocytic astrocytoma ¹⁴.

Treatment of diffuse astrocytoma may include the following:

1. Surgery, usually with radiation therapy.
2. A clinical trial of surgery and radiation therapy with or without chemotherapy for tumors that cannot be completely removed by surgery.
3. A clinical trial of radiation therapy delayed until the tumor progresses.
4. A clinical trial comparing high- dose and low-dose radiation therapy.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with adult diffuse astrocytoma ¹⁵.

Treatment of anaplastic astrocytoma may include the following:

1. Surgery plus radiation therapy, with or without chemotherapy.
2. A clinical trial of external radiation therapy plus hyperthermia therapy or new methods of delivering radiation therapy.
3. A clinical trial of new anticancer drugs and biologic therapy following radiation therapy.
4. A clinical trial of chemotherapy combined with different methods of delivering radiation therapy.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with adult anaplastic astrocytoma ¹⁶.

Treatment of glioblastoma may include the following:

1. Surgery plus radiation therapy.
2. Surgery plus radiation therapy and chemotherapy.
3. Chemotherapy placed into the brain (Gliadel Wafer) during surgery.
4. Radiation therapy given together with chemotherapy.
5. A clinical trial of external radiation therapy plus hyperthermia therapy or new methods of delivering radiation therapy.
6. A clinical trial of new anticancer drugs or biologic therapy following radiation therapy.
7. A clinical trial of chemotherapy and new methods of delivering radiation therapy.
8. Clinical trials of new treatments.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with adult glioblastoma ¹⁷.

Treatment of oligodendrogliomas may include the following:

1. Surgery, usually with radiation therapy.
2. A clinical trial of surgery and radiation therapy with or without chemotherapy for tumors that cannot be completely removed by surgery.
3. A clinical trial of chemotherapy using one or more drugs.

Treatment of anaplastic oligodendroglioma may include the following:

1. Surgery plus radiation therapy with or without chemotherapy.
2. Chemotherapy using more than one drug.
3. Radiation therapy with or without chemotherapy using more than one drug.
4. Clinical trials of new treatments.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with adult oligodendroglial tumors ¹⁸.

Treatment of mixed gliomas may include the following:

1. Surgery plus radiation therapy with or without chemotherapy.
2. A clinical trial of external radiation therapy plus hyperthermia therapy or new methods of delivering radiation therapy.
3. A clinical trial of new anticancer drugs or biologic therapy following radiation therapy.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with mixed gliomas ¹⁹.

Treatment of grade I and grade II ependymomas is usually surgery with or without radiation therapy.

Treatment of anaplastic ependymoma may include the following:

1. Surgery plus radiation therapy.
2. A clinical trial of surgery followed by chemotherapy before, during, and after radiation therapy.
3. A clinical trial of chemotherapy and/or biologic therapy.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with adult ependymal tumors ²⁰.

Treatment of medulloblastomas may include the following:

1. Surgery plus radiation therapy to the brain and spine.
2. A clinical trial of surgery and radiation therapy to the brain and spine for tumors that are more difficult to treat successfully.
3. A clinical trial of chemotherapy.

(Refer to the PDQ summary on Childhood Medulloblastoma Treatment ⁶ for more information.)

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with adult medulloblastoma ²¹.

Treatment of pineal parenchymal tumors may include the following:

1. Surgery plus radiation therapy with or without chemotherapy.
2. A clinical trial of external radiation therapy plus hyperthermia therapy or new methods of delivering radiation therapy.
3. A clinical trial of new anticancer drugs and biologic therapy following radiation therapy.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with adult pineal parenchymal tumor ²².

Treatment of meningiomas may include the following:

1. Surgery with or without radiation therapy.
2. Radiation therapy for tumors that cannot be removed by surgery.

Treatment of malignant meningioma may include the following:

1. Surgery plus radiation therapy.
2. A clinical trial of external radiation therapy plus hyperthermia therapy or new methods of delivering radiation therapy.
3. A clinical trial of new anticancer drugs and/or biologic therapy following radiation therapy.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with adult meningeal tumor ²³.

