Brain tumor

Definition

A brain tumor is an abnormal growth of tissue in the brain. Unlike other tumors, brain tumors spread by local extension and rarely metastasize (spread) outside the brain. A benign brain tumor is composed of non-cancerous cells and does not metastasize beyond the part of the brain where it originates. A brain tumor is considered malignant if it contains cancer cells, or if it is composed of harmless cells located in an area where it suppresses one or more vital functions.

Description

Each year, more than 17,000 brain tumors are diagnosed in the United States. About half of all primary brain tumors are benign, but in life-threatening locations. The rest are malignant and invasive.

Benign brain tumors, composed of harmless cells, have clearly defined borders, can usually be completely removed, and are unlikely to recur. Benign brain tumors do not infiltrate nearby tissues but can cause severe pain, permanent brain damage, and death. Benign brain tumors sometimes become malignant.

Malignant brain tumors do not have distinct borders. They tend to grow rapidly, increasing pressure within the brain (IICP) and can spread in the brain or spinal cord beyond the point where they originate. It is highly unusual for malignant brain tumors to spread beyond the central nervous system (CNS).

Primary brain tumors originate in the brain. They represent about 1% of all cancers and 2.5% of all cancer deaths.

Approximately 25% of all cancer patients develop secondary or metastatic brain tumors when cancer cells spread from another part of the body to the brain. Secondary brain tumors are most apt to occur in patients who have:

• breast cancer.
• colon cancer.
• kidney cancer.
• lung cancer.
• melanoma (cancer) of the skin. These metastatic brain tumors can develop on any part of the brain or spinal cord.
• cancer within the nasal passages and/or throat that follow the nerve pathways into the skull, and metastasize to the brain.

Brain tumors can develop at any age, but are most common in children between the ages of 3-12, and in adults aged 55-65. Primary brain cancer is the second most common cause of cancer death between birth and the age of 34, and the fourth most common cause of cancer death in men aged 35-54. Primary tumors of the brain and central nervous system are often associated with HIV infection. Men and caucasians have a higher risk of developing brain tumors. Other risk factors being studied include children with a history of previous radiation treatment to the head for cancer; parents with certain cancers (nervous system, salivary gland, colon); having an older father; having well-educated parents; occupational exposure to vinyl chloride, lead, and pesticides; history of epilepsy; history of certain genetic conditions (tuberous sclerosis, neurofibromatosis, von Hippel Lindau, familial polyposis, Osler-Weber-Rendu, Li-Fraumeni).

The name of a brain tumor describes where it originates, how it grows, and what kind of cells it contains. A tumor in an adult is also graded or staged according to:

• how malignant it is
• how rapidly it is growing and how likely it is to invade other tissues
• how closely its cells resemble normal cells. (The more abnormal a tumor cell looks, the faster it is likely to grow)

Low-grade brain tumors usually have well-defined borders. Some low-grade brain tumors form or are enclosed (encapsulated) in cysts. Low-grade brain tumors grow slowly, if at all. They may spread throughout the brain, but rarely metastasize to other parts of the body.

Mid-grade and high-grade tumors grow more rapidly than low-grade tumors. Described as "truly malignant," these tumors usually infiltrate healthy tissue. The growth pattern makes it difficult to remove the entire tumor, and these tumors recur more often than low-grade tumors.

A single brain tumor can contain several different types of cells. The tumor's grade is determined by the highest-grade (most malignant) cell detected under a microscope, even if most of the cells in the tumor are less malignant. An infiltrating tumor is a tumor of any grade that grows into surrounding tissue.

Glioma is the term used to refer to the most prevalent primary brain tumors. Gliomas arise from glial tissue, which supports and nourishes cells that send messages from the brain to other parts of the body. These tumors may be either malignant or benign. Astrocytomas, ependymomas, and mixed gliomas are three of the most common gliomas.

