Brain Tumors
NIH Publication No. 95-1558 Posted: 9/28/1998

Introduction

Each year more than 17,000 people in the United States find out they have a brain tumor. The National Cancer Institute (NCI) has written this booklet to help patients and their families and friends better understand brain tumors. We also hope others will read it to learn more about these tumors.

This booklet describes the symptoms, diagnosis, and treatment of brain tumors. Other NCI booklets about cancer, its treatment, and living with the disease are listed in the Other Booklets section. We know that booklets cannot answer every question about brain tumors. They cannot take the place of talks with doctors, nurses, and other members of the health care team, but we hope our information will help with these talks.

Words that may be new to readers appear in italics. Definitions of these words and other terms related to brain cancer can be found in the Dictionary. For some words, a "sounds-like" spelling is also given.

Our knowledge about brain tumors keeps increasing. For up-to-date information or to order this publication, call the NCI-supported Cancer Information Service (CIS) toll free at 1-800-4-CANCER (1-800-422-6237).

The Brain

Together, the brain and spinal cord form the central nervous system. This complex system is part of everything we do. It controls the things we choose to do--like walk and talk--and the things our body does automatically--like breathe and digest food. The central nervous system is also involved with our senses--seeing, hearing, touching, tasting, and smelling--as well as our emotions, thoughts, and memory.

The brain is a soft, spongy mass of nerve cells and supportive tissue. It has three major parts: the cerebrum, the cerebellum, and the brain stem. The parts work together, but each has special functions.

The cerebrum, the largest part of the brain, fills most of the upper skull. It has two halves called the left and right cerebral hemispheres. The cerebrum uses information from our senses to tell us what is going on around us and tells our body how to respond. The right hemisphere controls the muscles on the left side of the body, and the left hemisphere controls the muscles on the right side of the body. This part of the brain also controls speech and emotions as well as reading, thinking, and learning.

The cerebellum, under the cerebrum at the back of the brain, controls balance and complex actions like walking and talking.

The brain stem connects the brain with the spinal cord. It controls hunger and thirst and some of the most basic body functions, such as body temperature, blood pressure, and breathing.

The brain is protected by the bones of the skull and by a covering of three thin membranes called meninges. The brain is also cushioned and protected by cerebrospinal fluid. This watery fluid is produced by special cells in the four hollow spaces in the brain, called ventricles. It flows through the ventricles and in spaces between the meninges. Cerebrospinal fluid also brings nutrients from the blood to the brain and removes waste products from the brain.

The spinal cord is made up of bundles of nerve fibers. It runs down from the brain through a canal in the center of the bones of the spine. These bones protect the spinal cord. Like the brain, the spinal cord is covered by the meninges and cushioned by cerebrospinal fluid.

Spinal nerves connect the brain with the nerves in most parts of the body. Other nerves go directly from the brain to the eyes, ears, and other parts of the head. This network of nerves carries messages back and forth between the brain and the rest of the body.

About Brain Tumors

The body is made up of many types of cells. Each type of cell has special functions. Most cells in the body grow and then divide in an orderly way to form new cells as they are needed to keep the body healthy and working properly. When cells lose the ability to control their growth, they divide too often and without any order. The extra cells form a mass of tissue called a tumor. Tumors are benign or malignant.

• Benign brain tumors do not contain cancer cells. Usually these tumors can be removed, and they are not likely to recur. Benign brain tumors have clear borders. Although they do not invade nearby tissue, they can press on sensitive areas of the brain and cause symptoms.

• Malignant brain tumors contain cancer cells. They interfere with vital functions and are life threatening. Malignant brain tumors are likely to grow rapidly and crowd or invade the tissue around them. Like a plant, these tumors may put out "roots" that grow into healthy brain tissue. If a malignant tumor remains compact and does not have roots, it is said to be encapsulated. When an otherwise benign tumor is located in a vital area of the brain and interferes with vital functions, it may be considered malignant (even though it contains no cancer cells).

Doctors refer to some brain tumors by grade--from low grade (grade I) to high grade (grade IV). The grade of a tumor refers to the way the cells look under a microscope. Cells from higher grade tumors are more abnormal looking and generally grow faster than cells from lower grade tumors; higher grade tumors are more malignant than lower grade tumors.

Possible Causes

The causes of brain tumors are not known. Researchers are trying to solve this problem. The more they can find out about the causes of brain tumors, the better the chances of finding ways to prevent them. Doctors cannot explain why one person gets a brain tumor and another doesn't, but they do know that no one can "catch" a brain tumor from another person. Brain tumors are not contagious.

Although brain tumors can occur at any age, studies show that they are most common in two age groups. The first group is children 3 to 12 years old; the second is adults 40 to 70 years old.

By studying large numbers of patients, researchers have found certain risk factors that increase a person's chance of developing a brain tumor. People with these risk factors have a higher-than-average risk of getting a brain tumor. For example, studies show that some types of brain tumors are more frequent among workers in certain industries, such as oil refining, rubber manufacturing, and drug manufacturing. Other studies have shown that chemists and embalmers have a higher incidence of brain tumors. Researchers also are looking at exposure to viruses as a possible cause. Because brain tumors sometimes occur in several members of the same family, researchers are studying families with a history of brain tumors to see whether heredity is a cause. At this time, scientists do not believe that head injuries cause brain tumors to develop.