Treatment of central nervous system germ cell tumors depends on the type of cancer cells, the location of the tumor, whether the cancer can be removed in an operation, and other factors.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with adult central nervous system germ cell tumor ²⁴.

Treatment of craniopharyngiomas may include the following:

1. Surgery to remove the entire tumor.
2. Surgery to remove as much of the tumor as possible, followed by radiation therapy.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with adult craniopharyngioma ²⁵.

Treatment of recurrent adult brain tumors may include the following:

1. Surgery with or without chemotherapy.
2. Radiation therapy, if not used during previous treatment, with or without chemotherapy.
3. Internal radiation therapy.
4. Chemotherapy.
5. A clinical trial of new anticancer drugs.
6. A clinical trial of chemotherapy placed into the brain during surgery.
7. A clinical trial of biologic therapy.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with recurrent adult brain tumor ²⁶.

Treatment of a single metastatic brain tumor is usually surgery followed by radiation therapy to the brain.

Treatment of more than one metastatic brain tumor may include the following:

1. Radiation therapy to the brain.
2. Surgery, for large tumors that are pressing on areas of the brain and causing symptoms.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with adult tumors metastatic to brain ²⁷.

To Learn More About Adult Brain Tumors

For more information from the National Cancer Institute about adult brain tumors, see the following:

• Brain Tumor Home Page ²⁸
• What You Need to Know About™ Brain Tumors ²⁹
• National Cancer Institute Brain Tumor Study in Adults: Fact Sheet ³⁰

For general cancer information and other resources from the National Cancer Institute, see the following:

• What You Need to Know About™ Cancer - An Overview ³¹
• Understanding Cancer Series: Cancer ³²
• Staging: Questions and Answers ³³
• Chemotherapy and You: Support for People With Cancer ³⁴
• Radiation Therapy and You: Support for People With Cancer ³⁵
• Coping with Cancer ³⁶
• Support and Resources ³⁷
• Cancer Library ³⁸
• Information For Survivors/Caregivers/Advocates ³⁹

Get More Information From NCI

Call 1-800-4-CANCER

For more information, U.S. residents may call the National Cancer Institute's (NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 9:00 a.m. to 4:30 p.m. Deaf and hard-of-hearing callers with TTY equipment may call 1-800-332-8615. The call is free and a trained Cancer Information Specialist is available to answer your questions.

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Search the NCI Web site

The NCI Web site ⁴¹ provides online access to information on cancer, clinical trials, and other Web sites and organizations that offer support and resources for cancer patients and their families. For a quick search, use our “Best Bets” search box in the upper right hand corner of each Web page. The results that are most closely related to your search term will be listed as Best Bets at the top of the list of search results.

There are also many other places to get materials and information about cancer treatment and services. Hospitals in your area may have information about local and regional agencies that have information on finances, getting to and from treatment, receiving care at home, and dealing with problems related to cancer treatment.

Find Publications

The NCI has booklets and other materials for patients, health professionals, and the public. These publications discuss types of cancer, methods of cancer treatment, coping with cancer, and clinical trials. Some publications provide information on tests for cancer, cancer causes and prevention, cancer statistics, and NCI research activities. NCI materials on these and other topics may be ordered online or printed directly from the NCI Publications Locator ⁴². These materials can also be ordered by telephone from the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.

Changes to This Summary (09/16/2008)

The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

Editorial changes were made to this summary.

About PDQ

PDQ is a comprehensive cancer database available on NCI's Web site.

PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at NCI's Web site ⁴¹. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.

PDQ contains cancer information summaries.

The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions provide current and accurate cancer information.

The PDQ cancer information summaries are developed by cancer experts and reviewed regularly.

Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date on each summary ("Date Last Modified") indicates the time of the most recent change.

PDQ also contains information on clinical trials.

A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

Listings of clinical trials are included in PDQ and are available online at NCI's Web site ⁴³. Descriptions of the trials are available in health professional and patient versions. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.

Glossary Terms

The area of the body that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs.

