ON THIS PAGE: You will learn about the different types of treatments doctors use for people with a brain tumor. Use the menu to see other pages. Show
This section explains the types of treatments that are the standard of care for a brain tumor. “Standard of care” means the best treatments known. When making treatment plan decisions, you are encouraged to consider clinical trials as an option. A clinical trial is a research study that tests a new approach to treatment. Doctors want to learn whether the new treatment is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug, a new combination of standard treatments, or new doses of standard drugs or other treatments. Clinical trials are an option to consider for treatment and care for all types of brain tumors. Your doctor can help you consider all your treatment options. Learn more about clinical trials in the About Clinical Trials and Latest Research sections of this guide. How a brain tumor is treatedIn brain tumor care, different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatment. This is called a multidisciplinary team. Your care team may include a variety of other health care professionals, such as physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, dietitians, rehabilitation specialists, and others. It is important to have a care team that specializes in caring for people with a brain tumor, which may mean talking with medical professionals beyond your local area to help with diagnosis and treatment planning. The common types of treatments used for a brain tumor are described below. Your care plan may also include treatment for symptoms and side effects, an important part of your medical care. Treatment options and recommendations depend on several factors:
Some types of brain tumors grow rapidly; other tumors grow slowly. Considering all these factors, your doctor will talk with you about how soon treatment should start after diagnosis. Treatment options include those described below, such as surgery, radiation therapy, chemotherapy, and targeted therapy. For a low-grade brain tumor, surgery may be the only treatment needed, especially if all of the tumor can be removed. If there is visible tumor remaining after surgery, radiation therapy and chemotherapy may be used. For higher-grade tumors, treatment usually begins with surgery, followed by radiation therapy and chemotherapy. Your exact treatment plan will be developed with your health care team. Successfully treating brain tumors can be challenging. The body’s blood-brain barrier normally protects the brain and spinal cord from harmful chemicals. However, this barrier also keeps out many types of chemotherapy. Surgery can be difficult if the tumor is near a delicate part of the brain or spinal cord. Even when the surgeon can completely remove the original tumor, parts of the tumor may remain that are too small to be seen or removed during surgery. Radiation therapy can also damage healthy tissue. However, research in the past 20 years has helped to significantly lengthen the lives and improved the quality of life for many people with a brain tumor. These advancements include more refined surgeries, a better understanding of which types of tumors respond to chemotherapy and other drugs, and more targeted delivery of radiation therapy. Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Talk with your doctor about the goals of each treatment and what you can expect while receiving the treatment. These types of talks are called “shared decision-making.” Shared decision-making is when you and your doctors work together to choose treatments that fit the goals of your care. Shared decision-making is particularly important for a brain tumor because there are different treatment options. Learn more about making treatment decisions. Physical, emotional, and social effects of a brain tumorA brain tumor and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the tumor. Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of tumor, may receive this type of care. And it often works best when it is started right after a brain tumor diagnosis. People who receive palliative care along with treatment for the tumor often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment. Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the tumor, such as chemotherapy, surgery, or radiation therapy. Some of the symptoms of a brain tumor can be severe and have an enormous impact on the daily lives of patients and their family caregivers. However, many symptoms can often be managed with the use of certain medications. Supportive care for people with a brain tumor includes:
Before treatment begins, talk with your doctor about the goals of each treatment being recommended in the treatment plan. You should also talk about the possible side effects of the specific treatment plan and palliative care options. Many patients also benefit from talking with a social worker and participating in support groups. Ask your doctor about these resources, too. During treatment, your health care team may ask you to answer questions about your symptoms and side effects and to describe each problem. Be sure to tell the health care team if you are experiencing a problem. This helps the health care team treat any symptoms and side effects as quickly as possible. It can also help prevent more serious problems in the future. Learn more about the importance of tracking side effects in another part of this guide. Learn more about palliative care in a separate section of this website. SurgerySurgery is the removal of the tumor and some surrounding healthy tissue during an operation. It is usually the first treatment used for a brain tumor. It is often the only treatment needed for a low-grade brain tumor. Removing the tumor can improve neurological symptoms, provide tissue for diagnosis and genetic analysis, help make other brain tumor treatments more effective, and, in many instances, improve the prognosis of a person with a brain tumor. A neurosurgeon is a doctor who specializes in surgery on the brain and spinal column. Surgery to the brain requires the removal of part of the skull, a procedure called a craniotomy. After the surgeon removes the tumor, the patient's own bone will be used to cover the opening in the skull. There have been rapid advances in surgery for brain tumors, including the use of cortical mapping, enhanced imaging, and fluorescent dyes.
