A brain tumor is an intracranial solid neoplasm, a tumor (defined as an abnormal growth of cells) within the brain or the central

spinal canal.

Brain tumors include all tumors inside the cranium or in the central spinal canal. They are created by an abnormal and uncontrolled cell division, normally either in

the brain itself (neurons, glial cells (astrocytes, oligodendrocytes, ependymal cells, myelin-producing Schwann cells), lymphatic tissue, blood vessels), in

the cranial nerves, in the brain envelopes (meninges), skull, pituitary and pineal gland, or spread from cancers primarily located in other organs (metastatic

tumors).

Any brain tumor is inherently serious and life-threatening because of its invasive and infiltrative character in the limited space of the intracranial cavity. However,

brain tumors (even malignant ones) do not automatically cause death. Brain tumors or intracranial neoplasms can be cancerous (malignant) or non-cancerous

(benign); however, the definitions of malignant or benign neoplasms differs from those commonly used in other types of cancerous or non-cancerous neoplasms in

the body. Its threat level depends on the combination of factors like the type of tumor, its location, its size and its state of development. Because the brain is well

protected by the skull, the early detection of a brain tumor only occurs when diagnostic tools are directed at the intracranial cavity. Usually detection occurs in

advanced stages when the presence of the tumor has side effects that cause unexplained symptoms.

Primary (true) brain tumors are commonly located in the posterior cranial fossa in children and in the anterior two-thirds of the cerebral hemispheres in adults,

although they can affect any part of the brain.

Contents

[hide]

• 1 Taxonomy of brain tumors

o 1.1 By location and origin of the neoplasm

 1.1.1 Primary brain tumors

 1.1.2 Secondary brain tumors

o 1.2 By behavior of the neoplasm

• 2 Tumor development according to tissue type

o 2.1 Basic knowledge of the anatomy of the brain needed

for further reading

o 2.2 Meninges

o 2.3 Brain matter

o 2.4 Spinal cord and other tissues

• 3 In pediatrics

• 4 Prognosis

o 4.1 Glioblastoma multiforme

o 4.2 Oligodendrogliomas

• 5 Schematic overview of tumors

• 6 Characteristics of tumors
 • 7 Signs and symptoms

• 8 Diagnosis

• 9 Coping with the diagnosis

• 10 Treatment

o 10.1 Surgery

o 10.2 Radiation therapy

o 10.3 Chemotherapy

o 10.4 Research to treatment with the vesicular stomatitis

virus

• 11 Consequences for survivors

o 11.1 Physical consequences

o 11.2 Impact on the daily life of the family

o 11.3 Epileptic seizures

o 11.4 Psychological and behavioural consequences

o 11.5 Some practical consequences

 11.5.1 Driving

• 12 Occurence of Brain tumors

o 12.1 Worldwide figures

o 12.2 National figures

• 13 See also

• 14 References

• 15 External links

[edit]Taxonomy of brain tumors

[edit]By location and origin of the neoplasm

[edit]Primary brain tumors

Primary neoplasms of the brain are tumors that originate in the intracranial sphere or the central spinal canal, based on the organic tissues that make up the brain

and the spinal cord. From the brain-lemma we can learn a lot of things about the composition of the brain from different types of organic tissues. For the purpose

of this article we will discuss only some types.

 The brain itself is composed of neurons and glia (that function primarily as the physical support for neurons). The neuron itself is rarely the basis for a

tumor, though tumors of the glial cells are glioma and often are of the cancerous type.

 The brain is surrounded by a system of connective tissue membranes called meninges that separate the skull from the brain. Tumors of the meninges

are meningioma and are often benign neoplasms.

  Below the brain is pituitary and pineal gland which could be the basis for its own -albeit rare- kind of benign glandular neoplasms.

[edit]Secondary brain tumors

Secondary tumors of the brain are metastatic tumors that invaded the intracranial sphere from cancers primarily located in other organs. This means that a

(malignant) cancerous neoplasm has developed in another organ elsewhere in the body and that cancer cells leak from that primary tumor. The leaked cells enter

the lymphatic system and blood vessels, circulate through the bloodstream, and are deposited (strand in the small blood vessels in the brain) within normal tissue

elsewhere in the body, in this case in the brain. There these cells continue growing & dividing and become another invasive neoplai7tytfgdijrt5uyjdfsm of the

primary cancers tissue. Secondary tumors of the brain are very common in the terminal phases of patients with an incurable metastased cancer , most common

types of cancers that bring about secondary tumors of the brain are lung cancer, breast cancer and malignantmelanoma (skin cancer), kidney cancer and cancer

of the colon (in decreasing order of frequency).

