How to Know if You Have a Frontal Lobe Tumor

Brain tumors: an introduction

Overview

A encephalon tumor is an aberrant growth of cells inside the brain or skull; some are benign, others malignant. Tumors can grow from the brain tissue itself (chief), or cancer from elsewhere in the body tin can spread to the brain (metastasis). Treatment options vary depending on the tumor type, size and location. Treatment goals may exist curative or focus on relieving symptoms. Many of the 120 types of brain tumors can exist successfully treated. New therapies are improving the life span and quality of life for many people.

What is a brain tumor?

Normal cells grow in a controlled way as new cells supplant quondam or damaged ones. For reasons not fully understood, tumor cells reproduce uncontrollably.

A primary brain tumor is an aberrant growth that starts in the brain and usually does non spread to other parts of the body. Primary brain tumors may be benign or cancerous.

A benign encephalon tumor grows slowly, has distinct boundaries, and rarely spreads. Although its cells are not malignant, beneficial tumors can be life threatening if located in a vital expanse.

A malignant brain tumor grows quickly, has irregular boundaries, and spreads to nearby encephalon areas. Although they are often called brain cancer, cancerous encephalon tumors do not fit the definition of cancer because they do non spread to organs exterior the brain and spine.

Metastatic (secondary) brain tumors begin as cancer elsewhere in the body and spread to the brain. They form when cancer cells are carried in the blood stream. The almost mutual cancers that spread to the brain are lung and breast.

Whether a brain tumor is benign, malignant, or metastatic, all are potentially life-threatening. Enclosed inside the bony skull, the brain cannot aggrandize to make room for a growing mass. Every bit a result, the tumor compresses and displaces normal brain tissue. Some brain tumors cause a blockage of cerebrospinal fluid (CSF) that flows around and through the encephalon. This blockage increases intracranial pressure level and can enlarge the ventricles (hydrocephalus). Some brain tumors cause swelling (edema). Size, pressure level, and swelling all create "mass result," which cause many of the symptoms (Fig. 1).

Figure 1. Brain tumors may grow from nerves (neuroma), dura (meningioma), or pituitary gland (craniopharyngioma or pituitary adenoma). They may also abound from the encephalon tissue itself (glioma). As they grow they may compress normal tissue and cause symptoms.

Types of brain tumors

There are over 120 different types of brain tumors. Common brain tumors include:

Gliomas

• Astrocytoma
• Pilocytic Astrocytoma (grade I)
• Diffuse Astrocytoma (grade 2)
• Anaplastic Astrocytoma (grade III)
• Glioblastoma Multiforme (grade IV)
• Oligodendroglioma (grade Two)
• Anaplastic Oligodendroglioma (course III)
• Ependymoma (grade II)
• Anaplastic Ependymoma (grade Three)

Craniopharyngioma
Epidermoid
Lymphoma
Meningioma
Schwannoma (neuroma)
Pituitary adenoma
Pinealoma (pineocytoma, pineoblastoma)
Medulloblastoma

The World Health System (WHO) developed a classification and grading organization to standardize communication, treatment planning, and predict outcomes for encephalon tumors. Tumors are classified past their cell type and grade past viewing the cells, usually taken during a biopsy, under a microscope.

Cell type. Refers to the cell of origin of the tumor. For example, nervus cells (neurons) and back up cells (glial and schwann cells) give rising to tumors. Nigh one-half of all primary brain tumors abound from glial cells (gliomas). There are many types of gliomas because there are different kinds of glial cells.

Grade. Refers to the style tumor cells look under the microscope and is an indication of aggressiveness (due east.chiliad., depression form means least aggressive and high class means nearly aggressive) (Table i). Tumors often have a mix of jail cell grades and can change as they abound. Differentiated and anaplastic are terms used to describe how similar or aberrant the tumor cells appear compared to normal cells.

