Prof. Pietro MORTINI

What is a brain tumor?

A brain tumor is an abnormal growth of tissue in the brain. The tumor can either originate in the brain itself, or come from another part of the body and travel to the brain (metastasize).

Brain tumors may be classified as either

depending on their behavior.

A benign tumor does not contain cancer cells and usually, once removed, does not recur. Most benign brain tumors have clear borders, meaning they do not invade surrounding tissue. However, these tumors can cause symptoms similar to cancerous tumors because of their size and location in the brain.

Malignant brain tumors contain cancer cells. Malignant brain tumors are usually fast growing and invade surrounding tissue. Malignant brain tumors very rarely spread to other areas of the body, but may recur after treatment. Sometimes, brain tumors that are not cancer are called malignant because of their size and location, and the damage they can do to vital functions of the brain.

Metastatic brain tumors are tumors that begin to grow in another part of the body, then spread to the brain through the bloodstream. Common types of cancer that can travel to the brain include lung cancer, breast cancer, melanoma (a type of skin cancer), and colon cancer. All of these cancers are considered malignant once they have spread to the brain.


The following are the most common symptoms of a brain tumor. However, each person may experience symptoms differently. Symptoms vary depending on the size and location of tumor.

Many symptoms are related to an increase in pressure in or around the brain. There is no spare space in the skull for anything except the delicate tissues of the brain and its fluid. Any tumor, extra tissue, or fluid can cause pressure on the brain and result in increased intracranial pressure (ICP), which may result from one or more of the ventricles that drain cerebral spinal fluid (CSF, the fluid that surrounds the brain and spinal cord) becoming blocked and causing the fluid to be trapped in the brain.

This increased ICP may cause the following:

• headache
• vomiting (usually in the morning)
• nausea
• personality changes
• irritability
• drowsiness
• depression
• decreased cardiac and respiratory function and, eventually, coma if not treated

Symptoms of brain tumors in the cerebrum (front of brain) may include:

• increased intracranial pressure (ICP)
• seizures
• visual changes
• slurred speech
• paralysis or weakness on half of the body or face
• drowsiness and/or confusion
• personality changes/impaired judgment
• short-term memory loss
• gait disturbances
• communication problems

Symptoms of brain tumors in the brainstem (middle of brain) may include:

• increased intracranial pressure (ICP)
• seizures
• endocrine problems (diabetes and/or hormone regulation)
• visual changes or double vision
• headaches
• paralysis of nerves/muscles of the face, or half of the body
• respiratory changes
• clumsy, uncoordinated walk
• hearing loss
• personality changes

Symptoms of brain tumors in the cerebellum (back of brain) may include:

• increased intracranial pressure (ICP)
• vomiting (usually occurs in the morning without nausea)
• headache
• uncoordinated muscle movements
• problems walking (ataxia)

The symptoms of a brain tumor may resemble other conditions or medical problems.

Always consult your physician for a diagnosis.


In addition to a complete medical history and physical examination, diagnostic procedures for brain tumors may include the following:

Computed Tomography Scan – also called a CT or CAT scan.
Magnetic Resonance Imaging (MRI)
Bone Scan
Arteriogram (Also called an angiogram.) – an x-ray of the arteries and veins to detect blockage or narrowing of the vessels.
Myelogram – a procedure that uses dye injected into the spinal canal to make the structure clearly visible on x-rays.
Spinal tap (Also called a lumbar puncture)
Positron Emission Tomography (PET) – a type of nuclear medicine procedure that evaluate the metabolism of a particular organ or tissue, so that information about the physiology (functionality) and anatomy (structure) of the organ or tissue is evaluated, as well as its biochemical properties.

Neurological Examination – your physician tests reflexes, muscle strength, eye and mouth movement, coordination, and alertness.

Diagnosis of a brain tumor depends mostly on the types of cells involved and the tumor location.

Different types of brain tumors

There are many different types of brain tumors. They are usually categorized by the type of cell where the tumor begins, or they are also categorized by the area of the brain where they occur. The most common types of brain tumors include the following:


The most common type of primary brain tumor is a glioma. Gliomas begin from glial cells, which are the supportive tissue of the brain. There are several types of gliomas, categorized by where they are found, and the type of cells that originated the tumor. The following are the different types of gliomas:


Brain stem gliomas

Brain stem gliomas are tumors found in the brain stem. Most brain stem tumors cannot be surgically removed because of the remote location and delicate and complex function this area controls. Brain stem gliomas occur almost exclusively in children; the group most often affected is the school-age child. The child usually does not have increased intracranial pressure (ICP), but may have problems with double vision, movement of the face or one side of the body, or difficulty with walking and coordination.


Optic nerve gliomas

Optic nerve gliomas are found in or around the nerves that send messages from the eyes to the brain. They are frequently found in persons who have neurofibromatosis, a condition a child is born with that makes him/her more likely to develop tumors in the brain. Persons usually experience loss of vision, as well as hormone problems, since these tumors are usually located at the base of the brain where hormonal control is located. These are typically difficult to treat due to the surrounding sensitive brain structures.

• Oligodendrogliomas

• Metastatic tumors

In adults, metastatic brain tumors are the most common type of brain tumors. These are tumors that begin to grow in another part of the body, then spread to the brain through the bloodstream. When the tumors spread to the brain, they commonly go to the part of the brain called the cerebral hemispheres, or to the cerebellum. Often, a patient may have multiple metastatic tumors in several different areas of the brain. Lung, breast, and colon cancers frequently travel to the brain, as do certain skin cancers. Metastatic brain tumors may be quite aggressive and may return even after surgery, radiation therapy, and chemotherapy.



Pituitary tumors



Pineal region tumors


Specific treatment for brain tumors will be determined by your physician based on:

• your age, overall health, and medical history
• type, location, and size of the tumor
• extent of the condition
• your tolerance for specific medications, procedures, or therapies
• expectations for the course of the condition
• your opinion or preference

Treatment may include (alone or in combination):

• Surgery

Surgery is usually the first step in the treatment of brain tumors. The goal is to remove as much of the tumor as possible while maintaining neurological function. A biopsy is also done to examine the types of cells the tumor is made of for a diagnosis. This is frequently done if the tumor is in an area with sensitive structures around it that may be injured during removal.

• Chemotherapy
• Radiation therapy
• Steroids (to treat and prevent swelling especially in the brain)
• Anti-seizure medication (to treat and prevent seizures associated with intracranial pressure)
• Bone marrow transplantation
• Supportive care (to minimize the side effects of the tumor or treatment)
• Rehabilitation (to regain lost motor skills and muscle strength; speech, physical, and occupational therapists may be involved in the healthcare team)
• Antibiotics (to treat and prevent infections)
• Continuous follow-up care (to manage disease, detect recurrence of the tumor, and to manage late effects of treatment)

Newer therapies that may be used to treat brain cancer include the following:

• Stereotactic Radiosurgery – a new technique that focuses high doses of radiation at the tumor site, while sparing the surrounding normal tissue, with the use of photon beams from a linear accelerator or cobalt x-rays.
• Gene Therapy – a special gene is added to a virus that is injected into the brain tumor. An antivirus drug is then given which kills the cancer cells that have been infected with the altered virus.

Brain Tumors

Brain tumor1

Brain tumor2

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