Cancer Education Slides

Brain Tumor2010

What is Cancer?

• A group of 100 different diseases

• The uncontrolled, abnormal growth of cells

• Cancer may spread to other parts of the body

• Brain tumors: primary and secondary

What is a Primary Brain Tumor?

• An estimated 22,020 new cases in the United States in 2010

• A disease in which brain cells grow uncontrollably and form a tumor

• Can be benign (noncancerous) or malignant (cancerous)

• More than 100 types• Often divided into gliomas and non-glioma tumors• Gliomas are most common type of brain tumor• Meningioma is the most common type of non-glioma brain tumor

What Are the Parts of the Brain?

• Made up of four parts• Cerebrum: the largest

part is divided into frontal lobe, parietal lobe, temporal lobe, and occipital lobe

• Cerebellum: located at the back part of the brain below the cerebellum

• Brain Stem: connects the brain and spinal cord

• Meninges: membranes that surround the brain and spinal cord

Types of Brain Tumors: Gliomas

• Astrocytoma: begins in cells called astrocytes in the cerebrum or cerebellum– Glioblastoma is a grade IV astrocytoma and a very aggressive tumor type

• Mixed gliomas: tumors composed of more than one cell type

• Oligodendroglioma: begins in myelin-producing cells called oligodendrocytes that surround nerves

• Ependymomas: begin in the ependyma cells that line the area where cerebral spinal fluid is made and stored

• Brain stem glioma: begins in cells in brain stem

Types of Brain Tumors: Non-Glioma Tumors

• Meningioma: begins in the meninges and is often benign

• Pineal gland and pituitary gland tumor: start near the base of the brain

• Primary CNS lymphoma: begins in the lymphatic system of the brain

• Medulloblastoma: begins in granular cells in the cerebellum

• Craniopharyngioma: rare, benign tumor that begins near the pituitary gland

• Acoustic schwannoma: rare tumor that begins in the vestibular nerve and is often benign

• Germ cell tumors: begin in special cells in the fetus that become testicles in boys and ovaries in girls

What are the Risk Factors for a Brain Tumor?

• Age• Gender• Family history/genetics• Exposure to infections, viruses, and allergens

• Race and ethnicity• Ionizing radiation• Head injury and seizures• Diet (N-nitroso compounds)• Exposure to nerve agents

Hereditary Brain Tumors

• Von Hippel-Lindau syndrome: caused by a genetic mutation on the von Hippel-Lindau (VHL) gene; associated with hemangioblastomas (blood vessel tumors) of the brain

• Turcot syndrome: caused by a genetic mutation on the MLHI, PMS2 and APC genes; increased risk of glioblastoma or medulloblastoma

• Neurofibromatosis: caused by a genetic mutation on the NFI or NF2 genes; increased risk of acoustic schwannomas, meningiomas, and gliomas

What Are the General Symptoms of a Brain Tumor?

• Seizures: myclonic and tonic-clonic

• Headaches

• Personality or memory changes

• Nausea and vomiting

• Vision change

What Symptoms Are Specific to Tumor Site?

• Pressure or headache near tumor

• Loss of balance and difficulty with fine motor skills (cerebellum)

• Changes in judgment (frontal lobe)

• Partial or total loss of vision (occipital lobe or temporal lobe)

• Changes in speech, hearing, memory, or emotional state (frontal and temporal lobe)

• Altered perception of touch, arm or leg weakness or confusion on one side of the body (frontal or parietal lobe)

• Inability to look upward (pineal tumor)

• Lactation and altered menstrual periods in women, growth in the hands and feet (pituitary tumor)

• Difficulty swallowing, facial weakness or numbness, double vision (brain stem)

How is a Brain Tumor Cancer Diagnosed?

• Type of brain tumor Type of brain tumor is confirmed with a is confirmed with a biopsybiopsy

• Stereotactic biopsyStereotactic biopsy• Magnetic resonance Magnetic resonance

imaging (MRI)imaging (MRI)• Magnetic resonance Magnetic resonance

spectroscopy (MRS)spectroscopy (MRS)• Computed tomography Computed tomography

(CT or CAT) scan(CT or CAT) scan• Positron emission Positron emission

tomography (PET)tomography (PET)

• Neurological, vision, and hearing tests

• Blood tests• Lumbar puncture

(spinal tap)• Electroencephalograp

hy (EEG)• Cerebral arteriogram

(cerebral angiogram)

How is a Brain Tumor Treated?

• Treatment depends on type of tumor• More than one treatment may be used• Surgery• Radiation therapy• Chemotherapy• Targeted therapy• Supportive care

Brain Tumor Treatment: Surgery

• Often the first treatment used and the only treatment for most benign tumors

• Requires removal of part of the skull (craniotomy)

• The patient may be awake for part of the surgery to avoid damage while removing the tumor

• Removal of a tumor can relieve symptoms if it is creating pressure in the brain

Brain Tumor Treatment: Radiation Therapy

• The use of high-energy x-rays to destroy cancer cells

• Different methods of delivery that provide greater precision and reduce radiation exposure

• A combination of two or more techniques may be used

• Long-term side effects may include cognitive problems, including possible memory loss and declining intellectual performance

Brain Tumor Treatment: Types of Radiation Therapy

• Conventional radiation therapy

• Intensity modulated radiation therapy (IMRT)

