Treatment for brain & spinal cord tumours

Friday 30 September, 2011

On this page: | Surgery | Surgery for a brain tumour | Surgery for a spinal cord tumour | Radiotherapy | Stereotactic radiosurgery | Chemotherapy | Steroids | Seizures | Palliative treatment | Information reviewed by

The main treatments for brain or spinal cord tumours are surgery, radiotherapy and chemotherapy. These treatments may be used alone or in combination. Medication, such as steroids or anti-convulsants, may also be given to reduce symptoms.  Treatment cannot begin until the diagnosis is confirmed.

The choice of treatment will depend on:

  • the type, size and location of the tumour
  • your age, medical history and general state of health
  • the types of symptoms and side effects you have.

The aim of treatment is to remove the tumour, slow its growth, or relieve symptoms by shrinking the tumour and any swelling. There are also many types of new and experimental treatments, or improvements in existing treatments, that are sometimes used. These are given in clinical trials. 

Surgery

Surgery in the central and peripheral nervous system is called neurosurgery. In many cases, removing all or part of the tumour may allow you to lead an active life for some time.

Some tumours can be removed completely by neurosurgery. This type of operation is called a gross total resection. In other cases, the surgeon may only be able to remove part of the tumour. This procedure is called a partial resection. This may be because the tumour is widespread, near major blood vessels, or cannot be removed without damaging other important parts of the brain or spinal cord. A partial resection may improve your symptoms by reducing the pressure on your brain.

Sometimes a tumour cannot be removed because it would be too dangerous. This is called an irresectable or unresectable tumour. In this case, your doctor will talk to you about other treatment options to ease your symptoms.

Preparing for surgery

The types of scans used for diagnosing the tumour (e.g. CT, MRI, PET or MRS scans) are often done again to plan surgery by precisely pinpointing the location of the tumour.

You may also have what is called a functional MRI scan to help the doctors work out what areas of your brain control speech and movement. Brain mapping is another way to find these parts of the brain. Tiny electrodes are placed on the outside layer of the brain and stimulated with a low dose of electrical current.

This allows doctors to work out where the brain's sensitive areas are and try to avoid causing damage during surgery.

Surgery for a brain tumour

The surgeon will remove as much of the tumour as possible without damaging healthy parts of your brain. Surgery may be done as open surgery or stereotactic surgery. In open surgery, a relatively large opening needs to be made in the skull to access the tumour. In stereotactic surgery, only a small cut needs to be made.

Biopsy

A small sample of tumour tissue is removed and examined under a microscope. This is usually a diagnostic procedure but sometimes the entire tumour can be removed.

Craniotomy

The most common type of brain tumour operation. Some hair will be shaved off and you will be given a general anaesthetic. The surgeon will cut through the scalp and move it aside, then remove a piece of skull above the tumour. The bone and scalp are put back once the tumour is taken out.

Craniectomy

This is similar to a craniotomy except that the piece of skull that is removed for the operation is not replaced because the brain may swell. The bone may be replaced in the future when it won't cause extra pressure.

Awake craniotomy

This operation is done if the tumour is near parts of the brain that control speech or movement. When the brain is exposed, the level of anaesthetic is reduced and the patient awakens (becomes conscious) so they can speak, move and respond. This is not painful because the brain itself does not feel pain, and local anaesthetic is used to numb surrounding tissues.

During the operation, the surgeon asks the patient to speak or move parts of the body so they can identify and avoid certain parts of the brain. Once the tumour is removed, the patient is given general anaesthetic again for the rest of the procedure.

Endoscopic transnasal brain surgery

This rarer type of surgery is used if the tumour is near the base of the brain, for example a pituitary gland tumour. The surgeon puts a long tube (endoscope) up the nose, then uses small tools to remove all or part of the tumour through the nostrils. This type of surgery has a faster recovery time and fewer long-term side effects than a craniotomy. You can also have further treatment, if needed.

Surgery for a spinal cord tumour

The main surgery for a spinal cord tumour is called a laminectomy. In this procedure, the surgeon makes an opening through the skin, muscle and a vertebra in the spinal column to remove the tumour that is affecting the spinal cord. Afterwards, the vertebra is replaced. You will have a general anaesthetic for this operation.

After your brain or spinal cord operation
  • For the first 12-24 hours after the operation, you will be closely monitored. Nurses will regularly check your breathing, pulse, blood pressure, temperature, pupil size, arm and leg strength and function, and how aware (conscious) you are. These are called neurological observations. They show how your brain and body are recovering from the stress of the surgery.
  • Some people have a build-up of fluid in their brain. This is called hydrocephalus. The surgeon may place a long, thin, permanent or temporary tube called a shunt from your brain into your abdomen to drain the extra fluid. The fluid can then be safely absorbed into the bloodstream. A small valve is inserted just under the scalp to make sure the fluid flows away from the brain.
  • You may need to wear pressure stockings on your legs to prevent blood clots from forming. Tell your doctor if you have pain or swelling in your legs.
  • If you are recovering from a craniotomy, your head will be bandaged for the first day and a small tube will drain excess blood from the operation site. Your face and eyes may be swollen or bruised, but this is not usually painful and should ease within about a week.
  • You may have a headache or nausea after the operation. Both can be treated with medications.
  • If you have had an operation on your spinal cord, the nurses will regularly check the movement and sensation in your legs. You may need to rest flat in bed for 3-5 days to allow the wound to heal. A physiotherapist will help you learn how to roll over and how to get out of bed safely so the wound is not damaged further.
  • The length of your hospital stay, changes to your speech or movement, and any other side effects will depend on the extent of the operation. Your doctor will tell you when you can start regular activities again.