Unfortunately enough this is the most common cause of neoplasms in the intracranial cavity.

The skull bone structure can also be subject to a neoplasm that by it very nature reduces the volume of the intracranial cavity, and can damage the brain.

[edit]By behavior of the neoplasm

Brain tumors or intracanial neoplasms can be cancerous (malignant) or non-cancerous (benign). However, the definitions of malignant or benign neoplasms differs

from those commonly used in other types of cancerous or non-cancerous neoplasms in the body. In ordinary cancers (elsewhere in the body) three malignant

properties differentiate benign tumors from malignant forms of cancer : benign tumors are self-limited and do not invade or metastasize. The malignant

characteristics of tumors are :

 uncontrolled mitosis (growth by division beyond the normal limits),

 Anaplasia. Is a term to explain that the cells in the neoplasm have an obvious different form (in size and shape). Anaplastic cells display

marked pleomorphism. The cell nuclei are characteristically extremely hyperchromatic (darkly stained) and enlarged; the nucleus might have the same size

as the cytoplasm of the cell (nuclear-cytoplasmic ratio may approach 1:1, instead of the normal 1:4 or 1:6 ratio). Giant cells that are considerably larger than

their neighbors may be formed and possess either one enormous nucleus or several nuclei (syncytia). Anaplastic nuclei are variable and bizarre in size and

shape.

 invasion or infiltration : in medical literature these terms are used as synonymous equivalents. However for clarity in the articles that follow we will

adhere to a convention that they mean slightly different things (so readers should be aware that this convention is not kept outside these articles) :

 Invasion or invasiveness is the spatial expansion of the tumor through the uncontrolled mitosis, in the sense that the neoplasm invades

the space occupied by adjacent tissue, thereby pushing the other tissue aside and eventually compressing the tissue. Often these tumors are

associated with clearly outlined tumors in imaging.

 Inflitration is the behavior of the tumor either to grow (microscopic) tentacles that push into the surrounding tissue (often making the

outline of the tumor undefined or diffuse) or to have tumor cells "seeded" into the tissue beyond the circumference of the tumorous mass; this doesn't

mean that an infiltrative tumor doesn't take up space or doesn't compress the surrounding tissue as it grows, but an infiltrating neoplasm makes it

difficult to say where the tumor ends and the healthy tissue starts.

 metastasis (spread to other locations in the body via lymph or blood).

Of the above malignant characteristics, some elements don't apply to primary neoplasms of the brain :

 Primary brain tumors rarely metastasize to other organs; some forms of primary brain tumors can metastasize but will not spread outside the

intracranial cavity or the central spinal canal. Due to the blood-brain barrier cancerous cells of a primary neoplasm cannot enter the bloodstream and get

carried to another location in the body. (Occasional isolated case reports suggest spread of certain brain tumors outside the central nervous system, e.g.

bone metastasis of glioblastoma multiforme [1].)

 Primary brain tumors generally are invasive (i.e. they will expand spatially and intrude into the space occupied by other brain tissue and compress

those brain tissues), however some of the more malignant primary brain tumors will infiltrate the surrounding tissue.

Of numerous grading systems in use for the classification of tumor of the central nervous system, the World Health Organization (WHO) grading system is

commonly used for astrocytoma. Established in 1993 in an effort to eliminate confusion regarding diagnoses, the WHO system established a four-tiered histologic

grading guideline for astrocytomas that assigns a grade from 1 to 4, with 1 being the least aggressive and 4 being the most aggressive.

[edit]Tumor development according to tissue type

[edit]Basic knowledge of the anatomy of the brain needed for further reading

From the brain-wikipedia article and for the purpose of understanding this article some summary notes about the brain and its different types of organic tissues will

be provided.

