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Malignant brain tumours (brain cancers) may be treated with surgery, radiotherapy, chemotherapy or steroid therapy. These treatments may be used alone or in combination.
The choice of treatment will depend on:
The actual brain tumour: What type it is, whether it is a primary or secondary tumour, its size, and exactly where it is in your brain, and
The individual patient: your age, medical history and general state of health.
The aim of treatment will be:
To remove or destroy the tumour altogether; or, if this is not possible
To show the growth of the tumour, and to relieve the symptoms by reducing the size of the tumour and any swelling around it, so that it puts less pressure on other parts of the brain.
Before your treatment starts, make show you have discussed it with your doctor so that you know what to expect, including any risks involved. You may find it helpful to have your partner or a friend or relative with you when you talk to the doctor. You may also find it helpful to write down your questions before your visit.
If your doctor suggests you have more than one kind of treatment, this does not necessarily mean that your cancer is worse, or better, than the cancer of somebody who has only one type of treatment. Each person is different and treatment needs to be planned individually.
After your medical and surgical treatment has been completed, your doctor will probably want you to have regular check ups and x-ray scans. These will often continue for several years. If you have any problems or notice any new symptoms between these check ups, let the doctor know as soon as possible.
Some tumours can be completely removed by surgery. Where a tumour is more spread out, or where it cannot be removed completely without damaging other important parts of the brain, the surgeon may be able to remove part of the tumour and so improve your symptoms by reducing the pressure on the rest of the brain. Occasionally this is not possible.
Whether surgery removes all or only part of the tumour, it often improves a person's condition and frequently enables someone who was seriously ill to lead an active life, at least for a time.
The operation is called a craniotomy (the word means a temporary opening of the skull). Some of your hair will be shaved off, and you will be given a general anaesthetic. The surgeon cuts and moves aside the skin, then removes a piece of skull above the tumour. The tumour it self is then removed, the piece of skull replaced, and the skin stitched back in place.
If the tumour is at the back of the brain, the surgeon may not need to replace the piece of skull, as the muscles at the back of the neck are often strong enough to support the brain. This sort of operation is called a craniectomy (that is, the permanent removal of a piece of skull).
If hydrocephalus (building up of the cerebrospinal fluid in the brain) is a problem, particularly if the tumour itself is in too dangerous a position to remove, the surgeon may put a small permanent drain tube, called a shunt, just beneath the skin. The shunt will take the excess fluid from the brain and drain it into the abdomen. Sometimes, if the hydrocephalus has made a person very ill, a shunt may be put in first to relieve the symptoms, and surgery may follow a week or two later.
During surgery, the surgeon will do a biopsy. A tiny piece of tumour is removed and examined under the microscope, to discover exactly what type of tumour you have. This helps the doctors to offer advice about further treatment.
After the operation
For the first 12-24 hours or so after the operation, you will be closely observed by a nurse, usually in an intensive care unit. If all goes well you will be transferred to a regular ward. Your head will probably be bandaged and a small tube may be left under the skin to drain excess blood (the drain is usually removed the day after the operation) into a small bottle.
Your face and eyes may feel swollen after the operation, but this should go down within about a week. The length of your stay in hospital will depend on the extent of the operation, and on any treatment you may need afterwards.
Radiotherapy (x-ray treatment) treats cancer by using high energy x-rays to kill the cancers cells, while doing as little harm as possible to the surrounding healthy tissues.
In children, radiotherapy to the head is given in lower doses than is used for adults, because it can slow a child's intellectual development. It is not used at all for children under the age of two or three years.
For some types of childhood tumours, it may be necessary to give radiotherapy to the spine as well as the head, this can slow down bone growth in the spine, and the child may not grow as tall.
Radiotherapy can also slow a child's growth by affecting the pituitary gland in the brain, which secretes hormones that control growth. These children may need hormone therapy to help them to grow and develop normally.
In adults, radiotherapy is often used after surgery for malignant brain tumours. The course of radiotherapy you receive depends on the type and size of cancer that you have. Some people find that their symptoms fluctuate after surgery and during radiotherapy. The extent of this fluctuation varies from person to person.
In order to make absolutely certain that exactly the same area is being treated each time, the radiation therapist will make a number of marks on your skin. These marks will consist of lines, crosses and dots applied with special inks. Sometimes these non-permanent marks will have to be redone during the course of the treatment.
Occasionally, permanent marks, each consisting of a fine dot, may be suggested to you. These small black 'tattoo' dots are about the size of a pinhead. If these are necessary, the procedure will be explained to you so that you may give your informed consent.
Often a specific plastic mask must be made. This is worn in the machine so that your head will be kept perfectly still.
Frequency of the radiotherapy treatment will depend on the individual case, however, every week day for five or six weeks is commonplace.
Side effects of radiotherapy
Radiotherapy to your head may cause any hair in the treatment area to fall out. This hair usually grows back slowly, though it may not be as thick as before. Scalp and skin in the treatment area may also become red, dry and tender. Do not use any creams, lotions or soaps without talking to your doctor or radiation therapist first. You also need to check before shaving any affected skin. It is important to keep the affected skin out of the sun, it is very easily damaged by the sun's rays.
Other common side effects are tiredness, which may last a month or so after radiotherapy has finished and nausea, which can be helped by medication. Mild headaches are also quite common. Another common side effect is the loss of saliva glands. Periods may also cease (e.g. the early onset of menopause).
Chemotherapy is the use of anti-cancer (cytotoxic) drugs to damage or destroy cancer cells. The drugs work by stopping the cancer cells from growing and reproducing themselves.
In general chemotherapy is used more often to manage childhood brain tumours, but occasionally given to adults. It is usually given as a course of treatment over several days followed by a rest period of a few weeks to allow the body to recover from any side effects of the treatment. The number of courses given will depend on the type of cancer, and how well it is responding to the drugs.
You or your child may be given chemotherapy in hospital over a few days through an intravenous drip. Alternatively you may be given chemotherapy as an outpatient in the form of tablets.
Side Effects of Chemotherapy
Some drugs used in chemotherapy can cause side effects. Fatigue is often experienced by people undergoing chemotherapy. Ask your doctor what side effects to expect from the treatment.
Steroid drugs (usually Dexamethasone) are used to reduce the swelling that often surrounds brain tumours either before or after surgery or radiotherapy. They do not treat the tumour itself but they do help to relieve the swelling and pressure caused by the tumour. Steroids can be used at many stages of treatment, for varying lengths of time. Some people may need to take them for days, others for months.
Side effects of steroid therapy
The dose of steroids given will be kept as low as possible as steroids may cause the following side effects if taken over a long period of time.
Your appetite may increase, and you may find that you put on weigh quite quickly (within a few weeks), especially on your face, waist and shoulders. Steroids often produce a feeling of wellbeing, which may also make you feel more like eating.
The level of sugar in your blood may increase, and you may need to do a simple daily test to check for sugar in your urine. The doctor or nurse will show you how to do this.
Steroids cause muscular weakness in some people, and this can be troublesome, especially if your tumour is also causing weakness.
Steroids can cause acne and water retention
These side effects are temporary and will gradually disappear as your steroid dose is reduced. Steroid drugs often make people feel emotionally uplifted and it is common to feel a bit depressed for a while after you finish your dose. This depression lasts longer for some people than for others.
Do not stop taking steroids suddenly, as this can be dangerous (the dose can be gradually reduced by your doctor).
Other drugs are being trialled (eg thalidomide) that have shown to be effective in some cases.
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