Radiotherapy

Radiotherapy is a type of treatment that uses high-energy x-ray beams to kill or damage cancer cells. The radiation is specifically targeted at the treatment site to reduce the risk of damage to healthy cells. The treatment is painless.

Before your treatment begins, you will need to have an appointment to plan it. This is often called a simulation appointment because you will be put in the exact position needed for your treatment.

Your doctor will take measurements of your body, as well as doing an x-ray or CT scan, to work out the precise area to be treated. Several permanent marks (tattoos) the size of a small freckle may be placed on your skin. You may also have a mask made to fit your face. These measures ensure that the same area of your brain or spinal cord is treated every time.

The face mask - also called a cast - helps keep the head in position when treating the head or neck. It is a tight-fitting mesh, but you will have no difficulty breathing or seeing through it and you will only wear it for about 10 minutes at a time during treatment. However, let your doctor know if wearing the mask makes you uncomfortable.

Your radiotherapy treatment will probably start a few days after your planning session. It is usually given once daily, from Monday to Friday, for several weeks. However, the course of your treatment will depend on the size and type of the tumour.

Stereotactic radiosurgery

Stereotactic radiosurgery is a type of radiation therapy, not a type of surgery. It is a non-invasive treatment that uses high doses of precisely targeted radiation to treat a brain tumour in a single hospital visit. The treatment is so accurate that surrounding areas of healthy brain tissue are not affected. The patient is usually able to return home the same day as treatment.

Radiosurgery may be offered when traditional surgery is not suitable. It is most commonly used for some meningiomas and pituitary tumours, and a type of neuroma known as an acoustic neuroma. It is also used for metastatic cancers that have spread from another part of the body. It is not usually  used for gliomas.

Radiotherapy for children

Radiotherapy is rarely used for children under the age of five because high-dose therapy can affect a child's brain (intellectual) development. If a child receives radiotherapy, it is given at a lower dose than the dose given to adults.

Radiotherapy to the spine and head can slow a child's physical growth too. It can either reduce the growth of the bones, or affect the work of the pituitary gland, which produces growth hormones. Children may later need hormone therapy to help them grow and develop.

Your child's health care team will discuss treatment options and possible short- and long-term side effects with you before treatment starts.

Side effects

Radiotherapy causes many possible side effects. Side effects tend to peak about 1-3 weeks after treatment has ended, so it is important to have a follow-up session with your doctor within this time. Most side effects occur in the treatment area and are temporary, but some may be permanent or last for a few months or years. Talk to your doctor before treatment for more information.

Some common short-term side effects include:

  • nausea
  • headaches
  • tiredness or fatigue
  • hair loss in the treatment area
  • red, sore, inflamed or flaky skin in the treatment area.

Some people experience late-stage side effects, which can occur several years after treatment. These can include confusion or difficulty thinking clearly and remembering things (cognitive impairment) and personality changes. It is not always clear if these changes are caused by radiotherapy or damage in the brain due to the tumour. If you experience these symptoms, you may benefit from rehabilitative therapy or medication.

Many side effects - short-term side effects in particular - can be treated effectively with medication. Talk to your doctor about how to manage side effects. For more information on coping with side effects from treatment, call 13 11 20.

Chemotherapy

Chemotherapy is the use of cytotoxic drugs to treat cancer. The drugs travel through the blood around the body. The aim is to damage or destroy rapidly dividing cells such as cancer cells while causing the least possible damage to healthy cells. However, some healthy fast-growing cells, such as your hair cells, may also be affected, causing side effects.

It can be difficult to treat brain tumours with chemotherapy drugs because the body has a protection system called the blood-brain barrier. This guards the brain from substances circulating in the blood, such as germs or chemicals, that could harm it. Only certain drugs can get through this barrier.

You may be given chemotherapy through a drip inserted into your vein (intravenously) or by taking an oral capsule. Each treatment session is usually followed by a rest period of a few weeks. This allows your body to recover from any side effects.

Some patients who have a craniotomy have small, dissolvable chemotherapy wafers inserted into their brain during surgery.  The wafers release drugs into the brain over a couple of weeks. As the drug is placed directly at the tumour site, it doesn't affect other areas of the body and so reduces the chance of side effects.

Side effects

The way your body reacts to chemotherapy will be monitored carefully through regular blood tests. Your treatment schedule may be changed when your doctor sees how you are responding to the drugs.

