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Primary brain tumor
Alternative namesGlioblastoma multiforme; Ependymoma; Glioma; Astrocytoma; Brain tumor - primary; Medulloblastoma; Neuroglioma; Oligodendroglioma; Meningioma; Cancer - brain tumor (primary)
DefinitionA brain tumor is any growth of abnormal cells or uncontrolled proliferation of cells in the brain. Primary brain tumors involve any such growth that originates in the brain, rather than spreading to the brain from another part of the body.
Causes, incidence, and risk factors
Primary brain tumors include any tumor that originates in the brain. Tumors may be localized to a small area, invasive (spread to nearby areas), benign (noncancerous) or malignant (cancerous).
Tumors can directly destroy brain cells. They can also indirectly damage cells by producing inflammation, compressing other parts of the brain as the tumor grows, inducing cerebral edema (brain swelling), and causing increased intracranial pressure (the pressure within the skull).
Classification of brain tumors depends on the exact site of the tumor, the type of tissue involved, benign or malignant tendencies of the tumor, and other factors. The cause of primary brain tumors is unknown. Some tumors ( retinoblastoma , for example) tend to be hereditary. Others tumors ( craniopharyngioma ) are congenital (present from before birth).
Tumors may occur at any age, but many have a particular age group in which they are most common. The most common childhood brain tumors are astrocytoma, medulloblastoma, ependymoma, and brain stem glioma. Gliomas account for 75% of brain tumors among children but only 45% in adults. Other than retinoblastomas, most brain tumors are rare in the first year of life.
Childhood nervous system tumors may be classified as either infratentorial (located below the tentorium cerebelli), meaning they are in the posterior third of the brain, or as supratentorial meaning they are within the anterior two-thirds of the brain.
Central nervous system tumors account for about 20% of all childhood cancers. They are second in incidence only to leukemias. Half of brain tumors in children are infratentorial. The annual incidence in children less than 15 years old is about 3 per 100,000. More than 1,200 new cases occur each year.
Specific symptoms, treatment, and prognosis (probable outcome) vary according to the site and type of the tumor and the age and general health of the person.
The cornerstone of treatment is surgical removal of the tumor. If complete removal is not possible, radiation therapy may be beneficial. Chemotherapy is usually reserved for unremovable, progressive cases. There is a 38% to 94% cure rate based upon the tumor typeMedulloblastoma:
Surgical removal alone does not cure medullablastoma; radiation therapy or chemotherapy are often used with surgery.
Children younger than 3 often have poorer outcomes. There is a high incidence of metastatic disease at diagnosis in this age group, and low doses of radiation are used in these patients.
There is some controversy over the optimal approach to therapy for craniopharyngioma.
Additional symptoms that may be associated with primary brain tumors:
Signs and testsExamination often shows focal (isolated location) or general neurologic changes that are specific to the location of the tumor . Some tumors may not show symptoms until they are very large and cause rapid neurologic decline, others are characterized by slowly progressive symptoms. Most brain tumors will include signs typical of space-occupying masses (aggregations of cells) which cause increased intracranial pressure and compression of brain tissue.
The diagnosis may be confirmed, and the tumor localized, by:
This disease may also alter the results of a CPK isoenzymes test.
A primary brain tumor should have prompt treatment. Early treatment improves the chance of a good outcome for many tumors.
Surgery may reduce intracranial pressure and relieve symptoms in cases when the tumor cannot be removed. Stereotactic (guided by CT) surgery may be helpful in removing deep tumors.
Legal advice may be helpful in formulating advanced directives, such as power of attorney , in cases where continued physical or intellectual decline is likely.
Support GroupsThe stress of illness can often be helped by joining a support group where members share common experiences and problems. See cancer - support group .
Expectations (prognosis)Prognosis and outcome vary.
Calling your health care providerCall for an appointment with your health care provider if new, persistent headaches or other symptoms suggestive of a primary brain tumor occur.
Call your health care provider or go to the emergency room if seizures develop, or if there is the sudden development of stupor , vision changes, or speech changes.
Update Date: 11/7/2002Ezra E. W. Cohen, M.D., Department of Medicine, The University of Chicago, Chicago, IL. Review provided by VeriMed Healthcare Network.
Last updated: Tue, 06 Jan 2009 00:20:03 GMT