Choosing a Treatment Regimen
Many people diagnosed with brain tumors want to take an active part in making decisions that will affect their healthcare. To help guide yourself toward an informed choice, you will want to listen closely to your doctor, ask the questions that are uppermost in your mind, and learn about the benefits, risks, and side effects of each option.
Your best treatment depends on a number of factors such as the type of tumor, its size and its location. For a benign, slow-growing tumor, you will have a little more time to gather information and evaluate options. With a more aggressive tumor, you will want to quickly arrive at an initial decision with the help of your trusted doctor and healthcare team.
Brain tumors are often treated by a combination of different therapies, including medications, surgery, radiation therapy and chemotherapy. Selecting the best treatment options and sticking with them can improve your chances of long-term survival.
When Surgery is Required
Brain surgery is a daunting prospect for most people and it is natural to feel frightened. It can help to speak to your doctor and healthcare team beforehand and learn as much as you can to increase your comfort level before the day of surgery.
Before surgery, you will undergo various tests to check your general health including an EEG, which painlessly records your brain waves using pads attached to your head. You will also take part in neuro- observation tests, which include questions to determine how alert you are: squeezing the nurse’s hand or responding to a light shone your eyes to check how your pupils react. This provides the doctors with a baseline of what you are like before the operation to measure how everything is proceeding.
The surgery will probably be done with tools placed through an endoscope – a tube with a light and camera on the end. During the operation, there is a good chance you will be under anesthesia the entire time. However, you may be asked to stay awake for part of the operation; you will be sedated so the pain should be minimal or non-existent. By listening to your response to various oral cues, your surgeon can avoid disrupting important brain functions.
Sometimes the surgeon needs to deal with excess fluid that can build up in the brain over time, which requires installing a drainage system called a shunt. A tube to remove the fluid is threaded under the skin, down the neck and into the abdominal cavity.
The surgeon’s goal is to remove the whole tumor or to resection it, but this is not always possible. The tumor may be too deep, there may be multiple tumors or the tumor’s edges may be mixed with normal brain tissue, making complete removal difficult.
What to Expect After Surgery
After surgery you will be transferred to the intensive care unit to be monitored. Expect to be asked multiple questions, perform relatively simple tasks and have a light shone into your eyes to evaluate your brain function.
You will probably expect to feel relieved that surgery is behind you, but do not be surprised if you experience unexpected feelings of sadness once the operation is over. The fast pace of events that began with the initial discovery of the tumor now begins to slow down, leaving more time for contemplation. Identifying and securing supportive help in advance – a social worker or counselor who specializes in working with those who have brain tumors – is a great proactive step to take before you become too overwhelmed.
In addition to your emotional reactions, there are other post-surgery effects that may be part of your recovery: headaches, itching and numbness across your incision, fatigue, and even short-term memory loss. Your healthcare team will discuss your concerns with you and provide detailed instructions about home care. Recovery time after surgery varies from person to person, depending on the type of procedure, the area of the brain affected and your age and overall general health.
Radiation therapy can be used along with surgery or as an alternative to it. Treatments often run five days a week over a several week span. Spreading out the total dose of radiation over that time period helps protect healthy tissue around the tumor. The actual radiation treatment lasts only a few minutes and is generally painless. You will lie on the treatment table without moving and external beams of x-rays, gamma rays or protons will be aimed at the tumor.
Stereotactic radiotherapy, a newer form of radiation therapy, directs highly focused beams of ionizing radiation onto the tumor with high precision. This approach includes the CyberKnife and Gamma Knife systems and the Novalis Tx radiosurgery platform. If you are a candidate for this type of surgery, you will be placed in a rigid head frame and radiation will be given during a single visit or over several visits.
After radiation therapy, some patients experience nausea or become very tired. Temporary hair loss is common. Other possible side effects include dry skin on the scalp and ears, headaches, loss of appetite, loss of memory and speech problems. As with surgical side effects, patients can recover from many of these challenges with the passage of time.
Brain tumors are generally more challenging than other cancers to treat with chemotherapy. This is because most chemotherapy drugs cannot cross the blood-brain barrier that stops toxic chemicals from reaching brain cells. But some cancer drugs can be delivered directly to the brain or even cross the barrier with the purpose of interfering with the normal functioning of the rapidly dividing cells of the tumor to prevent tumor growth.
These drugs, given by mouth or injection, are often combined with radiation therapy or even with surgery. To treat certain aggressive brain tumors, the surgeon implants several biodegradable wafers of the chemotherapy drug, each about the size of dime, into the brain, and the wafer dissolves over several weeks.
Brain tumor drugs may cause side effects like nausea and vomiting, loss of appetite, headache, fever, chills and general weakness. Drugs that lower the levels of healthy blood cells make patients more susceptible to infections, bruising or bleeding easily, and feeling very weak and tired. But as the drugs' effects wear off, these problems will gradually disappear.
Advances are being made regularly by researchers in the treatment of brain tumors. One that is gaining increasing attention is gene therapy, which involves the transfer of genetic material into a tumor cell in order to destroy it or stop its growth. Angiogenesis inhibitors are drugs that interfere with the growth of blood vessels in the tumor.
Another treatment, immunotherapy, uses your immune system – your body’s own natural power of protection – to combat the brain tumor. Also called biological therapy, biotherapy or biological response modifier therapy, immunology is designed to repair, stimulate, or enhance the body’s own immune responses, alone or along with surgery, radiation and chemotherapy. It has been used with success to boost the killing power of immune system cells such as T-cells, NK-cells and macrophages and alter the growth patterns of brain cancer cells to promote behavior like those of healthy cells.
Steroids – not the steroids you typically associate with athletes – are also used increasingly to control the swelling due to accumulation of fluids from some brain tumors. These steroids belong to a class of drugs called corticosteroids and are given through an IV (intravenous) line, into a muscle, or orally to treat increasing or severe headaches, nausea and vomiting, seizures, coordination problems, or other signs of brain edema (brain swelling).