Adult Brain Tumors Treatment (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.

What are metastatic 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.

What are the symptoms of an adult brain tumor?

A doctor should be seen if the following symptoms appear:

What tests are used to find and diagnose adult brain tumors?

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

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.

What is the grade of a 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:

Brain Stem Gliomas

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 for more information.)

Pineal Astrocytic Tumor

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.

Pilocytic Astrocytoma (grade I)

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 Astrocytoma (grade II)

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 Astrocytoma (grade III)

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.

Glioblastoma (grade IV)

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:

Oligodendroglial Tumors

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

Mixed Gliomas

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.

Ependymal Tumors

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:

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

Medulloblastoma (grade IV)

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 for more information.)

Pineal Parenchymal Tumors

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:

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

Meningeal Tumors

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

Germ Cell Tumor

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 for more information.)

Craniopharyngioma (grade II)

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 Tumor Treatment for more information.

Other Adult Brain Tumors

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

Recurrent Adult Brain Tumor

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.

Metastatic Brain Tumors

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:

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.

Three types of standard treatment are used.

Surgery

Surgery is used, when possible, to treat adult brain tumor, as described in the Description 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.

Other types of treatment are being tested in clinical trials.

New methods of delivering radiation 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.

How are metastatic brain tumors treated?

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.

Treatment in a clinical trial

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.

Pineal Astrocytic Tumors

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.

Pilocytic Astrocytomas

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.

Diffuse Astrocytomas

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.

Anaplastic Astrocytomas

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.

Glioblastoma

Treatment of glioblastoma may include the following:

  1. Surgery plus radiation therapy, with or without chemotherapy.
  2. A clinical trial of chemotherapy placed into the brain during surgery.
  3. A clinical trial of radiation and concurrent chemotherapy.
  4. A clinical trial of external radiation therapy plus hyperthermia therapy or new methods of delivering radiation therapy.
  5. A clinical trial of new anticancer drugs and biologic therapy following radiation therapy.
  6. A clinical trial of chemotherapy and new methods of delivering radiation therapy.
  7. 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.

Oligodendroglial Tumors

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.

Mixed Gliomas

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.

Ependymal Tumors

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.

Medulloblastoma

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 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.

Pineal Parenchymal Tumors

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.

Meningeal Tumors

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.

Germ Cell Tumors

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.

Craniopharyngioma

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.

Recurrent Adult Brain Tumor

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.

Metastatic Brain Tumors

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.

To Learn More About Adult Brain Tumors

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

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

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Changes to This Summary (07/03/2008)

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. 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.

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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.

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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. 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.

Date last modified 2008-07-03