Treatment
Surgery
Radiation Therapy
Chemotherapy
People with brain tumors have several treatment
options. The options are
surgery, radiation therapy,
and chemotherapy. Many people get a combination of
treatments.
The choice of treatment depends mainly on the
following:
- The type and grade of brain tumor
- Its location in the brain
- Its size
- Your age and general health
For some types of brain cancer, the doctor also
needs to know whether cancer cells were found in the
cerebrospinal fluid.
Your doctor can describe your treatment choices, the
expected results, and the possible side effects. Because
cancer therapy often damages healthy cells and tissues,
side effects are common. Before treatment starts, ask
your health care team about possible side effects and
how treatment may change your normal activities. You
and your health care team can work together to
develop a treatment plan that meets your medical and
personal needs.
You may want to talk with your doctor about taking
part in a clinical trial, a research study of new
treatment methods. See the
Taking Part in Cancer
Research section.
Your doctor may refer you to a specialist, or you
may ask for a referral. Specialists who treat brain
tumors include neurologists, neurosurgeons, neuro-oncologists,
medical oncologists, radiation oncologists,
and neuroradiologists.
Your health care team may also include an oncology nurse, a registered dietitian, a mental health counselor,
a social worker, a physical therapist, an occupational
therapist, a speech therapist, and a physical medicine
specialist. Also, children may need tutors to help with
schoolwork. (The Rehabilitation section
has more information about therapists and tutors.)
You may want to ask your doctor these
questions before you begin treatment:
- What type of brain tumor do I have?
- Is it benign or malignant?
- What is the grade of the tumor?
- What are my treatment choices? Which do you
recommend for me? Why?
- What are the expected benefits of each kind of
treatment?
- What can I do to prepare for treatment?
- Will I need to stay in the hospital? If so, for
how long?
- What are the risks and possible side effects of
each treatment? How can side effects be
managed?
- What is the treatment likely to cost? Will my
insurance cover it?
- How will treatment affect my normal
activities? What is the chance that I will have
to learn how to walk, speak, read, or write after
treatment?
- Would a research study (clinical trial) be
appropriate for me?
- Can you recommend other doctors who could
give me a second opinion about my treatment
options?
- How often should I have checkups?
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Surgery is the usual first treatment for most brain
tumors. Before surgery begins, you may be given
general anesthesia, and your scalp is shaved. You
probably won't need your entire head shaved.
Surgery to open the skull is called a craniotomy.
The surgeon makes an incision in your scalp and uses a
special type of saw to remove a piece of bone from the
skull.
You may be awake when the surgeon removes part
or all of the brain tumor. The surgeon removes as much
tumor as possible. You may be asked to move a leg,
count, say the alphabet, or tell a story. Your ability to
follow these commands helps the surgeon protect
important parts of the brain.
After the tumor is removed, the surgeon covers the
opening in the skull with the piece of bone or with a
piece of metal or fabric. The surgeon then closes the
incision in the scalp.
Sometimes surgery isn't possible. If the tumor is in
the brain stem or certain other areas, the surgeon may
not be able to remove the tumor without harming
normal brain tissue. People who can't have surgery
may receive radiation therapy or other treatment.
You may have a headache or be uncomfortable for
the first few days after surgery. However, medicine can
usually control pain. Before surgery, you should
discuss the plan for pain relief with your health care
team. After surgery, your team can adjust the plan if
you need more relief.
You may also feel tired or weak. The time it takes to
heal after surgery is different for everyone. You will
probably spend a few days in the hospital.
Other, less common problems may occur after
surgery for a brain tumor. The brain may swell or fluid
may build up within the skull. The health care team
will monitor you for signs of swelling or fluid buildup.
You may receive steroids to help relieve swelling. A
second surgery may be needed to drain the fluid. The
surgeon may place a long, thin tube (shunt) in a
ventricle of the brain. (For some people, the shunt is
placed before performing surgery on the brain tumor.)
The tube is threaded under the skin to another part
of the body, usually the abdomen. Excess fluid is
carried from the brain and drained into the abdomen.
Sometimes the fluid is drained into the heart instead.
Infection is another problem that may develop after
surgery. If this happens, the health care team will give
you an antibiotic.
Brain surgery may harm normal tissue. Brain
damage can be a serious problem. It can cause
problems with thinking, seeing, or speaking. It can also
cause personality changes or seizures. Most of these
problems lessen or disappear with time. But sometimes
damage to the brain is permanent. You may need
physical therapy, speech therapy, or occupational
therapy. See the Rehabilitation section.
You may want to ask your doctor these
questions about surgery:
- Do you suggest surgery for me?
- How will I feel after the operation?
