The central nervous system consists of the brain and spine. They control your thought processing and bodily functions such as speech, memory, understanding (cognition), motor skills, coordination and balance. Because the brain and spine control such important functions, tumors in these areas can be particularly challenging but necessary to treat. Brain and spine tumor specialists have to remove tumors surgically or treat the tumor with radiation and/or drug therapy without disrupting essential functions.
Approximately 400,000 people are diagnosed with a brain or spine tumor in the U.S. every year. Tumors can grow in many different locations within the brain and spine, and each person’s anatomy is a little different, requiring treatment to be highly personalized to accommodate unique aspects. Most of these tumors are cancers that have spread to the brain or spine from other parts of the body (metastases). The majority of neurological tumors are malignant, but some are benign.
Primary Brain Tumors
A primary brain tumor is a tumor that begins in the brain rather than a malignancy that spreads to the brain from another part of the body. Tumors that spread to the brain are called metastases. Imaging can suggest the type of primary brain tumor but ultimately, it is the results of pathology (tests and analysis of tumor tissue removed during surgery) that confirms the type of brain tumor and its grade. Confirming this information requires the expertise of a neuro-pathologist.
Causes of Primary Brain Tumors
Most primary brain tumors have no known cause. Researchers have studied a wide variety of possible risk factors, including diet, occupational hazards, prior head injury — even water supply — but none has ever been established as a cause of primary brain tumors. Your tumor is not the result of anything you did or did not do.
Only very rarely is a personal risk of brain tumor passed on genetically. Your children and grandchildren are not at a heightened genetic risk of a neurological cancer. Unless they are experiencing symptoms of a neurological tumor, there is no need for anyone in your family to see a doctor or have a brain scan.
The only known cause is radiation therapy. The most common scenario is a young adult who had radiation therapy as a child for another cancer. Decades later, it is possible to develop a brain tumor but that is also extremely rare.
Gliomas are the most common type of primary brain tumors. They are divided into subsets:
- Astrocytomas are graded on four levels with grade 1 being most common among children (pediatric population).
- Grade 1 astrocytomas are contained rather than spread across a wide area and can often be cured with surgery alone.
- Grade 2 astrocytomas are low-grade tumors also known as diffuse (spread across a wide area) gliomas that typically grow slowly but have the potential to transform into more aggressive tumors, including grade 3 and grade 4 astrocytomas.
- Grade 3 astrocytomas, also known as anaplastic astrocytomas, are malignant gliomas that grow more quickly.
- Grade 4 astrocytomas, also known as glioblastoma multiforme or GBM, are malignant gliomas and are the most aggressive primary brain tumors.
- Oligodendrogliomas are either grade 2 or grade 3, and although they can develop in any part of the central nervous system, they are usually found in the white matter and outer layer of the brain — the cortex. They develop more often in men than women and typically between the ages of 35 and 44. If there are symptoms, they depend on the tumor’s location.
- Grade 2 oligodendrogeliomas are low-grade and grow slowly, but they do invade nearby brain tissues. They may form years before diagnosis without symptoms to indicate their presence.
- Grade 3 oligodendroegliomas, also known as anaplastic oligodendriogeliomas, are malignant (cancer), and they are fast-growing.
Gliomas typically cause symptoms with a rapid onset — from the tumor itself or from fluid around the tumor that causes swelling in the brain. Brain tumor symptoms can include the following.
- Seizures that you have not had before.
- Severe and debilitating headaches that persist despite over-the-counter pain relievers
- Nausea and vomiting brought on by headache severity
- Disturbances in vision
- Changes in personality or cognition — how you think and your memory
- Focal neurologic deficits (paralysis, change in muscle tone, weakness or involuntary movements).
Meningiomas get their name from the area where they start — the layers of tissue that cover the brain and the spinal cord, which are called the meninges. Most meningiomas are benign. They grow slowly and are far more common than gliomas, representing about 36% of primary brain tumors. They happen more than twice as often with women as with men, which may indicate a link to the female hormone progesterone. They often grow inward, causing pressure in the brain, rather than invading the brain, and they can affect the spinal cord.
Most people who have meningiomas do not need anything more than other than ongoing surveillance. However, in cases of large meningiomas, growing meningiomas or symptomatic meningiomas, treatment is recommended. Surgery or radiation therapy are considered first line treatments in these cases with the goal of extending your survival with the best quality of life.
