Brain Tumors, Part 2 — Treatment, Side Effects and Restrictions

Treatment

Like the symptoms, the treatment for a brain tumor depends upon its site, type and size. Tumors should all be treated promptly to increase the chance of a good outcome.

The goals of treatment might be cure of the disorder, relief of symptoms or improvement of function. There are three main types of treatment: surgery, radiation therapy and chemotherapy.

Most brain tumors require some sort of surgery. If a tumor is completely removed, it is said to be excised. If the tumor is deep within the brain or if it has infiltrated the surrounding brain tissue, the neurosurgeon might elect to remove as much of the tumor as possible, a process called "debulking". Sometimes the tumor is biopsied, where a piece of tissue is removed so it can be examined and tested in the laboratory. This will help the oncologist determine the type of tumor involved and how best to treat it. Sometimes a special technique called stereotactic (ster-ee-oh-TAK'-tihk) surgery, often guided by computer-assisted tomography (a CAT scan), can be helpful in removing tumors located very deep within the brain. Even if a tumor cannot be removed, surgery can reduce the intracranial pressure (the pressure on the brain) and relieve symptoms.

Girl in hospital.

Radiation therapy uses radiation or high-energy particles, such as x-rays, gamma rays and neutrons, to kill cancer cells and shrink tumors. Radiation comes from a machine that emits what is called external beam radiation therapy. Radiation therapy is only used with certain types of tumors that are sensitive to this treatment. There are sometimes side effects from radiation therapy, including fatigue, burns and possible damage to surrounding tissue.

Chemotherapy refers to many types of anticancer medications. These strong medicines are used for some brain tumors that are sensitive to chemotherapy drugs. They may be taken by mouth (orally), in a shot in the muscle (IM), or through a vein (IV). Some chemotherapy drugs have strong side effects, which are discussed in the next section.

Other medications that might be used are: corticosteroids and osmotic diuretics to reduce brain swelling; anticonvulsants to reduce seizures; analgesics to control pain; and antacids or histamine blockers to control stomach ulcers.

Treatment for a brain tumor might include other supportive or therapeutic services. Physical therapy, occupational therapy and speech therapy might be needed to address the effects of the tumor itself or of the surgery. Support from a psychologist or social worker might be helpful with adjustment issues, because a brain tumor can result in changes in abilities, behavior and many other aspects of life.

Possible treatment side effects

In addition to symptoms from brain swelling, increased pressure inside the skull, and surgery, a person with a brain tumor might also experience significant side effects of radiation therapy and chemotherapy. The degree and intensity of side effects depends on several factors, including the patient's age, the site of the tumor, the type and dosage of radiation therapy and the type and dosage of chemotherapy. Some people will experience minimal side effects, while others will encounter side effects from treatment that seem more devastating than the tumor itself.

Most of the side effects of radiation go away soon after the treatment is over. However, some complaints might persist. Nausea, fatigue, dry mouth and skin reactions in the treatment area are usually temporary. Sometimes, radiation therapy affects blood counts, but this is unusual when treating brain tumors. Hair loss may occur, but is often temporary. Sometimes, hair is darker when it regrows. A major side effect of radiation for brain cancer is damage to normal brain tissues. The damage can mild, moderate or severe. Newer techniques of radiation therapy have limited this damage to normal tissues.

Chemotherapy, often simply called "chemo", can cause many side effects. Some drugs affect the bone marrow or blood-producing tissue. The medical provider will monitor these effects by following blood counts. White blood cells (which fight off infections), red blood cells (which contain hemoglobin to carry oxygen to other parts of the body) and platelets (which help form clots) can all be affected by chemo. The result might be increased risk of infection; increased risk of bruising or bleeding; or anemia and fatigue. Other possible side effects of chemotherapy include:

Friends with cancer.
  • nausea and vomiting
  • weight change
  • diarrhea and constipation
  • mouth sores
  • fever
  • pain
  • temporary hair loss
  • depression and anxiety

Sometimes medications called steroids are prescribed to reduce inflammation in the brain. Common side effects of steroids include increased appetite and weight gain, swelling of the face and feet, restlessness, mood swings, burning indigestion and acne. As the doctor works to adjust the dosage of the steroids, the child may experience some fatigue and difficulty with concentration. These symptoms are usually eliminated when the dosage is adjusted to precisely fit the child's needs.

Physical, dietary and other restrictions

Some children with brain tumors are unable to participate fully in physical activities because of the tumor or the side effects of treatment. They might have times when they are very fatigued, or perhaps have experienced significant weight gain from the steroids. However, the child should be encouraged to participate in activities to the greatest extent possible. Depending on specific circumstances, the child might require snacks in the morning or afternoon. The child's medical team will provide advice and information on any necessary limitations or special requirements.


For more information

Part 1 — Introduction, Incidence, and Symptoms

Part 3 — Implications for School

National Brain Tumor Foundation

22 Battery Street
Suite 612
San Francisco, CA 94111-5520
nbtf@braintumor.org
Patient Information Line:
1.800.934.2873 9am-5pm PST

BRAIN

P.O. Box 5801
Bethesda, MD 20824
www.ninds.nih.gov
(800) 352-9424

Office of Cancer Communications

National Cancer Institute
Building 31, Room 10A-03
Bethesda, MD 20892-2580
www.cancernet.nci.nih.gov
800-4-CANCER (800-422-6237)

American Brain Tumor Association (ABTA)

2720 River Road
Suite 146
Des Plaines, IL 60018-4110
info@abta.org
http://www.abta.org
Tel: 847-827-9910 800-886-2282
Fax: 847-827-9918

American Cancer Society

National Home Office
1599 Clifton Road, NE
Atlanta, GA 30329-4251
http://www.cancer.org
Tel: 800-ACS-2345 (227-2345)

Brain Tumor Society

124 Watertown Street
Suite 3H
Watertown, MA 02472-2500
info@tbts.org
http://www.tbts.org
Tel: 617-924-9997 800-770-TBTS (8287)
Fax: 617-924-9998

Children's Brain Tumor Foundation

274 Madison Avenue
Suite 1301
New York, NY 10016
info@cbtf.org
http://www.cbtf.org
Tel: 212-448-9494 866-CBT-HOPE (228-4673)
Fax: 212-448-1022

Contributed by:

Robert Trueworthy, MD
Professor
Section Chief of Pediatric Hematology and Oncology
University of Kansas Medical Center

Kathy Davis, MSEd, PhD
Associate Professor
Project Director, Connected Kansas Kids
Director, KU Kids Healing Place
University of Kansas Medical Center