In most cases, patients with a brain tumor have no clear risk factors. The disease is probably the result of several factors acting together.

Primary Brain Tumors

Tumors that begin in brain tissue are known as primary brain tumors. (Secondary tumors that develop when cancer spreads to the brain are discussed in the Secondary Brain Tumors section.) Primary brain tumors are classified by the type of tissue in which they begin. The most common brain tumors are gliomas, which begin in the glial (supportive) tissue. There are several types of gliomas:

• Astrocytomas arise from small, star-shaped cells called astrocytes. They may grow anywhere in the brain or spinal cord. In adults, astrocytomas most often arise in the cerebrum. In children, they occur in the brain stem, the cerebrum, and the cerebellum. A grade III astrocytoma is sometimes called anaplastic astrocytoma. A grade IV astrocytoma is usually called glioblastoma multiforme.

• Brain stem gliomas occur in the lowest, stemlike part of the brain. The brain stem controls many vital functions. Tumors in this area generally cannot be removed. Most brain stem gliomas are high-grade astrocytomas.

• Ependymomas usually develop in the lining of the ventricles. They may also occur in the spinal cord. Although these tumors can develop at any age, they are most common in childhood and adolescence.

• Oligodendrogliomas arise in the cells that produce myelin, the fatty covering that protects nerves. These tumors usually arise in the cerebrum. They grow slowly and usually do not spread into surrounding brain tissue. Oligodendrogliomas are rare. They occur most often in middle-aged adults but have been found in people of all ages.

There are other types of brain tumors that do not begin in glial tissue. Some of the most common are described below:

• Medulloblastomas were once thought to develop from glial cells. However, recent research suggests that these tumors develop from primitive (developing) nerve cells that normally do not remain in the body after birth. For this reason, medulloblastomas are sometimes called primitive neuroectodermal tumors (PNET). Most medulloblastomas arise in the cerebellum; however, they may occur in other areas as well. These tumors occur most often in children and are more common in boys than in girls.

• Meningiomas grow from the meninges. They are usually benign. Because these tumors grow very slowly, the brain may be able to adjust to their presence; meningiomas often grow quite large before they cause symptoms. They occur most often in women between 30 and 50 years of age.

• Schwannomas are benign tumors that begin in Schwann cells, which produce the myelin that protects the acoustic nerve--the nerve of hearing. Acoustic neuromas are a type of schwannoma. They occur mainly in adults. These tumors affect women twice as often as men.

• Craniopharyngiomas develop in the region of the pituitary gland near the hypothalamus. They are usually benign; however, they are sometimes considered malignant because they can press on or damage the hypothalamus and affect vital functions. These tumors occur most often in children and adolescents.

• Germ cell tumors arise from primitive (developing) sex cells, or germ cells. The most frequent type of germ cell tumor in the brain is the germinoma.

• Pineal region tumors occur in or around the pineal gland, a tiny organ near the center of the brain. The tumor can be slow growing pineocytoma) or fast growing (pineoblastoma). The pineal region is very difficult to reach, and these tumors often cannot be removed.

Secondary Brain Tumors

Metastasis is the spread of cancer. Cancer that begins in other parts of the body may spread to the brain and cause secondary tumors. These tumors are not the same as primary brain tumors. Cancer that spreads to the brain is the same disease and has the same name as the original (primary) cancer. For example, if lung cancer spreads to the brain, the disease is called metastatic lung cancer because the cells in the secondary tumor resemble abnormal lung cells, not abnormal brain cells.

Treatment for secondary brain tumors depends on where the cancer started and the extent of the spread as well as other factors, including the patient's age, general health, and response to previous treatment.

Symptoms of Brain Tumors

The symptoms of brain tumors depend mainly on their size and their location in the brain. Symptoms are caused by damage to vital tissue and by pressure on the brain as the tumor grows within the limited space in the skull. They also may be caused by swelling and a buildup of fluid around the tumor, a condition called edema. Symptoms may also be due to hydrocephalus, which occurs when the tumor blocks the flow of cerebrospinal fluid and causes it to build up in the ventricles. If a brain tumor grows very slowly, its symptoms may appear so gradually that they are overlooked for a long time.

The most frequent symptoms of brain tumors include:

• Headaches that tend to be worse in the morning and ease during the day,
• Seizures (convulsions),
• Nausea or vomiting,
• Weakness or loss of feeling in the arms or legs,
• Stumbling or lack of coordination in walking (ataxic gait),
• Abnormal eye movements or changes in vision,
• Drowsiness,
• Changes in personality or memory, and
• Changes in speech.

These symptoms may be caused by brain tumors or by other problems. Only a doctor can make a diagnosis.

Diagnosis

To find the cause of a person's symptoms, the doctor asks about the patient's personal and family medical history and performs a complete physical examination. In addition to checking general signs of health, the doctor does a neurologic exam. This includes checks for alertness, muscle strength, coordination, reflexes, and response to pain. The doctor also examines the eyes to look for swelling caused by a tumor pressing on the nerve that connects the eye and the brain.