For a tumor that is near the brain’s speech center, it is increasingly common to perform the operation when the patient is awake for part of the surgery. Typically, the patient is awakened once the surface of the brain is exposed. Then, special electrical stimulation techniques are used to locate the specific part of the brain that controls speech. This approach can help avoid causing damage while removing the tumor. In addition to removing or reducing the size of the brain tumor, surgery can provide a tissue sample for an analysis using a biopsy (see Diagnosis). For some tumor types, the results of the biopsy can help determine if cancer medications or radiation therapy will be useful. For a cancerous tumor, even if it cannot be cured, removing it can relieve symptoms from the tumor pressing on the brain. Sometimes, surgery cannot be performed because the tumor is located in a place the surgeon cannot reach or it is near a vital structure. These tumors are called inoperable or unresectable. If the tumor is inoperable, the doctor will recommend other treatment options that may also include a biopsy or removal of a portion of the tumor. Before surgery, talk with your health care team about the possible side effects from the specific surgery you will have. Learn more about the basics of surgery. Radiation therapyRadiation therapy is the use of high-energy x-rays or other particles to destroy tumor cells. Doctors may use radiation therapy to slow or stop the growth of a brain tumor. It is typically given after surgery and possibly along with chemotherapy. A doctor who specializes in giving radiation therapy to treat a tumor is called a radiation oncologist. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. When radiation treatment is given using implants, it is called internal radiation therapy or brachytherapy. A radiation therapy regimen, or schedule, usually consists of a specific number of treatments given over a set period of time. External-beam radiation therapy can be directed at a brain tumor in the following ways:
With these different techniques, doctors are trying to be more precise and reduce radiation exposure to the surrounding healthy brain tissue. Depending on the size and location of the tumor, the radiation oncologist may choose any of the above radiation techniques. In certain situations, a combination of multiple techniques may work best. Short-term side effects from radiation therapy may include fatigue, mild skin reactions, hair loss, upset stomach, and neurologic symptoms, such as memory problems. Most side effects go away soon after treatment is finished. Also, radiation therapy is usually not recommended for children younger than 5 because of the high risk of damage to their developing brains. Longer term side effects of radiation therapy depend on how much healthy tissue received radiation and include memory and hormonal problems and cognitive (thought process) changes, such as difficulty understanding and performing complex tasks. Learn more about the basics of radiation therapy. Therapies using medicationTreatments using medication are used to destroy cancer cells. Medication may be given through the bloodstream to reach cancer cells throughout the body. When a drug is given this way, it is called systemic therapy. Medication may also be given locally, which is when the medication is applied directly to the cancer or kept in a single part of the body. This type of medication is generally prescribed by a medical oncologist, a doctor who specializes in treating cancer with medication. It may also be given by a neuro-oncologist Medications are often given through an intravenous (IV) tube placed into a vein using a needle or as a pill or capsule that is swallowed (orally). It may also be given through a catheter or port, which are used to make IV injections easier. If you are given oral medications, be sure to ask your health care team about how to safely store and handle them. The types of medications used for a brain tumor include:
Each of these types of therapies is discussed below in more detail. A person may receive 1 type of medication at a time or a combination of medications given at the same time. They can also be given as part of a treatment plan that includes surgery and/or radiation therapy. The medications used to treat a brain tumor are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. It is also important to let your doctor know if you are taking any other prescription or over-the-counter medications or supplements. Herbs, supplements, and other drugs can interact with the medications used for a brain tumor, causing unwanted side effects or reduced effectiveness. Learn more about your prescriptions by using searchable drug databases. ChemotherapyChemotherapy is the use of drugs to destroy tumor cells, usually by keeping the tumor cells from growing, dividing, and making more cells. A chemotherapy regimen, or schedule, usually consists of a specific number of cycles given over a set period of time. A patient may receive 1 drug at a time or a combination of different drugs given at the same time. The goal of chemotherapy can be to destroy tumor cells remaining after surgery, slow a tumor’s growth, or reduce symptoms. As explained above, chemotherapy to treat a brain tumor is typically given after surgery and possibly with or after radiation therapy, particularly if the tumor has come back after initial treatment. Some drugs are better at going through the blood-brain barrier. These are the drugs often used for a brain tumor.
