Brain TumorsTreatment of Brain Tumors

12 September 2018by Prof. Dr. Alper Kaya0ümörlerinin-Tedavisi.jpg

Specialists who treat brain tumors are brain surgeons and oncologists. The treatment to be chosen is closely related to the type, location, size and stage of the tumor. Presence of cancer cells in spinal fluid is also important in certain tumors. Most of the patients discuss these questions with their physicians before starting treatment:

  • Is this tumor benign or malignant?
  • What are the treatment options? Which one do you recommend for me? Why do you recommend this option?
  • What are the risks and possible complications of each treatment option?
  • What would be the costs of this option?
  • How will this treatment affect my daily life?

What are the treatment options in brain tumors?

Depending on the type, location, size and stage of the tumor surgery, radiation therapy and chemotherapy (medical treatment of cancer) may be chosen. However, it should be kept in mind that currently the most important treatment option in brain tumors is complete removal of the tumor with surgery. In benign tumors, this surgery cures the patient without requiring any further treatment. In malignant tumors, a well-performed surgery is the most important factor that improves patient’s survival.

How is surgical intervention of brain tumors performed?

Surgical intervention is the treatment of choice for most brain tumors. The type of surgery performed by opening the skull is called a craniotomy. Craniotomy is performed under general anesthesia. It is the only way to completely remove the tumor. The common questions that the patients ask their physicians before surgery are listed below:

  • How will I feel after surgery?

Patients come out of a well-performed surgery as they go in. There will be wound dressing at the surgical site. Patients can feel weakness with the effect of anesthesia and surgery, but they will be able to talk and won’t have any problems in mins, intelligence or arm and leg movements.

  • Will I have pain?

There will be tolerable pain at the site of procedure.

  • How long will I have to stay in hospital after surgery?

Patients are usually discharged at the fourth day without any problems.

  • Will this surgery have long-term effects? Will my hair grow back? If another material is used for the piece of skull to be removed from my head, would this have side effects?

If the tumor hasn’t cause any permanent damage before surgery, there will be no permanent damage after a well-performed surgery. However, it is not realistic to think that a brain surgery has no complications. Sometimes there can be potential risks due to tumor’s nature and its sensitive location. Every case should be discussed with the physician in detail. Hair that was cut for the surgery grows back. Materials used for the skull definitely have no side effects.

  • When can I go back to my normal life?

Usually, you can go back to your normal life in approximately 15 to 20 days.

  • What are my chances of cure?

This depends on what kind of tumor you have (as of oncological classification). Benign tumors usually have a 100% chance cure. In malignant tumors, however, every case should be discussed separately.

In some cases, the tumor cannot be operated. If the tumor is in brain stem or in a location dangerous to reach, it may not be possible to excise the tumor without damaging the surrounding normal brain tissue. Radiation therapy or another treatment modality can be recommended to these patients.

What are the side effects of surgery?

The most common complaints in the first couple of days after surgery are headache and a general feeling of discomfort. Headache can be usually controlled with painkillers. Patients feeling weak and tired after surgery is commonly observed. When do these symptoms improve depends on the patients. Another side effect that can occur after surgery is infection. Antibiotics are used in this situations. Normal brain tissue can be injured during surgery. This may lead to problems related to thinking, vision or speech, cause personality changes or seizures. The most of these problems usually decrease or disappear with time but sometimes the symptoms can be permanent. Even though brain surgeries are complicated procedures, they usually result in cure without any problems in experienced hands. The importance of the surgeon’s experience is indisputable.

How is radiation therapy for brain tumors performed?

Radiation therapy or radiotherapy is based on using high-energy beams to kill tumor cells. These beams can be X-rays, gamma-rays or protons. These beams are delivered to the point of tumor and adjacent tissue with a big device. Sometimes, delivering radiation to the whole brain or spinal cord may be necessary. Radiation therapy is generally used after surgery. Radiation delivered kills tumor cells that may be left at the operation site. Sometimes, patients who cannot have surgery are only given radiation therapy. The administration of radiation therapy is decided individually for every patient. This treatment plan depends on the type and size of tumor as well as the patient’s age. Physicians take certain precautions to protect the intact brain tissue around the tumor during radiation therapy. These are listed below:

  • Radiation therapy is delivered 5 days a week for a couple of days. Dividing the total dose into weeks is preferred to protect the intact brain tissue around the tumor.
  • Stereotactic radiation therapy. Thin radiation beams are given to the tumor from different angles. Patient wears a firm helmet for this procedure. Tumor’s exact location is determined using MRI or CT. Radiation can be given all at once or divided into multiple consecutive visits.
  • 3-dimensional conformal radiation therapy. A 3-dimensional image of the tumor and neighboring tissues are acquired on the computer. The physician aims radiation beams adjusted for the exact shape of tumor to the brain. The precise adjustment of radiation beams minimizes the damage to adjacent tissues. This is called “Gamma-knife”, referred as “non-surgical removal of tumor”.
  • Proton beam radiation therapy. Here, the source of radiation is protons instead of X-rays. The physician aims protons towards the tumor. Protons can penetrate healthy tissue without injuring.

How in medical treatment for brain tumors performed?

Using medications to kill cancer cells is called chemotherapy. Sometimes, these drugs can be used in brain tumors, too. Medications used for chemotherapy can be given by mouth or from veins. Both ways, the drug is absorbed into bloodstream and circulates through the whole body. Medications used in chemotherapy are usually delivered in sessions to give a chance to body to recover. Chemotherapy is usually administered in out-patient basis. In certain cases, it can be administered in the doctor’s office or in patient’s home. Rarely, patients need to be admitted to the hospital. Chemotherapy for brain tumors is usually applied to children. Adults can also have chemotherapy after surgery and radiation therapy. In patients with relapsing cancer, certain materials that contain chemotherapy drugs can be placed in the brain following the tumor’s removal during brain surgery. These materials release chemotherapy drugs slowly through a couple of weeks and eventually disappear. These drugs aim to kill cancer cells.

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