Not normal. An abnormal lesion or growth may be cancerous, premalignant (likely to become cancer), or benign.

A quickly growing cancer.

A term used to describe cancer cells that divide rapidly and have little or no resemblance to normal cells.

A star-shaped cell that helps nerve cells in the brain and spinal cord work the way they should. An astrocyte is a type of glial cell.

A tumor that begins in the brain or spinal cord in small, star-shaped cells called astrocytes.

Not cancerous. Benign tumors may grow larger but do not spread to other parts of the body.

Treatment to boost or restore the ability of the immune system to fight cancer, infections, and other diseases. Also used to lessen certain side effects that may be caused by some cancer treatments. Agents used in biological therapy include monoclonal antibodies, growth factors, and vaccines. These agents may also have a direct antitumor effect. Also called immunotherapy, biotherapy, biological response modifier therapy, and BRM therapy.

The removal of cells or tissues for examination by a pathologist. The pathologist may study the tissue under a microscope or perform other tests on the cells or tissue. There are many different types of biopsy procedures. The most common types include: (1) incisional biopsy, in which only a sample of tissue is removed; (2) excisional biopsy, in which an entire lump or suspicious area is removed; and (3) needle biopsy, in which a sample of tissue or fluid is removed with a needle. When a wide needle is used, the procedure is called a core biopsy. When a thin needle is used, the procedure is called a fine-needle aspiration biopsy.

A tube through which the blood circulates in the body. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins.

Cancer that has spread from the original (primary) tumor to the brain.

The part of the brain that is connected to the spinal cord.

A tumor located in the part of the brain that connects to the spinal cord (the brain stem). It may grow rapidly or slowly, depending on the grade of the tumor.

The growth of abnormal cells in the tissues of the brain. Brain tumors can be benign (non-cancerous) or malignant (cancerous).

Glandular organ located on the chest. The breast is made up of connective tissue, fat, and breast tissue that contains the glands that can make milk. Also called mammary gland.

Cancer that forms in tissues of the breast, usually the ducts (tubes that carry milk to the nipple) and lobules (glands that make milk). It occurs in both men and women, although male breast cancer is rare.

A term for diseases in which abnormal cells divide without control. Cancer cells can invade nearby tissues and can spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord.

Cancer that begins in the skin or in tissues that line or cover internal organs.

A flexible tube used to deliver fluids into or withdraw fluids from the body.

The individual unit that makes up the tissues of the body. All living things are made up of one or more cells.

CNS. The brain and spinal cord. Also called CNS.

The fluid that flows in and around the hollow spaces of the brain and spinal cord, and between two of the meninges (the thin layers of tissue that cover and protect the brain and spinal cord). Cerebrospinal fluid is made by tissue called the choroid plexus in the ventricles (hollow spaces) in the brain. Also called CSF.

Treatment with drugs that kill cancer cells.

A malignant, fast-growing tumor that develops from trophoblastic cells (cells that help an embryo attach to the uterus and help form the placenta). Almost all choriocarcinomas form in the uterus after fertilization of an egg by a sperm, but a small number form in a testis or an ovary. Choriocarcinomas spread through the blood to other organs, especially the lungs. They are a type of gestational trophoblastic disease. Also called chorioblastoma, chorioepithelioma, and chorionic carcinoma.

A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis, or treatment of a disease. Also called a clinical study.

The longest part of the large intestine, which is a tube-like organ connected to the small intestine at one end and the anus at the other. The colon removes water and some nutrients and electrolytes from partially digested food. The remaining material, solid waste called stool, moves through the colon to the rectum and leaves the body through the anus.

Cancer that forms in the tissues of the colon (the longest part of the large intestine). Most colon cancers are adenocarcinomas (cancers that begin in cells that make and release mucus and other fluids).

A benign brain tumor that may be considered malignant because it can damage the hypothalamus, the area of the brain that controls body temperature, hunger, and thirst.

Computed tomography scan. A series of detailed pictures of areas inside the body taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computed tomography scan, computerized tomography, computerized axial tomography scan, and CAT scan.