• Three-dimensional conformal radiation therapy

• Stereotactic radiosurgery

• Fractionated stereotactic radiation therapy

• Proton radiation therapy

Brain Tumor Treatment: Chemotherapy

• Use of drugs to kill cancer cells• Given to destroy cancer remaining after surgery, slow tumor growth, or reduce side effects

• A combination of medications is often used• Some drugs go through the blood-brain barrier better

• Side effects may include nausea and vomiting, loss of appetite, diarrhea, fatigue, low blood count, bleeding or bruising, numbness or tingling in the hands and feet, headaches, hair loss, and darkening of the skin and fingernails

Brain Tumor Treatment: Targeted Therapy

• Targeting faulty genes or proteins that contribute to cancer growth and development

• Different methods are being researched in clinical trials

Brain Tumor Treatment: Supportive Care

To help prevent or control symptoms and improve patient’s comfort during treatment

•Steroids

•Anti-seizure (convulsant) medication

•Shunt

•Anti-depressants

Brain Tumor Staging

• Staging is a way of describing a cancer, such as the size of the tumor and where it has spread

• There is no formal staging system for adult brain tumors

• Tumors are often referred to by grade, determined by mitosis (cell division), hypercellularity (large numbers of cells), vascular proliferation (blood vessel growth), and necrosis (dead tissue)

• Several factors can help determine a patient’s prognosis

• Treatment depends on the grade of the tumor• A recurrent brain tumor is a tumor that comes back after treatment

Brain Tumor Grading

• Grade I: refers to pilocytic astrocytomas, benign, slow-growing tumors

• Grade II: tumor does not have mitosis, vascular proliferation, or necrosis but has increased cellularity

• Grade III: tumor is hypercellular and has mitosis but no vascular proliferation or necrosis

• Grade IV: tumor has mitosis, hypercellularity, vascular proliferation and/or necrosis

Determining Prognosis

• Several factors can help determine a patient’s prognosis

• Tumor histology: how the tumor looks under a microscope

• Age of the patient• Extent of tumor residual: amount of tumor remaining after surgery

• Tumor location• Functional neurologic status• Metastatic spread• Biologic markers

Current Research

• Hyperfractionization: use of frequent, small doses of radiation therapy

• Gene therapy: replaces or repairs abnormal genes• Immunotherapy: boosts the immune system to attack the tumor

• Antiangiogenesis therapy: drugs that stop tumor blood vessel formation

• Blood-brain barrier disruption: increase chemotherapy effectiveness by temporarily disrupting the barrier

• Aggressive regimes for childhood tumors• New combination therapies

The Role of Clinical Trials for the Treatment of Brain

Tumors• Clinical trials are research studies involving people

• They test new treatment and prevention methods to determine whether they are safe, effective, and better than the standard treatment

• The purpose of a clinical trial is to answer a specific medical question in a highly structured, controlled process

• Clinical trials can evaluate methods of cancer prevention, screening, diagnosis, treatment, and/or quality of life

Clinical Trials: Patient Safety

• Informed consent: participants should understand why they are being offered entry into a clinical trial and the potential benefits and risks; informed consent is an ongoing process

• Participation is always voluntary, and patients can leave the trial at any time

• Other safeguards exist to ensure ongoing patient safety

Clinical Trials: Phases• Phase I trials determine the appropriate dose of a

new treatment in a small group of people and provide preliminary information about the drug’s safety

• Phase II trials provide information about the safety of the new treatment and provide the first evidence as to whether or not the new treatment is effective in treating the cancer that is being studied

• Phase III trials compare two or more different treatments. Most commonly, they test whether a new treatment is better than the standard treatment. Patients are typically divided randomly into two or more different groups. Each group gets a different treatment, and the researchers evaluate which group has had the best results. This is the best way to measure whether a new treatment results in longer life or better quality of life for patients

Clinical Trials Resources

• Coalition of Cancer Cooperative Groups (www.CancerTrialsHelp.org)

• CenterWatch (www.centerwatch.com)

• National Cancer Institute (www.cancer.gov/clinical_trials)

• EmergingMed (www.emergingmed.com)

Coping with Side Effects

• Side effects are treatable; talk with the doctor or nurse

• Ask about the level of caregiving needed during treatment and recovery

• Fatigue is a common, treatable side effect

• Pain is treatable; non-narcotic pain-relievers are available

• Antiemetic drugs can reduce or prevent nausea and vomiting

• Discuss best nutrition plan for you with health care team

• For more information, visit www.cancer.net/sideeffects

After Treatment

• Talk with the doctor about developing a follow-up care plan

• Regular physical examinations and MRI scans to monitor for new symptoms

• Possible evaluation of cognitive abilities to identify functional problems that may improve with speech or occupational therapy, counseling, or medications

• Support groups are recommended• Fear of recurrence is common; talk with your doctor about ways to cope

Where to Find More InformationCancer.Net Guide to Brain Tumor

(www.cancer.net/brain)

• Overview• Medical

Illustrations• Risk Factors• Symptoms• Diagnosis• Staging• Treatment

• Clinical Trials• Side Effects• After Treatment• Current Research• Questions to Ask the

Doctor• Patient Information

Resources

Cancer.Net

• The expertise of ASCO, the voice of the world’s cancer physicians

• Guides to more than 120 types of cancer and cancer-related syndromes

• Clinical trials information• Weekly feature articles• Videos and podcasts• Information in Spanish• The latest cancer news• Learn more at www.cancer.net or 888-651-3038