Depending on the results of the physical and neurologic examinations, the doctor may request one or both of the following:

• A CT (or CAT) scan is a series of detailed pictures of the brain. The pictures are created by a computer linked to an x-ray machine. In some cases, a special dye is injected into a vein before the scan. The dye helps to show differences in the tissues of the brain.

• MRI (magnetic resonance imaging) gives pictures of the brain, using a powerful magnet linked to a computer. MRI is especially useful in diagnosing brain tumors because it can "see" through the bones of the skull to the tissue underneath. A special dye may be used to enhance the likelihood of detecting a brain tumor.

The doctor may also request other tests such as:

• A skull x-ray can show changes in the bones of the skull caused by a tumor. It can also show calcium deposits, which are present in some types of brain tumors.

• A brain scan reveals areas of abnormal growth in the brain and records them on special film. A small amount of a radioactive material is injected into a vein. This dye is absorbed by the tumor, and the growth shows up on the film. (The radiation leaves the body within 6 hours and is not dangerous.)

• An angiogram, or arteriogram, is a series of x-rays taken after a special dye is injected into an artery (usually in the area where the abdomen joins the top of the leg). The dye, which flows through the blood vessels of the brain, can be seen on the x-rays. These x-rays can show the tumor and blood vessels that lead to it.

• A myelogram is an x-ray of the spine. A special dye is injected into the cerebrospinal fluid in the spine, and the patient is tilted to allow the dye to mix with the fluid. This test may be done when the doctor suspects a tumor in the spinal cord.

Treatment

Treatment for a brain tumor depends on a number of factors. Among these are the type, location, and size of the tumor, as well as the patient's age and general health. Treatment methods and schedules often vary for children and adults. The doctor develops a treatment plan to fit each patient's needs.

The patient's doctor may want to discuss the case with other doctors who treat brain tumors. Also, the patient may want to talk with the doctor about taking part in a research study of new treatment methods. Such studies, called clinical trials, are discussed in the Clinical Trials section.

Many patients want to learn all they can about their disease and their treatment choices so they can take an active part in decisions about their medical care. A person with a brain tumor will have many questions, and the doctor is the best person to answer them. Most patients want to know what kind of tumor they have, how it can be treated, how effective the treatment is likely to be, and how much it's likely to cost.

Here are some important questions to ask the doctor:

• What type of treatment will I receive?
• What are the expected benefits of treatment?
• What are the risks and possible side effects of treatment?
• What can be done about side effects?
• Would a clinical trial be appropriate for me?
• Will I need to change my normal activities? If so, for how long?
• How often will I need to have checkups?

Many people find it helpful to make a list of their questions before they see the doctor. Taking notes can make it easier to remember what the doctor says. Some patients find that it also helps to have a family member or friend with them when they talk with the doctor-- either to take part in the discussion or just to listen.

Patients and their families have a lot to learn about brain tumors and their treatment. They should not feel that they need to understand everything the first time they hear it. They will have other chances to ask the doctor to explain things that are not clear.

Planning Treatment

Decisions about treatment for brain tumors are complex. Before starting treatment, the patient might want a second doctor to review the diagnosis and treatment plan. There are several ways to find a doctor to consult:

• The patient's doctor may be able to suggest a doctor who specializes in treating brain tumors.

• The Cancer Information Service, at 1-800-4-CANCER, can tell callers about cancer centers and other NCI-supported programs in their area.

• Patients can get the names of specialists from their local medical society, a nearby hospital or cancer center, or a medical school.

Treatment Methods

Brain tumors are treated with surgery, radiation therapy, and chemotherapy. Depending on the patient's needs, several methods may be used. The patient may be referred to doctors who specialize in different kinds of treatment and work together as a team. This medical team often includes a neurosurgeon, a medical oncologist, a radiation oncologist, a nurse, a dietitian, and a social worker. The patient may also work with a physical therapist, an occupational therapist, and a speech therapist.

Before treatment begins, most patients are given steroids, which are drugs that relieve swelling (edema). They may also be given anticonvulsant medicine to prevent or control seizures. If hydrocephalus is present, the patient may need a shunt to drain the cerebrospinal fluid. A shunt is a long, thin tube placed in a ventricle of the brain and then threaded under the skin to another part of the body, usually the abdomen. It works like a drainpipe: Excess fluid is carried away from the brain and is absorbed in the abdomen. (In some cases, the fluid is drained into the heart.)

Surgery is the usual treatment for most brain tumors. To remove a brain tumor, a neurosurgeon makes an opening in the skull. This operation is called a craniotomy.

Whenever possible, the surgeon attempts to remove the entire tumor. However, if the tumor cannot be completely removed without damaging vital brain tissue, the doctor removes as much of the tumor as possible. Partial removal helps to relieve symptoms by reducing pressure on the brain and reduces the amount of tumor to be treated by radiation therapy or chemotherapy.

Some tumors cannot be removed. In such cases, the doctor may do only a biopsy. A small piece of the tumor is removed so that a pathologist can examine it under a microscope to determine the type of cells it contains. This helps the doctor decide which treatment to use.

Sometimes, a biopsy is done with a needle. Doctors use a special headframe (like a halo) and CT scans or MRI to pinpoint the exact location of the tumor. The surgeon makes a small hole in the skull and then guides a needle to the tumor. (Using this technique to do a biopsy or for treatment is called stereotaxis.)