Tabular array 1. Glioma Grading Calibration

Grade	Characteristics
I	Dull growing cells Most normal appearance Least malignant Unremarkably associated with long-term survival
Ii	Relatively slow growing cells Slightly abnormal appearance Tin can invade nearby tissue Sometimes recur equally a higher form
Iii	Actively reproducing aberrant cells Abnormal appearance Infiltrate normal tissue Tend to recur, often every bit a higher form
4	Rapidly reproducing abnormal cells Very abnormal appearance Expanse of dead cells (necrosis) in middle Form new blood vessels to maintain growth

What causes brain tumors?

Medical science neither knows what causes brain tumors nor how to forbid chief tumors that beginning in the brain. People most at risk for brain tumors include those who take:

• cancer elsewhere in the body
• prolonged exposure to pesticides, industrial solvents, and other chemicals
• inherited diseases, such as neurofibromatosis

What are the symptoms?

Tumors can touch the brain by destroying normal tissue, compressing normal tissue, or increasing intracranial pressure. Symptoms vary depending on the tumor's type, size, and location in the brain (Fig. 2). Full general symptoms include:

• headaches that tend to worsen in the morn
• seizures
• stumbling, dizziness, difficulty walking
• speech problems (e.g., difficulty finding the right word)
• vision problems, abnormal eye movements
• weakness on one side of the body
• increased intracranial pressure, which causes drowsiness, headaches, nausea and vomiting, sluggish responses

Figure two. Brain tumor symptoms are related to the functional areas of the brain in which they are located.

Specific symptoms include:

• Frontal lobe tumors may crusade: behavioral and emotional changes; dumb judgment, motivation or inhibition; impaired sense of smell or vision loss; paralysis on one side of the body; reduced mental abilities and memory loss.
• Parietal lobe tumors may cause: dumb speech; problems writing, cartoon or naming; lack of recognition; spatial disorders and middle-hand coordination.
• Occipital lobe tumors may crusade: vision loss in one or both eyes, visual field cuts; blurred vision, illusions, hallucinations
• Temporal lobe tumors may cause: difficulty speaking and understanding linguistic communication; short-term and long-term retentivity problems; increased aggressive beliefs
• Brainstem tumors may cause: behavioral and emotional changes, difficulty speaking and swallowing, drowsiness, hearing loss, musculus weakness on i side of the face (due east.g., head tilt, crooked grinning), musculus weakness on i side of the body, uncoordinated gait, drooping eyelid or double vision, and vomiting.
• Pituitary gland tumors may cause: increased secretion of hormones (Cushing's Disease, acromegaly), a cease in catamenia, abnormal secretion of milk, and decreased libido.

Who is affected?

The American Brain Tumor Clan estimates that most 80,000 people will be diagnosed with a main brain tumor in the U.s.a. this yr. Metastatic (secondary) brain tumors are 5 times more than common than master brain tumors and they occur in 10% to thirty% of cancer patients. People are surviving cancer longer than ever earlier. Equally a event, metastatic brain tumors volition likely increase in the years to come. Although encephalon tumors can occur at any historic period, they are virtually common in children 3 to 12 years onetime and in adults 40 to 70 years onetime.

How is a diagnosis fabricated?

Beginning, the doc will obtain your personal and family medical history and perform a complete physical examination. In addition to checking your general wellness, the doctor performs a neurological exam to check mental status and memory, cranial nerve function (sight, hearing, scent, tongue and facial motion), musculus strength, coordination, reflexes, and response to hurting. Additional tests may include:

• Audiometry, a hearing test performed past an audiologist, detects hearing loss due to tumors about the cochlear nerve (e.g., audio-visual neuroma).
• An endocrine evaluation measures hormone levels in your blood or urine to detect abnormal levels caused by pituitary tumors (e.g., Cushing'southward Disease).
• A visual field acuity exam is performed by a neuro-ophthalmologist to detect vision loss and missing areas in your field of view.


• A lumbar puncture (spinal tap) may be performed to examine cerebrospinal fluid for tumor cells, proteins, infection, and blood.

