Brain Tumor Diagnosis and Treatment

Doctors and other care-givers at the Brain Tumor Center at Dana-Farber/Brigham and Women's Cancer Center (DF/BWCC) will work closely with you and your family to develop a treatment plan suited to your needs. As well as providing specialized medical care, we offer a range of support services, including nutritional counseling, emotional and spiritual support, financial advice, and complementary therapies, such as acupuncture and massage.

Understanding Brain Tumors

A brain tumor is an abnormal growth of tissue in the brain that can either be benign (non-cancerous) or malignant (cancerous). There are two main types of brain cancers, primary and secondary.

Primary brain cancer originates in the brain or the lining of the brain and in rare instances can spread throughout the brain and spinal cord. Secondary brain cancer (also called metastatic) is more common and is caused by a cancer that has originated in another part of the body such as the breast or lung and has spread to the brain.

Our Brain Tumor Center provides compassionate and state-of-the-art brain cancer treatment for patients with primary and secondary brain tumors, spinal cord, and neurologic complications of cancer.

Brain Tumor Diagnosis and Treatment Facts

Brain Tumor Information from Our Experts

Our multidisciplinary team of specialists includes neurosurgeons, neuro-oncologists, radiation oncologists, social workers, dietitians, physical and occupational therapists, and nurse practitioners. In addition, there are also dedicated critical care specialists available 24/7 in the Neurologic Intensive Care Unit – including neuro-radiologists committed to analyzing imaging, neuro-pathologists devoted to diagnosing tumor type, and neuro-anesthesiologists that specialize in assisting surgical treatments.

A specialized multidisciplinary service within our Center, our Pituitary and Neuroendocrine Program is dedicated to providing the most advanced medical and surgical treatment options for patients with pituitary and neuroendocrine disorders. Our neurosurgery and neuroendocrine experts are world leaders in the treatment of pituitary diseases and tumors.

In addition, the Brain Tumor Center enhances its clinical program through research in an effort to understand the causes of brain tumors and expand treatment options for patients. Our researchers are developing new, innovative techniques that optimize the use of technology, radiation, gene therapy and biological therapies in the treatment of brain tumors.

Brain tumors are one of the many diseases and conditions that form the focus of our Neurosciences Center. Our multidisciplinary team of neurologists, neurosurgeons, psychiatrists, and radiologists offers the most innovative and advanced treatments and therapies for brain tumor and all diseases of the nervous system. Our dedication to discoveries and research in these areas has made us the choice for patients from the region and around the world.

Risk Factors for Brain Tumors

The Central Brain Tumor Registry of the United States (CBTRUS) estimates that approximately 70,000 people in the United States are diagnosed annually with primary brain and other central nervous system tumors. Furthermore, up to 30 percent of patients with non-brain cancer are estimated to develop metastases at some point, resulting in over 170,000 new intracranial diagnoses per year in the U.S. alone.

Although the cause of brain tumors is not known, both environmental and genetic risk factors have been suggested. The most consistently reported environmental risk factor for the development of both benign and malignant brain tumors is exposure to ionizing radiation, particularly high doses given at a young age. As with most diseases, risk increases with age and the rates of many brain tumors vary by gender. Other suggested risk factors for the development of brain tumors (some of which are modifiable) include use of hormonal medications, cigarette smoking, and increased body mass index.

In terms of genetic risk factors, persons with a family history of brain tumors have an increased risk of themselves developing a brain tumor although the overall risk remains low. Rare familial syndromes exist which are associated with an increased risk of brain tumors including:

  • Neurofibromatosis I and II
  • Li-Fraumeni syndrome
  • Tuberous Sclerosis
  • Lynch Syndrome
  • Melanoma/Astrocytoma Syndrome

The majority of brain tumors are believed to be caused by abnormalities in genes involved in cell growth and repair. Abnormalities in such genes are caused by alterations in the genes, or by chromosome rearrangement which change the function of the gene. Recently, several genetic changes have been reported to be associated with an increased risk of particular types of brain tumors. Our researchers are actively studying such genes to help develop personalized treatment for patients using these data.

Symptoms of Brain Tumors

Brain tumor symptoms depend on the size and location of the tumor. These symptoms are caused by the damage the tumor does to specific parts of the brain.

Focal neurological symptoms can occur as a result of a tumor in a specific part of the brain. Examples of this type of symptom include:

  • Weakness on one side of the body
  • Difficulty talking
  • A limited field of vision

As a brain tumor grows, other symptoms may arise from increased pressure within the skull. These include:

  • Headache
  • Nausea
  • Vomiting

Swelling around the tumor, called edema, can aggravate the symptoms caused by the tumor itself. When the tumor blocks the flow of cerebrospinal fluid, the chambers, also called ventricles, of the brain enlarge. This causes a condition called hydrocephalus.

If a brain tumor grows slowly, its symptoms might appear very gradually so that they might not be noticeable for a long time. The most common symptoms of a brain tumor are:

  • Headaches
  • Fainting (syncope caused by increased intracranial pressure
  • Seizures
  • Nausea with or without vomiting
  • Weakness or loss of feeling in the arms, legs, or both
  • Stumbling or inability to walk
  • Changes in vision or abnormal eye movements
  • Changes in personality, memory, or speech
Diagnosis of Brain Tumors

At Brigham and Women’s Hospital, our brain tumor specialists – neurosurgeons and neuro-radiologists – provide expert evaluation and diagnosis utilizing the latest in advanced imaging technologies.