ASTROCYTOMAS. Named for the star-like shape of their cells, astrocytomas can develop on any part of the brain or spinal cord. Non-infiltrating astrocytomas grow slowly, and rarely spread to nearby tissue. Mild-to-moderately anaplastic astrocytomas with well-differentiated borders do not grow as slowly as non-infiltrating astrocytomas, and they do spread to surrounding tissues.

Anaplastic astrocytomas, which are also called Grade III astrocytomas, look more abnormal and grow more rapidly than non-infiltrating or mild-to-moderately anaplastic tumors.

Grade IV astrocytomas are also called glioblastoma multiforme (GBM) tumors. Accounting for 30% of all primary brain tumors, GBMs are the most common brain tumors in middle-aged adults. GBMs are the most malignant of all brain tumors. Because they contain a greater mixture of cells than any other brain tumor, they are the most difficult to treat.

EPENDYMOMAS. Also called ependymal tumors, ependymomas account for 9% of all gliomas, and 5% of all intracranial tumors. These tumors, which are most common in children and adolescents, begin in the very thin membranes that help form cerebrospinal fluid (CSF) and line the brain cavities (ventricles) that contain it.

Ependymomas are usually benign, have well-differentiated borders, resemble normal cells, and grow very slowly. The cells of anaplastic (malignant) ependymomas look abnormal and grow more rapidly than the cells of benign tumors.

MIXED GLIOMAS. These heterogeneous tumors contain elements of astrocytomas and ependymomas and/or oligodendrogliomas. These are rare tumors that usually occur in middle-aged adults, grow slowly, and do not usually spread beyond the part of the brain where they originate. Mixed gliomas behave like tumors composed of the highest-grade cells they contain.

The most common brain tumors that do not develop from glial cells are medulloblastomas, meningiomas, and Schwannomas.

MEDULLOBLASTOMAS. Scientists once thought medulloblastomas (MDLs) developed from glial cells. These fast-growing, malignant tumors are now believed to originate in developing cells not normally present in the body after birth. They are sometimes called primitive neurodectal tumors (PNET).

MDL tumors are most common in children and are more common in boys than in girls. Only 30% of MDL tumors occur in adults. MDL tumors usually originate in the cerebellum (the part of the brain that controls coordination and some muscle activity), and are often carried to other parts of the brain by cerebrospinal fluid. MDL tumors rarely metastasize beyond the brain and spinal cord.

MENINGIOMAS. Meningiomas, which represent more than 20% of all primary brain tumors, originate in the membranes that enclose the brain and spinal cord (meninges). These tumors are usually benign and most often occur in women aged 30-50 years old. Meningiomas grow so slowly that the brain can sometimes become accustomed to their presence. Meningiomas compress, rather than invade, brain tissue and may grow to be quite large before any symptoms appear.

SCHWANNOMAS. Schwannomas originate in the Schwann cells. These cells produce myelin, material that protects the acoustic nerve, which controls hearing. These benign tumors are twice as common in women as in men, and are most often diagnosed in patients between the ages 30-60.

Schwannomas grow very slowly, and many people adapt to the slight hearing loss and balance problems that are the tumors' earliest symptoms. A pear-shaped Schwannoma can cause sudden or gradual loss of hearing in an ear. As the tumor progresses, it can press on the nerves that control movement and feeling in the face, and cause headaches and facial numbness or tingling. The patient may have trouble walking, swallowing, or controlling eye movements, and the sense of taste can be affected. A Schwannoma that grows large enough to press on the brainstem can be deadly.

CHILDHOOD BRAIN TUMORS. Brain tumors that occur in children are described as supratentorial (in the upper part of the brain) or infratentorial (in the lowest part of the brain). Astrocytomas and ependymomas are common supratentorial tumors. Infratentorial tumors include medulloblastomas, astrocytomas, and ependymomas.

— Rosalyn Carson-DeWitt, M.D.

Key Terms: Angiogram, Anti-convulsant drugs, Brain scan, Computerized tomography (CT) scan, Magnetic resonance imaging, Myelogram, Neurological exam, Seizures, Steroids.

