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Some Specific Brain Tumors

By

Steven A. Goldman

, MD, PhD, University of Rochester Medical Center

Last full review/revision Mar 2021| Content last modified Mar 2021
Click here for the Professional Version

Types of brain tumors (see also table Some Tumors That Originate in or Near the Brain) can vary in their characteristics, such as their location, the people they affect most often, and the symptoms they cause.

Gliomas

Gliomas include astrocytomas, oligodendrogliomas, and ependymomas. Astrocytomas are the most common glioma.

Some astrocytomas and oligodendrogliomas grow slowly and may initially cause only seizures. Others, such as anaplastic astrocytomas and anaplastic oligodendrogliomas, grow fast and are cancerous. (Anaplastic means that a cell has not become specialized to do a specific function—that is, the cell is undifferentiated, Undifferentiated cells in a tumor suggest that the tumor is rapidly growing.) Astrocytomas tend to develop in young people. They can become more aggressive and are then called glioblastomas. Glioblastomas tend to develop during middle or old age. Glioblastomas may grow so fast that they increase pressure in the brain, causing headaches and slowed thinking. If the pressure becomes high enough, drowsiness, then coma, may result.

Ependymomas develop from cells that line the spaces within the brain (ventricles). Ependymomas, which are uncommon, develop mainly in children and young adults. They are uncommon after adolescence.

Symptoms of gliomas vary depending on the tumor’s location.

  • Frontal lobes (located behind the forehead): Tumors located here can cause seizures, problems with walking, a compelling need to urinate, involuntary loss of urine (urinary incontinence), and paralysis. People may not be able to pay attention or think clearly. They may become lethargic. If tumors develop in the dominant frontal lobe (the left lobe in most people and the right lobe in some left-handers), they can cause problems with language. People may struggle to express themselves even though they know what they want to say.

  • Parietal lobes (located behind the frontal lobes): Tumors located here can cause loss of position sense (knowing where parts of the body are in space) and changes in sensation. People may be unable to tell whether they are being touched in one or two places. Sometimes vision is partially lost in both eyes so that neither eye can see the side of the body opposite the tumor. People may have seizures.

  • Temporal lobes (located above the ears at the temples): Tumors located here can cause seizures, and if they develop on the dominant side, people may be unable to understand and use language. Vision may be partially lost in both eyes so that neither eye can see the side opposite the tumor.

  • Occipital lobes (toward the back of the head, above the cerebellum): Tumors located here can cause partial loss of vision in both eyes, visual hallucinations (seeing things that are not there), and seizures.

  • In or near the cerebellum (located at the back of the head just above the neck): Tumors located here can cause nystagmus (rapid movement of the eyes in one direction, then a slower drift back to the original position), incoordination, unsteadiness in walking, and sometimes hearing loss and vertigo. They can block the drainage of cerebrospinal fluid, causing fluid to accumulate in the spaces within the brain (ventricles). As a result, the ventricles enlarge (a condition called hydrocephalus), and pressure within the skull increases. Symptoms include headaches, nausea, vomiting, difficulty turning the eyes upward, problems with vision (such as double vision), and lethargy. In infants, the head enlarges. Greatly increased pressure can cause herniation of the brain, which can result in coma and death.

Doctors diagnose gliomas based primarily on results of magnetic resonance imaging (MRI) and biopsy. MRI provides better result if a contrast agent (gadolinium) is used to make structures easier to see, For the biopsy, doctors may take a sample of tumor tissue before or during surgery. If it is taken before surgery, a small hole is drilled in the skull and a needle is inserted to remove the sample. The sample is analyzed to determine the exact type of tumor. The sample is also tested for genetic mutations that affect the tumor's growth. This information may help guide treatment.

Treatment of gliomas is similar to treatment of all brain tumors: surgery to remove the tumor, radiation therapy, and, for some types of gliomas, chemotherapy and/or immunotherapy.

Prognosis varies widely depending on the type of glioma, the location of the glioma, the genetic mutations present, and the extent of the tumor's spread.

Medulloblastomas

Medulloblastomas develop mainly in children and young adults. They develop in the cerebellum (located at the back of the head just above the neck). Thus, they may block the drainage of cerebrospinal fluid from the spaces within the brain (ventricles). Thus, fluid may accumulate in the ventricles, causing them to enlarge (called hydrocephalus). As a result, pressure on the brain increases. These tumors cause nystagmus (rapid movement of the eyes in one direction, then a slower drift back to the original position), loss of coordination, and unsteadiness in walking.

Medulloblastomas may spread through the cerebrospinal fluid (the fluid that surrounds the brain and spinal cord), above to the cerebrum and below to the spinal cord.

