Brain and Spinal Tumors: Frequently Asked Questions

Timothy Ryken, MD
Department of Neurosurgery
University of Iowa Hospitals and Clinics

First Published: October 2000
Last Revised: March 2004
Peer Review Status: Internally Peer Reviewed

How important is early diagnosis?

It is best to have the most information available early. Occasionally a diagnosis is even made before any symptoms are noted with all types of Neoplastic tumor diagnoses

Are there drug therapies? Or is surgery the only solution for brain tumors?

The treatment approach is dependent on determining the correct pathology or tumor type. For certain benign tumors, surgery is likely the best choice. For more aggressive tumors, a combination of radiation and chemotherapy is often utilized. The physician treating patients with brain tumors is continually considering these treatment possibilities in various combinations.

Is diagnosis of brain tumors difficult?

The diagnosis of any brain tumor must be based on a sample of the tissue obtained and examined microscopically. This process of pathologic diagnosis is a skill obtained over many years of practice. It is also the main process of diagnosis in use over the last 50 or more years. We may see tremendous changes in this process as our understanding of the genes involved expand dramatically over the next 5-10 years.

What is gamma knife surgery?

An excellent question! The Gamma Knife is one type of machine designed to deliver focused radiation. The general technique is called Stereotactic Radio Surgery and can be preformed with machines other than the Gamma Knife. The principal is to deliver high dose radiation with extreme precision. No surgery is actually involved.

Is one more susceptible to brain tumors as they get older?

The pattern of brain tumors diagnosed in the United States changes with age. Patients who are older are more likely to develop malignant tumors. The tumor type Glioblastoma occurs with increasing frequency in the elderly and is one of the few tumors that is increasing in incidence.

How dangerous is it to obtain a tissue sample?

Tissue from a brain tumor can be obtained either through a formal operation or through a smaller biopsy operation. Either way the risk is related to the location. Tumors that are located close to the brain surface and in areas away from important function carry a relatively low risk with either biopsy or resection. Tumors located deep in the brain almost always carry a moderate to high risk of complication.

Are cat-scans done for brain tumors or only MRIs? What exactly is an MRI?

CT scans are computed tomographic scans, which involve radiation, projected through the brain and recorded creating an image. MRI stands for Magnetic Resonance Imaging, and this technique involves recording the response of the molecules in the brain to alterations in magnetic fields. There is no radiation involved in MRI. And they tend to generate a more detailed image although they are more expensive and take longer to obtain.

Are there any experimental treatments that look promising?

I will address the experimental treatments for the most malignant brain tumors. The malignant gliomas carry the worst prognosis. The average survival for the most aggressive is less than one year. The survival has changed very little over the past 25 years. There are over 100 active research studies addressing the treatment of these tumors. I believe this number reflects the difficulties and lack of success of our clinical research in this area. At present, I believe the immune based and targeted immuno-therapies may offer the most hope. These techniques rely on triggering the bodyÕs own immune systems.

Are brain tumors hereditary?

The simple answer is no. However, there are certain hereditary diseases that pre-dispose families to selected tumor types. For example: Neurofibromatosis is a hereditary disease with an increase in tumors of the cranial nerves, such as acoustic neuromas.

Are there any dietary or environmental factor that could contribute to brain tumors?

It is generally believed that exposure to excessive radiation may predispose people to develop tumors in the brain and elsewhere. Young patients with leukemia that have been treated with radiation appear to have an increased incidence of brain tumors in adulthood. There are few confirmed relationships, "if any" of dietary factors leading to central nervous system tumors.

Why do they say that if you have a brain tumor you have seizures?

Who told you that? He may be exactly correct. It is very common for patients with brain tumors to present with a seizure. However, there are many patients who have seizures who do not have brain tumors. I would generally recommend that any patient with a new onset seizure have an image of the brain obtained.

Would you suggest trying experimental therapies?

Absolutely. These studies should be conducted in reputable medical centers, but because of the dismal prognosis we often recommend clinical trials as the standard therapy often results in a limited response.

Are they any changes one should notice that may be signs of a brain tumor?

In general the most common signs are: seizures, weakness in arms or legs, headaches, and possibly changes in vision or personality.

Could other medicines for tumors such as decadron cause any type of seizure?

Decadron is used frequently to reduce swelling around brain tumors. Usually the seizures are caused by irritation of the normal brain tissue either by the tumor cells or by the swelling.

If I suspect something is wrong with me, what kind of tests should I make sure my doctor does to completely alleviate my worries?

If you are concerned that you have a brain tumor I would suggest you discuss the symptoms that are concerning you with your physician. If he suspects you have a brain tumor he will most likely order a CT scan or possibly an MRI.

After receiving radiation treatment for a brain tumor, how many months afterwards would you expect radiation damage to appear?

This is a very challenging question. I have seen the effects of radiation from as early as several weeks to several years. Our literature would suggest that radiation necrosis occurs on average from 12-18 months. The difficulty is that radiation necrosis in many ways can imitate the original tumor or progression of the original tumor.

See related Patient Topics Bones, Joints and Muscles, Brain and Nervous System, Brain Cancer, Brain Diseases, Cancers, Spinal Cord Diseases or Spinal Diseases.

See related Provider Topics Bones, Joints and Muscles, Brain and Nervous System, Brain Cancer, Brain Diseases, Cancers or Spinal Diseases.

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