The process of identifying a disease, such as cancer, from its signs and symptoms.

Widely spread; not localized or confined.

The amount of medicine taken, or radiation given, at one time.

Any substance, other than food, that is used to prevent, diagnose, treat or relieve symptoms of a disease or abnormal condition. Also refers to a substance that alters mood or body function, or that can be habit-forming or addictive, especially a narcotic.

A type of brain tumor that begins in cells lining the spinal cord central canal (fluid-filled space down the center) or the ventricles (fluid-filled spaces of the brain). Ependymal tumors may also form in the choroid plexus (tissue in the ventricles that makes cerebrospinal fluid). Also called ependymoma.

A type of brain tumor that begins in cells lining the spinal cord central canal (fluid-filled space down the center) or the ventricles (fluid-filled spaces of the brain). Ependymomas may also form in the choroid plexus (tissue in the ventricles that makes cerebrospinal fluid). Also called ependymal tumor.

A type of radiation therapy that uses a machine to aim high-energy rays at the cancer from outside of the body. Also called external-beam radiation therapy.

Liquid.

A reproductive cell of the body. Germ cells are egg cells in females and sperm cells in males.

A type of tumor that begins in the cells that give rise to sperm or eggs. Germ cell tumors can occur almost anywhere in the body and can be either benign or malignant.

The most common type of germ cell tumor in the brain.

An organ that makes one or more substances, such as hormones, digestive juices, sweat, tears, saliva, or milk. Endocrine glands release the substances directly into the bloodstream. Exocrine glands release the substances into a duct or opening to the inside or outside of the body.

A biodegradable wafer that is used to deliver the anticancer drug carmustine directly into a brain tumor site after the tumor has been removed by surgery. Also called polifeprosan 20 carmustine implant.

A fast-growing type of central nervous system tumor that forms from glial (supportive) tissue of the brain and spinal cord and has cells that look very different from normal cells. Glioblastoma usually occurs in adults and affects the brain more often than the spinal cord. Also called grade IV astrocytoma, glioblastoma multiforme, and GBM.

The grade of a tumor depends on how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. Grading systems are different for each type of cancer.

A system for classifying cancer cells in terms of how abnormal they appear when examined under a microscope. The objective of a grading system is to provide information about the probable growth rate of the tumor and its tendency to spread. The systems used to grade tumors vary with each type of cancer. Grading plays a role in treatment decisions.

A type of cancer involving blood vessels and soft tissue.

When referring to cancerous and precancerous growths, a term used to describe cells that look abnormal under a microscope. These cells are more likely to grow and spread quickly than cells in low-grade cancerous and precancerous growths.

One of many chemicals made by glands in the body. Hormones circulate in the bloodstream and control the actions of certain cells or organs. Some hormones can also be made in the laboratory.

Radiation therapy that gives smaller doses (fractions) of radiation more often than standard radiation therapy so that the full treatment course can be given with fewer side effects. In hyperfractionation, individual doses are given more often than the standard dose of once a day. Also called hyperfractionated radiation therapy and superfractionated radiation therapy.

A type of treatment in which body tissue is exposed to high temperatures to damage and kill cancer cells or to make cancer cells more sensitive to the effects of radiation and certain anticancer drugs.

The complex group of organs and cells that defends the body against infections and other diseases.

Use of a syringe and needle to push fluids or drugs into the body; often called a "shot."

A type of radiation therapy in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near a tumor. Also called brachytherapy, radiation brachytherapy, and implant radiation therapy.

One of a pair of organs in the chest that supplies the body with oxygen, and removes carbon dioxide from the body.

Cancer that forms in tissues of the lung, usually in the cells lining air passages. The two main types are small cell lung cancer and non-small cell lung cancer. These types are diagnosed based on how the cells look under a microscope.

Cancerous. Malignant tumors can invade and destroy nearby tissue and spread to other parts of the body.

A rare, fast-growing tumor that forms in one of the inner layers of the meninges (thin layers of tissue that cover and protect the brain and spinal cord). Malignant meningioma often spreads to other areas of the body.