Patients are monitored with a brain MRI every 2 to 3 months while receiving active treatment. Then, the length of time between MRI scans increases depending on the tumor’s grade. Patients often have regular MRIs to monitor their health after treatment is finished and the tumor has not grown.If the tumor grows during treatment, other treatment options will be considered. The side effects of chemotherapy depend on the individual and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite, and diarrhea. These side effects usually go away after treatment is finished. Rarely, certain drugs may cause some hearing loss. Others may cause kidney damage. Patients may be given extra fluid by IV to protect their kidneys. Learn more about the basics of chemotherapy. Targeted therapy (updated 12/2021)In addition to standard chemotherapy, targeted therapy is another way doctors use medication to treat cancer. Targeted therapy is a treatment that targets the tumor’s specific genes, proteins, or the tissue environment that contributes to a tumor’s growth and survival. This type of treatment blocks the growth and spread of tumor cells and limits the damage to healthy cells. Not all tumors have the same targets, and some tumors may have more than 1 target. To find the most effective treatment, your doctor may run tests to identify the genes, proteins, and other factors in your tumor. This helps doctors better match each patient with the most effective treatment whenever possible. In addition, research studies continue to find out more about specific molecular targets and new treatments directed at them. Learn more about the basics of targeted treatments. For a brain tumor, there are 2 types of targeted therapy that may be used:
A variety of other targeted therapies are being studied in brain tumors that contain other specific molecular changes, such as IDH mutations, BRAF mutations, and FGFR fusions. Talk with your doctor about the possible side effects for a specific medication and how they can be managed. Alternating electric field therapy (tumor treating fields)This type of treatment uses a noninvasive portable device that interferes with the parts of a cell that are needed for tumor cells to grow and spread. It is given by placing electrodes that produce an electric field on the outside of a person’s head. The available device is called Optune. Alternating electrical field therapy may be an option for people newly diagnosed with glioblastoma or for those with recurrent glioblastoma. Researchers have found that people with recurrent glioblastoma who used the device lived as long as those who received chemotherapy. In addition, they had fewer side effects. Other research shows that people newly diagnosed with glioblastoma lived longer and were less likely to have the disease worsen when this treatment was used along with temozolomide after radiation therapy. This treatment approach is now considered a recommended option for glioblastoma. Treatment by brain tumor type (updated 12/2021)
This information is based on the ASCO and Society for Neuro-Oncology (SNO) guideline, “Therapy for Diffuse Astrocytic and Oligodendroglial Tumors in Adults.” Please note that this link takes you to another ASCO website. Remission and the chance of recurrenceA remission is when the tumor cannot be detected in the body. A remission can be temporary or permanent. For most primary brain tumors, despite imaging tests showing that the tumor growth is controlled or there are no visible signs of a tumor, it is common for a brain tumor to recur. Patients will often continue to receive regular MRI scans to watch for a recurrence. This uncertainty causes many people to worry that the tumor will come back. It is important to talk with your doctor about the possibility of the tumor returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the tumor does return. Learn more about coping with the fear of recurrence. If the tumor returns after the original treatment, it is called a recurrent tumor. A recurrent brain tumor generally comes back near where it originally started. Rarely, it may come back in another place or in several areas, which is called a multifocal recurrence. When this occurs, a new cycle of testing will begin again to learn as much as possible about the recurrence. After this testing is done, you and your doctor will talk about the treatment options. Often the treatment plan will include the treatments described above such as surgery, radiation therapy, chemotherapy, and targeted therapy, but they may be used in a different combination or given at a different pace. Options may include:
There is no single approach to treating a recurrent brain tumor, and your treatment plan will be based on many factors. Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects. Your doctor may suggest clinical trials of new drugs that are being created and tested to treat brain tumors that may help with recurrent tumors. Many of these new drugs are called "molecular targeted therapies" because they are small in size, which means they can be taken by mouth and/or can target specific parts of the brain tumor cells (see "Targeted therapy," above). These new drugs are being tested either alone or in combination with standard chemotherapy. Learn more about clinical trials on brain tumor treatment in the Latest Research section. People with a recurrent brain tumor sometimes experience emotions such as disbelief or fear. You are encouraged to talk with the health care team about these feelings and ask about support services to help you cope. It may also be helpful to talk with other patients, including through a support group. Learn more about dealing with a recurrence. Metastatic cancerIf cancer spreads from where it started to another part of the