Learn More About Brain Tumor Treatment
Brain Tumor Research and Tissue Neuro-Oncology Brain Bank
To study the molecular and genetic makeup of brain tumors, as well as their appearance on imaging, researchers at the Medical College of Wisconsin have established a tissue bank. A patient interested in participating can donate brain tissue samples from surgery or include plans to donate their entire brain for study as part of their legacy. This valuable resource helps our researchers learn about these tumors and help our brain tumor team better anticipate the disease process. Patients or families interested in this ongoing research project can contact their neuro-oncologist for additional information.
Additionally, research is being conducting into how brain tumors change the way your brain is wired, known as neuroplasticity. We are examining ways to induce adaptations in the brain’s motor cortex. We hope this will one day enable us to perform complete resections of such lesions while protecting critical functions. We have teamed up with a leading device manufacturer to help us develop these techniques. Learn more about this brain tumor research.
The large majority of pituitary tumors are benign. Problems arise when cancerous cells within the pituitary produce an excess of hormones such as growth hormones or prolactin, which can lead to multiple health problems. In addition, very large pituitary tumors (which often do not secrete hormones) can compress surrounding brain structures and nerve tissue, causing loss of peripheral vision and other neurological problems. Most pituitary tumors can be managed with minimally invasive procedures. Learn more about pituitary tumor treatment.
Brain Metastases Treatment if Your Cancer Spreads
If your cancer spreads, or metastasizes, to the brain from cancer that originates in another part of your body — an occurrence that is about 10% more common than cancers that start in the brain — the Brain and Spine Tumor Program has a team designed to care for your complex needs. The Brain Metastases Program offers specialized expertise that is vital for successful treatment because there are many nuances in medical decision-making and for personalizing treatment for each individual.
This program supports not only patients, but also their physicians who may need to refer them for brain metastasis care. A virtual network is available through an app called NIMBLE (Network for Integrated Management of Brain Metastasis Linking Experts) provides these physicians with a multidisciplinary, real-time virtual tumor board. Physicians can receive comprehensive treatment recommendations in hours rather than days.
Most tumors that grow in and around the spine are malignant – less than 10% are benign. Spine tumors can be primary, meaning they start in the spine, or metastatic, meaning they result from cancers that originate in other parts of the body and spread or metastasize to the spine. Many types of cancer have the potential to metastasize to the spine. Cancers that are more likely to metastasize to the spine include breast, lung, prostate, kidney, gastrointestinal and thyroid cancers.
Vertebral tumors grow within the bones making up the vertebrae and usually originate from cancers that have spread to the spine from other parts of the body — metastatic. These tumors put pressure on the spinal cord and cause structural problems like vertebral fractures.
Spine Tumor Causes and Risk Factors
The risk of developing a primary spine tumor is very low. The causes are still largely unknown — other than random gene mutations that are not inherited. The only correlation that has been made is that exposure to radiation therapy from treatment for an early childhood cancer may bring a spinal tumor into play 20 or 30 years after treatment. But essentially, there is no way to predict who will develop a primary spine tumor. Spine tumors that spread to the spine from cancer in another part of the body, however, are far more common. About 30 – 70% of cancers will spread to the spine at some point. Cancers that are most likely to spread to the spine include lung, prostate and breast cancers.
Spine Tumor Symptoms
When tumors grow in your spine, they cause many debilitating symptoms. The higher the location of the tumor, the more symptoms you will experience. They can grow in different parts of the spine. The cervical spine is the highest section in your neck. It is followed by the thoracic spine (mid-back) and the lumbar spine (lower back). Symptoms of spinal cancer include:
- Disruptions in your motor functions — problems sitting, standing, walking and running
- Difficulties with fine motor skills like writing or drawing — tasks that use the small muscles of the hands and wrists
Spine tumors can cause various types of pain that limit movement and affect quality of life.
- A sharp pain that radiates into the arms, legs or chest is typically caused by the tumor pinching nerve roots. People often describe this type of pain as searing or electric shock-like. Decompression of the nerve roots can provide relief for pain from tumors that are impinging on nerves.