A malignant brain tumor that begins in the lower part of the brain and that can spread to the spine or to other parts of the body. Medulloblastomas are a type of primitive neuroectodermal tumor (PNET).

A form of cancer that begins in melanocytes (cells that make the pigment melanin). It may begin in a mole (skin melanoma), but can also begin in other pigmented tissues, such as in the eye or in the intestines.

Having to do with the meninges (three thin layers of tissue that cover and protect the brain and spinal cord).

The three thin layers of tissue that cover and protect the brain and spinal cord.

A type of slow-growing tumor that forms in the meninges (thin layers of tissue that cover and protect the brain and spinal cord). Meningiomas usually occur in adults.

The spread of cancer from one part of the body to another. A tumor formed by cells that have spread is called a “metastatic tumor” or a “metastasis.” The metastatic tumor contains cells that are like those in the original (primary) tumor. The plural form of metastasis is metastases (meh-TAS-tuh-SEEZ).

To spread from one part of the body to another. When cancer cells metastasize and form secondary tumors, the cells in the metastatic tumor are like those in the original (primary) tumor.

Having to do with metastasis, which is the spread of cancer from one part of the body to another.

A brain tumor that forms from more than one type of brain cell, usually astrocytes and oligodendrocytes.

A procedure in which radio waves and a powerful magnet linked to a computer are used to create detailed pictures of areas inside the body. These pictures can show the difference between normal and diseased tissue. MRI makes better images of organs and soft tissue than other scanning techniques, such as computed tomography (CT) or x-ray. MRI is especially useful for imaging the brain, the spine, the soft tissue of joints, and the inside of bones. Also called magnetic resonance imaging, nuclear magnetic resonance imaging, and NMRI.

The National Cancer Institute, part of the National Institutes of Health of the United States Department of Health and Human Services, is the Federal Government's principal agency for cancer research. The National Cancer Institute conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the National Cancer Institute Web site at http://www.cancer.gov. Also called NCI.

NCI, part of the National Institutes of Health of the United States Department of Health and Human Services, is the Federal Government's principal agency for cancer research. It conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the NCI Web site at http://www.cancer.gov. Also called National Cancer Institute.

A bundle of fibers that receives and sends messages between the body and the brain. The messages are sent by chemical and electrical changes in the cells that make up the nerves.

A brain tumor that forms from both oligodendrocytes and astrocytes, which are types of glial cells (cells that cover and protect nerve cells in the brain and spinal cord and help them work the way they should). An oligoastrocytoma is a type of mixed glioma.

A rare, slow-growing tumor that begins in oligodendrocytes (cells that cover and protect nerve cells in the brain and spinal cord). Also called oligodendroglioma.

A rare, slow-growing tumor that begins in oligodendrocytes (cells that cover and protect nerve cells in the brain and spinal cord). Also called oligodendroglial tumor.

A part of the body that performs a specific function. For example, the heart is an organ.

One of a pair of female reproductive glands in which the ova, or eggs, are formed. The ovaries are located in the pelvis, one on each side of the uterus.

The essential or functional elements of an organ.

A doctor who identifies diseases by studying cells and tissues under a microscope.

PDQ is an online database developed and maintained by the National Cancer Institute. Designed to make the most current, credible, and accurate cancer information available to health professionals and the public, PDQ contains peer-reviewed summaries on cancer treatment, screening, prevention, genetics, complementary and alternative medicine, and supportive care; a registry of cancer clinical trials from around the world; and directories of physicians, professionals who provide genetics services, and organizations that provide cancer care. Most of this information, and more specific information about PDQ, can be found on the NCI's Web site at http://www.cancer.gov/cancertopics/pdq. Also called Physician Data Query.

Made up of cells that look like fibers when viewed under a microscope.

A tiny organ in the cerebrum that produces melatonin. Also called pineal body or pineal organ.

A type of brain tumor that occurs in or around the pineal gland, a tiny organ near the center of the brain.

A fast growing type of brain tumor that occurs in or around the pineal gland, a tiny organ near the center of the brain.