- What will you do for me if I have pain?
- How long will I be in the hospital?
- Will I have any long-term effects? Will my hair
grow back? Are there any side effects from
using metal or fabric to replace the bone in the
skull?
- When can I get back to my normal activities?
- What is my chance of a full recovery?
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Radiation therapy kills brain tumor cells with high-energy
x-rays, gamma rays, or protons.
Radiation therapy usually follows surgery. The
radiation kills tumor cells that may remain in the area.
Sometimes, people who can't have surgery have
radiation therapy instead.
Doctors use external and internal types of radiation
therapy to treat brain tumors:
- External radiation therapy: You'll go to a hospital
or clinic for treatment. A large machine outside the
body aims beams of radiation at the head. Because
cancer cells may invade normal tissue around a
tumor, the radiation may be aimed at the tumor and
nearby brain tissue, or at the entire brain. Some
people need radiation aimed at the spinal cord also.
The treatment schedule depends on your age, and the
type and size of the tumor. Fractionated external
beam therapy is the most common method of
radiation therapy used for people with brain tumors.
Giving the total dose of radiation over several weeks
helps to protect healthy tissue in the area of the
tumor. Treatments are usually 5 days a week for
several weeks. A typical visit lasts less than an hour,
and each treatment takes only a few minutes.
Some treatment centers are studying other ways of
delivering external beam radiation therapy:
- Internal radiation therapy (implant radiation
therapy or brachytherapy): Internal radiation isn't
commonly used for treating brain tumors and is
under study. The radiation comes from radioactive
material usually contained in very small implants
called seeds. The seeds are placed inside the brain
and give off radiation for months. They don't need to
be removed once the radiation is gone.
Some people have no or few side effects after
treatment. Rarely, people may have nausea for several
hours after external radiation therapy. The health care
team can suggest ways to help you cope with this
problem. Radiation therapy also may cause you to
become very tired with each radiation treatment.
Resting is important, but doctors usually advise people
to try to stay as active as they can.
Also, external radiation therapy commonly causes
hair loss from the part of the head that was treated.
Hair usually grows back within a few months.
Radiation therapy also may make the skin on the scalp
and ears red, dry, and tender. The health care team can
suggest ways to relieve these problems.
Sometimes radiation therapy causes brain tissue to
swell. You may get a headache or feel pressure. The
health care team watches for signs of this problem.
They can provide medicine to reduce the discomfort.
Radiation sometimes kills healthy brain tissue.
Although rare, this side effect can cause headaches,
seizures, or even death.
Radiation may harm the pituitary gland and other
areas of the brain. For children, this damage could
cause learning problems or slow down growth and
development. In addition, radiation increases the risk
of secondary tumors later in life.
You may find it helpful to read the NCI booklet
Radiation Therapy and You.
You may want to ask your doctor these
questions about radiation therapy:
- Why do I need this treatment?
- When will the treatments begin? When will
they end?
- How will I feel during therapy? Are there side
effects?
- What can I do to take care of myself during
therapy?
- How will we know if the radiation is working?
- Will I be able to continue my normal activities
during treatment?
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Chemotherapy, the use of drugs to kill cancer cells,
is sometimes used to treat brain tumors. Drugs may be
given in the following ways:
- By mouth or vein (intravenous): Chemotherapy
may be given during and after radiation therapy. The
drugs enter the bloodstream and travel throughout
the body. They may be given in an outpatient part of
the hospital, at the doctor's office, or at home.
Rarely, you may need to stay in the hospital.
The side effects of chemotherapy depend mainly on
which drugs are given and how much. Common
side effects include nausea and vomiting, loss of
appetite, headache, fever and chills, and weakness.
If the drugs lower the levels of healthy blood cells,
you're more likely to get infections, bruise or bleed
easily, and feel very weak and tired. Your health
care team will check for low levels of blood cells.
Some side effects may be relieved with medicine.
- In wafers that are put into the brain: For some
adults with high-grade glioma, the surgeon implants
several wafers into the brain. Each wafer is about
the size of a dime. Over several weeks, the wafers
dissolve, releasing the drug into the brain. The drug
kills cancer cells. It may help prevent the tumor
from returning in the brain after surgery to remove
the tumor.
People who receive an implant (a wafer) that
contains a drug are monitored by the health care
team for signs of infection after surgery. An
infection can be treated with an antibiotic.
You may wish to read the NCI booklet
Chemotherapy and You.
You may want to ask your doctor these
questions about chemotherapy:
- Why do I need this treatment?
- What will it do?
- Will I have side effects? What can I do about
them?
- When will treatment start? When will it end?
- How will treatment affect my normal
activities?
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