Radiation therapy (also called radiotherapy) is the use of high-powered rays to damage cancer cells and stop them from growing. It is often used to destroy tumor tissue that cannot be removed with surgery or to kill cancer cells that may remain after surgery. Radiation therapy is also used when surgery is not possible.

Radiation therapy may be given in two ways. External radiation comes from a large machine. Generally, external radiation treatments are given 5 days a week for several weeks. The treatment schedule depends on the type and size of the tumor and the age of the patient. Giving the total dose of radiation over an extended period helps to protect healthy tissue in the area of the tumor.

Radiation can also come from radioactive material placed directly in the tumor (implant radiation therapy). Depending on the material used, the implant may be left in the brain for a short time or permanently. Implants lose a little radioactivity each day. The patient stays in the hospital for several days while the radiation is most active.

External radiation may be directed just to the tumor and the tissue close to it or, less often, to the entire brain. (Sometimes the radiation is also directed to the spinal cord.) When the whole brain is treated, the patient often receives an extra dose of radiation to the area of the tumor. This boost can come from external radiation or from an implant.

Stereotactic radiosurgery is another way to treat brain tumors. Doctors use the techniques described in the Surgery section to pinpoint the exact location of the tumor. Treatment is given in just one session; high-energy rays are aimed at the tumor from many angles. In this way, a high dose of radiation reaches the tumor without damaging other brain tissue. (This use of radiation therapy is sometimes called the gamma knife.)

Chemotherapy is the use of drugs to kill cancer cells. The doctor may use just one drug or a combination, usually giving the drugs by mouth or by injection into a blood vessel or muscle. Intrathecal chemotherapy involves injecting the drugs into the cerebrospinal fluid.

Chemotherapy is usually given in cycles: a treatment period followed by a recovery period, then another treatment period, and so on. Patients often do not need to stay in the hospital for treatment. Most drugs can be given in the doctor's office or the outpatient clinic of a hospital. However, depending on the drugs used, the way they are given, and the patient's general health, a short hospital stay may be necessary.

Clinical Trials

Researchers are looking for treatment methods that are more effective against brain tumors and have fewer side effects. When laboratory research shows that a new method has promise, doctors use it to treat cancer patients in clinical trials. These trials are designed to answer scientific questions and to find out whether the new approach is both safe and effective. Patients who take part in clinical trials make an important contribution to medical science and may have the first chance to benefit from improved treatment methods.

Many clinical trials of new treatments for brain tumors are under way. Doctors are studying new types and schedules of radiation therapy, new anticancer drugs, new drug combinations, and combinations of chemotherapy and radiation.

Scientists are trying to increase the effectiveness of radiation therapy by giving treatments twice a day instead of once. Also, they are studying drugs called radiosensitizers. These drugs make the cancer cells more sensitive to radiation. Another method under study is hyperthermia, in which the tumor is heated to increase the effect of radiation therapy.

Many drugs cannot reach brain cells because of the blood-brain barrier, a network of blood vessels and cells that filters blood going to the brain. Researchers continue to look for new drugs that will pass through the blood-brain barrier. Studies are under way using different techniques to temporarily disrupt the barrier so that drugs can reach the tumor.

In other studies, scientists are exploring new ways to give the drugs. Drugs may be injected into an artery leading to the brain or may be put directly into the ventricles. Doctors are also studying the effectiveness of placing tiny wafers containing anticancer drugs directly into the tumor. (The wafers dissolve over time.)

Researchers are also testing the use of very high doses of anticancer drugs. Because these higher doses may damage healthy bone marrow, doctors combine this treatment with bone marrow transplantation to replace the marrow that has been destroyed.

Biological therapy is a new way of treating brain tumors that is currently under study. This type of treatment is an attempt to improve the way the body's immune system fights disease.

Patients interested in taking part in a clinical trial should discuss this option with their doctor. They may want to read Taking Part in Clinical Trials: What Cancer Patients Need To Know an NCI booklet that explains some of the possible benefits and risks of treatment studies.

One way to learn about clinical trials is through PDQ, a computerized resource developed by the National Cancer Institute. This resource contains information about cancer treatment and about clinical trials in progress all over the country. The Cancer Information Service can provide PDQ information to patients and the public.

Side Effects of Treatment

Cancer treatment often causes side effects. These side effects occur because treatment to destroy cancer cells damages some healthy cells as well.

The side effects of cancer treatment vary. They depend on the type of treatment used and on the area being treated. Also, each person reacts differently. Doctors try to plan the patient's therapy to keep side effects to a minimum. They also watch patients very carefully so they can help with any problems that occur.

A craniotomy is a major operation. The surgery may damage normal brain tissue, and edema may occur. Weakness, coordination problems, personality changes, and difficulty in speaking and thinking may result. Patients may also have seizures. In fact, for a short time after surgery, symptoms may be worse than before. Most of the side effects of surgery lessen or disappear with time.

Most of the side effects of radiation therapy go away soon after treatment is over. However, some side effects may occur or persist long after treatment is complete.

