Brain Cancer & Spinal Cancer

Brain & spine cancer at a glance

• Cancer of the brain or spinal cord occurs when cells grow out of control developing into tumors in these two important body parts that make up the central nervous system.
• Primary brain and spinal cancers begin in those areas. Secondary brain and spinal cancers are cancers that have spread (metastasized) to the brain or spine from another part of the body, often the lungs, kidney, breast or skin (melanoma).
• Symptoms of these cancers vary considerably, with spinal cancer symptoms including pain, weakness and numbness.
• Brain cancer symptoms are often related to the cancer’s location in the brain and can be a headache that changes throughout the day, memory loss, seizures, speech difficulty and others.
• Though most brain and spine tumors are benign and not cancerous (malignant), they must be monitored and treated to ensure they do not cause major problems.

Causes of brain cancer & spinal cancer

The chance of developing a cancerous brain or spinal tumor is less than 1% in a person’s lifetime, according to the American Cancer Society. The causes and risk factors of both brain and spinal cancers are not well known. Genetics do seem to play a role in certain types of these cancers however, there does not appear to be a risk of these cancers running in a family.

Causes and risk factors of brain cancer

• Age, as more brain cancers develop in people age 65 or older.
• Prior radiation treatment, especially when young.
• Compromised immune system can result in a risk for lymphomas.
• Gender, as certain types of brain cancers are more likely in men while others are more likely in women.

Causes and risk factors of spinal cancer

• Compromised immune system.
• Previous cancer from another area that can spread as a secondary spinal cancer.
• Exposure to radiation therapy or to some chemicals used in industry.
• Inherited disorders such as neurofibromatosis can be linked to spinal tumors.

Types of brain & spinal cancers

The National Institute of Neurological Disorders and Stroke reports more than 120 types of brain and spinal tumors. Tumors occur when genes that control cell growth mutate or are damaged. This results in a mass of cells (the tumor) that can kill healthy cells and disrupt brain/spine functions.

Some tumors are benign. These cells grow slowly, similar to normal cells, and have distinct edges that make surgical removal easier. These tumors do not spread to other parts of the body.

Some tumors are malignant. These are abnormal cancerous cells, can spread quickly to other parts of the body, and have indistinct edges that make surgical removal difficult.

Though only about 30% of brain tumors are actually cancerous, the benign ones are generally not considered to be truly benign (not causing harm) because they will grow and can cause serious and life-threatening issues. Neurosurgery is often required for benign brain and spine tumors, as well as malignant ones.

A primary cancer tumor of the brain or spine originates in that area. A secondary cancer tumor spreads to the brain or spine from some cancer at another location such as the breast, lung and skin (melanoma).

Brain and spinal tumors and cancers usually are named after their location or the type of cell they came from.

Brain cancer types

Glioma cancers grow from glial cells that hold neurons in place. These are the most common type of brain cancer, making up about half of primary brain cancers.

Astrocytoma cancers grow from the star-shaped astrocyte brain cells. These slow-growing cancers are the most common type of glioma. Different astrocytomas include the following:

• Pilocytic astrocytoma (grade I).
• Low-grade astrocytoma (grade II).
• Anaplastic astrocytoma (grade III).
• Glioblastoma multiforme (grade IV).
• Ependymomas.
• Brain stem gliomas.
• Oligodendrogliomas.

Nonglial cell brain cancers

• Meningioma cancers grow from the meninges, which is the brain’s covering. These occur more often in women, and make up 15%-25% of primary brain cancers.
• Pituitary cancers form around that gland and make up about 10% of brain tumors.
• Schwannoma tumors from schwannoma cells that protect nerves are most often benign.
• Central nervous system lymphoma cancer arises from lymphocyte blood cells. These are a form of non-Hodgkin’s lymphoma.

Types of spine cancer

A spinal cord primary cancer tumor, also known as an intradural tumor, starts in the spinal cord or its covering, called the dura. The main intradural tumors are below.

Intramedullary cancers that include astrocytomas, ependymomas and gliomas, which make up about 20% of primary spine cancers.

Extramedullary tumors grow in the membrane around the spinal cord or in the nerves coming from it. Meningiomas, nerve sheath tumors, neurofibromas and schwannomas are types of extramedullary spine cancers.

Symptoms of spinal and brain tumors

Signs of spinal and brain tumors and cancer vary due to such factors as the kind of tumor, its size, location and the patient’s health. Both types of cancer share some common symptoms.

