Once you have been diagnosed with a brain tumor, you will begin to work with a large medical team that will be made up of specialists that have experience with your type of brain tumor and from a range of different medical specialties including neuro-oncology, neurosurgery, otolaryngology (head and neck surgery), neurology, radiology, radiation oncology and pathology. There may be many different experts throughout your treatment journey including rehabilitation specialists, neuropsychologists and psychiatrists, endocrinologists, ophthalmologists, dentists, pharmacists and nutritionists.
At this point, you will have many questions for your medical team. Consider putting together a general list about your brain tumor and treatment options. At this point, you should also consider getting a second opinion at another facility specializing in the treatment of your cancer.
What type of brain cancer do I have?
What is the grade of my brain tumor?
How many of these tumors do you treat each year?
Do you have any patient materials about my type of brain tumor?
How will my tumor affect my functioning?
What are my treatment options?
Which do you recommend and why?
Do you recommend more than one treatment?
What is the timeline for my treatment?
Where will I receive treatment?
Can I drive to and from the hospital for my treatment?
Does my insurance cover the treatment you are recommending?
How will this affect my job / work schedule?
Will I need to apply for disability? Social security disability?
Will I need to take medications? If so, which ones and how often?
Are there any side effects to the treatment? To the medications?
What are the short and long-term side effects?
How will I manage my side effects?
Will my quality of life change? Will I function differently?
What will happen before, during and after my treatment?
What is the follow-up plan if the recommended treatment doesn’t work?
Do you have support groups here that you can recommend?
Do you have clinical trials available for newly-diagnosed (and recurrent) tumors of my type?
There are several different treatment options available for brain tumors. Surgery is usually considered first for brain cancer and in some cases, it can be curative, meaning that you need no further treatment when your tumor is removed. In most cases, surgery is followed up with another form of treatment to treat those cells that your neurosurgeon is unable to remove.
Before deciding upon a treatment path with your surgical team, you may want to discuss some other considerations:
Treatment Options for Brain Tumors
Depending upon your diagnosis, you may be required to make serious decisions about how to treat your tumor very quickly. You can rely on your medical team to help guide your decision, using their knowledge and experience with what types of treatments typically work best with your type and grade of tumor.
You should always consider getting a second opinion before embarking on a treatment course for your brain tumor. Searching area or regional hospitals with doctors who specialize in your type of tumor can help better inform your decision-making process. Please remember that while second opinion is important, it is often more important not to delay a decision to pursue a therapy as many of these tumors tend to be fairly aggressive and may lead to additional neurologic symptoms without early/rapid treatment.
Once you are working with a medical team, you will have lots of questions. It helps to keep a journal or notebook throughout your entire journey. You can record all your questions and answers as well as your schedule for appointments, meetings, treatment schedule, side effects, and other notes you want to make. Some patients find it very helpful to keep a detailed calendar of doctor and/or treatment appointments. Having someone with you for your appointments also helps ensure that all the information that you receive is retained and documented and offers very important emotional support too.
Treatment recommendations will depend upon several factors:
Some of the most advanced facilities are beginning to make medical information more available to patients. In tandem, new clinical software technology may help play a key role in filtering through the mountains of data that are generated for cancer patients. This technology may ultimately help clinicians provide personalized treatment that combines the best of all protocols. Digest some more Brainfood on this topic here > > >
Treatments range from ‘watchful waiting’ which means that your tumor will be monitored and no action will be taken until / when it is needed to multi-treatment recommendations combining surgery, radiation and/or chemotherapy.
Neurosurgery / Image Guided Surgery (IGS)
Depending upon your diagnosis, your doctor may recommend surgical removal of part or all of your tumor.
Your surgeon may use medical technology called image guided surgery for certain types of tumors. These computer-based systems are designed to help assess a patient case, plan the surgery and actually mirror the real human anatomy on screen – helping to guide the surgeon through important surgical steps taken during the procedure.
Another new and potentially game changing treatment option that has received Food and Drug Administration (FDA) approval for treatment of patients with benign skull base tumors is called ‘adaptive hybrid surgery’ (AHS). Clinicians can use sophisticated technology to remove most of a tumor and then integrate a personalized radiosurgery treatment into the surgery. Planning for follow-up radiosurgery during a brain surgery is intended to help doctors more safely remove the right amount of tumor while more accurately balancing the risks of surgery with the risks of radiosurgery toxicity. Check out our blog post on this topic > > >
Visit our Understand Image Guided Surgery in the Brain Tumors section of the website to explore the option of having your brain tumor treated with image guided surgery, also known as surgical navigation or neuronavigation.
Radiation Therapy / Stereotactic Radiosurgery (SRS) / Image Guided Radiotherapy (IGRT)
Doctors use radiation to target cancer cells with the goal of stopping tumor growth and destroying the cancer cells, while causing minimal impact to normal brain tissue. The most common treatment for brain tumors is called external beam radiation therapy, which is radiation given from a machine outside the patient’s body.
External beam radiation therapy can be given in a single treatment or over several appointments, called fractions, or sessions. The sessions can be once a day, five days a week and can last between two and ten weeks, depending upon the type of brain tumor and the goal of the treatment.
Another way to receive treatment is in smaller doses twice per day, which is called hyperfractionated radiation therapy. This form of treatment is fairly new and not yet used widely in current practice.
Visit our Understand Radiation Therapy Treatment in the Brain Tumors section of the website to explore the option of having your brain tumor treated with radiation therapy, image guided radiotherapy or frameless radiosurgery.
Chemotherapy is the use of chemical substances, also called anti-cancer drugs and chemotherapeutic agents, to kill cancer cells. If you are prescribed chemotherapy, you may receive it in the form of pills that you take orally or it may be given intravenously.
Most modern systemic treatments are biologically-targeted and not considered cyto-toxic, those that have broad impact on all dividing cells in the body, not just cells with specific tumor genetic alterations.
A course of chemotherapy may be given in combination with other types of treatment like surgery or radiation therapy. If it is used before surgery or radiation therapy, the goal is usually to shrink the tumor to make removal or radiation more effective. This is called neo-adjuvant therapy.
If chemotherapy is used after surgery or radiation therapy, the goal is to destroy any cancer cells that may have been left behind. This is called adjuvant therapy.
If you have cancer that comes back (recurrent cancer) or spreads to another part of your body (metastatic cancer), chemotherapy may be prescribed to destroy these cells.
If you have any questions or concerns about the treatment that is being recommended, you should seek out more information about the treatment types and perhaps consider another second opinion.