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Brain Cancer

In the spectrum of all cancers, brain cancer is a unique entity because it affects people of all ages—brain tumors are the most common cancer of children after leukemias—and has relatively few known causes and risk factors. Brain cancer is also interesting because there are more than 20 different types of primary brain tumors, and the brain is a common location for metastatic cancers from other organs. The most common metastases to the brain are lung and breast cancers.

The most common symptom experienced by people with brain tumors is progressive neurologic deficit, usually weakness. Headaches are the second most common symptom of brain tumors and occur for five different reasons: 1.) increased intracranial pressure (ICP), 2.) high blood pressure secondary to the elevated ICP, 3.) invasion or compression of pain-sensitive structures (e.g., blood vessels) by the tumor, 4.) secondary to difficulty with vision, and 5.) psychological secondary to other symptoms caused by the tumor. Other symptoms may depend on the location of the tumor. If the tumor is supratentorial (above the tentorium cerebelli, the sheet of dura mater that separates the inferior cerebellum from the superior cerebral cortex), other symptoms may include seizures and mental status changes. Infratentorial tumors, on the other hand, may have symptoms of hydrocephalus due to obstruction of cerebrospinal fluid flow.

Types of Brain Tumors

Acoustic neuromas, also known as vestibular schwannomas, are a common brain tumor, comprising approximately 10 percent of primary brain tumors. Acoustic neuromas arise from the vestibular division of cranial nerve VIII (vestibulocochlear nerve). Because this nerve is responsible for hearing function, patients with acoustic neuromas present with symptoms of hearing loss, tinnitus (ringing in the ears), and imbalance. The treatment of acoustic neuroma involves surgery and/or radiation therapy. Common complications after surgery include cranial nerve and brainstem dysfunction, as well as cerebrospinal fluid (CSF) leak.

Astrocytomas are the most common primary brain tumor, and there are many different types of astrocytomas. The World Health Organization (WHO) classifies astrocytomas with a grading system where increased grade equals increased malignancy. Grade I includes pilocytic astrocytoma, grade II low-grade astrocytomas, grade III anaplastic astrocytomas, and grade IV glioblastoma multiforme (GBM). The most common and malignant astrocytoma is GBM; typical survival in patients diagnosed with GBM is one year.

Another interesting clinical entity is brain stem glioma. Brain stem gliomas tend to occur in children and adolescents, and patients typically present cranial nerve palsies, gait abnormalities, and weakness. Brain stem gliomas are very malignant and are associated with poor prognosis; typical survival is from 6 to 12 months.

A positron emission tomography (PET) scan of a 62-year-old man with a brain tumor classified as a grade III astrocytoma.

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The choroid plexus is a leafy structure present in the brain's ventricles that produces CSF. Choroid plexus tumors account for just 1 percent of brain tumors and are primarily a disease of childhood, with 70 percent of patients under the age of 2 years. Some are even found in neonates, suggesting that choroid plexus tumors can also be a congenital condition. These tumors are usually benign but can also be malignant. Because choroid plexus produces CSF, patients usually present with symptoms of hydrocephalus: headache, nausea, vomiting, large head, and so forth. The only option for treatment is surgery.

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