Main anatomical regions of the vertebrate brain

When reading the human brain in the picture on the left, only a few of the areas are really of interest to us. The first type of tissue encountered beneath the

skullbone in the intracranial cavity is actually not shown on this picture : the meninges

[edit]Meninges
Human brains are surrounded by a system of connective tissue membranes called meninges that separate the skull from the brain. This three-layered covering is

composed of (from the outside in) the dura mater ("hard mother"), arachnoid mater ("spidery mother"), and pia mater ("soft mother"). The arachnoid and pia are

physically connected and thus often considered as a single layer, the pia-arachnoid. Below the arachnoid is the subarachnoid space which contains cerebrospinal

fluid (CSF also called "liquor" in Latin), which circulates in the narrow spaces between cells and through cavities called ventricles, and serves to nourish, support,

and protect the brain tissue. Blood vessels enter the central nervous system through the perivascular space above the pia mater. The cells in the blood vessel

walls are joined tightly, forming the blood-brain barrier which protects the brain from toxins that might enter through the blood. Tumors of the meninges

are meningioma and are often benign neoplasms.

[edit]Brain matter

The brains of vertebrates (including humans) are made of very soft tissue, with a texture that has been compared to jello. Living brain tissue is pinkish on the

outside and mostly white on the inside, with subtle variations in color

 the telencephalon (cerebral hemispheres or cerebrum)

 mesencephalon (midbrain),

 cerebellum

make out the biggest volume of the brain. These areas are composed of two broad classes of cells: neurons and glia. These two types are equally numerous in

the brain as a whole, although glial cells outnumber neurons roughly 4 to 1 in the cerebral cortex. Glia come in several types, which perform a number of critical

functions, including structural support, metabolic support, insulation, and guidance of development.

Primary tumors of the glialcells are called Glioma and often are malignant by the time they are diagnosed.

[edit]Spinal cord and other tissues

 the pink area in the picture is called the pons it's a specific region that consists of myelinated axons much like the spinal cord ;

 the yellow region is the diencephalon(thalamus and hypothalamus) which consist also of neuron and glialcell tissue with the hypophysis

(or pituitary gland) and pineal glandattached at the bottom which is glandular tissue, tumors of the pituitary and pineal gland are often benign

neoplasms;

 the turquoise region or medulla oblongata is the end of the spinal cord and is composed mainly of neuron tissue enveloped in

Schwanncells and meninges tissue. Our spinal cord is made up of bundles of these axons. Glial cells such as Schwann cells in the periphery or, within

the cord itself, oligodendrocytes, wrap themselves around the axon, thus promoting faster transmission of electrical signals and also providing for

general maintenance of the environment surrounding the cord, in part by shuttling different compounds around, responding to injury, etc.

[edit]In pediatrics
A brain-stem glioma in four year old. MRIsagittal, without contrast

In the US, about 2000 children and adolescents younger than 20 years of age are diagnosed with malignant brain tumors each year. Higher incidence rates were

reported in 1975–83 than in 1985–94. There is some debate as to the reasons; one theory is that the trend is the result of improved diagnosis and reporting, since

the jump occurred at the same time that MRIs became available widely, and there was no coincident jump in mortality. The CNS cancer survival rate in children is

approximately 60%. The rate varies with the type of cancer and the age of onset: younger patients have higher mortality.[2]

In children under 2, about 70% of brain tumors are medulloblastoma, ependymoma, and low-grade glioma. Less commonly, and seen usually in infants,

are teratoma and atypical teratoid rhabdoid tumor.[3] Germ cell tumors, including teratoma, make up just 3% of pediatric primary brain tumors, but the worldwide

incidence varies significantly.[4]

[edit]Prognosis

The prognosis of brain cancer varies based on the type of cancer. Medulloblastoma has a good prognosis with chemotherapy, radiotherapy, surgical resection,

and chemotherapy while glioblastoma multiforme has a median survival of only 12 months even with aggressivechemoradiotherapy and surgery. Brainstem

gliomas have the poorest prognosis of any form of brain cancer, with most patients dying within one year, even with therapy that typically consists of radiation to

the tumor along with corticosteroids. However, one type of brainstem glioma, a focal[5] seems open to exceptional prognosis and long-term survival has frequently

been reported.

[edit]Glioblastoma multiforme

Main article: Glioblastoma multiforme

Glioblastoma multiforme is the deadliest and most common form of malignant brain tumor. Even when aggressive multimodality therapy consisting of radiotherapy,

chemotherapy, and surgical excision is used, median survival is only 12–17 months. Standard therapy for glioblastoma multiforme consists of maximal surgical

resection of the tumor, followed by radiotherapy between two and four weeks after the surgical procedure to remove the cancer. This is followed by chemotherapy.

