BOB体育

At BOB体育, adult brain tumors are treated by neurosurgeons and neurologists. Our multidisciplinary team is dedicated to providing comprehensive care, from accurate diagnosis to advanced treatment options. We also understand that a brain tumor diagnosis by itself can be overwhelming, and it鈥檚 only natural to begin learning all one can about brain tumors.

Tumors are generally separated into two categories: 1) primary brain tumors (those arising in the head itself) or 2) metastatic brain tumors (those that spread from different areas of the body).

Primary tumors vs. metastatic tumors

A primary brain tumor is differentiated based on the cell type from which it originates, including glial cells (cells that separate and support the central nervous system called astrocytes, oligodendrocytes and ependymal cells), neuronal cells (nerve cells themselves), meningeal cells (cells that line the central nervous system) or Schwann cells (cells that line peripheral nerves).

Most primary brain tumors, specifically astrocytomas, are then further classified in a four-stage grading system based on World Health Organization (WHO) criteria. Grading ranges from I (benign and surgically curable) to IV (malignant).

A metastatic brain tumor is considered malignant, and the behavior of these tumors varies widely according to the type of tumor from which they arose. The most common types of metastatic tumors in order of frequency are: 1) lung cancer, 2) breast cancer, 3) renal cell cancer, 4) melanoma and 5) colon cancer.

Types of brain tumors

Every tumor that originates in the brain or spinal cord is classified as a central nervous system, or CNS, tumor. A CNS tumor can manifest in various forms. Some of the more common ones are described below.

Astrocytoma

Astrocytomas arise from astrocytes, which line and support the CNS. These tumors vary in grade based on their histologic features, as determined by a pathologist who examines the cells under a microscope. Low-grade astrocytomas represent 15% of primary tumors and tend to occur in patients in their 30s and 40s. Treatment involves surgical excision whenever possible. The 10-year survival for low-grade astrocytomas is around 50%.

Colloid cysts

Typically located near the brain鈥檚 center, colloid cysts are slow-growing tumors that can obstruct the flow of cerebrospinal fluid, leading to hydrocephalus and increased intracranial pressure.

BOB体育 neurosurgeons use minimally invasive techniques to remove colloid cysts. For patients with hydrocephalus, several options are available at BOB体育.

Choroid plexus tumor (anaplastic choroid plexus papilloma)

A choroid plexus tumor is a rare, benign tumor primarily found in children under the age of 2. The malignant form of this tumor is called a choroid plexus carcinoma, also referred to as an anaplastic choroid plexus papilloma. This cancerous brain tumor is most commonly located in the lateral ventricles, where it can lead to hydrocephalus.

Ependymoma

Ependymomas originate from the ependymal cells, which line the cerebrospinal fluid cavities within the brain and spinal cord. These tumors occur in adults and children and account for 2.5% of adult tumors. The five-year survival for these tumors ranges from 40% to 60%. Standard therapy involves resection and may include radiation and/or chemotherapy.

Epidermoid/dermoid

Epidermoids usually occur in the posterior fossa and are benign lesions that form keratin. Dermoids are found in the midline of the CNS and are typically associated with some form of dermal sinus (small connection to the skin). They include skin elements such as hair, sweat glands and oil glands. Both of these types of tumors are curable with surgical resection.

Glioblastoma multiforme (GBM)

The most common and malignant type of astrocytoma is the grade IV astrocytoma or glioblastoma multiforme. GBMs represent 25% of primary tumors and are the most commonly diagnosed tumors in those aged 55 to 75. Standard therapy involves resection or biopsy, followed by a combination of radiation and chemotherapy (oral Temozolomide, or Temodar). The average survival for these patients is about 14 to 18 months.

What do we know about glioblastoma?

Meningioma

Meningiomas arise from arachnoid cap cells along the dura, the leathery covering that surrounds the brain and spinal cord. Meningiomas account for 25% of primary tumors and increase in incidence with age. The vast majority of these tumors are benign and are curable with surgical resection. A significant number of these are treated successfully with radiosurgery. Standard therapy involves resection, radiosurgery or fractionated radiation. Additionally, medical therapies, such as chemotherapy and other treatments, may be options for some patients.

Neurocytomas

Neurocytomas are tumors, often benign, that form within the nervous tissue and typically present with increased intracranial pressure (ICP) or hydrocephalus.

Oligodendroglioma

These tumors arise from oligodendrocytes, cells that produce myelin (the covering of nerve cell processes) in the CNS. Oligodendrogliomas account for 15% to 20% of primary tumors and occur in two peaks, around the ages of 35 and 55. Survival is slightly better than astrocytomas. A test for 鈥�1p-19q chromosomal co-deletion鈥� is a test that can be done on the chromosomes within tumors of oligodendroglioma origin. On average, oligodendroglioma tumors with 1p-19q co-deletions tend to have a better response to therapy (radiation or chemotherapy) and a better overall outcome, regardless of treatment.

