Treatment for Brain tumor


Treatment options may include surgery, radiation therapy, or chemotherapy or a combination of treatments based on the type, location, and size of the tumor, your health, and age.

August 16, 2018

Treatment options may include surgery, radiation therapy, or chemotherapy or a combination of treatments based on the type, location, and size of the tumor, your health, and age. Supportive care is important before, during and after treatment to minimize symptoms and to improve your quality of life.
Some patients can qualify for clinical trials also.

Treatment for Brain tumor:

There are several treatment options for the people with brain tumors. The options include surgery, radiation therapy, and chemotherapy. Many people get a combination of treatments.
The choice of treatment depends mainly on the following:
  • The type and grade of brain tumor
  • Its location in the brain
  • Its size
  • Your age and general health

For some types of brain cancer, the doctor also needs to know whether cancer cells were found in the cerebrospinal fluid.
As cancer therapy often damages healthy cells and tissues, side effects are common. Therefore, before starting a treatment, discuss about possible side effects and how treatment may change your normal activities with your health care team. 
They can describe your treatment choices, the expected results, and the possible side effects. You can can work together with your health care team to develop a treatment plan that meets your medical and personal needs.
You can also talk with your doctor about taking part in a clinical trial. Neurologists, neurosurgeons, neuro-oncologists, medical oncologists, radiation oncologists, and neuroradiologists are specialists who treat brain tumors.
Your health care team may also include an oncology nurse, a registered dietitian, a mental health counselor, a social worker, a physical therapist, an occupational therapist, a speech therapist, and a physical medicine specialist. In case of children, they may need tutors to help with schoolwork. The below questions might comes in your mind before you begin treatment that you can discuss with your doctor:

  • What type of brain tumor do I have?
  • Is it benign or malignant?
  • What is the grade of the tumor?
  • What are my treatment choices? Which do you recommend for me? Why?
  • What are the expected benefits of each kind of treatment?
  • What can I do to prepare for treatment?
  • Will I need to stay in the hospital? If so, for how long?
  • What are the risks and possible side effects of each treatment? How can side effects be managed?
  • What is the treatment likely to cost? Will my insurance cover it?
  • How will treatment affect my normal activities? What is the chance that I will have to learn how to walk, speak, read, or write after treatment?
  • Would a research study or clinical trial be appropriate for me?
  • Can you recommend other doctors who could give me a second opinion about my treatment options? How often should I have checkups?

Before starting treatment, you might want a second opinion about your diagnosis and treatment plan. If you get a second opinion, the doctor may agree with diagnosis and treatment plan made by your first doctor, or he/she may suggest another approach. Either way, you will have more information and can feel more confident about the decisions you make, knowing that you have looked at your options.
It may take some time and effort to gather your medical records and see another doctor to get a second opinion. However, in many cases, the delay in starting treatment usually won't make treatment less effective. But, you should discuss this delay with your doctor to make sure. Some people with a brain tumor need treatment right away.
Different options for the treatment of brain tumor are:

Surgery:

Usually surgery is the first choice of treatment for most brain tumors. You may be given general anesthesia, and your scalp is shaved before surgery begins. You probably won't need your entire head shaved.
Surgery to open the skull is called a craniotomy. An incision in your scalp is made by the surgeon and a special type of saw is used to remove a piece of bone from the skull. You may be awake when the surgeon removes a part or all of the brain tumor. The surgeon removes as much tumor as possible. During surgery, you may be asked to move a leg, count, say the alphabet, or tell a story. Your ability to follow these commands helps the surgeon protect important parts of the brain. The opening in the skull will then be covered with the piece of bone or with a piece of metal or fabric. The surgeon then closes the incision in the scalp.
If the tumor is in the brain stem or certain other areas, from which the surgeon is unable to remove the tumor without harming normal brain tissue, surgery isn't possible. In such cases, the patient may receive radiation therapy or other treatment.
A headache or an uncomfortable feeling is common for the first few days after surgery. However, medicine can usually control pain. You should discuss the plan for pain relief with your health care team before surgery. After surgery, your team can adjust the plan if you need more relief. You may also feel tired or weak. The recovery time after surgery is different for everyone. You will probably spend a few days in the hospital.
The health care team will monitor you for signs of swelling or fluid buildup as there is a possibility that the The brain may swell or fluid may build up within the skull. You may receive steroids to help relieve swelling. A second surgery may be needed to drain the fluid. This can be done by placing a long, thin tube called shunt in a ventricle of the brain. The shunt is placed before performing surgery on the brain tumor for some people. The tube is threaded under the skin to another part of the body, usually the abdomen. Excess fluid is carried from the brain and drained into the abdomen. Sometimes the fluid is drained into the heart instead.
Another problem that may develop after surgery is infection. The health care team will give you an antibiotic in such cases. Brain damage can be a serious problem as brain surgery may harm normal tissue. It can cause problems with thinking, seeing, or speaking. It can also cause personality changes or seizures. Most of these problems lessen or disappear with time. But sometimes damage to the brain is permanent. You may need physical therapy, speech therapy, or occupational therapy.

Radiation therapy for brain tumors:

The brain tumor cells are killed with high-energy x-rays, gamma rays, or protons in Radiation therapy. The radiation therapy is often given to kills tumor cells that may remain in the area after a surgery. Sometimes, people who can't have surgery have radiation therapy instead.
Both external and internal types of radiation therapy are used to treat brain tumors.

