The most common brain tumor in women of all ages is a metastatic tumor. A metastasis is a tumor in the brain that originates from cancer elsewhere in the body. Typically, patients with a specific organ tumor other than the brain are evaluated by the specific oncology disciplines. For example, if a woman has breast cancer, she will typically be followed by a primary breast oncologist. When there is evidence of brain metastasis, then the primary role of the neuro-oncologist is management of brain metastasis and associated complications issues. In terms of primary brain tumors, which started in the brain and not anywhere else in the body, the most common type of in women is meningioma. And then followed by that, depending on age group, specifically in older women in their 50s or 60s and above the common tumor is glioma, more specifically glioblastoma.
In terms of primary tumors originating in the central nervous system, there are many different types of tumors with associated clinical and pathologic features. One of the most common benign types of tumors is a meningioma, which is tumor arising from the meninges, or membranous layer surrounding the central nervous system. These tumors are usually benign, however, may be symptomatic depending on their location and size; typical treatment is with either conventional surgery or radiosurgery. On the other spectrum are gliomas, which are a type of tumor that arise in the brain or spine, typically occurring in older people over age 50 years old. Glioblastoma multiforme is the most common and most aggressive malignant primary brain tumor. Treatment typically involves multiple modalities including surgical resection of as much of the tumor as possible, followed by concurrent or sequential chemoradiotherapy, antiangiogenesis therapy, and corticosteroids for symptoms.
A tumor like a meningioma, which is considered benign in most cases, is not generally managed with chemotherapy. In fact, with benign meningiomas, sometimes no intervention is required. If there is anything to be done it is surgery or radiation. Because these treatments are localized to the brain and are remote from a women’s reproductive system, not much needs to be done in terms of thinking about fertility, other than the fact that you do not want to be pregnant when you have to undergo these treatments. One exception is perhaps shielding the ovaries during radiation.
If instead a women ends up having a tumor that requires chemotherapy, like a brain metastases or a glioblastoma, that is a different situation. This is because chemotherapy can definitely impact fertility. If a woman is going to receive chemotherapy and wants to preserve her fertility for the future, the neuro-oncologist will likely send them to a reproductive endocrinologist to discuss the possible impacts of the chemotherapy on their fertility. The reproductive endocrinologists are sometimes able to take measures to preserve fertility, such as harvesting eggs, having them fertilized, and freezing them. Most women who undergo chemotherapy have to realize that they are taking a risk of infertility as a result of their chemotherapy. But if the chemotherapy is lifesaving or at least life extending, the risk to their fertility may be a risk worth taking.
There is significant anxiety associated with the diagnosis of a brain tumor and the first visit to the neuro-oncologist. You and your family will meet our multi-disciplinary team of neuro-oncologists, nurses, support staff, and social workers over the course of initial several visits. Further work-up may need to be pursued in terms of imaging and then various modalities of treatment options will be discussed.