By Dr Ananya Mandal, MD
The treatment of a brain tumors depends on the tumor’s type, size and location. Other important factors include the patient’s general state of health, their age and how widespread the cancer is. Treatments that may be offered include surgery, radiotherapy, chemotherapy or a combination of these.
Surgery is the most common approach to treating primary tumors, which are tumors that have originated in the brain tissue. Before surgery begins, the patient is given general anaesthesia. A section of the skull is removed to provide access to the brain in a procedure called craniotomy and the tumor is then cut away and removed. The piece of removed skull is replaced and the scalp is stitched back up and bandaged.
Sometimes, this form of surgery is not possible if the tumor is buried deep within the brain tissue and difficult to remove without damaging surrounding tissue. In these cases, radiosurgery using high-energy radiation directed at the tumor may be used instead.
Radiotherapy and chemotherapy
For primary malignant tumors, surgery is usually followed up with chemotherapy and radiotherapy to help prevent the tumor growing back. In some cases of benign primary tumor that are difficult to access, these treatments may be used instead of surgery to shrink the tumor. Radiotherapy involves high energy radiation being focused on the tumor, but at a lower intensity and over a longer period than in radiosurgery. Chemotherapy involves the use of anticancer agents to kill cancer cells and may be given in tablet form, intravenously or in as an implant.
Radiotherapy may be delivered either externally or internally. External radiotherapy uses a large machine to direct radiation at the tumor over a course of daily treatments lasting days or weeks. Internal radiotherapy or brachytherapy involves the placement of a small radioactive implant near to the cancer site.
Chemotherapy may be given during and after radiation therapy with or without surgery. Carmustine and temozolomide are two examples of chemotherapy drugs currently used in the treatment of high-grade brain tumours. Common side effects of chemotherapy include nausea, vomiting, gastrointestinal upset, anemia, susceptibility to infection, hair loss, appetite loss, mouth ulcers and weakness.
For secondary brain tumors or cancers that have spread to the brain from cancer in other parts of the body, treatment aims to relieve symptoms and prolong life, since the cancer cannot be cured. Treatment may involve corticosteroid pills to reduce pressure within the brain, chemotherapy and radiotherapy to shrink or control the tumor, anti-epileptic medication to prevent seizures, pain relievers and anti-nausea drugs.
Reviewed by Sally Robertson, BSc