Brain and Spinal Cord Tumors

OVERVIEW

Cancers of the central nervous system (CNS) include tumors of the brain and spinal cord, and primary lymphoma of the CNS, a form of lymphoma confined to the brain, spinal cord, their linings, and sometimes the inside of the eye. CNS cancers represent 1 to 2 percent of all cancer cases. In adults, the majority of CNS cancers occur in patients aged 40 to 70; the disease is more common in men than women. The American Cancer Society estimates that in 2007, 11,170 men and 9,330 women will be diagnosed with a tumor of the brain or spinal cord.

Most tumors of the central nervous system are cancerous. Primary brain tumors (those that originate in the brain) are classified by the type of tissue in which the cancer begins. The most common type of brain tumor is a glioma, which starts in the glial (supportive) tissue of the brain. There are three types of gliomas: astrocytoma, oligodendroglioma, and ependymoma. Other types of brain tumors include: medulloblastomas, gangliogliomas, chordomas, meningiomas, schwannomas, germ cell tumors, pituitary tumors, and pineal gland tumors. Primary central nervous system lymphoma is an aggressive non-Hodgkin's lymphoma that occurs when malignant cells arise in the lymphatic system of the brain and/or spine. This disease most often affects patients with AIDS or other disorders of the immune system.

Unlike other malignant tumors in the body, tumors of the central nervous system rarely spread to other organs. However, the location of these tumors can interfere with the crucial life functions of the brain and spinal cord.

The Cancer Center's Division of Neuro-Oncology is dedicated to diagnosing and treating tumors that affect the nervous system. The Cancer Center features many unique and innovative services:

  • board-certified neurologists, neurosurgeons, neuro-oncologists, medical oncologists, and radiation oncologists who are skilled in the most advanced diagnostic and treatment capabilities
  • one of the largest neuro-radiology services in the tri-state area to detect brain tumors, staffed by seven full-time neuro-radiologists, who utilize state-of-the-art CT, PET, MRI studies, and MR spectroscopy scans to differentiate tumors from other brain abnormalities, diagnose whether a tumor is malignant or benign, and monitor a patient's status after surgery
  • The Institute for Radiosurgery, which features revolutionary non-invasive same-day stereotactic radiosurgery to treat brain tumors accomplished by the XKnife three-dimensional radiosurgery system, which is available at select medical institutions throughout the country.
  • the Stealth Neuronavigation System, a state-of-the-art imaging and treatment system that helps a neurosurgeon plan surgery, carry it out, and review the procedure's outcome at the end of surgery. Stealth's computerized system produces live images of the surgery as it is in progress so that the neurosurgeon can remove the cancerous tumor with as little harm as possible to vital functions of the brain. The Cancer Center is one of only a few hospitals in New Jersey to have this technology.
  • complex spinal reconstructive surgery to treat spinal cord cancers or to relieve pain from inoperable tumors
  • a multisciplinary neuro-oncology clinic, where patients can be evaluated by a neuro-oncologist, neurosurgeon, radiation oncologist, and neuro-oncology nurse clinician during one convenient visit
  • bimonthly Brain Tumor Board meetings, where challenging cases are discussed and treatment is planned by a multidisciplinary team of experts

 

DIAGNOSTIC SERVICES

Hackensack University Medical Center's Department of Radiology boasts one of the largest neuro-radiology services in the tri-state area to detect brain tumors. Seven full-time neuro-radiologists utilize state-of-the-art CT, PET, MRI, and MR spectroscopy scans to differentiate tumors from other brain abnormalities. They diagnose whether a tumor is malignant or benign and monitor a patient's status after surgery to ascertain whether a tumor has recurred or if a questionable area is scar tissue. Other diagnostic methods that may be used include:

  • a neurologic exam to evaluate brain function
  • angiography (an imaging study of the blood vessels that supply the tumor)
  • traditional biopsy (removal of a tissue sample through an opening in the skull)
  • stereotactic biopsy (removal of tissue using a fine needle guided by a CT scan or MRI and a computer)
  • lumbar puncture (removal of a cerebrospinal fluid sample through a needle placed in the lower back)

 

RISK FACTORS

Radiation exposure is the only established environmental risk for brain tumors, most of which are caused by radiation to the head given to treat other cancers. People with compromised immune system - such as patients with AIDS or other immune system disorders and those taking immunosuppressants medications - have an increased risk of developing primary lymphoma of the central nervous system. Genetic risk factors include a family history of brain and spinal cord tumors and inherited conditions such as neurofibromatosis (type 2), tuberous sclerosis, and von Hippel-Landau disease.