Imaging tests

• Computed Tomography (CT) browse uses an Ten-ray beam and a reckoner to view anatomical structures. It views the brain in slices, layer-by-layer, taking a moving-picture show of each slice. A dye (contrast amanuensis) may be injected into your bloodstream. CT is very useful for viewing changes in bony structures.
  


• Magnetic Resonance Imaging (MRI) scan uses a magnetic field and radiofrequency waves to give a detailed view of the soft tissues of the encephalon. It views the brain three-dimensionally in slices that can be taken from the side or from the summit as a cross-section. A dye (dissimilarity agent) may be injected into your bloodstream. MRI is very useful to evaluate encephalon lesions and their effects on surrounding brain (Fig. iii).

Figure three. MRI scans of a benign and cancerous brain tumor. Beneficial tumors accept well defined edges and are more easily removed surgically. Cancerous tumors accept an irregular border that invades normal tissue with finger-like projections making surgical removal more than difficult.

Biopsy

If a diagnosis cannot be fabricated clearly from the scans, a biopsy may be performed to determine what type of tumor is present. Biopsy is a process to remove a small amount of tumor cells to be examined by a pathologist under a microscope. A biopsy can exist taken as part of an open surgical process to remove the tumor or as a split up diagnostic procedure, known equally a needle biopsy. A pocket-size burr hole is drilled in the skull so that a hollow needle can exist guided into the tumor and a tissue sample removed (Fig. 4). A stereotactic frame and a figurer are ofttimes used to assist precisely locate the tumor and direct the needle to deep tumors in critical locations.

Biomarkers or genetic mutations found in the tumor may aid determine prognosis. These include: IDH1, IDH2, MGMT, and 1p/19q co-deletion.

Figure 4. During a needle biopsy, a hollow cannula is inserted into the tumor. Small biting instruments remove bits of tumor for the pathologist to examine and determine the exact tumor cell blazon.

Who treats encephalon tumors?

Because there are so many kinds of brain tumors and some are complex to treat, many doctors may be involved in your care. Your squad may include a neurosurgeon, oncologist, radiation oncologist, radiologist, neurologist, and neuro-ophthalmologist.

What treatments are bachelor?

Treatment options vary depending on the type, form, size and location of the tumor; whether it has spread; and your age and general health. The goal of treatment may exist curative or focus on relieving symptoms (palliative care). Treatments are frequently used in combination with one some other. The goal is to remove all or every bit much of the tumor every bit possible through surgery to minimize the chance of recurrence. Radiation therapy and chemotherapy are used to treat tumors that cannot be removed past surgery alone. For case, surgery may remove the majority of the tumor and a pocket-sized corporeality of balance tumor near a disquisitional structure tin later be treated with radiation.

Ascertainment

Sometimes the best handling is observation. For example, benign, slow growing tumors that are small and accept few symptoms may be observed with routine MRI scans every year until their growth or symptoms necessitate surgery. Observation may be the best option for people who are older or with other health atmospheric condition.

Medication

Medications are used to control some of the common side effects of brain tumors.

• Steroids, such as dexamethasone (Decadron), are used to reduce swelling and fluid build-up (edema) around the tumor. Because steroids can crusade stomach ulcers and gastric reflux, famotidine (Pepcid) or pantoprazole (Protonix) are prescribed to reduce the amount of acrid produced in the stomach.
  
• Furosemide (Lasix) or mannitol (Osmitrol) may be used to control edema and swelling.
  
• Anticonvulsants are used to prevent or control seizures. The most common ones include phenytoin (Dilantin), valproic acrid (Depakote), carbamazepine (Tegretol), and levetiracetam (Keppra).

Surgery

Surgery is the handling of option for encephalon tumors that tin be reached without causing major injury to vital parts of the brain. Surgery can help to refine the diagnosis, remove as much of the tumor equally possible, and release pressure within the skull. A neurosurgeon performs a craniotomy to open the skull and remove the tumor (Fig v). Sometimes only function of the tumor is removed if it is well-nigh critical areas of the brain. A partial removal can still relieve symptoms. Radiations or chemotherapy may be used on the remaining tumor cells.