Some patients have nausea for several hours after treatment. Patients receiving radiation therapy may become very tired as treatment continues. Resting is important, but doctors usually advise their patients to try to stay reasonably active. Radiation therapy to the scalp causes most patients to lose their hair. When it grows back, the new hair is sometimes softer and may be a slightly different color. In some cases, hair loss is permanent.

Skin reactions in the treated area are common. The scalp and ears may be red, itchy, or dark; these areas may look and feel sunburned. The treated area should be exposed to the air as much as possible but should be protected from the sun. Patients should not wear anything on the head that might cause irritation. Good skin care is important at this time. The doctor may suggest certain kinds of soap or ointment, and patients should not use any other lotions or creams on the scalp without the doctor's advice.

Sometimes brain cells killed by radiation form a mass in the brain. The mass may look like a tumor and may cause similar symptoms, such as headaches, memory loss, or seizures. Doctors may suggest surgery or steroids to relieve these problems. About 4 to 8 weeks after radiation therapy, patients may become quite sleepy or lose their appetite. These symptoms may last several weeks, but they usually go away on their own. Still, patients should notify the doctor if they occur.

Children who have had radiation therapy for a brain tumor may have learning problems or partial loss of eyesight. If the pituitary gland is damaged, children may not grow or develop normally.

The side effects of chemotherapy depend on the drugs that are given. In general, anticancer drugs affect rapidly growing cells, such as blood cells that fight infection, cells that line the digestive tract, and cells in hair follicles. As a result, patients may have a lower resistance to infection, loss of appetite, nausea, vomiting, or mouth sores. Patients may also have less energy and may lose their hair. These side effects usually go away gradually after treatment stops.

Some anticancer drugs can cause infertility. Women taking certain anticancer drugs may have symptoms of menopause (hot flashes and vaginal dryness; periods may be irregular or stop). Some drugs used to treat children and teenagers may affect their ability to have children later in life.

Certain drugs used in the treatment of brain tumors may cause kidney damage. Patients are given large amounts of fluid while taking these drugs. Patients may also have tingling in the fingers, ringing in the ears, or difficulty hearing. These problems may not clear up after treatment stops.

Treatment with steroids to reduce swelling in the brain may cause increased appetite and weight gain. Swelling of the face and feet is common. Steroids can also cause restlessness, mood swings, burning indigestion, and acne. However, patients should not stop using steroids or change their dose without consulting the doctor. The use of steroids must be stopped gradually to allow the body to adjust to the change.

Loss of appetite can be a problem for patients during therapy. People may not feel hungry when they are uncomfortable or tired. Some of the common side effects of cancer treatment, such as nausea and vomiting, can also make it hard to eat. Yet good nutrition is important because patients who eat well generally feel better and have more energy. Eating well means getting enough calories and protein to help prevent weight loss, regain strength, and rebuild normal tissues. Many patients find that eating several small meals and snacks during the day works better than trying to have three large meals.

Patients being treated for a brain tumor may develop a blood clot and inflammation in a vein, most often in the leg. This is called thrombophlebitis. A patient who notices swelling in the leg, leg pain, and/or redness in the leg should notify the doctor right away.

Doctors, nurses, and dietitians can explain the side effects of cancer treatment and can suggest ways to deal with them. In addition, the NCI booklets Radiation Therapy and You, Chemotherapy and You, and Eating Hints for Cancer Patients contain helpful information about cancer treatment and coping with side effects. Young People With Cancer: A Handbook for Parents provides information to help children handle the side effects of treatment.

Rehabilitation

Rehabilitation is a very important part of the treatment plan. The goals of rehabilitation depend on the patient's needs and how the tumor has affected his or her daily activities. The medical team makes every effort to help patients return to their normal activities as soon as possible.

Patients and their families may need to work with an occupational therapist to overcome any difficulty in activities of daily living, such as eating, dressing, bathing, and using the toilet. If an arm or leg is weak or paralyzed, or if a patient has problems with balance, physical therapy may be necessary. Speech therapy may be helpful for individuals having trouble speaking or expressing their thoughts. Speech therapists also work with patients who are having difficulty swallowing.

If special arrangements are necessary for school-age children, they should be made as soon as possible. Sometimes, children have tutors in the hospital or after they go home from the hospital. Children who have problems learning or remembering what they learn may need tutors or special classes when they return to school.

Followup Care

Regular followup is very important after treatment for a brain tumor. The doctor will check closely to make sure that the tumor has not returned. Checkups usually include general physical and neurologic exams. From time to time, the patient will have CT scans or MRIs.

Patients who receive radiation therapy to large areas of the brain or certain anticancer drugs may have an increased risk of developing leukemia or a second tumor at a later time. Also, radiation that affects the eyes may lead to the development of cataracts. Patients should carefully follow their doctor's advice on health care and checkups. If any unusual health problem occurs, they should report it to the doctor as soon as it appears.

Living With a Brain Tumor

The diagnosis of a brain tumor can change the lives of patients and the people who care about them. These changes can be hard to handle. Patients and their families and friends may have many different and sometimes confusing emotions.

At times, patients and those close to them may feel frightened, angry, or depressed. These are normal reactions when people face a serious health problem. Most patients, including children and teenagers, find it helps to share their thoughts and feelings with loved ones. Sharing can help everyone feel more at ease and can open the way for others to show their concern and offer their support.

