Brain cancer

Signs and Symptoms

A brain tumor often produces the following signs and symptoms:

• Loss of appetite
• Headaches that often are worse in the morning
• Seizures (convulsions)
• Nausea or vomiting
• Weakness or loss of feeling in the arms or legs
• Stumbling or lack of coordination when walking
• Abnormal eye movements or changes in vision
• Drowsiness
• Changes in personality or memory
• Changes in speech
• Changes in hearing
• Changes in mood
• Changes in mental capacity and concentration

Who Is Most At Risk?

People with the following conditions or characteristics may be at risk for developing a brain tumor:

• Radiation exposure
• Exposure to pesticides, herbicides, fertilizer
• Certain occupations, such as lead, petroleum, plastic, rubber, and textile workers, as well as aircraft and vehicle operators
• Exposure to electromagnetic fields
• Certain viruses, especially Epstein-Barr virus
• Certain genetic disorders
• People who have had transplants and individuals with AIDS
• A small percentage of brain tumors may be hereditary (approximately 5% of gliomas)
• People over age 45

Studies have not shown an association between brain cancer and cell phone use.

What to Expect at Your Provider's Office

If you have symptoms of a brain tumor, you should see your health care provider immediately. Your provider will ask about your personal and family medical history and perform a complete physical and neurologic exam. This includes checks for alertness, muscle strength, coordination, reflexes, and response to pain, and an eye exam to look for swelling caused by a tumor pressing on the nerve that connects the eye and the brain.

Your provider may order a computed tomography (CT) scan, magnetic resonance imaging (MRI) scan, magnetic resonance spectroscopy (MRS) scan, or single-photon emission computed tomography (SPECT) scan. A positron emission tomography (PET) scan or a combination PET-CT scan may help doctors assess the metabolic effects of cancer. Additional tests may include skull x-ray, brain scan, angiogram or arteriogram, and a myelogram (x-ray of the spine, using dye). If cancer is present, others who may become involved in your care include a neurosurgeon, medical oncologist, radiation oncologist, nurse, dietitian, social worker, physical therapist, occupational therapist, and speech therapist.

Treatment Options

Treatment Plan

Treatment for a brain tumor depends on the type, location, and size of the tumor, as well as the person's age and general health. Treatment generally involves surgery, radiation therapy, chemotherapy, brachytherapy, or some combination of these.

Drug Therapies

Your health care provider may prescribe the following therapies:

• Steroids. To relieve swelling.
• Anticonvulsants. To prevent or control seizures.
• Radiation therapy. To destroy tumor tissue that cannot be removed with surgery or to kill cancer cells that may remain after surgery, or when surgery is not possible.
• Chemotherapy. To kill cancer cells.
• Brachytherapy. To destroy tumor cells from the inside (internal radiation therapy).
• Bevacizumab (avastin). A biologic drug that blocks the growth of blood vessels that feed tumors.
• Immunotherapy. Including cytokine therapy, passive immunotherapy, and active immunotherapy, which help bolster the immune system to fight the tumor.

Surgical and Other Procedures

Surgery is the most common treatment. To remove a brain tumor, a neurosurgeon performs a craniotomy, which involves making an opening in the skull. If the tumor cannot be at least partially removed, the surgeon may perform a biopsy, in which a small piece of the tumor is removed so that a pathologist can examine it under a microscope to determine the type of cancer cells. This necessary information helps doctors prescribe other forms of treatment.

Physicians may insert a shunt to drain cerebrospinal fluid. A shunt is a long, thin tube placed in the brain and then threaded under the skin to another part of the body, usually the abdomen. It works like a drainpipe, allowing excess fluid to be carried away from the brain and absorbed in the abdomen. Scientists are also developing therapies such as targeted toxins.

Complementary and Alternative Therapies

A comprehensive treatment plan for brain cancer may include a range of complementary and alternative therapies. Many naturally-oriented doctors believe that nutrients and herbs may protect against side effects from conventional therapies, as well as enhance chemotherapy and support anticancer activities. Other doctors are concerned that certain natural medications may interfere with conventional cancer therapies. It is important for patients to educate themselves and inform their health care providers about any therapies, conventional and natural, that they are using. Mind-body therapies -- such as meditation, relaxation techniques, guided imagery, hypnosis, yoga, and qi gong -- may reduce the effects of stress and enhance your quality of life and your response to treatment. Ask your team of providers about the best way to incorporate these therapies into your overall treatment plan, and make sure to inform your provider about any herbs, supplements, or treatments you are taking.