Most patients with glioblastoma take a corticosteroid, typically dexamethasone, during their illness to palliate symptoms. Experimental treatments include gamma-

knife radiosurgery.[6]

[edit]Oligodendrogliomas

Main article: Oligodendroglioma

Oligodendroglioma is an incurable but slowly progressive malignant brain tumor. They can be treated with chemotherapy, surgical resection, and radiotherapy, but

initially most neuro-oncologists opt for a course of watchful waiting, with only symptomatic therapy. Median survival for these types of tumors is up to 11.6 years in

cases of low grade oligodendroglioma.

[edit]Schematic overview of tumors

[show]
v•d•e
Nervous tissue tumors/NS neoplasm/Neuroectodermal tumor (ICD-O 9350-9589) (C70-C72/D32-D33, 191-192/225)

[edit]Characteristics of tumors

Tumors have characteristics that allow pathologists to determine how dangerous a tumor is/was for the patient, how it will evolve and it will allow the medical team

to determine the management plan for the patient.

Anaplasia : or dedifferentiation; loss of differentiation of cells and of their orientation to one another and blood vessels, a characteristic of anaplastic tumor tissue.

Anaplastic cells have lost total control of their normal functions and many have deteriorated cell structures. Anaplastic cells often have abnormally high nuclear-to-

cytoplasmic ratios, and many are multinucleated. Additionally, the nuclei of anaplastic cells are usually unnaturally shaped or oversized nuclei. Cells can become

anaplastic in two ways: neoplastic tumor cells can dedifferentiate to become anaplasias (the dedifferentiation causes the cells to lose all of their normal

structure/function), or cancer stem cells can increase in their capacity to multiply (i.e., uncontrollable growth due to failure of differentiation).

Atypia: is an indication of abnormality of a cell (which may be indicative for malignancy). Significance of the abnormality is highly dependent on context.

Neoplasia: is the (uncontrolled) division of cells; as such neoplasia is not problematic but its consequences are: the uncontrolled division of cells means that the

mass of a neoplasm increases in size, in a confined space such as the intracranial cavity this quickly becomes problematic because the mass invades the space

of the brain pushing it aside, leading to compression of the brain tissue and increased intracranial pressure [7] and destruction of brain parenchyma. Increased

Intracranial pressure (ICP) may be attributable to the direct mass effect of the tumor, increased blood volume, or increased cerebrospinal fluid (CSF) volume may

in turn have secondary symptoms

Necrosis: is the (premature) death of cells, caused by external factors such as infection, toxin or trauma. Necrotic cells send the wrong chemical signals which

prevents phagocytes from disposing of the dead cells, leading to a build up of dead tissue, cell debris an toxins at or near the site of the necrotic cells [8]

Arterial and venous hypoxia or the deprivation of adequate oxygen supply to certain areas of the brain, this is due to the fact that the tumor taps into nearby

bloodvessels for its supply of blood, the neoplasm enters into competition for nutrients with the surrounding braintissue.

More generally a neoplasm may cause release of metabolic end products (e.g., free radicals, altered electrolytes, neurotransmitters), release and recruitment of

cellular mediators (e.g., cytokines) that disrupt normal parenchymal function.

[show]
v•d•e
Pathology: Tumor, Neoplasm, Cancer, and Oncology (C00-D48, 140-239)

[edit]Signs and symptoms

This section may require cleanup to meet Wikipedia's quality standards. Please improve this section if you can. (June 2010)
The visibility of signs and symptoms of brain tumors mainly depends on two factors: tumor size (volume) and tumor location. The moment that symptoms will

become apparent, either to the person or people around him (symptom onset) is an important milestone in the course of the diagnosis and treatment of the tumor.

The symptom onset - in the timeline of the development of the neoplasm - depends in many cases on the nature of the tumor but in many cases it's also related to

the change of the neoplasms nature from "benign" (i.e. slow-growing/late symptom onset) to more malignant (fast growing/early symptom onset) grading, and

Sightly frequently with the moment for seeking medical attention.