Treatment of medulloblastomas depends on the type of medulloblastoma, the person's age, and extent of the tumor's spread. Typically in children over 3 years old, doctors remove as much of the tumor as can be done safely. Then, chemotherapy and, if necessary, radiation therapy are used. Very young children are given several chemotherapy drugs after surgery to try to delay or avoid radiation therapy. (In children, some tissues are more sensitive to radiation than in adults.) In adults, surgery is followed by radiation therapy. Adding chemotherapy may improve survival.

With treatment, the percentage of people who are alive 5 years later (the survival rate) vary depending on age. Overall, rates are about

  • 50% or more at 5 years

  • 40% at 10 years

Meningiomas

Meningiomas are among the most common brain tumors. They are usually noncancerous but may recur after they are removed.

Meningiomas are the only brain tumor that is more common among women. They usually appear in people aged 40 to 60, but they can begin growing during childhood or later life. These tumors do not directly invade the brain but may compress the brain or cranial nerves, block the absorption of cerebrospinal fluid, or do both. Meningiomas can also grow into bones in the head, sometimes causing visible changes and affecting vision and hearing.

Symptoms of meningiomas depend on where the tumor develops. They may include weakness or numbness, seizures, an impaired sense of smell, changes in vision, headaches, and impaired mental function. In older people, a meningioma may cause dementia.

Diagnosis of meningiomas is usually based on results of magnetic resonance imaging (MRI) using a contrast agent to make structure easier to see.

If meningiomas do not cause symptoms and are small, treatment consists of regular imaging to monitor them. If meningiomas cause symptoms, are enlarging, or are located in certain critical areas of the brain, doctors remove them if possible, sometimes using radiosurgery, Radiosurgery does not require an incision. Instead, it uses focused radiation to destroy the tumor.

Pineal Tumors

Tumors can develop near the pineal gland, a small structure deep within the brain. Pineal tumors usually develop during childhood and often cause early puberty, especially in boys. They can block the drainage of cerebrospinal fluid around the brain, leading to hydrocephalus (accumulation of fluid in the brain's ventricles, causing them to enlarge). As a result, pressure on the brain increases.

The most common type of pineal tumor is a germ cell tumor. (Germ cell tumors originate in cells that develop into the reproductive system in males and females. These cells are called germ cells.)

Symptoms of pineal tumors include the inability to look up and changes in the position of the eyelid. The eyes may be unable to adjust to changes in light.

Diagnosis of pineal tumors typically involves magnetic resonance imaging (MRI) followed by biopsy. Blood tests are sometimes also done.

Radiation therapy, chemotherapy, radiosurgery, and surgery are used alone or in combination. Germ cell tumors are very sensitive to radiation therapy and are often cured.

Pituitary Gland Tumors

The pituitary gland, located at the base of the brain, controls much of the body’s endocrine (hormone) system. Most tumors of the pituitary gland are pituitary adenomas, which are usually noncancerous. Pituitary adenomas tumors may secrete abnormally large amounts of pituitary hormones or block production of hormones. When large amounts of hormones are secreted, effects vary depending on which hormone is involved.

  • For growth hormone, extreme height (gigantism) or disproportionate enlargement of the head, face, hands, feet, and chest (acromegaly)

  • For corticotropin, Cushing syndrome, causing fat and fluid to accumulate in the face and shoulders (buffalo hump), purple stretch marks on the abdomen, high blood pressure, weak bones, easy bruising, and poor wound healing

  • For prolactin, the cessation of menstrual periods (amenorrhea) in women, production of breast milk in women who are not breastfeeding (galactorrhea), and, in men, loss of libido, erectile dysfunction, and enlargement of the breasts (gynecomastia)

  • For vasopressin, diabetes insipidus (which causes excessive thirst and excessive urination)

Pituitary gland tumors can block hormone production by destroying the tissues in the pituitary gland that secrete hormones, eventually resulting in insufficient levels of these hormones in the body.

Headaches commonly occur. Vision is affected if the tumor puts pressure on the optic nerve. Rarely, bleeding into the tumor occurs, causing a sudden headache and loss of vision.

Doctors suspect pituitary tumors in people with unexplained headaches, characteristic visual problems, or problems due to abnormalities in hormone production. Diagnosis is usually based on magnetic resonance imaging (MRI) and blood tests to measure levels of hormones produced by pituitary tumors.

Treatment

  • Surgery or drugs

Treatment of pituitary tumors depends on which hormone is being overproduced. For example, pituitary tumors that produce growth hormone are surgically removed. Sometimes, particularly if the tumor cannot be surgically removed or a lot of tissue is affected, radiation therapy is required.

Adenomas that overproduce prolactin are treated with drugs that act like dopamine, the hormone in the brain that blocks prolactin production. These drugs (such as bromocriptine, pergolide, and cabergoline) lower blood levels of prolactin and often shrink the tumor. Surgery and radiation therapy are usually not needed.

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