In addition to a thorough medical history and detailed neurological examination, diagnostic testing for brain tumors can include:

  • Magnetic resonance imaging (MRI) – a diagnostic imaging procedure that uses a combination of large magnets, radiofrequencies, and computer technology to produce detailed images of organs – such as the brain – and structures within the body.
  • Advanced MRI – Advanced MRI techniques are used to determine the tumor’s proximity to critical areas of the brain and identify other important tumor characteristics. They are essential to devising the best treatment approach. Examples include:
    • Functional MRI (fMRI) – Functional MRI (fMRI) is used to map areas of the brain that are responsible for critical functions, such as movement and speech;
    • Diffusion tensor imaging (DTI) – DTI is used to identify white matter tracts, the signaling pathways in the brain;
    • Magnetic resonance spectroscopy (MRS) – MRS provides details on specific tumor characteristics and type, as well as tumor metabolism. This technology is useful in determining the tumor’s boundaries to achieve complete tumor removal/treatment during surgery.
  • Positron emission tomography (PET) scan – to evaluate brain metabolism
  • Computed tomography (CT) scan – a diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce images, often called slices, of the body – for this application, the brain.
  • Arteriogram (angiogram)
  • Myelogram
  • Spinal tap – to measure pressure in the spinal canal and brain
Brain Tumor Treatment

Neurosurgeons at the Brain Tumor Center offer state-of the-art treatments for patients with benign or malignant tumors.

They use advanced technologies to remove as much of the tumor as possible while preserving the surrounding brain tissue. These include a revolutionary open-style MRI scanner that allows the neurosurgeon to see MRI images in real time during surgery.

This intra-operative MRI, in our advanced multimodality image-guided (AMIGO) operating suite, can help the neurosurgeon remove the tumor more precisely, reducing the risk of damage to other parts of the brain, and more completely. Other surgical technologies include the use of 3-D navigation systems that allow us to precisely locate deep-seated or small brain tumors; monitor speech, motor or visual functions during surgery; and observe delicate cranial nerve functions. In some instances, patients undergo a functional MRI prior to surgery so that areas of the brain with important function are identified and safe surgical planning is maximized.

Additional advanced techniques to treat brain tumors include interstitial laser ablation, a new technique that employs MRI and specialized software to measure heat treatment delivered through a laser fiber. This technique, also performed in the AMIGO suite at Brigham and Women’s Hospital, can be used to treat tumors in patients where traditional surgical techniques and radiation are not feasible. An upcoming study will evaluate non-invasive MRI-guided high-intensity focused ultrasound in the treatment of brain tumors.

Our Skull Base Surgery Program specializes in and treats the most complex skull base tumors. Our multidisciplinary surgical team uses the latest imaging technology to reach any area of the skull base and treat a wide variety of cranial disorders, including brain tumors.

Skull base surgery involves the removal of tumors or vascular lesions within the skull base. Typically, surgeons approach the tumor at the skull base by removing a section of the base of the skull to avoid placing significant pressure on the brain.

Our innovative surgical treatments through the side or underneath the skull base help minimize injury to the brain. These surgical treatments include:

  • Expanded endonasal approaches (EEA) – minimally invasive procedures that use an endoscope and/or microscope to remove tumors through the nose.
  • Anterior skull base approaches – tumor is removed through the front or side of the skull base, often with manipulation of the bones around the eye or jaw.
  • Lateral skull base approaches – tumor is removed after removing bone from just in front of or behind the ear.
  • Posterior skull base approaches – performed for lesions farther down in the skull base which are often near the brainstem.
  • Skull base radiosurgery – uses targeted radiation to control tumor growth.

In addition to surgery, radiation therapy and medical therapies may be indicated for treatment to eradicate the entire tumor and may be used together to enhance treatment results. Advanced radiation techniques include frameless stereotactic radiosurgery and radiotherapy and 3D conformal radiation therapy and intesity-modulated radiation therapy (IMRT). These techniques are designed to deliver high doses of radiation to the tumor, while sparing normal surrounding tissue. New medical therapies target a wide range of tumor growth mechanisms.

Chemotherapy may be used alone or in combination with radiation therapy. Treatments range from standard chemotherapy to use of anti-angiogenic agents (which target the blood vessels feeding the tumor) and new molecular agents.

Our Research

The brain tumor team also enhances its clinical program through research in an effort to understand the causes of brain tumors and expand treatment options for our patients. Our researchers are developing new, innovative techniques that optimize the use of technology, radiation, gene therapy and biological therapies. If you wish to learn more about our dedication to brain tumor research, please refer to our research.

Multidisciplinary Care

Neurosurgeons at Brigham and Women’s Hospital and Dana-Farber/Brigham and Women’s Cancer Center provide the latest and most innovative treatment available to adults challenged with cancer. Our world-renowned specialists provide comprehensive and personalized care for each patient and support for their families.

Additional Resources

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