Paradigm-guided surgery technologies, tumor fluorescence, intraoperative MRI/CT, and functional brain mapping have improved the surgeon's ability to precisely locate the tumor, define the tumor's borders, avoid injury to vital brain areas, and confirm the corporeality of tumor removal while in the operating room.

Figure 5. Surgery involves cutting a window in the skull (craniotomy) to remove the tumor.

Laser Interstitial Thermal Therapy

Laser ablation is a minimally invasive treatment that transmits oestrus to "melt" brain tumors from the inside out. A probe is inserted to the tumor through a burr pigsty in the skull. The laser catheter is guided with real-time MRI.

Radiation

Radiation therapy uses controlled high-energy rays to care for brain tumors. Radiations damages the DNA within cells, making them unable to dissever and abound. The benefits of radiation are not immediate but occur with fourth dimension. Aggressive tumors, whose cells split rapidly, tend to answer quickly to radiation. Over fourth dimension, the aberrant cells die and the tumor may shrink. Benign tumors, whose cells divide slowly, may take months to show an effect.

Pinpoint accuracy is critical so that the lethal dose is applied only to the tumor and not to surrounding healthy tissues. There are two ways to deliver radiation, external and internal beams.

External beam radiation is delivered from exterior the body by a machine that aims high-free energy rays (x-rays, gamma rays) at the tumor (Fig. 6).

Effigy 6. A machine rotates around the patient, aiming radiations beams at the tumor. The radiation beams are shaped to lucifer the tumor and minimize exposure to normal brain tissue.

• Stereotactic radiosurgery (SRS) delivers a high dose of radiation during a unmarried session. Frames and masks are used to keep the patient immobile.
• Fractionated radiotherapy delivers lower doses of radiation over many visits. Patients return daily over several weeks to receive the complete radiations dose.
• Proton beam therapy delivers accelerated proton energy to the tumor at a specific depth. The radiation beam does not go beyond the tumor.
• Whole encephalon radiotherapy (WBRT) delivers the radiation dose to the entire brain. It may be used to care for multiple brain tumors and metastases.

Internal radiations (brachytherapy) is delivered from inside the torso by radioactive seeds surgically placed inside the tumor. Later the patient undergoes a craniotomy to remove the tumor, the radioactive implants are placed within the empty tumor cavity. The radiation dose is delivered to the first few millimeters of tissue in the cavity where cancerous cells may still remain. Patients have no risk of radiation injury to other parts of their own trunk or to others around them because the dose is short lived.

Chemotherapy

Chemotherapy drugs work by disrupting jail cell segmentation. Over fourth dimension, chemotherapy causes the abnormal cells to die and the tumor may shrink. This treatment tin can also harm normal cells, but they tin repair themselves ameliorate than abnormal cells. Treatment is delivered in cycles with rest periods in between to allow the trunk to rebuild salubrious cells.

Chemotherapy drugs tin be taken orally equally a pill, intravenously (IV), or every bit a wafer placed surgically into the tumor. The drugs about ordinarily used to treat brain tumors are temozolomide (Temodar) and bevacizumab (Avastin). The most common side effects are nausea, low blood counts, infections, fatigue, constipation, and headaches. Chemotherapy is also used to increase tumor jail cell death during radiations therapy.

Some chemotherapy drugs (BCNU wafer) are applied locally to the tumor bed after the tumor has been removed. By applying it directly to the diseased expanse of the brain, side effects are limited and the drug has a more benign issue.

Chemotherapy is typically used for high-grade gliomas; it is not routinely used for benign tumors.

Figure 7. Chemotherapy for loftier-grade gliomas is usually taken equally a pill daily for a set up menstruation of time called a cycle. The drug circulates through the bloodstream to the brain where it crosses the blood-brain-barrier to the tumor.