Symptoms of solid neoplasms of the brain (primary brain tumors and secondary tumors alike) can be divided is 3 main categories :

 Consequences of intracranial hypertension : The symptoms that often occur first are those that are the consequences of increased intracranial

pressure: Large tumors or tumors with extensive perifocal swelling (edema) inevitably lead to elevated intracranial pressure (intracranial hypertension),

which translates clinically into headaches, vomiting (sometimes without nausea), altered state of consciousness (somnolence, coma), dilatation of the pupil

on the side of the lesion (anisocoria), papilledema (prominent optic disc at the funduscopic eye examination). However, even small tumors obstructing the

passage of cerebrospinal fluid (CSF) may cause early signs of increased intracranial pressure. Increased intracranial pressure may result in herniation (i.e.

displacement) of certain parts of the brain, such as the cerebellar tonsils or the temporal uncus, resulting in lethal brainstem compression. In very young

children, elevated intracranial pressure may cause an increase in the diameter of the skull and bulging of the fontanelles.

 Dysfunction : depending on the tumor location and the damage it may have caused to surrounding brain structures, either through compression or

infiltration, any type of focal neurologic symptoms may occur, such as cognitive and behavioral impairment (including impaired judgment, memory loss, lack

of recognition, spatial orientation disorders),personality or emotional changes, hemiparesis, hypoesthesia, aphasia, ataxia, visual field impairment, impaired

sense of smell, impaired hearing, facial paralysis, double vision, but more severe symptoms might accur too such as: paralysis on one side of the

body hemiplegia or impairment to swallow . These symptoms are not specific for brain tumors — they may be caused by a large variety of neurologic

conditions (e.g. stroke, traumatic brain injury). What counts, however, is the location of the lesion and the functional systems (e.g.motor, sensory, visual,

etc.) it affects. A bilateral temporal visual field defect (bitemporal hemianopia—due to compression of the optic chiasm), often associated with endocrine

disfunction—either hypopituitarism or hyperproduction of pituitary hormones and hyperprolactinemia is suggestive of a pituitary tumor.

 Irritation : signs abnormal fatigue, weariness, absences and tremors, but also epileptic seizures.

The above symptoms are true for ALL types of Neoplasm of the brain (i.e. that includes secondary tumors). It is very likely that a person might carry a primary

benign neoplasme for several years and have no visible symptoms at all, or suffer no effects. Many present some vague an intermittent symptoms like headaches

and occasional vomiting, and weariness which is easily mistaken for gastritis or gastroenteritis. It might seem strange that despite having a mass in his skull

exercising pressure on the brain the patient feels no pain, while headaches could cause an excrutiating pain. If you ever suffered a concussion due to a fall you

might remember that the bump on the outside of your skull was painful but there was no pain inside your head. The brain has on his outside (in the meninges) no

nervesensors to feel and transmit pain to the brains pain center, it cannot signal pain if it doesn't get a sensory input. That is why secondary symptoms like those

described above should alert doctors to the possible diagnosis of a neoplasm of the brain.

If a person suffering from a metastasized cancer is diagnosed it wil be likely that a scan of the skull will be made and a secondary tumor discovered.
In a recent study by the Dutch GP Association [1], a list of causes of headaches [2] was published, that should alert GP's to take their diagnosis further then to

choose for symptomatic treatment of headaches with simple pain medication (note the occurence of brain tumors as possible cause) :

Alarm Signals Possible Cause to be investigated

first headache complaint from patient over 50 brain tumor, arteriïtis temporalis

first migaine attack in patient over 40 brain tumor

headache from patient under 6 brain tumor, hydrocephalus

senior patient with pain at temples arteriïtis temporalis

pregnancy with unknown headache pre-eclampsia

increased headaches after trauma sub/epidural hematoma

high-pitched headaches with high bloodpressure malign hypertension

acute high pitched headache meningitis, CVA (Cerebrovascular accident or stroke), subarachnoïdal hemorrage

headache and fever (with reduced consciencesness) meningitis

Stiffness of the neck/neurological dysfunction meningitis, brain tumor

headache with signs of elevated intracranial pressure brain tumor

focal neurological dysfunction brain tumor

early morning vomiting or vomiting unrelated to headache brain tumor

behavioural changes or rapid decline in school results brain tumor

aura migraine always at one side brain tumor

[edit]Diagnosis
Although there is no specific or singular clinical symptom or sign for any brain tumors, the presence of a combination of symptoms and the lack of corresponding

clinical indications of infections might be an indicator to step up the diagnostic investigation to the direction of an intracranial neoplasm.