Worries about tests, treatments, hospital stays, rehabilitation, and medical bills are common. Parents may worry about whether their children will be able to take part in normal school or social activities. Doctors, nurses, social workers, and other members of the health care team may be able to calm fears and ease confusion. They can also provide information and suggest helpful resources.

Patients and their families are naturally concerned about what the future holds. Sometimes they use statistics to try to figure out whether the patient will be cured or how long he or she will live. It is important to remember, however, that statistics are averages based on large numbers of patients. They cannot be used to predict what will happen to a certain patient because no two cancer patients are alike. The doctor who takes care of the patient and knows that person's medical history is in the best position to discuss the patient's outlook (prognosis).

People should feel free to ask the doctor about their prognosis, but it is important to keep in mind that not even the doctor can tell exactly what will happen. When doctors talk about recovering from a brain tumor, they may use the term remission rather than cure. Even though many people recover completely, doctors use this term because a brain tumor can recur.

Support for Cancer Patients

Living with a serious disease is not easy. Everyone involved faces many problems and challenges. Finding the strength to cope with these difficulties is easier when people have helpful information and support services.

The doctor can explain the disease and give advice about treatment, going back to work or school, or other activities. If patients want to discuss concerns about the future, family relationships, and finances, it may also help to talk with a nurse, social worker, counselor, or clergy member.

Friends and relatives who have had personal experience with cancer can be very supportive. Also, it helps many patients to meet and talk with other people who are facing problems like theirs. Cancer patients often get together in self-help and support groups, where they can share what they have learned about cancer and its treatment and about coping with the disease. In addition to groups for adults with cancer, special support groups for children or teens with cancer or for parents whose children have cancer are available in many cities. It's important to keep in mind, however, that each patient is different. Treatments and ways of dealing with cancer that work for one person may not be right for another--even if they both have the same kind of cancer. It's always a good idea to discuss the advice of friends and family members with the doctor.

Often, a social worker at the hospital or clinic can suggest local and national groups that will help with rehabilitation, emotional support, financial aid, transportation, or home care.

Other Booklets

Cancer patients, their families and friends, and others may find the following booklets useful. They are available free of charge from the National Cancer Institute. You may request them by calling 1-800-4-CANCER.

Booklets About Cancer Treatment

• Radiation Therapy and You: A Guide to Self-Help During Treatment
• Chemotherapy and You: A Guide to Self-Help During Treatment
• Eating Hints for Cancer Patients
• Taking Part in Clinical Trials: What Cancer Patients Need To Know

Booklets About Living With Cancer

• Taking Time: Support for People With Cancer and the People Who Care About Them
• Facing Forward: A Guide for Cancer Survivors
• Young People With Cancer: A Handbook for Parents
• When Cancer Recurs: Meeting the Challenge Again
• Advanced Cancer: Living Each Day

National Cancer Institute Information Resources

You may want more information for yourself, your family, and your health care provider. The following National Cancer Institute (NCI) services are available to help you.

Telephone
Cancer Information Service (CIS)
Provides accurate, up-to-date information on cancer to patients and their families, health professionals, and the general public. Information specialists translate the latest scientific information into understandable language and respond in English, Spanish, or on TTY equipment.

Toll-free: 1-800-4-CANCER (1-800-422-6237)

TTY (for deaf and hard of hearing callers): 1-800-332-8615

Internet

These Web sites may be useful:

http://cancer.gov		NCI's primary Web site; contains information about the Institute and its programs.
http://cancertrials.nci.nih.gov		cancerTrials™; NCI's comprehensive clinical trials information center for patients, health professionals, and the public. Includes information on understanding trials, deciding whether to participate in trials, finding specific trials, plus research news and other resources.
http://cancernet.nci.nih.gov		CancerNet™; contains material for health professionals, patients, and the public, including information from PDQ® about cancer treatment, screening, prevention, supportive care, genetics, and clinical trials; CANCERLIT®, a bibliographic database; and a dictionary with medical terms related to cancer.

E-mail
CancerMail
Includes NCI information about cancer treatment, screening, prevention, and supportive care. To obtain a contents list, send e-mail to cancermail@icicc.nci.nih.gov with the word "help" in the body of the message.

Fax
CancerFax^®
Includes NCI information about cancer treatment, screening, prevention, and supportive care. To obtain a contents list, dial 1-800-624-2511 or 301-402-5874 from your touch tone phone or fax machine hand set and follow the recorded instructions.

