TREATMENT FOR BRAIN TUMOR
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NHS guidelines say that everyone with a brain tumour should be under the care of a multi disciplinary team (MDT). An MDT is a team of health professionals who work together to decide on the best way to care for you. There are 2 different types of MDT involved in treating brain and central nervous system tumours. These teams work closely together, and some staff might belong to both teams.
The team you first see is the neuroscience MDT. This team is responsible for planning the first stages of your treatment, including surgery. After surgery, or if surgery is not possible, you will be under the care of the cancer network MDT. This team is responsible for providing further treatment and support, including radiotherapy and chemotherapy.[15]
The specialist MDTs are likely to include the following health professionals
How your specialists decide on treatment
The most suitable treatment for any brain tumour depends on the following things.
Surgery, radiotherapy and chemotherapy are all used to treat brain tumours. New treatments are being developed all the time for brain tumours that respond poorly to treatment, or are in parts of the brain that are difficult to reach. A combination of treatments may be the best way of removing or controlling your tumour.[15]
You may have surgery for a brain tumour
Even if your surgeon doesn't think they can completely remove your brain tumour, they are still likely to want to take out as much of it as possible. This is called subtotal resection or debulking. It can help by slowing down the progress of the tumour and relieving symptoms. It also makes it easier to treat the tumour cells left behind with radiotherapy or chemotherapy. With smaller tumours it is easier for treatment to reach all the cancer cells, particularly in the centre of the tumour.
We have a whole section on brain tumour surgery with more detail on what will happen[15]
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.
Radiotherapy may be used following, or in some cases in place of, 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.
Radiotherapy is the most common treatment for secondary 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.]Stereotactic radiotherapy is usually recommended in cases involving fewer than 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.[16]
UCLA Neuro-Oncology publishes real-time survival data for patients with a diagnosis of glioblastoma multiforme. They are the only institution in the United States that displays how brain tumor patients are performing on current therapies. They also show a listing of chemotherapy agents used to treat high grade glioma tumors.[17]
The team you first see is the neuroscience MDT. This team is responsible for planning the first stages of your treatment, including surgery. After surgery, or if surgery is not possible, you will be under the care of the cancer network MDT. This team is responsible for providing further treatment and support, including radiotherapy and chemotherapy.[15]
The specialist MDTs are likely to include the following health professionals
- Brain surgeons (neurosurgeons)
- Brain specialists (neurologists)
- Cancer specialist doctors (medical oncologists)
- Radiotherapy doctors (clinical oncologists)
- Clinical nurse specialists
- Psychologists who work with people with brain disorders (neuropsychologists)
- Palliative care specialists, for help with controlling symptoms
- A neuroradiologist (specialist in neurological scans)
How your specialists decide on treatment
The most suitable treatment for any brain tumour depends on the following things.
- The type of brain tumour
- The position of the tumour - how near it is to vital or delicate parts of the brain
- Size of the tumour
- Grade of the tumour
- Your age
- Your general health
- Your medical history
- Your own wishes about your condition and treatment
Surgery, radiotherapy and chemotherapy are all used to treat brain tumours. New treatments are being developed all the time for brain tumours that respond poorly to treatment, or are in parts of the brain that are difficult to reach. A combination of treatments may be the best way of removing or controlling your tumour.[15]
- Surgery
You may have surgery for a brain tumour
- To remove the whole tumour
- Remove most of the tumour (called a subtotal resection or debulking)
- To take a biopsy of the tumour
- To remove all or part of a growing benign tumour
Even if your surgeon doesn't think they can completely remove your brain tumour, they are still likely to want to take out as much of it as possible. This is called subtotal resection or debulking. It can help by slowing down the progress of the tumour and relieving symptoms. It also makes it easier to treat the tumour cells left behind with radiotherapy or chemotherapy. With smaller tumours it is easier for treatment to reach all the cancer cells, particularly in the centre of the tumour.
We have a whole section on brain tumour surgery with more detail on what will happen[15]
- RADIOTHERAPY
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.
Radiotherapy may be used following, or in some cases in place of, 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.
