Diseases and Conditions
Brain Tumors We Treat
Glioblastoma multiforme (GBM) is the most common and most aggressive malignant primary brain tumor in humans, involving glial cells and accounting for 52 percent of all functional tissue brain tumor cases and 20 percent of all intracranial tumors. Despite being the most prevalent form of primary brain tumor, GBMs occur in only two or three cases per 100,000 people in Europe and North America. Treatment usually involves surgery, chemotherapy and radiation therapy. Administering corticosteroids for brain swelling may help to reduce the symptoms from the tumor. More novel techniques such as anti-angiogenic therapy and immunotherapy are also utilized to treat this malignant entity.
Metastatic Brain Tumors
Metastatic brain tumors are the most common brain tumors. Many tumors or cancer types can spread to the brain, the most common being lung cancer, breast cancer, melanoma, kidney cancer, bladder cancer, certain sarcomas, testicular and germ cell tumors, and a number of others.
Some types of cancers only spread to the brain infrequently, such as colon cancer or, very rarely, prostate cancer. These tumors can produce headaches and neurological deficits depending on their location within the brain. Treatment of these types of tumors is primarily surgery and chemotherapy, along with fractionated radiotherapy. In many cases, if the number and size of lesions permit, radiosurgery can be the primary mode of treatment.
A meningioma is a type of tumor that develops from the meninges, the membrane that surrounds the brain and spinal cord. Most meningiomas (90 percent) are categorized as benign tumors, with the remaining 10 percent being atypical or malignant. However, the word "benign" can be misleading in this case. When benign tumors grow and constrict and affect the brain, they can cause disability and even be life threatening.
Meningiomas are most common in people between the ages of 40 and 70. They are more common in women than in men. Treatment for meningiomas may include serial imaging with only observation if the lesion is asymptomatic. Other treatments include surgery, radiosurgery or fractionated radiotherapy.
Pituitary adenomas arise from the pituitary gland itself and account for 15-20 percent of primary brain tumors and are the third most common intracranial tumor after gliomas and meningiomas. More than 99 percent of pituitary adenomas are benign (not malignant or cancerous) and are slow growing. From autopsy studies and MRIs of normal individuals, it is known that 10-20 percent of the general population has a pituitary adenoma. Most of these tumors remain small and do not cause significant harm or symptoms. Many do progress, however, and grow to cause major hormonal and neurological problems. The mainstay of treatment for these lesions is typically transphenoidal surgery for removal of the tumor. Some tumors may respond to medical therapies and radiation therapy as well.
Astrocytomas are a type of neoplasm of the brain. They originate in a particular kind of glial cell (supporting cell) that is a star-shaped brain cell called an astrocyte. This type of tumor does not usually spread outside the brain and spinal cord, nor does it usually affect other organs. These tumors are usually graded into four separate categories based on their features, reflecting the malignant potential of the tumor in terms of invasion and growth rate. Treatment of these types of tumors is usually surgery, accompanied by chemotherapy and radiotherapy.
The supporting cells in the brain that support nerve cells are called glial cells. A tumor of these cells is known as a glioma. Oligodendroglioma is a type of glioma and develops from cells called oligodendrocytes. Oligodendrogliomas are divided into two types: a slow-growing tumor or a more aggressive anaplastic form, which grows more quickly.
Treatment usually involves seizure control with anti-epileptic medications. Treatment for these tumors is usually surgery, accompanied by chemotherapy and radiotherapy. Certain genetic variations in these tumors may make some more susceptible to chemotherapy.
An ependymoma is a tumor that arises from the ependyma, a tissue of the central nervous system. Usually, in pediatric cases the location is intracranial, while in adults it is spinal. The most common location of intracranial ependymoma is the fourth ventricle.
Ependymomas make up about 5 percent of adult intracranial gliomas and up to 10 percent of childhood tumors of the central nervous system (CNS). Their occurrence seems to peak at five years of age, and then again at age 35. They develop from cells that line both the hollow cavities of the brain and the spinal cord's central canal.
Ependymomas are also seen in patients with neurofibromatosis type 2. Treatment for ependymomas is usually surgery, which can be curative in many cases. In other cases, radiotherapy may be necessary for additional treatment.
A craniopharyngioma is a slow-growing, benign brain tumor that occurs more often in children than in adults. It is not malignant, but it can behave aggressively, damaging surrounding structures. Typically, there are no symptoms in the early stages of the disease, making diagnosis difficult. As a result, people often seek treatment only after the tumor has damaged nearby structures, causing vision changes, hormonal changes or injury to another part of the brain. Treatment for craniopharyngioma is typically surgical resection. Residual or recurrent tumor may be treated with radiation therapy.
Pineal Region Tumors
This entity represents a brain tumor on or near the pineal gland. There are at least 17 types of pineal gland tumors, most of which are not cancerous but can nonetheless cause neurological dysfunction. They account for about 1 percent of brain tumors in adults, but up to 8 percent of such tumors in children. Symptoms can include frozen upward gaze, hydrocephalus and precocious puberty. Treatment of benign pineal tumors is by surgery. Malignant tumors are usually treated with radiation followed by chemotherapy.
Primary CNS Lymphoma
Lymphoma is a disease in which malignant (cancer) cells form in the body's lymphatic system. Primary CNS lymphoma can start in the brain, in the spinal cord or in the coverings of the brain. Typically, primary CNS lymphoma occurs in patients that have acquired immunodeficiency syndrome (AIDS) or other disorders of the immune system, or that have had a kidney transplant. Diagnosis of primary CNS lymphoma may require surgical biopsy, but the mainstay of treatment is usually corticosteroids, along with chemotherapy and, rarely, radiation therapy.
Acoustic neuroma-or more appropriately termed vestibular schwannoma-is a tumor that arises from the cells that form the covering of a particular cranial nerve. These tumors are usually located in the cerebello-pontine angle and can sometimes invade the region of the inner ear. Patients typically present with progressive hearing loss or difficulty with their balance. Treatment for these tumors may involve radiation therapy and/or surgical removal.
The Montefiore Einstein Center for Cancer Care also treats a variety of rare skull-base lesions. These include, but are not limited to, chondrosarcoma, chordoma, sino-nasal carcinoma and esthesioneuroblastoma.