Your personal care team at Columbia Cancer includes experts from many disciplines, including surgery, medical oncology, radiation oncology, and more. Your team will create an individualized treatment plan for you based on:
- Your age, overall health, and medical history
- The type, location, and size of your tumor
- Whether the tumor has spread
- How well you might tolerate specific treatments
- Your expectations and preferences
Sometimes your doctor might recommend that you watch and wait for changes to the tumor rather than treating it right away.
In some cases, surgery may be the best option to treat brain and spinal tumors. Removing the tumor relieves pressure on your brain, spine, or nerves. You might also have radiation therapy and medication therapy.
If you have a brain or spinal tumor, your surgeon’s goal is to remove as much of the tumor as possible without harming healthy tissue or causing you to lose function. Sometimes it’s not possible to remove the entire tumor due to its size, location, or spread.
Brain tumor surgery
The type, location, and size of your tumor and other factors will determine how your surgeon removes the tumor. Other surgical specialists may be involved if necessary, such as an otolaryngologist, head and neck surgeon, ophthalmologist, oral and maxillofacial surgeon, and plastic surgeon.
- Craniotomy. Your neurosurgeon temporarily removes a section of skull bone to access your brain and the tumor. We can sometimes use minimally invasive techniques, which usually result in less blood loss, less pain and pain medication, a smaller opening in the skull, and faster recovery.
- Transsphenoidal surgery. This minimally invasive operation is done through your nostrils or the inside of your mouth using an endoscope—a long flexible tube with a camera and light. You’ll have tiny, often invisible incisions.
- Stereotactic radiosurgery (Gamma Knife Icon). Your neurosurgeon and radiation oncologist uses highly targeted radiation beams to treat the tumor. This advanced, minimally invasive treatment is effective and often leads to fewer complications and side effects. We offer frameless immobilization techniques, if appropriate.
- Laser Interstitial Thermal Therapy. This is a minimally invasive technique used to treat difficult to reach and or recurrent brain tumors. Using minimally invasive techniques, a small laser is placed through a small craniotomy in the skull. Using MRI guidance, the laser is then used to destroy the tumor while preserving the surrounding healthy tissue.
Spinal tumor surgery
Spinal tumor surgery is delicate because tumors are often close to important parts of your spine and nerves. That’s why it’s critical for you to have this operation at a high-volume center and by neurosurgeons who have done many of these operations. Your spinal surgery team will stimulate your spinal cord and closely monitor your function during your operation, which helps ensure the best possible outcome. Sometimes you will have a combination of these surgeries to treat your spinal tumor.
- Resection. Surgery that removes part or all of the tumor is called a resection. If the tumor isn’t well-differentiated from critical spinal areas, it may be best practice to do a partial resection, followed by radiation therapy.
- Vertebroplasty and kyphoplasty. Sometimes the goal of spine tumor surgery is to decompress your spinal cord. Neurosurgeons use these advanced procedures to remove pressure on a nerve, reconstruct bone, and realign your spine. Your surgeon will use X-ray equipment to guide the procedure.
- Spine stabilization. If you have a metastatic spine tumor, the goal is to make your spine as stable as possible. Advanced and minimally invasive surgery can preserve your mechanical and neurologic function and improve your quality of life. They include retropleural thoracotomy, short segment fusion, and using cages to boost fusion.
- Stereotactic radiosurgery or stereotactic body radiotherapy. Your neurosurgeon and radiation oncologist uses highly targeted radiation beams to treat the tumor while minimizing dose to critical normal organs. This advanced, minimally invasive treatment is effective and often leads to fewer complications and side effects.
Radiation therapy causes cancer cells to break or die by targeting the DNA with high-energy particles, such as X-rays, gamma rays, electron beams, or protons. Radiation oncologists direct these particles to the tumor site from outside of your body to precisely target cancer cells, often sparing nearby tissue. You might hear this called external beam radiation therapy. For brain and spine tumors, you might have a version called image-guided radiation therapy (IGRT) or intensity-modulated radiation therapy (IMRT).
You might have radiation therapy to shrink your tumor, to destroy parts of the tumor or cancer cells left behind after surgery, or to help relieve symptoms.
You’ll have radiation therapy on a schedule your radiation oncologist sets—daily, weekly, every other day, or a single treatment.
