The number of patients with tumors of the brain and the spinal cord has been growing every year. These tumors either originate directly in the brain tissue, they are metastases of malignant tumors elsewhere in the body or tumors that grow from other tissues and push on the brain tissue.
Histological analyses of tumors are usually available within two weeks after a surgical procedure. The results are then discussed at neuro-oncological session attended by two clinical oncologists (Motol University Hospital and Bulovka University Hospital) and a specialist in Gamma knife radiosurgery (Na Homolce Hospital). A histological analysis of a tumor is the decisive factor in the assessment of subsequent procedures and treatment.
Meningioma
Meningioma is in vast majority of cases a benign tumor which forms in the dura mater. It occurs primarily in older adults and is quite rare in young people. This tumor grows very slowly and thus patients usually come when it has reached a relatively large size which increases intracranial pressure. Epileptic seizures often occur as the first symptom but there are other neurological symptoms (partial paralysis of one side of the body, speech impairment) or behavioral changes. Some patients suffer from headaches. Meningiomas form anywhere in the dura mater and symptoms may vary according to the specific location of the tumor. Meningiomas are usually treated surgically, the skull is opened and the tumor resected. Total removal of the tumor is not possible in some patients and these must be regularly followed (generally every 6 to 12 months with MRI scan). If a tumor growth is detected, another surgery or radiotherapy is performed. Malignant progression of this type of tumor is rare and is treated with head irradiation. The likelihood of recurrence (regrowth) is quite low in meningiomas but follow-ups of patients after resection are necessary (for roughly 10 -20 years). Meningiomas can be in rare cases familial.
They can be also located in the region of the spinal canal, which is mostly manifested by paralysis and loss of sensation in lower extremities. If the location of the tumor is in the cervical spine region, upper limbs are often paralysed as well. Meningiomas are treated surgically with good prognosis but regular follow-ups are necessary.
Brain gliomas
These tumors grow directly from the brain tissue and include benign tumors and also highly malignant tumors with grim prognosis.
Pilocytic astrocytoma and ganglioglioma
These tumours occur primarily in children and young patients and are benign. They are most frequently located in the cerebelum or the optical nerve but they may develop anywhere. Gliomas are treated with surgery and the prognosis is often good even in those cases when a complete removal of the tumor is not possible. Regular follow-ups with MRI examination are necessary (usually every year).
Diffuse astrocytoma (fibrillary astrocytoma)
Diffuse astrocytoma is a benign tumor which forms in any location in the brain but most frequently develops in the cerebral hemispheres. This tumor, despite being benign at the beginning, usually progresses into a malignant form in the long term prognosis (7 – 10 years). Symptoms of diffuse astrocytoma generally include epileptic seizures, occassionally headaches or other symptoms depending on the tumor location such as partial paralysis of one side of the body, speech impairment, behavioral changes. Diffuse astrocytoma is diagnosed based on MRI brain scan. Tumors can be observed or resected but complete resection of the tumor is never entirely possible. Still, the goal of surgical treatment is to resect as large part of the tumor as possible. Radiation is not the treatment of choice for diffuse astrocytomas as it has not been proved to have any benefit. Gemistocytar astrocytoma is a rare type of diffuse astrocytoma with much worse prognosis.
Anaplastic astrocytoma
This tumor progresses from diffuse astrocytomas. It is a malignant type of tumor. It develops in males more frequently, usually at around the age of 40. Despite recent development in medicine, anaplastic astrocytomas are still impossible to cure. Patients have poor prognosis (the overall survival time is around 3 years). The symptoms are similar to those of diffuse astrocytomas. Astrocytomas are usually resected and patients subsequently undergo chemotherapy (Temodal) and radiotherapy. Patients are followed every 3 to 6 months with MRI brain scan, another surgery may follow if needed. The surgery itself cannot cure the disease but may significantly improve patients' condition.
Glioblastoma multiforme
It is the most common and, unfortunately, also the most aggressive type of brain tumor. It generally develops in cerebral hemispheres, other locations are rare. This tumor is mostly primary (the so-called primary glioblastoma) but it also progresses from diffuse or anaplastic astrocytomas. The period from the onset of symptoms until the diagnosis is usually less than 3 months. The treatment is surgical - resection of as much of the tumor as possible. Glioblastoma has a very poor prognosis despite combined treatment including surgery, chemotherapy and radiotherapy. The overall survival time is 12 to 15 months since diagnosis. Patients are followed every 3 months with MRI brain scan. If a regrowth is detected, another surgery is considered. Two rare variants - gliosarcoma and giant cell glioblastoma - have the same prognosis.
Oligodendroglioma and anaplastic oligodendroglioma
These types of tumors develop most frequently in cerebral hemispheres.The average age of patients at diagnosis is usually between 40 and 50 years of age. Symptoms of these tumors are identical with those of astrocytous tumors. Unlike astrocytous tumors, the prognosis of oligodendrogliomas is quite good. Research has discovered that these tumors often carry a structural genetic aberration (the loss of short arm of chromozome 1 and the loss of long arm of chromozome 19). If a patient has a tumor with this type of chromozomal deletion, it means that the tumor has better prognosis and longer overall survival. Our department is one of only a few departments in the Czech Republic which routinely tests patients with oligodendrogliomas for the presence of this chromosomal aberration. Oligodendrogliomas are primarily treated surgically. If histological analysis confirms a higher grade of oligondendroglioma - anaplastic oligodendroglioma - concomitant chemoradiotherapy is indicated. Patients with a benign form of oligodendrogliomas are regularly followed. Patients are regularly followed every 6 months, those with anaplastic oligodendroglioma every 3 months. Prognosis of patients with the genetic abberation is good, the overall survival time is about 10 years as opposed to patients without the chromozomal deletion in whom it is about 2 years.
Brain metastases
Brain metastases are secondary tumors from cancer that has spread to the brain from another location in the body. The most common sources of brain and spinal tumors are lung and kidney cancer, breast cancer in women and malignant melanoma. The treatment depends on the primary type of cancer and the condition of patients when brain metastases are diagnosed. Surgery is indicate d for patients in a good condition whose prognosis is longer than 6 months considering their primary disease and who have no more than 2 metastases. When there are more than two metastases, radiation therapy is the treatment of choice (either Gamma knife radiosurgery or whole brain radiotherapy). A surgery performed at our department is not the final step of the treatment, an attending oncologist must also treat the primary oncological disease.
Vestibular schwannoma – acoustic nerve tumor
Vestibular schwannoma is a rare benign tumor which characteristically impairs hearing in one ear. The tumor can reach a significant size and put pressure on surrounding cranial nerves (facial and trigeminal nerve). Apart from hearing impairment, the tumor also causes the loss of sensation in the face, paralysis of the face on the affected side, and headaches. Large schwannomas may be treated only surgically, patients with those smaller in size undergo Gamma knife radiosurgery. Patients are regularly followed every 12 months with MRI scan.
