Major treatment options for patients with brain cancer include surgery, radiation and chemotherapy. Sometimes a patient may need a combination of these therapies.
Treatment plan usually depends on grade, type, location, size and general health and age of the patient. The patient is counselled and explained in details the benefits and adverse effects that are associated with each of the various modalities of therapy.
Almost all modalities of therapy can be associated with sometimes severe effects that may affect day to day living. Hence, patient counselling is important.
Brain cancer or tumor treatment is often undertaken by specialists like neurologists, neurosurgeons, neuro-oncologists, radiation or medical oncologists and neuroradiologists. On the team there may be a dietician, cousellor for mental health and well being, oncology nurse, physical, occupational and speech therapist. (1, 2)
Surgical treatment is usually the beginning for most operable tumors. Surgery is commonly used to remove the whole tumour, to remove most of the tumor (called debulking operation), to take biopsy or to remove a growing benign tumor. (1, 2)
Patient’s scalp may be shaved and readied for the surgery. The surgery is commonly performed under general anesthesia. If the entire skull is opened up the procedure is called craniotomy.
Sometimes surgery may be performed by making a small burr hole under the guidance of an imaging technique like MRI or CT scan.
In some cases patient may be awake during the surgery and his or her cognition, speech and memory may be tested as the surgery for tumor removal progresses.
After surgery the incision is closed up with drains places to remove excess accumulated blood and fluids and the head is bandaged.
After brain surgery
There may be initial headache, fatigue or discomfort that subsides within the course of a few days.
Sometimes there may be excess build up of fluids in the brain that leads to pressure. This is tackled with the use of drugs like steroids. Drainage shuts may also be used to ease the swelling.
Brain surgery is associated with risk of infections. This may be prevented by use of antibiotics. Post surgery there may also be some physical impairments. This can be handled with adequate physical therapy and rehabilitation.
Radiation therapy involves killing of the brain tumor cells using high energy rays like X rays, gamma rays or proton beams.
A video outlining radiation therapy.
Radiotherapy may be undertaken after completion of surgery, or before if the tumor is inoperable.
Radiotherapy may be applied externally or internally. It may target the tumor alone, tumor along with its surroundings, or whole brain (with or without spinal cord). (1, 2)
The types of radiation therapy include;
- External radiation therapy – This technique uses the high energy beams that are targeted towards the tumor. The usual regimen is usually 5 days a week for a few weeks. The therapy lasts only a few minutes. External radiotherapy may be intensity modulated or three dimensional radiation therapy, proton beam therapy, or stereotactic therapy using X rays or gamma rays.
- Internal radiation therapy (also known as implant radiation therapy or brachytherapy) - In these cases, small implants or seeds that are radioactive are placed within the brain tumor. The radiation may continue for months and these seeds need not be removed after their purpose is served.
Radiotherapy may lead to common side effects such as nausea, fatigue, hair loss, skin burns and changes like dryness, tenderness or redness that is commonly seen after external radiation.
Sometimes there may be swelling of the brain due to radiotherapy. This may lead to headaches. These can be relieved by steroids. If the pituitary gland is harmed there may be problems with growth - especially in children. Radiation also raises the risk of brain tumors later in life.
Some brain tumors may be treated using radiosurgery. Radiosurgery is a type of stereotactic radiotherapy where the radiotherapy beams are directed specifically at the tumor. It is also called gamma knife treatment. (3)
Chemotherapy is the use of anti-cancer or anti-tumor drugs in the management of brain cancer. These may be administered by mouth or via injections – intravenously.
Chemotherapy may be given during or after radiotherapy. These do not require hospital stay and are given to consolidate therapy with other modalities.
Commonly they cause side effects like anemia, nausea and vomiting, lack of appetite, fever, chills, fatigue, diarrhea, hair loss etc. These drugs may also lead to suppression of immunity that causes increased susceptibility to infections. (1)
Potential new therapies
There are numerous research and clinical trials with new modalities of therapy for brain cancer. Some patients may take part in these trials. For all therapies regular follow up tests that were used for initial diagnosis may be needed to check for cure, remission or recurrence. (4)
Treatment of metastatic tumors depends on the original tumor management. Surgery, radiation and chemotherapy are still preferred modalities of therapy in these patients.
Patients may need care and comfort for widely spread advanced cancers. These include therapy for brain swelling (steroids and diuretics), seizures (anticonvulsants or antiepileptic drugs), pain relievers and other palliative measures. (5)