Brain tumors

If it's suspected that you have a brain tumor, your doctor may recommend a number of tests and procedures, including:

A neurological exam. A neurological exam may include, among other things, checking your vision, hearing, balance, coordination, strength and reflexes. Difficulty in one or more areas may provide clues about the part of your brain that could be affected by a brain tumor.

Imaging tests. Magnetic resonance imaging (MRI) is commonly used to help diagnose brain tumors. Sometimes a dye is injected through a vein in your arm during your MRI study.

A number of specialized MRI scan components — including functional MRI, perfusion MRI and magnetic resonance spectroscopy — may help your doctor evaluate the tumor and plan treatment.

Sometimes other imaging tests are recommended in certain situations, including computerized tomography (CT) and positron emission tomography (PET).

Collecting and testing a sample of abnormal tissue (biopsy). A biopsy can be performed as part of an operation to remove the brain tumor, or a biopsy can be performed using a needle.

A stereotactic needle biopsy may be done for brain tumors in hard to reach areas or very sensitive areas within your brain that might be damaged by a more extensive operation. Your neurosurgeon drills a small hole into your skull. A thin needle is then inserted through the hole. Tissue is removed using the needle, which is frequently guided by CT or MRI scanning.

The biopsy sample is then viewed under a microscope to determine if it's cancerous or benign. Sophisticated laboratory tests can give your doctor clues about your prognosis and your treatment options. Studying your biopsy sample and determining exactly which type of brain tumor you have is a complex process. If you're uncertain about your diagnosis, consider seeking a second opinion at a medical center where many brain biopsies are evaluated every year.

Brain tumor treatment depends on several factors, including:

The tumor’s location, size and type.

The number of tumors.

Your age.

Your overall health.

Benign (noncancerous) brain tumors can usually be successfully removed with surgery and don’t usually grow back. It often depends on if your neurosurgeon can safely remove all of the tumor.

Treatments that are fairly well tolerated by the brains of adults, such as radiation therapy, may prevent the normal development of a child’s brain, especially in children younger than age five.

Healthcare providers often use a combination of therapies to treat a tumor. Your treatment options might include:

Brain surgery (craniotomy): When possible, neurosurgeons remove the tumor. They work very carefully, sometimes performing surgery when you’re awake (you won’t feel pain), to minimize damage to functional areas of your brain.

Radiation therapy: High doses of X-rays destroy brain tumor cells or shrink the tumor in this type of treatment.

Radiosurgery: This is a type of radiation therapy that uses very focused beams of radiation (gamma rays or proton beams) to destroy a tumor. It’s not actually surgery because it doesn’t require an incision (cut).

Brachytherapy: This is a form of radiation therapy. It involves surgically placing radioactive seeds, capsules or other implants directly in or near the cancerous tumor.

Chemotherapy: This therapy consists of anticancer drugs that kill cancer cells in your brain and throughout your body. You might receive chemotherapy through an injection into a vein or take it as a pill. Your healthcare provider may recommend chemotherapy after surgery to kill any cancer cells left behind or to prevent remaining tumor cells from growing.

Immunotherapy: Immunotherapy, also called biological therapy, is a type of treatment that uses your body’s immune system to fight cancer. The therapy mainly consists of stimulating your immune system to help it do its job more effectively.

Targeted therapy: With this treatment, drugs target specific features in cancer cells without harming healthy cells. Your healthcare provider may recommend targeted therapy if you have trouble tolerating the side effects of chemotherapy, such as fatigue and nausea.

Watchful waiting/active surveillance: If you have a brain tumor that’s very small and isn’t causing symptoms, your healthcare provider may recommend closely monitoring the tumor for signs of growth with regular testing.

Other treatments that help with symptoms caused by brain tumors include:

Shunts: If the tumor causes pressure within your skull to increase, you may need to have a shunt (a thin piece of tubing) surgically placed in your brain to drain excess cerebrospinal fluid.

Drugs such as mannitol and corticosteroids: These medications can help reduce pressure within your skull. They reduce swelling around the tumor.

Palliative care: This is a specialized form of care that provides symptom relief, comfort and support to people living with serious illnesses. It also provides support to caregivers and those impacted by a loved one’s condition.