There are many possible side effects of chemotherapy. Whether they occur depends on the type of drugs you are given and how you react. Some of these side effects may include:

  • tiredness, fatigue and lack of energy
  • nausea, vomiting or loss of appetite
  • diarrhoea or constipation
  • hair loss
  • mouth sores and ulcers
  • a tingly feeling (nerve or muscle damage)
  • breathlessness due to low red blood cells levels (anaemia)
  • increased risk of infections.

These problems can be managed. For example, you may be given medication at the same time as chemotherapy to prevent nausea. Ask your doctor what side effects to expect and how to control them. You can also read our free booklet about chemotherapy, available by calling 13 11 20.

Steroids

Steroids are made naturally in the body, but they can also be produced artificially and used as drugs. One use is to reduce swelling in the brain. They may be given before, during or after surgery, or during radiotherapy.

The side effects that people get depend on the dose and the length of their treatment. Most side effects are temporary and will disappear as the medication dose is reduced. Steroids given for a short time may cause increased appetite, weight gain, insomnia, restlessness and mood swings. If you have trouble sleeping, it may help to take the drugs in the morning.

If taken for several months, steroids can cause puffy skin (fluid retention or oedema) in the feet, hands or face; high blood pressure; unstable blood sugar levels; diabetes; or muscle weakness. You are also more likely to get infections.

Your medical team will monitor your treatment, and will change your dose when required. If you are worried about side effects, talk to your doctor.

Seizures

A tumour may cause seizures, which are disruptions to the normal patterns of electrical impulses in the brain. Seizures are sometimes called fits or convulsions. They can often be prevented with anti-convulsant medication (also called anti-epileptic or anti-seizure medication).

  • Generalised seizures - These types of seizure typically affect the whole body. The most common type is called a tonic-clonic seizure (previously known as a grand mal seizure). A seizure often starts with a sudden cry, followed by the person falling down and losing consciousness. The person's muscles may twitch violently and their breath may be shallow for up to two minutes.
  • Partial seizures - These affect one part of the body, such as an arm or a leg. Symptoms include twitching; jerking; tingling or numbness; altered sensations (hallucinations), such as changed vision or hearing, sensing strange tastes or smells, or a feeling of déjà vu. Partial seizures may cause a brief loss of consciousness.

After a seizure, a person may be confused and is often very tired. It is important that they are able to rest.

First-aid tips to help someone having a seizure
  • Remain calm and stay with the person, but do not restrain them or put anything in their mouth.
  • Time the seizure.
  • Protect the person from injury (e.g. by moving hazards or placing a soft pillow under their head and shoulders).
  • Lie the person on their side as soon as possible, or right away if they have vomited. This is important if they are unconscious or have food or fluid in their mouth.
  • Call an ambulance (000) if the seizure lasts more than five minutes, if multiple seizures occur, or if anyone is injured.
  • Talk to the person and explain what has occurred. In some cases, people are confused after a seizure.
  • Observe and reassure the person until they have recovered or the ambulance arrives.
  • If the seizure occurs while a person is in a wheelchair or car, support their head and leave them safely strapped in their seat until the seizure is over. Afterwards, remove them from their seat, if possible, and roll them onto their side if there is food, water or vomit in their mouth. If help is needed, call an ambulance immediately.
  • For more detailed information about seizures, contact Epilepsy Action Australia on 1300 374 537 or visit www.epilepsy.org.au.
Anti-convulsant medications

There are many types of anti-convulsant drugs, which are used to prevent seizures. You may have blood- and liver-function tests while you are taking them. This is to check whether the dose is effective and how your liver is coping with the medication.

Side effects vary and may include tiredness, weight changes, gum problems, tremors, nausea or vomiting, and depression. Some people are allergic to anti-convulsants and may get a rash. Tell your medical team if you have any skin changes or other side effects, or if the medication does not seem to be working for you.

Your doctor can adjust your dose to reduce any side effects, or can give you another type to try. It is important not to stop taking the medicine or change the dose without your doctor's advice.

Palliative treatment

Palliative treatment helps to improve quality of life by controlling the symptoms of a brain or spinal cord tumour. It is not focused on finding a cure. It is particularly important for people with aggressive or advanced tumours, but it isn't just for end-of-life care. It can be used at different times.

Often treatment is concerned with pain relief and managing other physical symptoms. Treatment may include radiotherapy, chemotherapy or other medication. Palliative care also involves providing emotional support and rehabilitation.

Call the Cancer Council Helpline for more information.

Information reviewed by: Prof. Michael Besser AM, Consultant Emeritus in Neurosurgery, Royal Prince Alfred Hospital & The Children's Hospital at Westmead; Lindy Cohn, Helpline, Cancer Council NSW; Laraine Cross, Senior Clinician, Social Work, Calvary Mater Newcastle; Christine and Richard Harris, Christine and Gordon Holding, Consumers; Marina Kastelan, Brain Clinical Nurse Coordinator, North Shore Private Hospital; Lorna O'Brien, Helplline Manager, Cancer Council NSW; and Karen Robinson, Neuro-oncology Care Coordinator, Liverpool Hospital Cancer Therapy Centre.

Back to top

for