We use targeted radiation treatments to zero in on the brain tumor while sparing important healthy tissue as much as possible. Your radiation oncologist and care team will discuss the specific treatment plan that is right for you. These types of radiation therapy include:
- Adaptive radiotherapy. We offer Ethos™, a new technology uses artificial intelligence to personalize a patient’s radiation treatments. Ethos enables radiation oncologists to quickly recalculate treatment to account for changes in the size and shape of the tumor and accommodate any anatomical changes in the patient. Patient treatment plans can be reassessed and optimized before every session. This would allow maximal radiation dose to be delivered to the tumor while reducing the risk of irradiating nearby health tissues and providing potentially better cancer control.
- Stereotactic radiosurgery. We use the Gamma Knife Icon for a “frameless” stereotactic radiosurgery. The Gamma Knife Icon has image-guided monitoring systems that can track patient movement during treatment. These innovative treatments allow for more precise, high-dose radiation treatments for brain tumors without restricting the patient’s position with an immobile frame.
- Image Guided Radiation Therapy (IGRT). Allows physicians to take a series of images during the treatment. These detailed images can help improve the accuracy of radiation therapy in selected patients, allowing physicians to deliver higher doses of radiation which can mean shorter treatment schedules.
- Intensity-modulated radiation therapy (IMRT). An advanced form of three-dimensional conformal radiotherapy (3DCRT), using highly controlled photon or proton beams to deliver precise radiation that conforms to the shape of the tumor. The goal of IMRT is to deliver the highest dosage of radiation more directly to the tumor, sparing healthy tissue and limiting side effects.
Some brain tumors respond to chemotherapy or targeted therapy, but the blood-brain barrier keeps many drugs from reaching the brain. Chemotherapy is usually reserved for people with faster-growing tumors and tumors that have come back after initial treatment.
Chemotherapy stops cancer growth and spread by causing rapidly dividing cancer cells to become damaged and die. Sometimes people with brain tumors have a small tube called a ventricular access catheter placed through a small hole in their skull. This minor procedure allows your doctor to infuse medication directly into your cerebrospinal fluid.
You might have chemotherapy:
- After surgery, to kill any remaining cancer cells
- If your tumor has come back after treatment
- If your tumor metastasized from another part of your body
Chemotherapy is a “systemic” treatment—it interferes with all fast-dividing cells in your body. This is why it causes side effects like hair loss. Chemotherapy can be given through an IV in our infusion center or sometimes through a pill, depending on the medication.
Chemotherapy drugs are generally given in cycles, with a period of treatment followed by a period of rest.
Some brain and spine tumors have specific genes, proteins, or tissue environments that we can target with drugs. These targeted therapies can stop cancer from growing in a more targeted and precise way.
Your doctor may run genetic tests on your tumor to match you with the most effective treatment. Depending on the results, you might also qualify for a clinical trial of a new therapy.
This new approach has revolutionized the treatment of many different tumors. Immunotherapy helps the body’s own immune system identify and eliminate tumor cells.
Depending on your tumor type, immunotherapy may be an effective option for you. New forms of immunotherapy are under active investigation in clinical trial.
You may qualify to participate in a clinical trial, which is a research study to learn more about promising new treatments or supportive care therapies. The hope is to improve the quality of life and survivorship of cancer patients. Columbia Cancer offers many brain and spinal tumor clinical trials. You can talk to your care team about whether a clinical trial is an option for you.
Brain and spinal tumors themselves can cause many physical, neurological, and emotional symptoms, and so can the treatment for these tumors.
Palliative care can help you deal with the physical symptoms and side effects of your treatment. It also includes support for the emotional, social, and financial issues that come with having a brain or spine tumor. When you have palliative care alongside your medical treatment—even starting when you’re diagnosed—you will likely feel physically better and have a better quality of life.
Palliative care often includes your family members or loved ones, giving them the support they need to support you.
Palliative care can include:
- Emotional and spiritual support
- Nutrition support
- Medications like corticosteroids, which help reduce brain swelling and pain without pain medications and anti-seizure medications to stop seizure activity.
- Services to help you relax, such as mindfulness, yoga, massage and reiki
- Treatment like chemotherapy and radiation therapy, with the goal of reducing symptoms rather than killing the cancer cells.
Our palliative care team at Columbia Cancer are compassionate caregivers who are here to support you and your family throughout your cancer journey.