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  1. About Brain Tumors
  2. Symptoms of Brain Tumors
  3. Diagnosis
  4. Orthodox Treatment
  5. Side Effects of Orthodox Treatment

About Brain Tumors

Each year more than 17,000 people in the United States find out they have a brain tumor

The body is made up of many types of cells. Each type of cell has special functions. Most cells in the body grow and then divide in an orderly way to form new cells as they are needed to keep the body healthy and working properly. When cells lose the ability to control their growth, they divide too often and without any order. The extra cells form a mass of tissue called a tumor. Tumors are benign or malignant.

Benign brain tumors do not contain cancer cells. Usually these tumors can be removed, and they are not likely to recur. Benign brain tumors have clear borders. Although they do not invade nearby tissue, they can press on sensitive areas of the brain and cause symptoms.

Malignant brain tumors contain cancer cells. They interfere with vital functions and are life threatening. Malignant brain tumors are likely to grow rapidly and crowd or invade the tissue around them. Like a plant, these tumors may put out "roots" that grow into healthy brain tissue. If a malignant tumor remains compact and does not have roots, it is said to be encapsulated. When an otherwise benign tumor is located in a vital area of the brain and interferes with vital functions, it may be considered malignant (even though it contains no cancer cells).


Doctors refer to some brain tumors by grade--from low grade (grade I) to high grade (grade IV). The grade of a tumor refers to the way the cells look under a microscope. Cells from higher grade tumors are more abnormal looking and generally grow faster than cells from lower grade tumors; higher grade tumors are more malignant than lower grade tumors.

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Symptoms of Brain Tumors

The symptoms of brain tumors depend mainly on their size and their location in the brain. Symptoms are caused by damage to vital tissue and by pressure on the brain as the tumor grows within the limited space in the skull. They also may be caused by swelling and a buildup of fluid around the tumor, a condition called edema.
Symptoms may also be due to hydrocephalus, which occurs when the tumor blocks the flow of cerebrospinal fluid and causes it to build up in the ventricles. If a brain tumor grows very slowly, its symptoms may appear so gradually that they are overlooked for a long time.

The most frequent symptoms of brain tumors include:

  • Headaches that tend to be worse in the morning and ease during the day,
  • Seizures (convulsions),
  • Nausea or vomiting,
  • Weakness or loss of feeling in the arms or legs,
  • Stumbling or lack of coordination in walking (ataxic gait),
  • Abnormal eye movements or changes in vision,
  • Drowsiness,
  • Changes in personality or memory, and
  • Changes in speech.

These symptoms may be caused by brain tumors or by other problems. Only a doctor can make a diagnosis.

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Diagnosis

To find the cause of a person's symptoms, the doctor asks about the patient's personal and family medical history and performs a complete physical examination. In addition to checking general signs of health, the doctor does a neurologic exam. This includes checks for alertness, muscle strength, coordination, reflexes, and response to pain. The doctor also examines the eyes to look for swelling caused by a tumor pressing on the nerve that connects the eye and the brain.

Depending on the results of the physical and neurologic examinations, the doctor may request one or both of the following:

  • A CT (or CAT) scan is a series of detailed pictures of the brain. The pictures are created by a computer linked to an x-ray machine. In some cases, a special dye is injected into a vein before the scan. The dye helps to show differences in the tissues of the brain.
  • MRI (magnetic resonance imaging) gives pictures of the brain, using a powerful magnet linked to a computer. MRI is especially useful in diagnosing brain tumors because it can "see" through the bones of the skull to the tissue underneath. A special dye may be used to enhance the likelihood of detecting a brain tumor.

The doctor may also request other tests such as:

  • A skull x-ray can show changes in the bones of the skull caused by a tumor. It can also show calcium deposits, which are present in some types of brain tumors.
  • A brain scan reveals areas of abnormal growth in the brain and records them on special film. A small amount of a radioactive material is injected into a vein. This dye is absorbed by the tumor, and the growth shows up on the film. (The radiation leaves the body within 6 hours and is not dangerous.)
  • An angiogram, or arteriogram, is a series of x-rays taken after a special dye is injected into an artery (usually in the area where the abdomen joins the top of the leg). The dye, which flows through the blood vessels of the brain, can be seen on the x-rays. These x-rays can show the tumor and blood vessels that lead to it.
  • A myelogram is an x-ray of the spine. A special dye is injected into the cerebrospinal fluid in the spine, and the patient is tilted to allow the dye to mix with the fluid. This test may be done when the doctor suspects a tumor in the spinal cord.
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Orthodox Treatment

Treatment for a brain tumor depends on a number of factors. Among these are the type, location, and size of the tumor, as well as the patient's age and general health. Treatment methods and schedules often vary for children and adults. The doctor develops a treatment plan to fit each patient's needs.

Brain tumors are treated with surgery, radiation therapy, and chemotherapy. Depending on the patient's needs, several methods may be used.

Before treatment begins, most patients are given steroids, which are drugs that relieve swelling (edema). They may also be given anticonvulsant medicine to prevent or control seizures. If hydrocephalus is present, the patient may need a shunt to drain the cerebrospinal fluid.

Surgery is the usual treatment for most brain tumors. To remove a brain tumor, a neurosurgeon makes an opening in the skull. This operation is called a craniotomy.