Definition

Like all other parts of the body, the brain and central nervous system are made up of cells that ordinarily grow and divide to create new cells as needed. This is usually an orderly process; but when cells lose their ability to grow normally or to die off naturally, they divide too often and produce tumors that are made up of these extra cells.

Description

The brain and spinal cord together comprise what is known as the central nervous system (CNS). Like all tumors in the body, CNS tumors are either benign or malignant. Benign tumors are called non-cancerous because they have precise borders, are not invasive, and the cells that make up the growth are similar to other normal cells and grow relatively slowly. However, benign CNS tumors can press on a specific region of the spinal cord or brain and, thereby, cause symptoms. However, when such a benign tumor develops in an area that interferes with essential nervous system functioning, it is treated as malignant.

Malignant, or cancerous, tumors of the central nervous system are likely to be fast-growing, are invasive into surrounding healthy tissue, and the cells are very different from normal cells. These tumors can create a life-threatening situation by stopping vital functions of the brain. Some cancerous CNS tumors do not put out roots nor do they grow rapidly. These tumors are described as being encapsulated.

Another way that brain and central nervous system tumors are classified is by site of origin. Those that actually develop in the brain or spinal cord are called primary CNS tumors. Metastasis to the brain or spinal cord is, for the most part, a one-way street, meaning these tumors almost never metastasize to other areas in the body. The tumors that develop elsewhere in the body and metastasize, or spread, to the central nervous system are considered to be secondary CNS tumors. Such metastatic cells do not resemble other CNS cells. Instead, they have the same appearance as the cancer cells at the original cancer site elsewhere in the body.

Frequently observed signs of a brain tumor are the following:

• severe headaches
• an ataxic, or stumbling, gait
• nausea and vomiting
• lack of coordination
• unusual drowsiness
• weakness or loss of feelings in the arms and legs
• changes in personality or memory
• changes in speech
• changes in vision or abnormal eye movements
• seizures

Approximately 1 1/2% of all diagnosed cancers are CNS cancers, and they account for about 2 1/2% of all cancer deaths. The American Cancer Society (ACS) estimates that in 2001 17,200 malignant tumors of the brain or spinal cord will be diagnosed in adults and children in the United States. Of those people diagnosed, ACS projects that 13,100 will die from malignant CNS tumors.

Typically, diagnosis of CNS tumor is made by a physician who does a complete physical examination, including a family history and neurological examination. Computerized tomography (CT) scans, magnetic resonance imaging (MRI) scans, skull x rays, brain scans, angiograms, or myelograms are among the means of visualizing the brain or spinal cord to search for tumors.

General categories of treatment methods for CNS tumors include surgery, radiation therapy, and chemotherapy, with surgery being the single most commonly used therapy. Steroids are usually given prior to treatment to decrease swelling, and anti-convulsant drugs may be given to prevent seizures.

Types of Cancers

Primary brain tumors are also classified by their site of origin. Gliomas, occurring in the glial, or supportive tissues around the brain, are the most common. Gliomas are further broken down into the following variations:

• Astrocytomas are named for the star-shaped, small cells that they are comprised of. Children may develop these in their brain stem, cerebrum, or cerebellum, while adults commonly develop them in the cerebrum.
• Brain-stem gliomas are usually astrocytomas that originate in the bottom, stem-like portion of the brain. Because this area controls many essential bodily functions, such tumors often cannot be removed.
• Ependymomas occur in the linings of the four brain ventricles, or chambers, or along the spinal cord. These are more common in children.
• Oligodendrogliomas are very rare and, when seen, are usually found in middle-aged adults. They grow slowly and ordinarily do not invade surrounding brain or spinal cord tissue. They originate in the cells responsible for the manufacture of myelin, a fatty covering for nerve tissue.

