Brain tumors that begin in the brain

Primary brain tumors originate in the brain itself or in tissues close to it, such as in the brain-covering membranes (meninges), cranial nerves, pituitary gland or pineal gland.

Primary brain tumors begin when normal cells acquire errors (mutations) in their DNA. These mutations allow cells to grow and divide at increased rates and to continue living when healthy cells would die. The result is a mass of abnormal cells, which forms a tumor.

In adults, primary brain tumors are much less common than are secondary brain tumors, in which cancer begins elsewhere and spreads to the brain.

Many different types of primary brain tumors exist. Each gets its name from the type of cells involved. Examples include:

• Gliomas. These tumors begin in the brain or spinal cord and include astrocytomas, ependymomas, glioblastomas, oligoastrocytomas and oligodendrogliomas.
• Meningiomas. A meningioma is a tumor that arises from the membranes that surround your brain and spinal cord (meninges). Most meningiomas are noncancerous.
• Acoustic neuromas (schwannomas). These are benign tumors that develop on the nerves that control balance and hearing leading from your inner ear to your brain.
• Pituitary adenomas. These are mostly benign tumors that develop in the pituitary gland at the base of the brain. These tumors can affect the pituitary hormones with effects throughout the body.
• Medulloblastomas. These are the most common cancerous brain tumors in children. A medulloblastoma starts in the lower back part of the brain and tends to spread through the spinal fluid. These tumors are less common in adults, but they do occur.
• Germ cell tumors. Germ cell tumors may develop during childhood where the testicles or ovaries will form. But sometimes germ cell tumors affect other parts of the body, such as the brain.
• Craniopharyngiomas. These rare, noncancerous tumors start near the brain's pituitary gland, which secretes hormones that control many body functions. As the craniopharyngioma slowly grows, it can affect the pituitary gland and other structures near the brain.

Cancer that begins elsewhere and spreads to the brain

Secondary (metastatic) brain tumors are tumors that result from cancer that starts elsewhere in your body and then spreads (metastasizes) to your brain.

Secondary brain tumors most often occur in people who have a history of cancer. But in rare cases, a metastatic brain tumor may be the first sign of cancer that began elsewhere in your body.

In adults, secondary brain tumors are far more common than are primary brain tumors.

Any cancer can spread to the brain, but common types include:

• Breast cancer
• Colon cancer
• Kidney cancer
• Lung cancer
• Melanoma

Alternative medicine

Little research has been done on complementary and alternative brain tumor treatments. No alternative treatments have been proved to cure brain tumors. However, complementary treatments may help you cope with the stress of a brain tumor diagnosis.

Some complementary treatments that may help you cope include:

• Acupuncture
• Art therapy
• Exercise
• Meditation
• Music therapy
• Relaxation exercises

Talk with your doctor about your options.

Coping and support

A diagnosis of a brain tumor can be overwhelming and frightening. It can make you feel like you have little control over your health. But you can take steps to cope with the shock and grief that may come after your diagnosis. Consider trying to:

• Learn enough about brain tumors to make decisions about your care. Ask your doctor about your specific type of brain tumor, including your treatment options and, if you like, your prognosis. As you learn more about brain tumors, you may become more confident in making treatment decisions.
• Keep friends and family close. Keeping your close relationships strong will help you deal with your brain tumor. Friends and family can provide the practical support you'll need, such as helping take care of your house if you're in the hospital. And they can serve as emotional support when you feel overwhelmed by cancer.
• Find someone to talk with. Find a good listener who is willing to listen to you talk about your hopes and fears. This may be a friend or family member. The concern and understanding of a counselor, medical social worker, clergy member or cancer support group also may be helpful.

Ask your doctor about support groups in your area. Or check your phone book, library or a cancer organization, such as the National Cancer Institute or the American Cancer Society.

Overview

Embryonal tumors are growths of cells that happen in the brain. The growths involve cells that are left over from fetal development, called embryonal cells.

Embryonal tumors are a type of brain cancer, also called malignant brain tumor. This means the cells that make up the tumor can grow to invade the brain and cause damage to healthy brain tissue. They also can spread through the fluid that surrounds the brain and spinal cord, called cerebrospinal fluid.

Embryonal tumors most often happen in babies and young children. But they can happen at any age.

There are several kinds of embryonal tumors. The most common is medulloblastoma. This type of embryonal tumor starts in the lower back part of the brain, called the cerebellum.

If your child is diagnosed with an embryonal tumor, seek care at a medical center that has experience caring for children with brain tumors. Medical centers with expertise in pediatric brain tumors provide access to the latest treatments and technology to ensure proper diagnosis and treatment.

Symptoms

Symptoms of an embryonal tumor may include:

• Headaches.
• Nausea.
• Vomiting.
• Feeling more tired than usual.
• Double vision.
• Difficulty with balance.
• Seizures.

When to see a doctor

Make an appointment with a doctor or other healthcare professional if you have any symptoms that worry you.

Causes

The cause of an embryonal tumor often isn't known. This cancer causes a growth of cells in the brain. The growth involves cells that are left over from fetal development, called embryonal cells.

Embryonal tumors start when embryonal cells develop changes in their DNA. A cell's DNA holds the instructions that tell the cell what to do. In healthy cells, the DNA gives instructions to grow and multiply at a set rate. The instructions tell the cells to die at a set time. In cancer cells, the DNA changes give different instructions. The changes tell the cancer cells to grow and multiply quickly. Cancer cells can keep living when healthy cells would die. This causes too many cells.