Pituitary adenomas

An adenoma is a common benign tumor of the pituitary gland. Approximately 10% of people will have a pituitary adenoma by the time of their death. A pituitary tumor can form at any age. Some tumors secrete excess hormones that cause bodily imbalances, hyperprolactinemia, acromegaly (enlargement of the extremities, face and soft tissues) or Cushing鈥檚 disease.

Schwannoma

Schwannomas originate from Schwann cells, which produce the myelin that covers peripheral nerves, and account for 8% to 10% of primary tumors. The most common location for Schwannomas is on the eighth cranial nerve (vestibular schwannoma), followed by the fifth nerve. These tumors are almost always benign and can be cured with surgical removal. Radiosurgery can successfully treat these lesions when they are small in size.

Diagnosis

A brain tumor diagnosis is typically made using MRI with and without contrast. Primary brain tumors are diagnosed in about 17,000 patients every year, of which 3,500 are in children under the age of 20. Metastatic tumors are much more common and are found in up to 170,000 patients per year.

Treatment

Decisions regarding the treatment of brain tumors are made during a formal conference known as the Brain Tumor Board. Surgeons and pathologists, along with medical and radiation oncologists, discuss each specific tumor and formulate a treatment strategy.

What to expect

When you come for your visit, please bring your imaging results as your physician will review them with you in person. The treatment plan may include follow-up imaging, medical management or surgery.

Before surgery, you will need lab work, an anesthesia preop visit and potentially more imaging. You will need to stop your blood thinner medications if you take them. The night before surgery, you will be instructed to stop eating at midnight. After surgery, you may be sent home the same day or be admitted to the 4th or 5th floor of the HVN hospital.

When you are discharged, you will be given instructions on wound care, when you can shower and any new medications. You will have access to the care team through EPIC MyChart and our office at (352) 273-9000. You will have a follow-up appointment with your physician and/or the APP to ensure you are healing well and recovering as expected. Once your tumor is sent to the pathologist during surgery, it will take them 10 days to six weeks to return a final pathology report that will come to your MyChart for review and to develop a further treatment plan.

Primary brain tumor treatment

Treatment for primary brain tumors and metastatic tumors may include surgery, radiation and chemotherapy. The mainstay of this treatment is surgical resection whenever possible, depending on the size and location of the tumor. Brain tumor surgery involves an incision on the scalp, removal of bone over the area of the tumor (craniotomy) and removal of the tumor. Most patients remain in the hospital for two to three days after surgery.

Tumors such as astrocytoma, GBM, oligodendroglioma, ependymoma, and medulloblastoma are infiltrative, and thus, even with the removal of all visualized tumors, microscopic disease will remain. Fractionated radiation therapy, with or without a clinical trial, may be used after surgery to address any remaining disease.

Radiosurgery is another treatment option, most often for benign lesions (meningioma, schwannoma) or metastatic tumors. This technique allows for a very high one-time dose of radiation to be delivered to the tumor while sparing surrounding brain tissue and structures. This treatment is only acceptable for lesions less than 3 cm in diameter, separate from the brain and easily delineated on an MRI or CT scan.

Metastatic tumor treatment

Metastatic tumors are slightly more circumscribed but also tend to recur in the location of previous treatment or elsewhere in the brain. Surgery, radiosurgery, fractionated radiation, chemotherapy, and clinical trials are all options and often used in combination. Each patient and their doctor should discuss each individual鈥檚 ideal option(s).

Follow-up

Following brain tumor treatment, most patients will need serial follow-up, including exams and MRI brain imaging, to evaluate for recurrence or other long-term effects of the tumor or treatment.

Aftercare and more

• Brain radiation - discharge
• Brain surgery - discharge
• Chemotherapy - what to ask your doctor
• Radiation therapy - questions to ask your doctor
• Stereotactic radiosurgery - discharge

Tumor grading

What is the difference between cancer grades and cancer stages?

Solid organ cancers like lung, breast, prostate and colon cancers are staged. Staging tells us about the degree of spread. However, since primary brain tumors rarely 鈥渟pread鈥� outside the brain and spinal cord, they are graded. Grading can tell us the aggressiveness of the cancer.

Grades range from one to four, with one being the least aggressive and four being the most aggressive. Grade one tumors are commonly benign and can be cured through surgery. However, benign tumors can still be troublesome, depending on their location and operability. Tumors with a grade of three or four are commonly referred to as malignant.

Grading also assists in determining the prognosis for the patient and helps us assess treatment options, which might include:

• Surgery alone
• Surgery followed by radiation treatment
• Surgery followed by radiation and chemotherapy

Clinical trial research

For information about clinical research being conducted at the University of Florida in the areas of treatment, education, support, prevention and diagnosis, please visit our clinical trials web page.

Relevant articles

Call (352) 273-6990 for a second opinion or a medical evaluation.

Resources

For more information about brain tumors, check out the following resources: