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The brain and spinal column make up the central nervous system where vital functions such as thought, speech and bodily movement are controlled. A brain tumor begins when normal cells in the brain mutate and grow uncontrollably, forming a tumor. Brain tumors can be low grade (slow growing) or high grade (fast growing).
Types of Brain Cancer
Brain Cancers are categorized by the type of brain cell or by the location in the brain where it first develops. The most common primary brain tumors are gliomas, which originates in the glial tissue, which is a supportive cell in the brain. There are two main types of supportive cells: astrocytes and olidendrocytes. Most gliomas are either called astrocytoma or oligodendroglioma.
Astrocytomas develop from small, star shaped cells called astrocytes in the brain or spinal cord. They most often occur in the cerebrum, which is responsible for sensory imput, speech, and movement.
Oligodendrogliomas develop from oligodendrocyte cells, which are responsible for making the myelin, a protein and fat substance that surrounds the nerves.
Ependymomas are brain tumors that originate in the ependyma (a membrane lining the canal of the spinal chord and ventricles of the brain).
Brain Stem Gliomas are tumors which start in the glial cells of the brain stem.
Mixed Gliomas are tumors which include more than one type of glioma cell types.
Gliomas are given a grade, which is a measure of how close to normal cells the tumor looks under a microscope.
Grade I: Pilocytic Astrocytoma
Grade II: Diffuse astrocytoma
Grade III: Anaplastic astrocytoma
Grade IV: Glioblastoma (Glioblastoma multiforme GBM)
Brain Stem Gliomas originate in the brain stem, the lowest part of the brain, connecting the brain and spinal cord.
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Acoustic Scwannoma is a tumor that begins in a nerve in the inner ear, called the Vestibular Nerve, as is usually benign.
Craniopharyngiomas are benign tumors that begins near the pituitary gland (at the base of the brain).
Medulloblastomas are rare cancers which originate in the cerebellum. Also called PNET, medulloblastomas often spread through the cerebrospinal fluid (CSF) to other locations in the brain and spine.
Meningiomas are the most common type of primary brain tumors. They begin in the meninges (the membranes that envelop and protect the central nervous system). They are generally non cancerous.
Pineal Gland and Pituitary Gland Tumors are abnormal growths that develop in and around the pineal gland (the small endocrine gland pituitary glands, and can cause excessive or abnormally low production of hormones that regulate important functions in the body.
Primary Central Nervous System Lymphoma is a form of lymphoma that begins in the lymphatic system (a network of organs that carry a fluid called lymph throughout the body). Primary CNS Lymphoma begins when lymphocytes in the brain, spinal chord, meminges or eyes becomes malignant and begin to spread.
Treatment For Primary Brain Cancer
The treatment of brain cancer depends on the size and location of the tumor, and whether the cancer has spread within the central nervous system. The treatment options include:
Radiation-intensity-modulated radiation therapy (IMRT) and image guided radiation therapy (IGRT), and gamma knife radiosurgery
Chemotherapy-for glioblastomas and both high and low grade gliomas Temozolomide (Temodar), Carmustine (BCNU) and Lomustine (CCNU), and for oligodendrogliomas, Temozolomide or a combination of treatments called PCV (Procarbazine,CCNU, and vincristine)
Targeted therapy and New kinds of Chemotherapy such as angiogenesis inhibitors such as Bevacizumab (Avastin) which prevent the tumor to develop new blood vessels, and growth factor inhibitors (EGRF) which block the growth receptors of tumors, and new drugs which target the specific gene changes in the tumor
Immunotherapy Treatments which use the patient’s own immune system to stop tumor growth, employing monoclonal antibodies which attach to proteins of cancer cells
Brain Tumors that originate in other locations in the body
Brain metastases are cancer cells that have spread to the brain from primary tumors in other organs in the body. An estimated 24-45% of all cancer patients in the United States have brain metastases.
Treatment options depend on the primary tumor type, and the stage of the disease. Therapies include:
Radiation therapy (WBRT whole brain radiation therapy, focal beam, and stereotactic radiation therapy)
Radiation therapy has become a mainstream therapy for brain metastasis. Radiation therapy includes WBRT and stereotactic radiosurgery. Stereotactic radiosurgery is a more preferred treatment modality for radiation resistant lesions such as non-small cell lung cancer, renal cell carcinoma, and melanoma. It is also frequently used in brain metastasis from breast cancer
Chemotherapy A variety of chemotherapeutic agents have been used to treat brain metastasis from lung, breast, and melanoma, including cisplatin, cyclophosphamide, etoposide, fluorouracil (5FU), ifosfamide, irinotecan, mitomycin, prednisone, temozolomide, teniposide, and vinorelbine
Most tumors that metastasize to the brain are not chemo-sensitive, though small-cell lung cancer, breast cancer, and lymphoma respond to chemotherapy. In most cases several therapeutic agents are used in combination and in conjunction with whole-brain radiation therapy
Combined therapies In many cases, numerous agents are used in combination and in conjunction with whole-brain radiation therapy
Targeted Therapies Temozolomide has recently been used as a single agent to treat brain metastasis from breast cancer. Complete remission was achieved in 36% of patients, and an additional 58% had a partial response.
Tyrosine kinase inhibitors and monoclonal antibodies Gefitinib and erlotinib, epidermal growth factor receptor (EGFR) have been used to treat non-small cell lung cancers that metastasize to the brain, especially if they have the EGFR mutation.
The use of lapatinib in combination with capecitabine has been used to treat HER2 positive brain metastasis, and vemurafenib is used in BRAF V600E–positive melanoma with brain metastasis. New research has suggested that sorafenib or sunitinib can lower the incidence of metastasis of renal cell carcinoma to the brain.
Monoclonal antibodies such as trastuzumab is commonly used to treat metastatic breast cancer, and Ipilimumab is administered to treat metastatic melanoma to the brain
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