The diagnosis will often start with an interrogation of the patient to get a clear view of his medical antecedents, and his current symptoms. Clinical and laboratory

investigations will serve to exclude infections as cause of the symptoms. Examinations in this stage may include ophtamological, otolaryngological (or ENT) and/or

Electrophysiological exams, other means such as electroencephalography (EEG) play a role in the diagnosis of brain tumors.

Swelling, or obstructing the passage of cerebrospinal fluid (CSF) may cause (early) signs of increased intracranial pressure which translates clinically

into headaches, vomiting, or an altered state of consciousness, (and in children) changes to the diameter of the skull and bulging of the fontanelles. More complex

symptoms such as endocrine dysfunctions should alarm doctors not to exclude brain tumors.

A bilateral temporal visual field defect (due to compression of the optic chiasm) or dilatation of the pupil, and the occurrence of either slowly evolving or the sudden

onset of focal neurologic symptoms, such as cognitive and behavioral impairment (including impaired judgment, memory loss, lack of recognition, spatial

orientation disorders), personality or emotional changes, hemiparesis, hypoesthesia, aphasia, ataxia, visual field impairment, impaired sense of smell, impaired

hearing, facial paralysis, double vision, but also more severe symptoms might accur too such as: tremors, paralysis on one side of the body hemiplegia, but also

(epileptic) seizures in a patient with a negative history for epilepsy, impairment to swallow should raise red flags.

Micrograph of an oligodendroglioma, a type ofbrain cancer. Brain biopsy. H&E stain.

Imaging plays a central role in the diagnosis of brain tumors. Early imaging methods —invasive and sometimes dangerous— such

aspneumoencephalography and cerebral angiography, have been abandoned in recent times in favor of non-invasive, high-resolution techniques, such

as computed tomography (CT)-scans and especially magnetic resonance imaging (MRI). Neoplasms will often show as differently coloured masses (also referred

to as processes) in CT or MRI results.

 Benign brain tumors often show up as hypodense (darker than brain tissue) mass lesions on cranial CT-scans. On MRI, they appear either hypo-

(darker than brain tissue) or isointense (same intensity as brain tissue) on T1-weighted scans, or hyperintense (brighter than brain tissue) on T2-weighted

MRI, although the appearance is variable.

 Contrast agent uptake, sometimes in characteristic patterns, can be demonstrated on either CT or MRI-scans in most malignant primary and

metastatic brain tumors.

 Perifocal edema , or pressure-areas, or where the brain tissue has been compressed by an invasive process also appears hyperintense on T2-

weighted MRI, they might indicate the presence a diffuse neoplasm (unclear outline)
This is because these tumors disrupt the normal functioning of the blood-brain barrier and lead to an increase in its permeability. However it is not possible to

diagnose high versus low grame gliomas based on enhancement pattern alone.

Another possible diagnostic indicator would be neurofibromatosis which can be in type one or type two.

Glioblastoma multiforme and anaplastic astrocytoma have been associated in case reports on PubMed[who?] with the genetic acute

hepatic porphyrias (PCT, AIP, HCP and VP), including positive testing associated with drug refractory seizures. Unexplained complications associated with drug

treatments with these tumors should alert physicians to an undiagnosed neurological porphyria.

The definitive diagnosis of brain tumor can only be confirmed by histological examination of tumor tissue samples obtained either by means of brain biopsy or

open surgery. The histological examination is essential for determining the appropriate treatment and the correct prognosis. This examination, performed by

a pathologist, typically has three stages: interoperative examination of fresh tissue, preliminary microscopic examination of prepared tissues, and followup

examination of prepared tissues after immunohistochemical staining or genetic analysis.

[edit]Coping with the diagnosis

This section may require cleanup to meet Wikipedia's quality standards. Please improve this section if you can. (June 2010)

Being diagnosed with a brain tumor can be overwhelming. As you come to terms with your diagnosis, your life will most certainly be turned upside down with visits

to doctors and surgeons as you prepare for your treatment. Some advice to help you cope :

 Learn whatever you can or want to know about your specific neoplasm. Ask your medical team where you can get more information about it and your

treatment options. Patient groups may help you get to reliable information and post treatment support.