External radiation therapy:

This procedure is administrated in a hospital or clinic. A large machine outside the body is aimed to direct beams of radiation at either the whole brain or more commonly, at specific portions of the brain. Sometime,s radiation aimed at the spinal cord is also required.
The treatment schedule depends on your age, and the type and size of the tumor. The most common method of radiation therapy used for people with brain tumors is Fractionated external beam therapy, in which small doses or fractions of radiation are given usually once each day. In this way the total dose of radiation is given over several weeks helps to protect healthy tissue in the area of the tumor. Treatments are usually 5 days a week for several weeks. A typical session takes only a few minutes and a visit lasts less than an hour.
Some other ways of delivering external beam radiation therapy are:

Intensity-modulated radiation therapy or 3-dimensional conformal radiation therapy:

These types of treatment use computers to more closely target the brain tumor to lessen the damage to healthy tissue.

Proton beam radiation therapy:

The source of radiation is protons rather than X-rays in this case. The doctor aims the proton beam at the tumor. The dose of radiation to normal tissue from a proton beam is less than the dose from an X-ray beam.

Stereotactic radiation therapy:

Narrow beams of X-rays or gamma rays are directed at the tumor from different angles. You have to wear a rigid head frame for this procedure. The therapy may be given during a single visit (stereotactic radiosurgery) or over several visits.

Internal radiation therapy or implant radiation therapy or brachytherapy:

Internal radiation isn't commonly used for treating brain tumors and is under study. A radioactive material is usually contained in very small implants called seeds from which the radiation comes. The seeds are placed inside the brain and give off radiation for months. They don't need to be removed once the radiation is done.
There is almost no side effects after treatment. However the patient may have nausea for several hours after external radiation therapy which is very rare. The health care team can suggest ways to help you cope with this problem. Radiation therapy also may cause you to become very tired with each radiation treatment. Therefore taking rest is important. But doctors usually advise people to try to stay as active as they can.
Hair loss from the part of the head that was treated is the most common side effect in case of external radiation therapy. But usually, hair grows back within a few months. Radiation therapy also may make the skin on the scalp and ears red, dry, and tender. The health care team can suggest ways to relieve these problems.
Sometimes brain tissue can swell because of radiation therapy. You may get a headache or feel pressure. The health care team watches for signs of this problem. They can provide medicine to reduce the discomfort. Radiation sometimes kills healthy brain tissue which can cause headaches, seizures, or even death. However these side effects are very rare.
The pituitary gland and other areas of the brain may get harm because of radiation. This damage could cause learning problems or slow down growth and development for children. In addition, radiation increases the risk of secondary tumors later in life.

Chemotherapy for brain tumors:

The use of drugs to kill cancer cells is known as chemotherapy. Drugs may be given in the following ways:

By mouth or vein (intravenous):

Chemotherapy may be given during and after radiation therapy. The drugs enter the bloodstream and travel throughout the body to kill the cancer cells. Usually it is given given in an outpatient part of the hospital, at the doctor's office, or at home. Rarely, you may need to stay in the hospital.
The side effects of chemotherapy depend mainly on the type and dose of drugs. Most common side effects include nausea and vomiting, loss of appetite, headache, fever and chills, and weakness. You are more likely to get infections, bruise or bleed easily, and feel very weak and tired if the drugs lower the levels of healthy blood cells. Therefore the levels of blood cells will be checked by your health care team. Some side effects may be relieved with medicine.

In wafers that are put into the brain:

For some adults with high-grade glioma, several wafers are implanted into the brain by the surgeon. Each wafer is about the size of a dime. The wafers get dissolved over several weeks, releasing the drug into the brain which kills cancer cells. It may help prevent the tumor from returning in the brain after surgery to remove the tumor.
Patients who receive an implant or a wafer that contains a drug are monitored by the health care team for signs of infection after surgery. An infection can be treated with an antibiotic.

Supportive care for patients and caregivers:

A brain tumor and its treatment can lead to other health problems too. You may receive supportive care before, during, and after cancer treatment to prevent or control these problems. It can improve your comfort and quality of life during treatment. The following problems could arise which can be taken care by your health care team:

  • Swelling of the brain: Steroids can be used to help relieve swelling of the brain for people with brain tumors if required.
  • Seizures: Brain tumors can cause seizures or convulsions. Certain drugs can help prevent or control seizures.
  • Fluid buildup in the skull: If fluid builds up in the skull, the surgeon may place a shunt to drain the fluid. Information about shunts is provide in the Surgery part of the Treatment section.
  • Sadness and other feelings: It is normal to feel sad, anxious, or confused after a diagnosis of a serious illness. Some people find it helpful to talk about their feelings.

Many people with brain tumors slow down the progress of the disease by receive supportive care along with treatments.

Follow-up care after brain tumor treatment:

You will need regular checkups after treatment for a brain tumor. Checkups may be every 3 months for certain types of brain tumors to ensure your health. Any changes in your health are noted and treated if needed. You should contact your doctor if you have any health problems between checkups.
The recurrence of a tumor can be checked by follow up. Checkups may include careful physical and neurological  exams, as well as MRI or CT scans. The shunt can be checked by your doctor to see that it is working well, if you have one.