Nutrition and Supplements

Following these nutritional tips may help reduce symptoms:

• Try to eliminate suspected food allergens, such as dairy (milk, cheese, and ice cream), wheat (gluten), soy, corn, preservatives and chemical food additives. Your provider may want to test you for food allergies.
• Eat fewer red meats and more lean meats, cold-water fish, tofu (soy, if no allergy is present) or beans for protein. Use quality protein sources, such as organic meat and eggs, whey, and vegetable protein shakes, as part of a balanced program aimed at gaining muscle mass and preventing wasting, a side effect of cancer therapies.
• Use healthy cooking oils, such as olive oil or coconut oil.
• Reduce or eliminate trans-fatty acids, found in such commercially-baked goods as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
• Avoid caffeine and other stimulants, alcohol, and tobacco.
• Exercise, 5 days a week if possible. Talk to your doctor about the best regimen for you.

You may address nutritional deficiencies with the following supplements. Working with nutritionists and herbal professionals may be part of a comprehensive cancer care program. Remember to inform your providers about any nutritional therapies and herbal medicines that you are using. Some supplements may interfere with cancer therapies and new information is becoming available all the time.

• Probiotic supplement (containing Lactobacillus acidophilus). 5 to 10 billion CFUs (colony forming units) a day, for maintenance of gastrointestinal and immune health. Refrigerate your probiotic supplements for best results. In cases of severe immunosuppression or immunodeficiency, probiotics may not be appropriate. Work with your provider to determine if this type of supplement is right for you.
• Omega-3 fatty acids. Such as fish oil, 1 to 2 capsules or 1 tbsp. (15 mL) of oil, 1 to 2 times daily, to help reduce inflammation and enhance immunity. Cold-water fish, such as salmon or halibut, are good sources. Omega-3 supplements may increase the blood-thinning effects of certain medications such as warfarin (Coumadin) and aspirin. Speak to your provider.
• Melatonin. 2 to 6 mg at bedtime, for immune support and to promote sleep. Higher doses may be needed in cancer. Consult your provider. Melatonin may interact with a variety of medications, including but not limited to antidepressants, psychiatric medications, blood-thinning medications, sedatives, and blood pressure medications. Speak to your doctor.

Herbs

Herbs are a way to strengthen and tone the body's systems. As with any therapy, you should speak to your provider before starting treatment.

Combine essential oils of bergamot (Citrus bergamia), chamomile (Matricaria recutita), and lavender (Lavendula angustifolia) in aromatherapy applications. Place several drops in a warm bath, or 4 to 6 drops in 1 tbsp. (15 mL) of vegetable oil for massage.

Homeopathy

An experienced homeopath can prescribe a regimen for supporting general health during brain cancer that is designed especially for you. Acute remedies may help relieve symptoms associated with complications.

Homeopathy may help reduce symptoms and strengthen overall constitution, reduce the effects of stress during cancer, and may decrease the side effects of chemotherapy. Work with a knowledgeable prescriber.

Radium bromatum. Is specific for radiation poisoning, especially followed by arthritic complaints. Acute dose is 3 to 5 pellets of 12X - 30C, every 1 to 4 hours until symptoms are relieved.

Acupuncture

While acupuncture is not used as a treatment for cancer itself, evidence suggests it can be a valuable therapy for cancer-related symptoms (particularly nausea and vomiting) that often accompany chemotherapy treatment. Studies also indicate that acupuncture may help reduce pain and shortness of breath. Acupressure (pressing on rather than needling acupuncture points) also helps control breathlessness. Patients can learn this technique to treat themselves.

Some acupuncturists prefer to work with a patient only after the completion of conventional medical cancer therapy. Others will provide acupuncture or herbal therapy during active chemotherapy or radiation. Acupuncturists treat cancer patients based on an individualized assessment of the excesses and deficiencies of qi located in various meridians. In many cases of cancer-related symptoms, a qi deficiency is usually detected in the spleen or kidney meridians.

Prognosis/Possible Complications

The outlook varies greatly depending on the type of tumor and other factors. Some types of brain cancer have a 5-year survival rate above 80%. Brain cancer has significant emotional and psychological effects. Patients who receive radiation therapy to large areas of the brain or certain anticancer drugs may have a higher risk of developing leukemia or a second tumor at a later time. Radiation that affects the eyes may lead to the later development of cataracts.

Since brain tumors can develop in parts of the brain that control motor skills, speech, vision and thinking, rehabilitation may be a necessary part of recovery. Rehabilitation may include physical therapy, vocational therapy, and cognitive and speech therapy.

Following Up

After treatment, it is important to get regular follow-up exams, to make sure the tumor has not returned. Checkups usually include physical and neurologic exams and occasional CT scans or MRIs.

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