A slow growing type of brain tumor that occurs in or around the pineal gland, a tiny organ near the center of the brain.

The main endocrine gland. It produces hormones that control other glands and many body functions, especially growth.

The original tumor.

The likely outcome or course of a disease; the chance of recovery or recurrence.

In medicine, the course of a disease, such as cancer, as it becomes worse or spreads in the body.

Energy released in the form of particle or electromagnetic waves. Common sources of radiation include radon gas, cosmic rays from outer space, medical x-rays, and energy given off by a radioisotope (unstable form of a chemical element that releases radiation as it breaks down and becomes more stable).

The use of high-energy radiation from x-rays, gamma rays, neutrons, protons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Also called radiotherapy and irradiation.

Giving off radiation.

A small, radioactive pellet that is placed in or near a tumor. Cancer cells are killed by the energy given off as the radioactive material breaks down and becomes more stable.

A drug that makes tumor cells more sensitive to radiation therapy.

To come back or to return.

Cancer that has recurred (come back), usually after a period of time during which the cancer could not be detected. The cancer may come back to the same place as the original (primary) tumor or to another place in the body. Also called recurrent cancer.

Treatment with anticancer drugs directed to a specific area of the body.

In medicine, an improvement related to treatment.

Convulsion; a sudden, involuntary movement of the muscles.

A depression of the bone at the base of the skull where the pituitary gland is located.

A problem that occurs when treatment affects healthy tissues or organs. Some common side effects of cancer treatment are fatigue, pain, nausea, vomiting, decreased blood cell counts, hair loss, and mouth sores.

The male reproductive cell, formed in the testicle. A sperm unites with an egg to form an embryo.

The bones, muscles, tendons, and other tissues that reach from the base of the skull to the tailbone. The spinal column encloses the spinal cord and the fluid surrounding the spinal cord. Also called spine, backbone, and vertebral column.

A column of nerve tissue that runs from the base of the skull down the back. It is surrounded by three protective membranes, and is enclosed within the vertebrae (back bones). The spinal cord and the brain make up the central nervous system, and spinal cord nerves carry most messages between the brain and the rest of the body.

The bones, muscles, tendons, and other tissues that reach from the base of the skull to the tailbone. The spine encloses the spinal cord and the fluid surrounding the spinal cord. Also called backbone, spinal column, and vertebral column.

The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer, and whether the cancer has spread from the original site to other parts of the body.

Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from the original site to other parts of the body. It is important to know the stage of the disease in order to plan the best treatment.

In medicine, treatment that experts agree is appropriate, accepted, and widely used. Health care providers are obligated to provide patients with standard therapy. Also called standard of care or best practice.

A type of external radiation therapy that uses special equipment to position the patient and precisely give a single large dose of radiation to a tumor. It is used to treat brain tumors and other brain disorders that cannot be treated by regular surgery. It is also being studied in the treatment of other types of cancer. Also called stereotaxic radiosurgery, radiosurgery, and radiation surgery.

A procedure to remove or repair a part of the body or to find out whether disease is present. An operation.

An indication that a person has a condition or disease. Some examples of symptoms are headache, fever, fatigue, nausea, vomiting, and pain.

Treatment with anticancer drugs that travel through the blood to cells all over the body.

A type of germ cell tumor that may contain several different types of tissue, such as hair, muscle, and bone. Teratomas occur most often in the ovaries in women, the testicles in men, and the tailbone in children. Not all teratomas are malignant.

One of two egg-shaped glands inside the scrotum that produce sperm and male hormones. Also called testis.

A group or layer of cells that work together to perform a specific function.

An abnormal mass of tissue that results when cells divide more than they should or do not die when they should. Tumors may be benign (not cancerous), or malignant (cancerous). Also called neoplasm.

Necessary to maintain life. Breathing is a vital function.

To eject some or all of the contents of the stomach through the mouth.

A type of high-energy radiation. In low doses, x-rays are used to diagnose diseases by making pictures of the inside of the body. In high doses, x-rays are used to treat cancer.