Dictionary

acoustic (ah-KOOS-tik): Having to do with sound or hearing.

anaplastic (an-ah-PLAS-tik): A term used to describe cancer cells that divide rapidly and bear little or no resemblance to normal cells.

angiogram (AN-jee-o-gram): An x-ray of blood vessels; the person receives an injection of dye to outline the vessels on the x-ray.

anticonvulsants (an-tee-kon-VUL-sants): Drugs that prevent, reduce, or stop convulsions or seizures.

astrocytoma (as-tro-sye-TOE-mas): A tumor that begins in the brain or spinal cord in small, star-shaped cells called astrocytes.

ataxic gait (ah-TAK-sik): Awkward, uncoordinated walking.

benign (beh-NINE): Not cancerous; does not invade nearby tissue or spread to other parts of the body.

biological therapy (by-o-LAHJ-i-kul): Treatment to stimulate or restore the ability of the immune system to fight infection and disease. Also used to lessen side effects that may be caused by some cancer treatments. Also known as immunotherapy, biotherapy, or biological response modifier (BRM) therapy.

biopsy (BY-ahp-see): The removal of cells or tissues for examination under a microscope. When only a sample of tissue is removed, the procedure is called an incisional biopsy or core biopsy. When an entire tumor or lesion is removed, the procedure is called an excisional biopsy. When a sample of tissue or fluid is removed with a needle, the procedure is called a needle biopsy or fine-needle aspiration.

bone marrow: The soft, sponge-like tissue in the center of bones that produces white blood cells, red blood cells, and platelets.

bone marrow transplantation (trans-plan-TAY-shun): A procedure to replace bone marrow destroyed by treatment with high doses of anticancer drugs or radiation. Transplantation may be autologous (an individual's own marrow saved before treatment), allogeneic (marrow donated by someone else), or syngeneic (marrow donated by an identical twin).

brain stem: The part of the brain that is connected to the spinal cord.

brain stem glioma (glee-O-ma): A tumor located in the part of the brain that connects to the spinal cord (the brain stem). It may grow rapidly or slowly, depending on the grade of the tumor.

central nervous system: CNS. The brain and spinal cord.

cerebellum (sair-uh-BELL-um): The portion of the brain in the back of the head between the cerebrum and the brain stem. The cerebellum controls balance for walking and standing, and other complex motor functions.

cerebral hemispheres (seh-REE-bral HEM-iss-feerz): The two halves of the cerebrum, the part of the brain that controls muscle functions of the body and also controls speech, emotions, reading, writing, and learning. The right hemisphere controls muscle movement on the left side of the body, and the left hemisphere controls muscle movement on the right side of the body.

cerebrospinal fluid (seh-REE-bro-SPY-nal): CSF. The fluid flowing around the brain and spinal cord. Cerebrospinal fluid is produced in the ventricles in the brain.

cerebrum (seh-REE-brum): The largest part of the brain. It is divided into two hemispheres, or halves, called the cerebral hemispheres. The cerebrum controls muscle functions of the body and also controls speech, emotions, reading, writing, and learning.

chemotherapy (kee-mo-THER-a-pee): Treatment with anticancer drugs.

clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease.

craniopharyngioma (KRAY-nee-o-fah-rin-jee-O-ma): A benign brain tumor that may be considered malignant because it can damage the hypothalamus, the area of the brain that controls body temperature, hunger, and thirst.

craniotomy (kray-nee-AH-toe-mee): An operation in which an opening is made in the skull.

CT scan: Computed tomography scan. A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized tomography and computerized axial tomography (CAT) scan.

edema (eh-DEE-ma): Swelling caused by excess fluid in body tissues.

encapsulated (en-KAP-soo-lay-ted): Confined to a specific, localized area and surrounded by a thin layer of tissue.

ependymomas: Brain tumors that usually begin in the central canal of the spinal cord. Ependymomas may also develop in the cells lining the ventricles of the brain, which produce and store the special fluid (cerebrospinal fluid) that protects the brain and spinal cord. Also called ependymal tumors.

gamma knife: Radiation therapy in which high-energy rays are aimed at a tumor from many angles in a single treatment session.

germ cell tumors: Tumors that begin in the cells that give rise to sperm or eggs. They can occur virtually anywhere in the body and can be either benign or malignant.

germinoma (jer-mih-NO-ma): The most frequent type of germ-cell tumor in the brain.

glioblastoma multiforme (glee-o-blas-TOE-ma mul-tih-FOR-may): A type of brain tumor that forms from glial (supportive) tissue of the brain. It grows very quickly and has cells that look very different from normal cells. Also called grade IV astrocytoma.

glioma (glee-O-ma): A cancer of the brain that comes from glial, or supportive, cells.

hair follicles (FOL-i-kuls): Shafts or openings on the surface of the skin through which hair grows.

hydrocephalus (hye-dro-SEF-uh-lus): The abnormal buildup of cerebrospinal fluid in the ventricles of the brain.

hyperthermia (hye-per-THER-mee-a): A type of treatment in which body tissue is exposed to high temperatures to damage and kill cancer cells or to make cancer cells more sensitive to the effects of radiation and certain anticancer drugs.

hypothalamus (hye-po-THAL-uh-mus): The area of the brain that controls body temperature, hunger, and thirst.

immune system (im-YOON): The complex group of organs and cells that defends the body against infection or disease.

infertility: The inability to produce children.

intrathecal chemotherapy (in-tra-THEE-kal KEE-mo-THER-a-pee): Anticancer drugs that are injected into the fluid-filled space between the thin layers of tissue that cover the brain and spinal cord.

malignant (ma-LIG-nant): Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body.

medical oncologist (on-KOL-o-jist): A doctor who specializes in diagnosing and treating cancer using chemotherapy, hormonal therapy, and biological therapy. A medical oncologist often serves as the main caretaker of someone who has cancer and coordinates treatment provided by other specialists.

