Understanding Brain Tumors

By: Brian Hoeflinger, MD

Disclaimer: Opinions are my own. Not medical advice.

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Brain tumors are like any other tumor in the body as they are masses of cells that grow uncontrollably, but in the brain. While the term often brings to mind malignant brain cancer, not all brain tumors are cancerous. There are nearly 150 different brain tumors, with approximately 70% being benign. Brain tumors can be categorized into malignant vs. benign and primary vs. secondary.

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Types of Brain Tumors

1. Benign (Non-Cancerous) Brain Tumors

The most common benign brain tumor is a meningioma. These tumors arise from the membranes covering the brain and spinal cord and do not actually grow into the brain tissue itself but rather push on the brain as they grow larger, causing pressure on the brain. Meningiomas are usually very slow-growing and can be cured with full surgical resection. However, on rare occasions, a benign meningioma can turn malignant, which causes a much quicker worsening of the patient's condition. This can lead to death without prompt treatment.

2. Secondary Brain Tumors

Secondary tumors originate elsewhere in the body and spread to the brain, a process called metastasis. The most common cancers that spread, or metastasize, to the brain include lung, breast, melanoma, renal, and colon cancers. These tumors are typically malignant, meaning they are cancerous, and tend to cause significant swelling and pressure on the surrounding brain tissue. Surgery alone is often insufficient most of the time due to the presence of multiple areas of the brain to which the cancer has already spread. In addition, many of these types of tumors spread throughout the body, not just the brain. This often results in widespread, or diffuse, metastatic disease throughout the body and typically results in a poor prognosis for the patient.

3. Primary Brain Tumors

Primary brain tumors, such as Astrocytomas, arise from the brain tissue itself and can range from benign to highly malignant. These tumors are graded from Grade 1 to Grade 4:

• Grade 1 Astrocytoma: Typically benign, these tumors can be cured with complete surgical resection alone as these tumors do not invade normal brain tissue. No adjuvant therapy is required, which is a fancy way of saying no other form of treatment is usually required. Grade 1 tumors are most common in children and younger adults and have a 96% survival rate at five years with surgery alone.
• Grade 2 Astrocytoma: This is a low-grade form of brain cancer which usually cannot be cured with surgery alone because the tumor actually invades the normal brain. Patients typically have a life expectancy of up to 10 years with maximal treatment and the typical age for a patient to develop a Grade 2 astrocytoma is under 40 years old.
• Grade 3 Astrocytoma (Anaplastic Astrocytoma): A progression of Grade 2 cancer, these tumors also invade normal brain tissue, with a life expectancy of up to 3-5 years with maximal treatment.
• Grade 4 Astrocytoma (Glioblastoma Multiforme): The most malignant and common form of primary brain cancer, with an average life expectancy of around 12-15 months with maximal treatment. Grade 3 and 4 Astrocytomas typically occur in individuals over 50 years old, but there are always exceptions to every rule. In general though, the more malignant, or aggressive, types of tumors occur more commonly in people with advancing age.

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Treatment Approaches for Astrocytomas

• Grade 1: The recommended treatment is usually surgical resection alone.
• Grades 2-4: The recommended treatment typically involves initial surgical resection to resect, or remove, as much of the tumor as is safely possible. This is typically followed by a course of adjuvant therapy, which most commonly includes chemotherapy and radiation therapy to the brain. Treatment decisions for patients with brain cancer also consider many other factors such as the patient's age, current medical problems, current neurologic status, genetic factors of the tumor, and, what I feel is the most important but often overlooked factor, the patient's and their families wishes.

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Patient and Family Considerations

Being diagnosed with a brain tumor, especially one that is malignant, is a life-shattering experience for everyone involved. For some, it is clearly a death sentence. As physicians, we tend to advise people to treat their disease full speed ahead because that is what we are trained to do. But as I've grown as a doctor and as a person, I have learned that more is not always better and that the disease is not more important than the patient. As we present the treatment options to the patient and their family, we must never lose sight that we are not the ones going through the treatment. The patient is. We are not the ones there day after day for month, and even years, helping care for a loved one. The family is. No matter what we want as a treating physician, we can never lose sight that it is the patient and their family and loved ones who have the final say in their care. So if a patient and/or their family wishes for minimal or no treatment, we have to to respect that decision and not let our own "need to treat at all costs" interfere. Because in the end, it is the patient and their family's peace of mind that matters the most, not our own.

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Best wishes,

Brian Hoeflinger

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