Adjunct therapies

• Immunotherapy or biotherapy activates the immune system (T-cells and antibodies) to destroy tumor cells. Research is exploring ways to prevent or treat cancer through vaccines.
• Gene therapy uses viruses or other vectors to innovate new genetic material into tumor cells. This experimental therapy can cause tumor cells to die or increase their susceptibility to other cancer therapies.
• Hyperbaric oxygen uses oxygen at higher than normal levels to promote wound healing and assist fight infection. It may as well improve the tumor's responsiveness to radiation and is being studied experimentally. Currently it is beingness used to help the torso naturally remove dead tumor cells and treat radiation necrosis.

Tumor Treating Fields or TTFields

TTFields slows and reverses tumor growth by keeping cells from dividing. TTFields is used for the handling of glioblastoma multiforme (GBM) in combination with temozolomide in adults who have been newly diagnosed. Information technology is also approved for treatment of recurrent GBM afterwards surgical and radiation options have been exhausted. Treatment involves wearing a device resembling a bathing cap that delivers electromagnetic energy to the scalp.

Clinical trials

Clinical trials are research studies in which new treatments—drugs, diagnostics, procedures, and other therapies—are tested in people to see if they are safe and effective. Inquiry is always being conducted to ameliorate the standard of medical care. Information about current clinical trials, including eligibility, protocol, and locations, are plant on the Web. Studies can be sponsored past the National Institutes of Health (meet clinicaltrials.gov) as well as private industry and pharmaceutical companies (meet world wide web.centerwatch.com).

Recovery & prevention

Self care

Your primary intendance doctor and oncologist should discuss whatsoever home care needs with you and your family. Supportive measures vary according to your symptoms. For instance, canes or walkers tin can assist those having problem walking. A plan of care to accost changes in mental status should be adapted to each patient's needs.

Driving privileges may be suspended while taking anti-seizure medication. Equally each state has different rules nearly driving and seizures, discuss this issue with your doctor.

It may also be appropriate to talk over advance medical directives (e.m., living volition, health care proxy, durable power of chaser) with your family unit to ensure your medical care and wishes are followed.

Rehabilitation

Considering encephalon tumors develop in parts of the encephalon that control movement, spoken communication, vision and thinking, rehabilitation may be a necessary part of recovery. Although the brain tin can sometimes heal itself after the trauma of treatment, it will take time and patience. A neuropsychologist tin can aid patients evaluate changes acquired by their brain tumor and develop a program for rehabilitation. A neuropsychological evaluation assesses the patient'southward emotional state, daily behavior, cerebral (mental) abilities, and personality.

Physical therapy, occupational therapy, and spoken language therapy may be helpful to improve or correct lost functions.

Recurrence

How well a tumor will respond to treatment, remain in remission, or recur after treatment depends on the specific tumor type and location. A recurrent tumor may be a tumor that still persists later treatment, one that grows back some time subsequently treatment destroyed it, or a new tumor that grows in the same identify as the original one.

When a encephalon tumor is in remission, the tumor cells accept stopped growing or multiplying. Periods of remission vary. In general, benign tumors recur less oftentimes than malignant ones.

Since information technology is impossible to predict whether or when a particular tumor may recur, lifelong monitoring with MRI or CT scans is essential for people treated for a brain tumor, even a benign lesion. Follow-up scans may be performed every 3 to six months or annually, depending on the type of tumor you had.

Sources & links

If you have more than questions, please contact Mayfield Brain & Spine at 800-325-7787 or 513-221-1100.

Support groups provide an opportunity for patients and their families to share experiences, receive support, and learn about advances in treatments and medications.