medulloblastoma (MED-yoo-lo-blas-TOE-ma): A malignant brain tumor that begins in the lower part of the brain and can spread to the spine or to other parts of the body. Medulloblastomas are sometimes called primitive neuroectodermal tumors (PNET).

membrane: A very thin layer of tissue that covers a surface.

meninges (meh-NIN-jeez): The three membranes that cover and protect the brain and spinal cord.

meningioma (meh-nin-jee-O-ma): A type of tumor that occurs in the meninges, the membranes that cover and protect the brain and spinal cord. Meningiomas usually grow slowly.

menopause (MEN-o-pawz): The time of life when a woman's menstrual periods stop permanently. Also called "change of life."

metastasis (meh-TAS-ta-sis): The spread of cancer from one part of the body to another. Tumors formed from cells that have spread are called "secondary tumors" and contain cells that are like those in the original (primary) tumor. The plural is metastases.

MRI: Magnetic resonance imaging (mag-NET-ik REZ-o- nans IM-a-jing). A procedure in which a magnet linked to a computer is used to create detailed pictures of areas inside the body. Also called nuclear magnetic resonance imaging (NMRI).

myelin (MYE-eh-lin): The fatty substance that covers and protects nerves.

myelogram (MYE-eh-lo-gram): An x-ray of the spinal cord after an injection of dye into the space between the lining of the spinal cord and brain.

neuroma (noo-RO-ma): A tumor that arises in nerve cells.

neurosurgeon (NOO-ro-SER-jun): A doctor who specializes in surgery on the brain, spine, and other parts of the nervous system.

oligodendroglioma (OL-ih-go-den-dro-glee-O-ma): A rare, slow-growing tumor that begins in brain cells called oligodendrocytes, which provide support and nourishment for cells that transmit nerve impulses. Also called oligodendroglial tumor.

pathologist (pa-THOL-o-jist): A doctor who identifies diseases by studying cells and tissues under a microscope.

pineal gland (PIN-ee-al): A tiny organ located in the cerebrum that produces melatonin. Also called pineal body or pineal organ.

pineal region tumors (pIN-ee-al...TOO-mers): Types of brain tumors that occur in or around the pineal gland, a tiny organ near the center of the brain.

pineoblastoma (PIN-ee-o-blas-TOE-ma): A fast growing type of brain tumor that occurs in or around the pineal gland, a tiny organ near the center of the brain.

pineocytoma (PIN-ee-o-sye-TOE-ma): A slow growing type of brain tumor that occurs in or around the pineal gland, a tiny organ near the center of the brain.

pituitary gland (pih-TOO-ih-tair-ee): The main endocrine gland; it produces hormones that control other glands and many body functions, especially growth.

primitive neuroectodermal tumors (NOO-ro-ek-toe-DER-mul): PNET. A type of bone cancer that forms in the middle (shaft) of large bones. Also called Ewing's sarcoma/primitive neuroectodermal tumor.

prognosis (prog-NO-sis): The likely outcome or course of a disease; the chance of recovery or recurrence.

radiation oncologist (ray-dee-AY-shun on-KOL-o-jist): A doctor who specializes in using radiation to treat cancer.

radiation therapy (ray-dee-AY-shun): The use of high-energy radiation from x-rays, neutrons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy) or from materials called radioisotopes. Radioisotopes produce radiation and can be placed in or near the tumor or in the area near cancer cells. This type of radiation treatment is called internal radiation therapy, implant radiation, interstitial radiation, or brachytherapy. Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. Also called radiotherapy.

radiosensitizers: Drugs that make tumor cells more sensitive to radiation.

recur: To occur again. Recurrence is the return of cancer, at the same site as the original (primary) tumor or in another location, after the tumor had disappeared.

remission: A decrease in or disappearance of signs and symptoms of cancer. In partial remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although there still may be cancer in the body.

risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease.

schwannoma (shwah-NO-ma): A tumor of the peripheral nervous system that begins in the nerve sheath (protective covering). It is almost always benign, but rare malignant schwannomas have been reported.

seizures (SEE-zhurz): Convulsions; sudden, involuntary movements of the muscles.

shunt: A surgically created diversion of fluid (e.g., blood or cerebrospinal fluid) from one area of the body to another area of the body.

stereotaxis (stair-ee-o-TAK-sis): Use of a computer and scanning devices to create three-dimensional pictures. This method can be used to direct a biopsy, external radiation, or the insertion of radiation implants.

steroids (STEH-roidz): Drugs used to relieve swelling and inflammation.

surgery: A procedure to remove or repair a part of the body or to find out whether disease is present.

thrombophlebitis (throm-bo-fleh-BY-tis): Inflammation of a vein that occurs when a blood clot forms.

tissue (TISH-oo): A group or layer of cells that are alike in type and work together to perform a specific function.

tumor (TOO-mer): An abnormal mass of tissue that results from excessive cell division. Tumors perform no useful body function. They may be benign (not cancerous) or malignant (cancerous).

ventricles (VEN-trih-kulz): Fluid-filled cavities in the heart or brain.

vital: Necessary to maintain life. Breathing is a vital function.

x-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer.

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