Frequently Asked Questions    

1.      What is a brain tumor?

2.      What is the difference between a primary brain tumor and  a metastatic (secondary) brain tumor?

3.      What is the difference between a benign brain tumor and a malignant (cancerous) brain tumor?

4.      What does it mean when a brain tumor is in remission?

5.      What are recurrent tumors?

6.      Is a brain tumor cancer?

7.      How is a brain tumor diagnosed?

8.      How is a brain tumor treated?

9.      What will happen to a patient with a brain tumor?

10.   What are the parts of the brain?  

1. What is a brain tumor?

A brain tumor is an abnormal mass of tissue in which the cells grow and multiply without restraint, apparently unregulated by the mechanisms that control normal cells. One factor that distinguishes brain tumors from other tumors is that they arise in the skull, an organ encased by bone, and there is very little room for expansion with the skull. They are also among the few types of tumors that generally do not tend to metastasize or spread to other parts of the body.

Whereas certain brain tumors occur almost exclusively during childhood and adolescence, others are predominantly tumors of adult life. The patient's age appears to correlate with the site where some tumors develop in the brain. Although most primary tumors attack member of both sexes with equal frequency, some, such as meningiomas, occur more frequently in women, while others, such as medulloblastomas, more commonly afflict boys and young men.

The prognosis for patients with a brain tumor is as individual as the patients themselves. Your doctors will help you understand the possible consequences of your specific tumor.  

2. What is the difference between a primary brain tumor and a metastatic (secondary) brain tumor?

Primary brain tumors originate in the brain. The tumor cells do not travel to the brain from other parts of the body and, in most cases, primary brain tumor cells do not travel to other parts of the body either. The most common exception to this rule is the primary brain tumor of childhood called medulloblastoma, which can spread to the lymph nodes, bone marrow, lungs or other parts of the body. But even in this case, it is unusual for medulloblastoma to spread outside the nervous system. Pathologists classify primary brain tumors into two groups: the gliomas, composed of "glial" cells that invade the neural tissue surrounding them; and the nonglial tumors, which are not composed of glial cells and compress, rather than invade, the neighboring brain tissue as they grow.

Metastatic (secondary) brain tumors have spread to the brain from another part of the body. They most often metastasize from tumors of the lung or breast, but almost any tumor can spread to the brain. They arise when abnormal cells that developed elsewhere in the body are carried to the brain by the blood flow. Metastatic tumors are the most common form of brain tumor, affecting 20-40% of all cancer patients.

 3. What is the difference between a benign brain tumor and a malignant (cancerous) brain tumor?

Benign brain tumors do exist, and often can be cured with surgery alone. Some primary brain tumors are called benign because their rate of growth is so slow that many years may pass before the tumor grows large enough to compress functional areas of the brain, causing symptoms that require treatment. Others are considered benign because - once the tumor is diagnosed and treated - in many cases, the patient will be cured and live a normal life span and in many others, the tumor will not grow back for many years or even decades.

We use the term benign with caution, however. Even a benign brain tumor may cause intolerable symptoms or may not be controllable because of its particular location in the brain. A tumor in the brain stem or the spinal cord, for example, is often impossible to remove with surgery. In those particular locations even a small amount of tumor growth can compress and cause very serious damage to brain or spinal structures that control functions critical to life. While such a tumor may be called "benign" because of its slow growth, the situation is far from benign.

No one is certain why, but some benign brain tumors may change over time to become malignant. The meningioma, for instance, is one type of primary brain tumor that can be cured, either with surgery alone or sometimes with surgery and radiation therapy. In such cases, meningioma is considered a benign tumor. But in rare cases, even a meningioma may have invasive features, which the pathologist can see in the tumor's cells under the microscope and which suggest that the tumor may behave more aggressively than usual. In such a case, the meningioma may not be curable. It may continue to grow despite surgery, irradiation and chemotherapy and might cause death by its uncontrolled growth. It is because of this potential for aggressive and uncontrolled growth that a tumor is considered malignant.

Malignant brain tumors behave in an aggressive manner and require aggressive treatments. They grow much more quickly than benign tumors and tend to invade normal brain tissue. The goal of treatment in some cases is to control the growth of the tumor as long as possible with the least possible side effects. But just because a tumor is considered malignant does not always mean that it cannot be cured. Many malignant tumors, including malignant primary brain tumors, are curable. Medulloblastoma, for example, is considered a malignant tumor, yet many patients are cured of medulloblastoma by surgery, radiation therapy and chemotherapy.  

