Brain Tumors Treatment, Part 2

by National Cancer Institute

(Page 4 of 6)

Getting a Second Opinion

Before starting treatment, the patient might want a second opinion about the diagnosis and the treatment plan. Some insurance companies require a second opinion; others may cover a second opinion if the patient or doctor requests it.

There are a number of ways to find a doctor for a second opinion:

• The patient's doctor may refer the patient to one or more specialists. At cancer centers, several specialists often work together as a team.

• The Cancer Information Service, at 1-800-4-CANCER, can tell callers about nearby treatment centers.

• A person with a brain tumor can request a consultation with a team of specialists in NCI's Neuro-Oncology Branch of the Warren Grant Magnuson Clinical Center at the National Institutes of Health in Bethesda, Maryland (301-402-6298).

• A local or state medical society, a nearby hospital, or a medical school can usually provide the names of specialists.

• The American Board of Medical Specialties (ABMS) has a list of doctors who have met certain education and training requirements and have passed specialty examinations. The Official ABMS Directory of Board Certified Medical Specialists lists doctors' names along with their specialty and their educational background. The directory is available in most public libraries. Also, ABMS offers this information on the Internet at http://www.abms.org. (Click on "Who's Certified.")

Preparing for Treatment

The doctor can describe treatment choices and discuss the results expected with each treatment option. The doctor and patient can work together to develop a treatment plan that fits the patient's needs.

Treatment depends on a number of factors, including the type, location, size, and grade of the tumor. For some types of brain cancer, the doctor also needs to know whether cancer cells were found in the cerebrospinal fluid.

These are some questions a person may want to ask the doctor before treatment begins:

• What type of brain tumor do I have?
• Is it benign or malignant?
• What is the grade of the tumor?
• What are my treatment choices? Which do you recommend for me? Why?
• What are the benefits of each kind of treatment?
• What are the risks and possible side effects of each treatment?
• What is the treatment likely to cost?
• How will treatment affect my normal activities?
• Would a clinical trial (research study) be appropriate for me? Can you help me find one?

People do not need to ask all of their questions or understand all of the answers at one time. They will have other chances to ask the doctor to explain things that are not clear and to ask for more information.

Methods of Treatment

People with brain tumors have several treatment options. Depending on the tumor type and stage, patients may be treated with surgery, radiation therapy, or chemotherapy. Some patients receive a combination of treatments.

In addition, at any stage of disease, patients may have treatment to control pain and other symptoms of the cancer, to relieve the side effects of therapy, and to ease emotional problems. This kind of treatment is called symptom management, supportive care, or palliative care.

The doctor is the best person to describe the treatment choices and discuss the expected results.

A patient may want to talk to the doctor about taking part in a clinical trial, which is a research study of new treatment methods.

Surgery is the usual treatment for most brain tumors. Surgery to open the skull is called a craniotomy. It is performed under general anesthesia. Before surgery begins, the scalp is shaved. The surgeon then makes an incision in the scalp and uses a special type of saw to remove a piece of bone from the skull. After removing part or all of the tumor, the surgeon covers the opening in the skull with that piece of bone or with a piece of metal or fabric. The surgeon then closes the incision in the scalp.

These are some questions a person may want to ask the doctor before having surgery:

• How will I feel after the operation?
• What will you do for me if I have pain?
• How long will I be in the hospital?
• Will I have any long-term effects? Will my hair grow back? Are there any side effects from using metal or fabric to replace the bone in the skull?
• When can I get back to my normal activities?
• What is my chance of a full recovery?

Sometimes surgery is not possible. If the tumor is in the brain stem or certain other areas, the surgeon may not be able to remove the tumor without damaging normal brain tissue. Patients who cannot have surgery may receive radiation or other treatment.

Radiation therapy (also called radiotherapy) uses high-energy rays to kill tumor cells. The radiation may come from x-rays, gamma rays, or protons. A large machine aims radiation at the tumor and the tissue close to it. Sometimes the radiation may be directed to the entire brain or to the spinal cord.

Radiation therapy usually follows surgery. The radiation kills tumor cells that may remain in the area. Sometimes, patients who cannot have surgery have radiation therapy instead.

The patient goes to a hospital or clinic for radiation therapy. The treatment schedule depends on the type and size of the tumor and the age of the patient. Each treatment lasts only a few minutes.

Doctors take steps to protect the healthy tissue around the brain tumor:

Fractionation — Radiation therapy usually is given five days a week for several weeks. Giving the total dose of radiation over an extended period helps to protect healthy tissue in the area of the tumor.

Hyperfractionation — The patient gets smaller doses of radiation two or three times a day instead of a larger amount once a day.

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