 Make sure you verify the information comes from reliable resources including your library and online sources.

 Write down your questions so that you'll remember to ask them at your next appointment with your doctor.

 The more you know about your condition, the better prepared you'll be to make decisions about your treatment.

 Make a timetable and the questions you will need to ask at that time even if you understand them now that might not be the case post-

surgery.

 Build a support network is your most imperative task before surgery

 if you are an adult patient and you don't have family carers that can come and support you, you should initiate contacts with patient-

support groups to have a volunteer come for regular visits who can support and inform you, help you talk to the doctors and plan regular update

appointments to help you through the initial recovery (until you are sufficiently advanced in cognitive rehabilitation);

 to interface for you with the reality outside the hospital (time doesn't stop, it stops only in your head) and support you with any assistance

you will need until you have sufficiently recovered to return to some measure of independent life. Please note that you might need to foresee a

translator if you are not a native speaker of the local language or if you happen do be in a foreign country (to help you understand doctor in you native

language);
  until you come off anti-epileptica (medication that prevents epileptic seizures you should never be left alone, so if you are a single and

living alone in your house or apartment you should not return to your home, away from some form of supervised care until you are free of epileptic

seizures (neighbours don't suffice, even flatsharing singles (i.e. students) should not depend on their flatmates;

 if you a parent of a child or an adolescent patient : both the patient and his family carers & siblings need outside support : arrange it; as a

family carer you have the pre-operative period and the initial recovery to prepare.

 Apart from you family supporting you after surgery you should also address your friends, this can scare them away because they have difficulty giving

themselves a place in your situation and life (so give them a chance in advance.

 Making contacts with patient-support groups is essential : they can provide a wide range of home-coming support, transport for out-patient (radio-

therapy) treatments, assistance with transport (patients will be unable to drive a car fo some time after surgery), activities with other patients and their

relatives.

 You may find it helps to have someone to talk to about your emotions. Other people who may provide support include social workers and

psychologists — ask your medical team for a referral if you feel that you need someone else to talk to. Talk with your pastor, rabbi or other spiritual leader in

order to pay you regular visits, you may not be able to ask for their visit when you need it, because of your mental state (lack of initiative). Other people with

similar experiences can offer a unique perspective, so consider joining a support group — whether it's in your community or online. Ask your health care

team about brain tumor support groups in your area, or contact an organisation like American Brain Tumor Association or whatever equivalent in your

country of residence.

 Take care of yourself. Try to stay healthy during your treatment for a meningioma by taking care of yourself. Eat a diet rich in fruits and vegetables and

get moderate exercise daily if your doctor allows it. Get enough sleep so that you wake feeling rested. Reduce stress in your life by focusing on what's

important to you. These measures won't cure your meningioma, but they may help you feel better as you recover from surgery or help you to cope during

radiation therapy.[9]

[edit]Treatment

When a brain tumor is diagnosed, a medical team will be formed to assess the options of treatment presented by the leading surgeon to the patient and his family.

Given the location of primary solid neoplasms of the brain in most cases there is no "do-nothing" option, neurosurgeons do take the time to observe the evolution

of the neoplasm before proposing a management plan to the patient and his relatives. Different types of treatment are available to the doctors and can be

combined to give the best chances of survival :

 surgery : complete or partial ressection of the tumor ; objective : to remove as many tumor cells as possible

 radiotherapy

 chemotherapy

 kill as many as possible of the cells left behind

 put remaining tumor cells into a nondividing, sleeping state for as long as possible

Survival rates in primary brain tumors depend on the type of tumor, age, functional status of the patient, the extent of surgical tumor removal, to mention just a few

factors.[10]

[edit]Surgery
The primary course of action described in medical literature is surgical removal (ressection), a craniotomy(to open the skull) to best access the tumor site, currently

minimal invasive techniques are being studied but far form being common practise. The prime remediating objective of surgery is to remove as many tumorcells as

possible, in any case surgery will reduce the tumor size and will attempt to completely remove the neoplasm. In some cases access to the tumor is impossible and

impedes surgery.

Many meningiomas, with the exception of some tumors located at the skull base, can be successfully removed surgically. Most pituitary adenomas can be

removed surgically, often using a minimally invasive approach through the nasal cavity and skull base (trans-nasal, trans-sphenoidal approach). Large pituitary

adenomas require a craniotomy (opening of the skull) for their removal. Radiotherapy, including stereotactic approaches, is reserved for the inoperable cases.