The cancer cells might form a mass called a tumor. The tumor can grow and press on parts of the brain. The cancer cells also can travel in the fluid that supports the brain and spine. This can spread the cancer to other parts of the brain and spinal cord. When cancer spreads, it's called metastatic cancer.

Risk factors

Risk factors for embryonal tumors include:

• Young age. This cancer can happen at any age. But it happens most often in children.
• Hereditary syndromes. Some conditions that run in families can raise the risk of embryonal tumor. Examples include Fanconi anemia, Li-Fraumeni syndrome, nevoid basal cell carcinoma syndrome, Rubinstein-Taybi syndrome and Turcot syndrome.

Diagnosis

Your healthcare team reviews your child's medical history and symptoms. Tests and procedures used to diagnose embryonal tumors include:

• Neurological exam. During this procedure, vision, hearing, balance, strength, coordination and reflexes are tested. This helps find out which part of the brain might be affected by the tumor.
• Imaging tests. Imaging tests make pictures of the brain. The pictures can show the size and location of the tumor. The pictures may show pressure or blockages of the fluid in the brain. CT and MRI are often used to diagnose brain tumors. Advanced techniques, such as perfusion MRI and magnetic resonance spectroscopy, also may be used.
• Removal of tissue for testing. A biopsy is a procedure to remove a sample of tissue from the tumor for testing. The sample is often taken during surgery to remove the tumor. Your child's healthcare team may want to remove tissue before surgery if the imaging tests show features that aren't typical of embryonal tumors. The tissue is looked at in a lab to determine the types of cells.
• Removal of cerebrospinal fluid for testing. A spinal tap, also called a lumbar puncture, involves inserting a needle between two bones in the lower spine. The needle draws out the fluid from around the spinal cord. The fluid, called cerebrospinal fluid, is tested to look for tumor cells or other things that aren't typical. This test is only done after managing the pressure in the brain or removing the tumor.

Treatment

Treatment for embryonal tumors usually involves surgery. Other treatments might be used after surgery to reduce the risk that the tumor may come back. Which treatments are best for your child depends on your child's age. Your child's healthcare team also considers the type of embryonal tumor and its location.

Embryonal tumor treatment options may include:

• Surgery to relieve fluid buildup in the brain. Some embryonal tumors may block the flow of fluid in the brain. This can cause a buildup of fluid that puts pressure on the brain, called hydrocephalus. To reduce the pressure, a brain surgeon, also called a neurosurgeon, can create a pathway for the fluid to flow out of the brain. Sometimes this procedure can be combined with surgery to remove the tumor.
• Surgery to remove the tumor. A brain surgeon removes as much of the tumor as possible. The surgeon takes care not to harm nearby tissue. Typically, children with embryonal tumors receive additional treatments after surgery to target any remaining cancer cells.
• Radiation therapy. Radiation therapy uses powerful energy beams to kill tumor cells. The energy can come from X-rays, protons and other sources. During radiation therapy, a machine directs beams of energy to specific points on the body. Standard radiation uses X-rays. A newer form of radiation uses proton beams. Proton beam radiation can be carefully targeted to deliver the radiation to the area of the tumor or other areas at risk. This lowers the risk of hurting nearby healthy tissue. Proton beam therapy is available at a limited number of healthcare centers in the United States.
• Chemotherapy. Chemotherapy uses strong medicines to kill tumor cells. Many chemotherapy medicines are given through a vein, but some are taken in pill form. Chemotherapy may be recommended after surgery or radiation therapy. Sometimes it's done at the same time as radiation therapy.
• Clinical trials. Clinical trials are studies of new treatments. These studies give your child a chance to try the latest treatment options. The risk of side effects for these treatments may not be known. Ask a member of the healthcare team whether your child can participate in a clinical trial.

Preparing for an appointment

Make an appointment with a doctor or other healthcare professional if your child has any symptoms that worry you. If your health professional thinks your child may have an embryonal tumor, that person may refer you to a specialist. Often, this is a doctor who specializes in cancer that affects children, called a pediatric oncologist.

Appointments can be short, and being prepared can help. Here's some information that may help you get ready for your child's visit.

What you can do

When you make the appointment, ask if there's anything you need to do for your child in advance, such as fasting before having a specific test. Make a list of:

• Your child's symptoms, including any that seem unrelated to the reason for the appointment.
• Key personal information, including recent life changes and family medical history.
• All medicines, vitamins or other supplements your child takes, including the doses.
• Questions to ask your child's healthcare professional.

For embryonal tumors, some basic questions to ask your child's healthcare professional include:

• Does my child have cancer?
• Does my child need more tests?
• What are my child's treatment options?
• What are the potential risks for these treatment options?
• Do any of the treatments cure the cancer?
• Can I have a copy of the pathology report?
• How much time can I take to consider the treatment options?
• Are there brochures or other printed materials that I can take with me? What websites do you recommend?

Don't hesitate to ask other questions.

What to expect from your child's doctor

Your healthcare professional is likely to ask you several questions, such as:

• When did your child's symptoms begin?
• Have your child's symptoms been continuous or occasional?
• How severe are your child's symptoms?
• What, if anything, seems to improve your child's symptoms?
• What, if anything, appears to worsen your child's symptoms?