- Mechanical pain is pain the tumor causes in muscles, joints, bones and tissues. This type of pain reflects spine instability from the tumor. It causes pain in the upright position (sitting or standing), and people experience relief when lying down. Fusion surgery of the spine can enhance spine stability and alleviate mechanical pain.
- Biologic pain is persistent pain in one spot or region that does not change in intensity with a change in position such as sitting, standing or lying down. It is due to swelling and inflammation caused by a tumor that has infiltrated the bones. Biologic pain responds to NSAIDs, steroids and to radiation therapy.
Others symptoms include:
- Sensory deficits such as numbness, tingling and pain in the extremities — the arms, legs and trunk.
- Spine tumors can affect the autonomic nervous system, which controls and regulates bowel and bladder function as well as other bodily functions. When the bowels and bladder are affected, you may experience urinary retention or incontinence, or stool incontinence.
Types of Spine Tumors
Spine tumors are classified based on whether they grow in the spinal cord or in the dura — the protective covering of the spinal cord and nerves.
Intra-Axial (Growing Inside the Spinal Cord)
- Astrocytomas. Spinal astrocytomas are sometimes benign, are slow-growing and don’t spread outside of the spine. A small percentage will be more aggressive or can even turn into cancer if they aren’t treated. Typically, a complete surgical resection is not possible given the tumor’s invasion of the surrounding spinal cord tissue. These tumors require additional treatment with radiation therapy.
- Ependymomas. Spinal ependymomas are primary tumors that arise within the spinal cord. They tend to be benign and slow-growing. If they are progressively getting larger or causing neurological decline like paralysis or bladder dysfunction, they may warrant surgical resection with microsurgery techniques. A complete curative resection is sometimes possible because these are well-defined tumors that can be separated from surrounding spinal cord.
Intradural-Extra-Axial (Tumors Growing Inside the Dura but Outside of the Spinal Cord)
- Myxopapillary ependymomas are slow-growing tumors and usually benign. They grow outside of the spinal cord, arising from the fibrous band connecting the spinal cord and the tailbone. They are treated with surgery, which is curative when a complete resection (complete removal of tumor) is performed.
- Schwannomas and meningiomas are typically benign but a small percentage can become cancerous. Schwannomas are slow-growing tumors that develop from nerve cell roots in the spine. They are sometimes called neuromas. Meningiomas grow from the dura — the protective lining of the spinal cord.
Neuro-Oncology Cognitive Clinic
Patients with brain tumors can experience changes in thinking, memory, emotions and other cognitive abilities. As part of our dedication to preserving quality of life, the Brain and Spine Tumor Program includes a neuropsychologist who monitors these changes and helps you adjust. Learn more about the Neuro-Oncology Cognitive Clinic.
Get a Second Opinion for Brain or Spine Cancer
A second opinion can provide you with peace of mind in knowing that your diagnosis is accurate and that you have explored all treatment options available to you, including clinical trials. Our new patient coordinator will help ease your way by gathering your medical records and scheduling tests and appointments. Learn more about our Cancer Second Opinion Program, which includes virtual as well as in-person options.
Tumor Board: Coordinated Cancer Care
The entire Brain and Spine Tumor Program team meets every week to discuss patients and monitor results. During these tumor board meetings, neurosurgeons, neuro-oncologists, radiation oncologists, neuroradiologists, neuropathologists, neuropsychologists, researchers and others use their collective expertise to develop individualized treatment plans for patients with brain and spine tumors.
Group evaluation and planning is especially important for patients with recurring cancer. Sophisticated image-guidance such as advanced magnetic resonance imaging (MRI) guides our diagnostics, some treatments and monitoring of your progress. Our multidisciplinary approach ensures that every treatment option is considered for every patient, including any available clinical trials.
Virtual Visits Are Available
Safe and convenient virtual visits by video let you get the care you need via a mobile device, tablet or computer wherever you are. We’ll gather your medical records for you and get our experts’ input so we can offer treatment options without an in-person visit. To schedule a virtual visit, call 1-866-680-0505.
Cancer and the COVID-19 Vaccine
There is currently no data that suggests current or former cancer patients should avoid getting the COVID-19 vaccine. Cancer can weaken your immune system, so we recommend that most patients get the vaccine as soon as possible.