Brain and Spinal Tumors
Tumors are abnormal tissue growth caused by cells that grow out of control. Brain and spine tumors can start in the brain or spine itself, called primary tumors. They can also spread from other parts of your body through your bloodstream, called metastatic tumors.
Lung cancer, breast cancer, melanoma, and colon cancer may spread to your brain. The most common types of brain tumors are metastatic and require the expertise of a team of doctors to find the best treatment plan.
Spine tumors can compress the spinal cord and or spinal nerves, making treating them serious and complex. Each should be evaluated by experienced nervous system surgeons and oncologists at a major medical center.
Brain and spine tumors are rare, and some subtypes are extremely rare. About 79,000 people in the US are diagnosed with a brain or spinal tumor each year, according to the American Cancer Society. About 24,000 people will have cancerous tumors. Only about 1% of the population will have a brain tumor in their lifetime.
Brain and spinal tumors are either benign or malignant (cancerous).
Benign tumors grow in place and do not invade surrounding tissue. They may need to be removed due to their size and location if they are pressing on nearby tissues or causing symptoms similar to malignant tumors. Though they may require ongoing surveillance, once removed, they usually don’t come back.
Malignant tumors usually grow fast and invade surrounding tissue. They require treatment and close monitoring. Malignant tumors originating from the brain and spinal cord rarely spread to other areas of your body, but they can come back after treatment. Metastases are also considered malignant.
Types of Brain Tumors
According to the World Health Organization, there are more than 120 types of central nervous system tumors.
Gliomas are the most common type of brain tumor in adults. They form in the glial cells, which support the nerves in your brain and spine.
Glioblastoma is the most common type of glioma. It usually forms in your cerebrum, the largest part of your brain. It can also start in your spine. Glioblastomas make their own blood vessels, and can quickly grow and invade nearby areas. About 14,000 people in the US are diagnosed each year.
Types of Spine Tumors
We categorize spine tumors into three groups:
Vertebral column tumors
Most tumors involving the bones and cartilage cells in your vertebral column have spread (metastasized) from another area of your body, usually through your bloodstream. In women, most tumors have spread from the breast or lung. In men, most tumors have spread from the prostate or lung.
Occasionally vertebral column tumors start in your spine. Benign tumor types include osteoid osteoma, osteoblastoma, and giant cell tumors. Malignant tumor types include chondrosarcoma and Ewing’s sarcoma.
These tumors arise from the dura, a thick three-layer membrane that surrounds your spinal fluid and spinal cord. Most are benign meningiomas and nerve sheath tumors--schwannomas and neurofibromas.
These tumors come from the supporting cells in your spinal cord. Most of these tumors are astrocytomas (more common in children) or ependymomas (more common in adults). Blood vessel tumors, called hemangioblastomas, can also start here and are usually associated with an inherited condition called von Hippel-Lindau disease.
Most brain tumors occur in people without any known risk factors. If you’re diagnosed with a brain or spinal tumor, it’s not your fault. Most of these tumors are caused by cancer spreading from other sites in your body, or by alterations in the genes that control brain cell growth. Other risk factors include:
- Genetic conditions. Some people with genetic conditions like neurofibromatosis, von Hippel-Lindau disease, Li-Fraumeni syndrome, and retinoblastoma are at high risk. Occasionally people in the same family who don’t have these syndromes may develop brain and spine tumors. Schwannomas may also have a genetic trigger.
- Radiation therapy. People who have had radiation therapy to the head to treat other cancers have an increased risk of brain and spinal tumors.
- Family history. Most people with brain tumors do not have a family history of the disease. In rare cases, brain or spinal tumors can run in families.
- Weak immune system. People who have a weak immune system have a higher risk of developing a central nervous system (CNS) lymphoma. This includes people who have AIDS or who have had an organ transplant.
Each person may experience the symptoms of brain and spinal tumors differently. Symptoms can also vary based on the tumor’s size and location.
Brain Tumor Symptoms
Brain tumors often come with a headache that won’t go away. The headache is related to increased pressure in and around your brain. It tends to get worse when you lay down.
If the tumor is blocking a ventricle, which drains cerebrospinal fluid, intracranial pressure can increase. Symptoms can include:
- Vomiting and nausea
- Personality or mood changes, such as irritability and depression
- Visual changes and vision loss
- Problems with speech, understanding speech, or writing
- Weakness or loss of use of one side of your body
- Difficulty walking or problems with balance
Spinal Tumor Symptoms
Back pain that doesn’t improve with rest is the most common symptom of a spine tumor. Most back pain is not caused by a tumor. However, if you have a history of cancer, it’s important to seek medical attention for back pain because it’s common for other cancers to spread to your spine.
You might also experience:
- Sciatica, or pain that radiates from your lower back, down your buttocks and back of your leg
- Numbness in your legs, arms or chest
- Difficulty walking
- Scoliosis, or curvature of the spine resulting from a spine-deforming tumor
- Impaired bladder or bowel function
If you have impaired bladder or bowel function or paralysis, seek treatment immediately.
Screening and Diagnosis
If you have symptoms of a brain or spinal tumor, getting a diagnosis is urgent. The source of the tumor, the total number of lesions and whether the tumor is malignant or benign will determine your prognosis and treatment.
To start, your doctor will take your medical history and do a physical exam. They’ll also do a neurological exam to evaluate your eye movements, hearing, sensation, motor function, swallowing, balance, and coordination.
Should you need further screening, your doctor may order:
- MRI (magnetic resonance imaging) test uses powerful magnetic fields to create 3D pictures that detect tumors with greater detail.
- CT (computed tomography) scan takes data from several X-ray images and converts them into pictures on a monitor. It can show tissues and blood vessels in addition to bones.
Depending on which type of tumor your doctor suspects, you might have additional tests and procedures.
- Cerebral angiogram, a minimally invasive procedure that takes a picture of the tumor’s blood vessels.
- Chest X-ray to find out if the tumor started elsewhere in your body.
- Bone scan to detect tumors and bone abnormalities.
- Myelogram, an X-ray or CT scan with an injection of contrast dye to highlight your nervous system.
- Spinal tap to draw a small amount of cerebrospinal fluid from your spine. A pathologist will examine the fluid under a microscope to look for infection, cancer cells, or other problems.
- Blood draw to check for tumor markers that indicated a particular tumor type.
- PET scan (positron emission tomography) uses a small amount of radioactive glucose, injected into your vein, to show where glucose is being used in your body. A scanner rotates around your body to create an overall picture. Cancer cells use more glucose than normal cells do.
- Magnetic resonance spectroscopy (MRS), which produces images depicting your brain’s chemistry and function. Your doctor will compare normal tissue to abnormal tissue. This procedure uses the same equipment as an MRI so they’re often done at the same time.
- Biopsy, a tissue sample taken before or during surgery to confirm diagnosis.