The Cancer Institute at Good Samaritan - Brain & Spine Cancer
Brain tumors are masses of abnormal cells that grow out of control. Although brain tumors rarely spread to other parts of the body, they may spread through the brain tissue. Even benign (non-cancerous) tumors can, as they grow, destroy and compress normal brain tissue, causing damage that is often disabling and sometimes fatal. For this reason, doctors usually speak of "brain tumors" rather than "brain cancers." The main concerns with brain tumors are how readily they spread through the rest of the brain or spinal cord and whether they can be permanently removed and not come back.
There are two main types of brain cancer. Primary brain cancer starts in the brain. Metastatic brain cancer starts somewhere else in the body and moves to the brain. Brain tumors can be benign, with no cancer cells, or malignant, with cancer cells that grow quickly.
A spinal tumor is a cancerous (malignant) or noncancerous (benign) growth that develops within or near your spinal cord or within the bones of your spine. A spinal tumor or a growth of any kind can affect nerves in the area of the tumor, leading to pain, neurological problems and sometimes paralysis. Whether cancerous or not, a spinal tumor can threaten life and cause permanent disability.
Brain and spinal cord tumors are different in adults and children. They often form in different areas, develop from different cell types, and may have a different outlook and treatment.
Signs & Symptoms
Some of the most common symptoms are:
- Changes in ability to talk, hear or see
- Deep venous thrombosis (DVT, or blood clot)
- Endocrine dysfunction (hormone/gland changes)
- Headaches, usually worse in the morning
- Muscle jerking or twitching
- Nausea and vomiting
- Numbness or tingling in arms or legs
- Problems with balance or walking
- Problems with thinking or memory
No one knows the exact causes of brain tumors. Doctors can seldom explain why one person develops a brain tumor and another does not.
Depending on the location and type of spinal tumor, various signs and symptoms can develop, especially as a tumor grows and affects the spinal cord or nerve roots, blood vessels or bones of the spine.
Spinal tumor symptoms may include:
- Back pain, often radiating to other parts of the body
- Loss of sensation or muscle weakness, especially in the arms or legs
- Difficulty walking, sometimes leading to falls
- Decreased sensitivity to pain, heat and cold
- Loss of bowel or bladder function
- Paralysis that may occur in varying degrees and in different parts of the body, depending on which nerves are compressed
When to see a doctor
There are many causes of back pain, and most back pain isn't caused by a spinal tumor. Early diagnosis and treatment are important for spinal tumors, see a doctor about back pain if:
- It's persistent and progressive
- It's not activity related
- It gets worse at night
- You have a history of cancer and develop new back pain
Seek immediate medical attention if you experience:
- Progressive muscle weakness or numbness in your legs
- Changes in bowel or bladder function
Brain cancer is most often diagnosed and treated by a neurosurgeon. With extensive diagnostic experience, Good Samaritan’s board certified neurosurgeons can use a number of tests to determine if a tumor is indeed present and the type. Some of the tests performed to first diagnose the tumor are later used to monitor treatment. Like many other medical conditions, follow-up care for a brain tumor might go on for years or even a lifetime.
A neurologist or neurosurgeon will first administer a neurological exam, series of relatively painless tests and procedures used to assess a person’s nerves, senses, muscle strength, reflexes, balance, and mental state.
A basic neurological exam includes:
- Eye Tests
- Hearing Tests
- Reflex Tests
- Balance and Coordination Tests
- Sense of Touch Tests
- Sense of Smell Tests
- Facial Muscle Tests
- Tongue Movement and Gag Reflex Tests
- Head Movement Tests
- Mental Status Tests (basic questions, such as the name of the current president or day of the week)
- Abstract Thinking Tests (i.e, questions on interpreting a common saying)
- Memory Tests
If the results of the neurological examination lead the neurosurgeon to suspect a brain tumor, a scan will be ordered, or the patient might be referred to a specialist for more testing. These additional tests might include scans, X-rays, or laboratory tests. Good Samaritan’s Department of Imaging Services perform scans that generate images of the brain for the purpose of diagnosing tumors. They take the place of X-rays, which do not show tumors located behind the bones of the skull or spine. The purpose of a scan is to give the neurosurgeon a closer look at the brain and to provide information that will assist in making a diagnosis.
Scanning techniques available include:
- Computed Tomography (CT)
- Magnetic Resonance Imaging (MRI)
- Angiography and MRI Angiography (MRA)
- Positron Emission Tomography (PET, FDG-PET)
- Some common lab tests in patients with brain tumors include:
- Lumbar Puncture (Spinal Tap)
- Audiometry (a hearing test)
- Endocrine Evaluation
- Perimetry (measures the size of the visual fields)
- Biomarker Research (the detection of tiny bits of genetic material in bodily fluids)
- Genetic profiling
- Biopsy – needle biopsy, stereotactic biopsy or open biopsy
Good Samaritan’s Outpatient Laboratory offers convenient hours, dedicated parking and available walk in appointments.
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Spinal tumors sometimes may be overlooked because they're not common and their symptoms resemble those of more common conditions. For that reason, it's especially important that a physician knows the patient’s complete medical history and performs both general physical and neurological exams. If the doctor suspects a spinal tumor, one or more of the following tests can help confirm the diagnosis and pinpoint the tumor's location:
- Spinal magnetic resonance imaging (MRI)
- Computerized tomography (CT)
- Myelogram or spinal MRI
- Biopsy – needle biopsy, stereotactic biopsy or open biopsy
Treatment of brain cancer is usually complex involving several members of the cancer team:
- Neurosurgeons - specialists in the brain and nervous system
- Oncologists – physicians who specialize in the medical management of cancer, including chemotherapy
- Radiation Oncologists - doctors who practice radiation therapy
- Your primary health care provider
- Social Worker
- Physical Therapist
The most widely used treatments are surgery, radiation therapy and chemotherapy. In most cases, more than one of these is used.
Most people with a brain tumor undergo surgery. The purpose of surgery is to confirm that the abnormality seen during testing is indeed a tumor and to remove the tumor. If the tumor cannot be removed, the neurosurgeon will take a sample of the tumor to identify its type.
In some cases, mostly in benign tumors, symptoms can be completely cured by surgical removal of the tumor. The neurosurgeon will attempt to remove the entire tumor when possible.
The newest method of delivering radiation is capable of delivering a high dose of precisely targeted radiation and The Cancer Institute at Good Samaritan uses two linear accelerators to do so - the Varian Edge and the Varian TrueBeam. In stereotactic radiosurgery (SRS), Good Samaritan’s skilled radiation oncologists use computers to focus radiation beams on tumors with pinpoint accuracy and from multiple angles. This approach has proved effective in the treatment of brain tumors, and research is now under way to determine the best technique, radiation dose and schedule for SRS in the treatment of spinal tumors.
Ideally, the goal of spinal tumor treatment is to eliminate the tumor completely, but this may be complicated by the risk of permanent damage to the surrounding nerves. Doctors also must take into account the patient’s age, overall health, the type of tumor and whether it is primary or has spread to the spine from elsewhere in the body.
- Radiation Therapy and Stereotactic Radiosurgery
- Other drugs