Whenever possible, the surgeon attempts to remove the entire tumor. However, if the tumor cannot be completely removed without damaging vital brain tissue, the doctor removes as much of the tumor as possible. Partial removal helps to relieve symptoms by reducing pressure on the brain and reduces the amount of tumor to be treated by radiation therapy or chemotherapy.

Some tumors cannot be removed. In such cases, the doctor may do only a biopsy. A small piece of the tumor is removed so that a pathologist can examine it under a microscope to determine the type of cells it contains. This helps the doctor decide which treatment to use.

Radiation therapy (also called radiotherapy) is the use of high-powered rays to damage cancer cells and stop them from growing. It is often used to destroy tumor tissue that cannot be removed with surgery or to kill cancer cells that may remain after surgery. Radiation therapy is also used when surgery is not possible.

Radiation therapy may be given in two ways. External radiation comes from a large machine. Implant radiation therapy comes from radioactive material placed directly in the tumor

External radiation may be directed just to the tumor and the tissue close to it or, less often, to the entire brain. (Sometimes the radiation is also directed to the spinal cord.) When the whole brain is treated, the patient often receives an extra dose of radiation to the area of the tumor. This boost can come from external radiation or from an implant.

Stereotactic radiosurgery is another way to treat brain tumors. Doctors use the techniques described in the Surgery section to pinpoint the exact location of the tumor. Treatment is given in just one session; high-energy rays are aimed at the tumor from many angles. In this way, a high dose of radiation reaches the tumor without damaging other brain tissue. (This use of radiation therapy is sometimes called the gamma knife.)

Chemotherapy is the use of drugs to kill cancer cells. The doctor may use just one drug or a combination, usually giving the drugs by mouth or by injection into a blood vessel or muscle. Intrathecal chemotherapy involves injecting the drugs into the cerebrospinal fluid.

Chemotherapy is usually given in cycles: a treatment period followed by a recovery period, then another treatment period, and so on. Patients often do not need to stay in the hospital for treatment. Most drugs can be given in the doctor's office or the outpatient clinic of a hospital. However, depending on the drugs used, the way they are given, and the patient's general health, a short hospital stay may be necessary.

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Side Effects of Orthodox Treatment

Cancer treatment often causes side effects. These side effects occur because treatment to destroy cancer cells damages some healthy cells as well.

The side effects of cancer treatment vary. They depend on the type of treatment used and on the area being treated. Also, each person reacts differently.

A craniotomy is a major operation. The surgery may damage normal brain tissue, and edema may occur. Weakness, coordination problems, personality changes, and difficulty in speaking and thinking may result. Patients may also have seizures. In fact, for a short time after surgery, symptoms may be worse than before. Most of the side effects of surgery lessen or disappear with time.

Most of the side effects of radiation therapy go away soon after treatment is over. However, some side effects may occur or persist long after treatment is complete.

Some patients have nausea for several hours after treatment. Patients receiving radiation therapy may become very tired as treatment continues. Radiation therapy to the scalp causes most patients to lose their hair. In some cases, hair loss is permanent.

Skin reactions in the treated area are common. The scalp and ears may be red, itchy, or dark; these areas may look and feel sunburned. The treated area should be exposed to the air as much as possible but should be protected from the sun. Patients should not wear anything on the head that might cause irritation. Good skin care is important at this time.

Sometimes brain cells killed by radiation form a mass in the brain. The mass may look like a tumor and may cause similar symptoms, such as headaches, memory loss, or seizures. About 4 to 8 weeks after radiation therapy, patients may become quite sleepy or lose their appetite. These symptoms may last several weeks, but they usually go away on their own.

Children who have had radiation therapy for a brain tumor may have learning problems or partial loss of eyesight. If the pituitary gland is damaged, children may not grow or develop normally.

The side effects of chemotherapy depend on the drugs that are given. In general, anticancer drugs affect rapidly growing cells, such as blood cells that fight infection, cells that line the digestive tract, and cells in hair follicles. As a result, patients may have a lower resistance to infection, loss of appetite, nausea, vomiting, or mouth sores. Patients may also have less energy and may lose their hair.

Some anticancer drugs can cause infertility. Women taking certain anticancer drugs may have symptoms of menopause (hot flashes and vaginal dryness; periods may be irregular or stop). Some drugs used to treat children and teenagers may affect their ability to have children later in life.

Certain drugs used in the treatment of brain tumors may cause kidney damage. Patients are given large amounts of fluid while taking these drugs. Patients may also have tingling in the fingers, ringing in the ears, or difficulty hearing. These problems may not clear up after treatment stops.

Treatment with steroids to reduce swelling in the brain may cause increased appetite and weight gain. Swelling of the face and feet is common. Steroids can also cause restlessness, mood swings, burning indigestion, and acne. However, patients should not stop using steroids or change their dose without consulting the doctor. The use of steroids must be stopped gradually to allow the body to adjust to the change.

Loss of appetite can be a problem for patients during therapy. People may not feel hungry when they are uncomfortable or tired. Some of the common side effects of cancer treatment, such as nausea and vomiting, can also make it hard to eat. Yet good nutrition is important because patients who eat well generally feel better and have more energy.

Patients being treated for a brain tumor may develop a blood clot and inflammation in a vein, most often in the leg. This is called thrombophlebitis.

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