 

SYMPTOMS

General symptoms for brain and spinal cord tumors include headaches, nausea or vomiting, weakness or numbness in arms or legs, trouble walking or uncoordinated walking, seizures or convulsions, changes in vision or unusual eye movements, drowsiness, changes in memory, and changes in speech. There are also particular symptoms associated with specific locations of brain tumors. Tumors of the cerebellum - which is located at the back of the brain and controls movement - cause poor coordination when walking, difficulty performing fine motor movements of the arms and legs, and changes in speech. Symptoms of a tumor of the cerebral right or left hemisphere affect the opposite side of the body corresponding to the tumor. Tumors of the spinal cord affect both sides of the body: arms and legs in case of the cervical spinal cord, and both lower extremities if the tumor is located in the thoracic spine.

 

 

BRAIN CANCER TREATMENT OPTIONS

 

Most brain tumors are treated with a combination of surgery, radiation therapy, and sometimes chemotherapy. Treatment is based on where the cancer is located, its type, the stage (whether it has metastasized outside the brain), and the patient's overall health condition and likelihood to function well after treatment. Even if a malignant brain tumor cannot be cured by these methods, survival may be prolonged with brain cancer treatment options such as those provided by the John Theurer Cancer Center.

Surgery

The first step in surgical treatment is removal of as much of the tumor as possible. Each year, more than 200 surgeries to remove brain tumors (both malignant and non-malignant) are performed at The Cancer Center, making it one of the most active services in New Jersey. A number of surgical advances - traditional, minimally invasive, and radiosurgical - are used at The Cancer Center to help neurosurgeons pinpoint the exact location of a tumor and aid in its removal. These advances include:

  • the Stealth Neuronavigation System, a state-of-the-art imaging and treatment system that helps a neurosurgeon plan surgery, carry it out, and review the procedure's outcome at the end of surgery. Stealth's computerized system produces live images of the surgery as it is in progress to that the neurosurgeon can remove the cancerous tumor with as little harm as possible to vital functions of the brain.
  • intra-operative motor mapping, which monitors a patient's speech, language, movement, and other functions during a wake craniotomy, a type of brain surgery that is performed while the patient is awake. Intra-operative motor mapping can confirm for the neurosurgeon the areas of the brain that are normal so that he/she can remove the tumor without harming normal functioning.
  • state-of-the-art microscopes, which are used to provide superior views of the surgical field during every brain surgery
  • complex spinal reconstructive surgery, used to treat spinal cord cancers or to relieve pain from inoperable tumors
  • minimally invasive endoscopic surgery to remove pituitary tumors

Radiation Therapy

Radiation therapy is used to shrink and/or destroy tumor cells and to control the symptoms and side effects of central nervous system cancers. If the tumor has spread along the cerebrospinal fluid pathways, radiation therapy to the whole brain and spinal cord may be used. Radiation therapy may also be used before or after surgery as an adjuvant therapy to shrink the tumor and improve the outcome of surgery. The Cancer Center's Radiation Oncology Division boasts many innovative techniques used today, including external beam radiation therapy, intensity modulated radiation therapy, brachytherapy, TomoTherapy, and 3-D conformal radiation therapy, which may be used to treat large brain lesions that cannot be reached with stereotactic radiosurgery.

The Cancer Center is one of only several sites in the New Jersey-New York area to offer patients with glioblastomas that have recurred a new brachytherapy technique called the Gliasite Radiation Therapy System. This state-of-the-art treatment system delivers focused amounts of radiation to the tumor internally through a small balloon placed there during surgery to remove the original tumor.

Stereotactic Radiosurgery

Many brain tumors that cannot be treated with surgery can be treated with stereotactic radiosurgery. At Hackensack University Medical Center's Institute for Radiosurgeryneurosurgeons and radiation oncologists use the XKnife three-dimensional radiosurgery system, which is only available at select medical institutions throughout the country. Radiosurgery is a non-invasive, outpatient treatment that does not involve cutting, bleeding, or anesthesia. During radiosurgery, the scalpel is replaced with concentrated beams of radiation that are contoured precisely to the shape of the tumor. These beams destroy the tumor, yet spare surrounding healthy brain tissue.

Chemotherapy

Chemotherapy is used to destroy cancer cells within an organ or structure and any that have spread throughout the body and to help control symptoms and side effects of cancer. For patients with certain types of brain tumors, chemotherapy may be given before surgery or radiation therapy to help shrink the tumor and improve the surgical outcome. High-dose intravenous chemotherapy is the main treatment for primary central nervous system lymphoma.