Although there is no generally accepted therapeutic management for primary brain tumors, a surgical attempt at tumor removal or at least cytoreduction (that is,

removal of as much tumor as possible, in order to reduce the number of tumor cells available for proliferation) is considered in most cases.[11] However, due to the

infiltrative nature of these lesions, tumor recurrence, even following an apparently complete surgical removal, is not uncommon. Several current research studies

aim to improve the surgical removal of brain tumors by labeling tumor cells with a chemical (5-aminolevulinic acid) that causes them to fluoresce [12]. Postoperative

radiotherapy and chemotherapy are integral parts of the therapeutic standard for malignant tumors. Radiotherapy may also be administered in cases of "low-

grade" gliomas, when a significant tumor burden reduction could not be achieved surgically.

The main treatment option for single metastatic tumors is surgical removal, followed by radiotherapy and/or chemotherapy. Multiple metastatic tumors are

generally treated with radiotherapy and chemotherapy. Stereotactic radiosurgery (SRS), such as Gamma Knife, Cyberknife or Novalis Tx, radiosurgery, remains a

viable option. However, the prognosis in such cases is determined by the primary tumor, and it is generally poor.

[edit]Radiation therapy

The goal of radiation therapy is to selectively kill tumor cells while leaving normal brain tissue unharmed. In standard external beam radiation therapy, multiple

treatments of standard-dose "fractions" of radiation are applied to the brain. Each treatment induces damage to both healthy and normal tissue. By the time the

next treatment is given, most of the normal cells have repaired the damage, but the tumor tissue has not. This process is repeated for a total of 10 to 30

treatments, depending on the type of tumor. This additional treatment provides some patients with improved outcomes and longer survival rates.

Radiosurgery is a treatment method that uses computerized calculations to focus radiation at the site of the tumor while minimizing the radiation dose to the

surrounding brain. Radiosurgery may be an adjunct to other treatments, or it may represent the primary treatment technique for some tumors.

Radiotherpy may be used if there is incomplete resection of the tumor. Forms of radiotherapy used for brain cancer include external beam radiation

therapy, brachytherapy ,and in more difficult cases, stereotactic radiosurgery, such as Gamma knife, Cyberknife or Novalis Tx radiosurgery, remains a viable

option. [13]

Radiotherapy is the most common treatment for secondary cancer brain tumors. The amount of radiotherapy depends on the size of the area of the brain affected

by cancer. Conventional external beam whole brain radiotherapy treatment (WBRT) or 'whole brain irradiation' may be suggested if there is a risk that other

secondary tumors will develop in the future.[14]Stereotactic radiotherapy is usually recommended in cases of under three small secondary brain tumors.

In 2008 a study published by the University of Texas M. D. Anderson Cancer Center indicated that cancer patients who receive stereotactic radiosurgery (SRS)

and whole brain radiation therapy (WBRT) for the treatment of metastatic brain tumors have more than twice the risk of developing learning and memory problems

than those treated with SRS alone.[15][16]

[edit]Chemotherapy
Patients undergoing chemotherapy are administered special drugs designed to kill tumor cells. Although chemotherapy may improve overall survival in patients

with the most malignant primary brain tumors, it does so in only about 20 percent of patients. Chemotherapy is often used in young children instead of radiation, as

radiation may have negative effects on the developing brain. The decision to prescribe this treatment is based on a patient’s overall health, type of tumor, and

extent of the cancer. The toxicity, the many side effects and the uncertain outcome of chemotherapy in braintumors puts this treatment further down the line op

treatment options for medical teams.

UCLA Neuro-Oncology publishes real-time survival data for patients with this diagnosis. They are the only institution in the United States that shows how brain

tumor patients are performing on current therapies. They also show a listing of chemotherapy agents used to treat high grade glioma tumors.

A shunt operation is used not as a cure but to relieve the symptoms.[3] The hydrocephalus caused by the blocking drainage of the cerebrospinal fluid can be

removed with this operation.

Researchers are presently investigating a number of promising new treatments including gene therapy, highly focused radiation therapy, immunotherapy and

novel chemotherapies. A number of new treatments are being made available on an investigational basis at centers specializing in brain tumor therapies.