body, doctors call it metastatic cancer. If this happens, it is a good idea to talk with doctors who have experience in treating it. Doctors can have different opinions about the best standard treatment plan. Clinical trials might also be an option. Learn more about getting a second opinion before starting treatment, so you are comfortable with your chosen treatment plan. For many people, a diagnosis of metastatic cancer is very stressful and difficult. You and your family are encouraged to talk about how you feel with doctors, nurses, social workers, or other members of the health care team. It may also be helpful to talk with other patients, such as through a support group or other peer support program. Your treatment plan may include a combination of surgery, radiation therapy, targeted therapy, and immunotherapy, which is a type of treatment designed to boost the body's natural defenses to fight the tumor. Learn more about immunotherapy below and in the Latest Research section of this guide. Treatment of brain metastases (updated 05/2022)If cancer spreads to the brain from another part of the body, it is called a brain metastasis, metastatic cancer, or a secondary brain tumor. Brain metastases have traditionally been treated with surgery or radiation therapy. Chemotherapy is not often used because the blood-brain barrier keeps many drugs from reaching the brain. In the past, chemotherapy was mostly used only if radiation therapy did not work. However, other medications like targeted therapy and immunotherapy are options for certain people. Current options for treating brain metastases include:
Below is a general summary of when and how surgery and radiation therapy are used to treat brain metastases:
The information in this section is based on a joint guideline from ASCO, the Society for Neuro-Oncology (SNO), and the American Society for Radiation Oncology (ASTRO), “Treatment for Brain Metastases,” and ASCO’s endorsement of the ASTRO guideline, “Radiation Therapy for Brain Metastases.” Please note that these links take you to a different ASCO website. Treatment of leptomeningeal metastasesIf cancer spreads to the meninges or the CSF, it is called leptomeningeal metastases. People with leptomeningeal metastases may receive chemotherapy given directly into the CSF of the brain. This may be done with a lumbar puncture and is called intrathecal chemotherapy. Or it may be given using a catheter with a reservoir, called an Ommaya reservoir. Radiation therapy may also be an option. Managing the symptoms and side effects of brain metastasesThe symptoms of brain metastases depend on where in the brain the cancer has spread, how much cancer is in the brain, and how quickly it spreads. Relieving a person's symptoms and side effects is an important part of cancer care. Treatment for symptoms can continue even when active treatment to cure or slow down the cancer stops. Be sure to talk with the health care team about new symptoms or changes to existing symptoms. ASCO recommends the following options to help relieve symptoms of brain metastases:
Learn about other options to help manage the symptoms of brain metastases. This information is based on ASCO's endorsement of recommendations on the use of anti-seizure medications and steroids for metastatic brain tumors from the Congress of Neurological Surgeons. Please note that this link takes you to another ASCO website. If treatment does not workRecovery from a brain tumor is not always possible. If the tumor cannot be cured or controlled, the disease may be called advanced or terminal. This diagnosis is stressful, and for some people, an advanced brain tumor is difficult to discuss. However, it is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important. People who have an advanced brain tumor and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment can make staying at home a workable option for many families. Learn more about advanced care planning. After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss. The next section in this guide is About Clinical Trials. It offers more information about research studies that are focused on finding better ways to care for people with a brain tumor. Use the menu to choose a different section to read in this guide. What is a lesion and how does it help us study the brain quizlet?A lesion is a general term for any abnormality in tissue, usually cause by disease and trauma. Studying damaged brains is the most useful way to increase our understanding of the links between the brain and our behavior. Electrodes placed on the scalp. X-ray from many angles to see a slice of the brain.
Which method best allows researchers to examine brain anatomy?Magnetic resonance imaging (MRI) uses changes in electrically charged molecules in a magnetic field to form images of the brain. Both technologies are more precise than ordinary X-rays and can help find problems when people fall ill.
Which technique for investigating the function of brain regions is similar to Lesioning but has no ill effects?Brain Stimulation
The procedure of stimulating a specific area of the brain is much the same as in lesioning, but the much milder current in this research does no damage to the neurons. It does cause the neurons to react as if they had received a message. This is called electrical stimulation of the brain, or ESB.
What name is given to the process of matching a perceptual description of a word on to a stored memory description of that word?The process of pattern recognition involves matching the information received with the information already stored in the brain. Making the connection between memories and information perceived is a step of pattern recognition called identification.
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