Brain cancer symptoms

These generally relate to the area of the brain the tumor is in. For example, a tumor in the front part of the brain can cause difficulty concentrating. A large tumor can create pressure throughout the brain, resulting in multiple symptoms.

Signs of a brain tumor can be similar to symptoms of other conditions. So, it is important to have such symptoms evaluated. Early signs of brain cancer are numbness, seizures and headaches. Headache pain that changes as the person moves, wakes the individual up at night, or lasts for days or weeks at a time are also causes for concern. Other symptoms include:

• Loss of memory.
• Vomiting and nausea.
• High blood pressure.
• Mood swings and change in personality.
• Tiredness for no reason.
• Difficulty talking clearly.
• Infertility or impotence.

Spinal cancer symptoms

Signs of a spine tumor or cancer can come on slowly or rapidly. Pain is the most common symptom and can result from the tumor pressing on the spinal cord and its nerves.

This tumor pressure can also create numbness in the legs and arms. Symptoms can progress, making the person lose control over functions like tying shoes and fastening buttons. Signs include:

• Muscle weakness and numbness in the limbs.
• Pain in the back, neck, legs or arms.
• Trouble walking.
• Loss of sensation in the body.
• Urinary incontinence.
• Deformed spine.
• Degrees of paralysis.

Diagnosis and treatment

Our multidisciplinary team diagnoses these tumors and cancers and often monitors them throughout treatment. For brain cancer, we utilize biopsy, lab tests, imaging tests, nuclear bone scan and angiography, which uses X-rays to get 3-D images of the brain’s blood vessels.

We diagnose spine tumors and cancers using angiography, nuclear bone scan, spinal tap (lumbar puncture) that tests cerebrospinal fluid, imaging tests such as MRI, CT scan and PET scan.

Part of our diagnosis includes evaluating the grade of the cancer. Spine and brain cancers, which typically don’t move to other parts of the body (metastasize), are graded I-IV, with I being the slowest growing and easiest to remove surgically.

Brain cancer treatment

Surgery to remove the tumor or parts of it is the first line of treatment. This type of treatment can also be used to reduce symptoms of brain tumors due to pressure from the tumor mass that affects brain functions. However, surgery is not always possible, depending on specific types of tumors in certain locations, as well as the patient’s condition.

Our neurosurgeons utilize brain mapping tools to enhance precision and safety, reducing the risk of damaging neurological function. When possible, we perform minimally invasive surgery (MIS) using an endoscope to view the tumor in the brain. MIS can reduce pain for the patient while speeding recovery and return to normal functions.

When performing surgery, a neurosurgeon may also use local chemotherapy or radiation therapy, which is targeted to the area of the tumor.

Radiation therapy may be used alone to treat brain cancer by destroying cancerous cells and reducing symptoms. This can be highly targeted to spare healthy tissues. Radiation therapy also can be used on tumors that can’t be surgically removed or cancers that have moved to the brain from other parts of the body, such as lung cancer.

Chemotherapy is often used on high-grade brain cancers. This can be done systematically throughout the body, which can present a challenge in utilizing a formula of chemotherapy that can break the natural blood barrier that protects the brain. Local chemotherapy involves leaving chemo drugs near the tumor site after it has been surgically removed or partially removed.

Targeted therapy uses proteins to damage the growth function in cancer cells. Targeted therapy is often used along with chemotherapy.

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Surgery to remove the cancer is the first choice if it can be done without damaging the spinal cord and nerves. Our neurosurgeons employ advanced techniques that allow them to remove spine tumors that were previously inaccessible.

Even with these advances, surgery often cannot remove the entire tumor. In such cases we will also use radiation therapy and chemotherapy. We may use medications to reduce swelling that the tumor or radiation can cause.

Risks of treatment

Our doctors will discuss the risks and side effects of each treatment with the individual patient and his or her family. However, all surgeries carry risks, such as for infection, pain, blood loss, scarring, deep venous thrombosis and more. Brain and spinal surgery carry additional risks related to potential damage to the areas of the brain or spine that can affect a variety of physical and mental functions.

Chemotherapy side effects include fatigue, nausea, hair loss, infection and poor appetite. Radiation therapy side effects can be fatigue, stomach upset, skin reactions and memory issues. The side effects of both treatments generally fade away after treatment ends.