Links

• American Brain Tumor Association (www.abta.org) 1.800.886.2282
  
• National Brain Tumor Society (www.braintumor.org) one.800.934.2873
  
• National Cancer Institute (www.cancer.gov)

Glossary

anaplastic: when cells divide rapidly and bear fiddling or no resemblance to normal cells in appearance or office.

astrocytoma: a tumor arising in the supportive cells (astrocytes) of the brain or spinal cord; most frequently in the cerebrum.

benign: does not invade nearby tissues or spread; noncancerous.

biopsy: a sample of tissue cells for examination under a microscope to make up one's mind the being or crusade of a disease.

brachytherapy: a type of radiation therapy where capsules containing radioactive substances are surgically implanted into the tumor to deliver radiation; also called internal radiotherapy.

cancer: generic term for more than 100 unlike diseases acquired past uncontrolled, aberrant growth of cells. Cancer cells tin can invade and destroy normal tissue, and tin travel through the bloodstream and lymphatic system to reach other parts of the body.

chemotherapy: treatment with toxic chemicals (e.1000., anticancer drugs).
chondrosarcoma: a rare, cancerous bone tumor arising from primitive notochord cells and composed of cartilage.

chordoma: a rare, bone tumor arising from primitive notochord cells; usually occurs at the base of the spine (sacrum) or at the skull base (clivus).
craniopharyngioma: a benign tumor arising from cells located near the pituitary stem.

differentiation: refers to how adult cancer cells are in a tumor. Well-differentiated tumor cells resemble normal cells and tend to grow and spread at a slower rate than undifferentiated, which lack the construction and function of normal cells and grow uncontrollably.

edema: tissue swelling caused past the accumulation of fluid.

ependymoma: a tumor arising from the ependyma cells lining the ventricles of the encephalon and central canal of the spinal cord.

epidermoid: a benign, congenital tumor arising from ectodermal cells; also called pearly tumor.

glioma: any tumor arising from glial tissue of the encephalon, which provides energy, nutrients, and other support for nervus cells in the brain.

hydrocephalus: an abnormal build-up of cerebrospinal fluid usually caused past a blockage of the ventricular organization of the brain; also called "h2o on the brain."

immunotherapy: treatment designed to meliorate or restore the allowed system's ability to fight infection and disease.

intracranial pressure (ICP): pressure level within the skull. Normal ICP is 20 mm HG.

lesion: a general term that refers to whatever modify in tissue, such as tumor, blood, malformation, infection, or scar tissue.

lymphoma: a rare tumor arising from lymph cells; may metastasize to the brain from lymphoma tumor elsewhere in the torso.

cancerous: having the backdrop of invasive growth and power to spread to other areas.

mass effect: harm to the brain due to the bulk of a tumor, the blockage of fluid, and/or backlog accumulation of fluid inside the skull.

medulloblastoma: a tumor arising from primitive nerve cells; most often in the cerebellum.

meningioma: a tumor arising from the meninges, the membrane that surrounds the brain and spinal cord.

metastasis: the spreading of malignant cells.

metastatic: cancerous tumor that has spread from its original source through the blood or lymph systems.

oligodendroglioma: a tumor arising from the support cells (oligodendroglia) that produce myelin, the fatty roofing around nervus cells.

pituitary adenoma: a tumor arising from cells in the pituitary gland; tumor may be hormone-secreting (prolactin, adrenocorticotropic, growth hormone) or not.

radiation: high-energy rays or particle streams used to care for affliction.

schwannoma (also called neuroma): a tumor arising from Schwann cells that produce myelin.

stereotactic: a precise method for locating deep brain structures by the apply of iii-dimensional coordinates.

tumor: an abnormal growth of tissue resulting from uncontrolled multiplication of cells and serving no physiological function; can be benign or malignant.

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updated > 9.2018
reviewed past > Ronald Warnick, MD, Christopher McPherson, MD, Yair Gozal, MD, PhD, Mayfield Clinic, Cincinnati, Ohio

Mayfield Certified Health Info materials are written and adult past the Mayfield Clinic. We comply with the HONcode standard for trustworthy health information. This information is non intended to supersede the medical communication of your health care provider.

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