Radiotherapy is the most common treatment for secondary 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.]Stereotactic radiotherapy is usually recommended in cases involving fewer than 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.[16]
- Chemotherapy
UCLA Neuro-Oncology publishes real-time survival data for patients with a diagnosis of glioblastoma multiforme. They are the only institution in the United States that displays how brain tumor patients are performing on current therapies. They also show a listing of chemotherapy agents used to treat high grade glioma tumors.[17]
STEROIDS
Steroids occur naturally in the body in small amounts and help to control many functions. They can also be made artificially and used as drugs. They are very powerful anti inflammatories. An anti inflammatory is a drug that helps to stop swelling.
Steroids for brain tumours
It is common to have steroids as part of your treatment for a brain tumour. Your specialist may recommend steroids in any of the following situations.
Surgery and radiotherapy can both increase swelling at first. So your specialist will wait until this has worn off before reducing your steroid dose.
Remember - it is extremely important to take your steroids exactly as your doctor has told you. Steroids occur naturally in your body. When you take steroid tablets, the unusually large amounts in your bloodstream stop your body from making its own supply. So if you stop taking your tablets suddenly, the level of steroids will very suddenly drop and this can be very harmful. Never just stop taking your tablets. You must cut them down gradually, with the help and advice of your doctor.
A brain tumour may be too advanced to respond well to treatment when it is first diagnosed. Or it maycome back after treatment. In both these situations, it may continue growing and may make your symptoms worse. Steroids can help to keep symptoms under control for as long as possible.
Side effects
Steroids are important chemicals in the body and have a lot of different effects. So when you take steroid tablets, there are a lot of possible side effects
Your side effects will disappear once you have finished your steroid treatment. There is a slight possibility of having permanent diabetes after long term treatment, but your doctors and nurses will be watching out for this and will try to prevent it if at all possible.
OtherA shunt is used not as a cure but to relieve symptoms by reducing hydrocephalus caused by blockage of cerebrospinal fluid.
Researchers are presently investigating a number of promising new treatments including gene therapy, highly focused radiation therapy, immunotherapy and novel chemotherapies. A variety of new treatments are being made available on an investigational basis at centers specializing in brain tumor therapies.[18]
Steroids for brain tumours
It is common to have steroids as part of your treatment for a brain tumour. Your specialist may recommend steroids in any of the following situations.
- When you are first diagnosed
- Before and after surgery
- Before and after radiotherapy
- For an advanced brain tumour
Surgery and radiotherapy can both increase swelling at first. So your specialist will wait until this has worn off before reducing your steroid dose.
Remember - it is extremely important to take your steroids exactly as your doctor has told you. Steroids occur naturally in your body. When you take steroid tablets, the unusually large amounts in your bloodstream stop your body from making its own supply. So if you stop taking your tablets suddenly, the level of steroids will very suddenly drop and this can be very harmful. Never just stop taking your tablets. You must cut them down gradually, with the help and advice of your doctor.
A brain tumour may be too advanced to respond well to treatment when it is first diagnosed. Or it maycome back after treatment. In both these situations, it may continue growing and may make your symptoms worse. Steroids can help to keep symptoms under control for as long as possible.
Side effects
Steroids are important chemicals in the body and have a lot of different effects. So when you take steroid tablets, there are a lot of possible side effects
- Weight gain and water retention
- Increased appetite
- Sugar in your urine (diabetes), causing increased thirst, passing a lot of urine and if untreated, drowsiness and even unconsciousness
- Difficulty sleeping
- Changes in mood - high spirits or more rarely, paranoia, depression or hallucinations
- Increased risk of infection
- Hiding symptoms of infection (so that an infection becomes more severe before it is discovered)
- Stomach irritation, which can lead to an ulcer - always take tablets with food and ask your doctor for anti acid medicines if you need them
- An acne type rash
- Skin thinning, causing stretch marks
- Flushing and night sweats
- Muscle wasting with long term use
- Bone thinning with long term use
Your side effects will disappear once you have finished your steroid treatment. There is a slight possibility of having permanent diabetes after long term treatment, but your doctors and nurses will be watching out for this and will try to prevent it if at all possible.
OtherA shunt is used not as a cure but to relieve symptoms by reducing hydrocephalus caused by blockage of cerebrospinal fluid.
Researchers are presently investigating a number of promising new treatments including gene therapy, highly focused radiation therapy, immunotherapy and novel chemotherapies. A variety of new treatments are being made available on an investigational basis at centers specializing in brain tumor therapies.[18]