4. What does it mean when a brain tumor is in remission?

When a brain tumor is in remission, the tumor cells have entered a phase in which they generally have stopped growing or multiplying. This may or may not mean that these tumor cells will never grow again. After treatment, in some cases, the tumor has actually been destroyed and the area it occupied in the brain is composed only of dead tissue. In other circumstances, tumor cells remain alive, or viable, and retain the capacity to grow actively again, meaning that the tumor may recur at a later date.  

5. What are recurrent tumors?

Tumor recurrence is a term that describes any of three conditions.

1.      A recurrent tumor may be a tumor that still persists after primary treatment - a tumor that does not respond to surgery, radiation therapy, or chemotherapy or a combination of these therapies.

2.      Alternatively, it may be a tumor that grows back some time after therapy has seemed to destroy it.

3.      A new tumor that grows in the same place as the original one is also called a "recurrent" tumor because it is difficult, often impossible, to distinguish its cells from the cells of the original tumor.

Once treated, a brain tumor may remain in remission for many years, or may never recur. Unfortunately, it is not yet possible to predict whether, or when, any particular tumor may recur, which is why lifelong medical monitoring is essential for people treated for a brain tumor, even for a benign lesion.  

6. Is a brain tumor cancer?

Some brain tumors are a form of cancer and some are not. The word cancer suggests a tumor that behaves aggressively and in fact, the word malignancy generally means cancer. According to this definition, most anaplastic astrocytomas as well as medulloblastomas are considered cancer, whereas meningiomas and pituitary tumors are not. In practical terms, these working definitions become blurred, however, because a benign tumor growing in the brain stem or spinal cord may cause severe injury or death whereas frequently, medulloblastoma, a form of cancer, can be cured.  

7. How is a brain tumor diagnosed?

The most accurate diagnosis of a brain tumor is made with surgery, which permits the neurosurgeon to see the tumor and obtain a specimen for a pathological examination. Diagnostic surgery is not without its risks, however and there are several diagnostic procedures available today that have considerably improved the chances of detecting brain tumors without resorting to surgery. If a patient's symptoms lead the doctor to suspect a tumor, then a neurological examination, computerized tomography (CT) scans, and magnetic resonance (MR) imagings are the first diagnostic tools most often used to determine if more definitive procedures are needed. Other studies, such as X-ray films of the head and skull, an electroencephalogram (EEG) or radioisotopic brain scans, may also be done.  

8. How is a brain tumor treated?

Surgery is the chief form of treatment for brain tumors that lie within the membranes covering the brain or in parts of the brain that can be removed without damaging critical neurological functions. Because a tumor will recur if any tumor cells are left behind, the surgeon's goal is to remove the entire tumor whenever possible. Radiation therapy and chemotherapy, in general, are used as secondary or adjuvant treatment for tumors that cannot be cured by surgery alone. Radiosurgery is used as both a primary and an adjunctive therapy for many brain disorders.  

9. What will happen to a patient with a brain tumor?

To a large extent, what happens to you from this point forward depends on the type of tumor you have, its location, the area of the brain involved and the forms of therapy you'll have. But each patient is different, and these are not the only factors to be considered. The more you and your family know and understand each aspect of your treatment, the less uncertainty remains about what will happen. The confidence you place in yourself and your medical caretakers makes a tremendous difference. Perhaps most important of all is your outlook toward your condition and treatment and your willingness to believe in the power of healing - to be a survivor.  

10. What are the parts of the brain?

The BRAINSTEM acts as the pathway for motor and sensory messages to the body and face. Tumors located in the brainstem cause cranial nerve symptoms such as inversion of the eyes and motor and sensory changes. In addition, the brainstem contains vital cardiac, respiratory and vasomotor functions.

The CEREBELLUM is one of many parts of the brain that controls motor coordination. A tumor located in this area can cause nausea and vomiting, loss of balance, double vision, difficulty walking and difficulty with fine motor skills.

The FRONTAL LOBE controls the higher cognitive functions such as judgement and emotions, and motor ability. A tumor located in this area can cause marked mood elevation or loss of initiative. Other symptoms may include hemiplegia, difficulty talking and slowing of movements.

The OPTICAL LOBE is the area of the brain that perceives vision. Tumors in this area can cause loss of vision partially or completely in one eye.

The PARIETAL LOBE is the part of the brain that controls the sensory, perceptual and speech functions. Tumors in this area can produce a decrease in perception of light touch and pressurre. Other symptoms may include impairment of right-left discrimination and visual-spacial orientation of the body.

The TEMPORAL LOBE is the area that contains speech, hearing and emotional changes. Tumors in this area can produce aggresive behavior, difficulty processing or expressing words, and memory disorders.