The Enid News and Eagle, Enid, OK

January 31, 2014

What you should know about tumors of the brain

By Judy Rupp, columnist
Enid News and Eagle

— When Warren had a brain tumor in the early 1970s, there only was one neurologist and one neurosurgeon in his city. With trained neuro nurses unavailable, the neurosurgeon sat at Warren’s bedside overnight following surgery so that he could observe signs of hemorrhage or other danger signs.

That was before MRI, before sophisticated surgical techniques to locate and shrink tumors, before new radiation and chemotherapy treatments had emerged. Yet Warren, like a minority of patients today, survived.

A brain tumor is not necessarily cancer. By definition, a tumor is an accumulation of abnormal cells. Some tumors are cancerous, meaning they grow faster than other tissues, aggressively invade nearby cells and spread to other parts of the body.  Even a malignant brain tumor, however, rarely spreads outside the brain.

And a benign brain tumor may be at least equally threatening. Inside the boney confines of the skull, any abnormal growth can cause inflammation and put increased pressure on tissue under and around it.

Symptoms depend largely on where the tumor is located and what areas of the brain receive the pressure. Warren suddenly developed double vision and initially thought he needed new glasses. A more common symptom is a severe headache, unlike any you have ever had, and one that does not respond to usual headache remedies.

Other symptoms include seizures or convulsions; balance problems; changes in speech, vision or hearing; difficulty walking; memory glitches; changes in mood, personality or ability to concentrate; weakness in one part of the body; and numbness or tingling in the arms or legs

All of these symptoms also occur with other disorders.

Why one person gets a brain tumor and another does not is always a puzzle. There are two main risk factors: 1) having received radiation to the head, many years earlier, and 2) family history. It’s important to note that only a very few families have such a history.

When symptoms and a physical examination suggest a brain tumor, a doctor can confirm the diagnosis with an MRI or CT scan, angiogram, spinal tap and/or biopsy. The biopsy may be taken at the same time that part or the entire tumor is removed.

Initial treatment is usually surgery. An incision is made in the scalp and a specialized saw is used to remove a piece of bone from the skull through which instruments can be placed.

Although general anesthesia can be used, the surgeon may want the patient to be awake while the tumor is being removed. To determine effects on crucial parts of the brain, the doctor may ask the patient to move a hand or leg, count or tell a story.

Specialized neurosurgical nurses are trained so they can monitor the patient and look for signs of swelling or accumulation of fluid, which can cause severe problems.

In cases where surgical removal threatens normal functions, radiation can be used instead. Radiation therapy can also be used after surgery to kill tumor cells that may remain.

Research in the 1970s and 1980s concluded that radiation following surgery improved survival significantly in patients with glioma, the most common kind of brain tumor.

Chemotherapy was not a standard treatment for brain tumors in Warren’s day because most chemotherapy drugs at that time could not cross the blood brain barrier.

Today, chemotherapy may be delivered effectively by mouth, intravenously or in wafers that are placed in the brain. As the wafers dissolve, the drug is released into the brain, killing cancer cells and helping to prevent return of the tumor.

Gliomas, which account for about 70 percent of brain tumors, require a large number of blood vessels to grow. The most recent treatment focuses on antiangiogenesis agents — drugs that block the growth of these new blood vessels

Bevacizumab (Avastin), an antiangiogenesis drug approved for treatment of colorectal and other cancers, is now being studied for possible treatment of gliomas. However, a large multicenter study found that glioblastoma patients given Avastin did not live any longer than those given chemoradiation alone.

Even though brain tumor patients continue to face long odds, some hopeful signs have begun to appear over the last five years. More patients are surviving for at least two years after the diagnosis, and those who survive that long are even more likely to be long-term survivors.

Rupp is care coordinator for Long Term Care Authority of Enid Aging Services. Contact her at 237-2236.