Other CNS tumors do not originate in glial tissue. Among these are:

• Medulloblastomas, tumors of the cerebellum, are most common in male children. Studies have shown these to originate in primitive nerve cells that normally would have disappeared soon after birth.
• Meningiomas are usually benign. They develop in the meninges, or brain linings, and grow very slowly. Because of this slow growth, they may go undetected for years. Meningiomas are more common in women between the ages of 30 and 50.
• Schwannomas are also benign tumors, specific to the myelin-producing cells (Schwann cells) for the acoustic, or hearing, nerve. These, too, are more common in women than men.
• Craniopharyngiomas are usually benign, but because of their location near the pituitary gland and hypothalmus, they can easily affect vital functions and are therefore treated as if malignant. They occur more frequently in children and teenagers.
• Germinomas, or germ cell tumors, develop from primitive sex cells called germ cells.
• Pineal-region tumors originate in the area near the pineal gland, a small central brain gland that secretes melatonin, a brain chemical. These can be either fast-growing pineoblastoma, or slow-growing pineocytoma.

Resources

Organizations

The American Cancer Society's Resource Center for Brain/Central Nervous System Tumors in Children. (800) ACS-2345.

Cancer Care, Inc. (800) 813-4673. .

National Cancer Institute. .

—Joan Schonbeck, R.N.

The noun has one meaning:

Meaning #1: a tumor in the brain
  Synonym: brain tumour

The examples and perspective in this article deal primarily with USA and do not represent a worldwide view of the subject. Please improve this article and discuss the issue on the talk page.

Brain Tumor
Classification and external resources
Brain metastasis in the right cerebral hemisphere from lung cancer shown on T1-weighted magnetic resonance imaging with intravenous contrast. (L=left, P=posterior, back of the head)
ICD-10	C71., D33.0-D33.2
ICD-9	191, 225.0
DiseasesDB	30781
MedlinePlus	007222 000768
eMedicine	emerg/334
MeSH	D001932

The brain tumor is an abnormal growth of cells within the brain, which can be cancerous or non-cancerous (benign).

It is defined as any intracranial tumor created by abnormal and uncontrolled cell division, normally either in the brain itself (neurons, glial cells (astrocytes, oligodendrocytes, ependymal cells), lymphatic tissue, blood vessels), in the cranial nerves (myelin-producing Schwann cells), in the brain envelopes (meninges), skull, pituitary and pineal gland, or spread from cancers primarily located in other organs (metastatic tumors).

Primary (true) brain tumors are commonly located in the posterior cranial fossa in children and in the anterior two-thirds of the cerebral hemispheres in adults, although they can affect any part of the brain.

In the United States in the year 2005, it was estimated there were 43,800 new cases of brain tumors (Central Brain Tumor Registry of the United States, Primary Brain Tumors in the United States, Statistical Report, 2005–2006),^[1] which accounted for 1.4 percent of all cancers, 2.4 percent of all cancer deaths,^[2] and 20–25 percent of pediatric cancers.^[2][3] Ultimately, it is estimated there are 13,000 deaths per year in the United States alone as a result of brain tumors.^[1]

Contents 1 Signs and symptoms 2 Diagnosis 3 Treatment and prognosis 3.1 Research to treatment with the vesicular stomatitis virus 4 Brain tumors in infants and children 5 See also 6 References 7 External links

Signs and symptoms

Symptoms of brain tumors may depend on two factors: tumor size (volume) and tumor location. The time point of symptom onset in the course of disease correlates in many cases with the nature of the tumor ("benign", i.e. slow-growing/late symptom onset, or malignant, fast growing/early symptom onset) is a frequent reason for seeking medical attention in brain tumor cases.

Large tumors or tumors with extensive perifocal swelling edema inevitably lead to elevated intracranial pressure (intracranial hypertension), which translates clinically into headaches, vomiting (sometimes without nausea), altered state of consciousness (somnolence, coma), dilatation of the pupil on the side of the lesion (anisocoria), papilledema (prominent optic disc at the funduscopic examination). However, even small tumors obstructing the passage of cerebrospinal fluid (CSF) may cause early signs of increased intracranial pressure. Increased intracranial pressure may result in herniation (i.e. displacement) of certain parts of the brain, such as the cerebellar tonsils or the temporal uncus, resulting in lethal brainstem compression. In young children, elevated intracranial pressure may cause an increase in the diameter of the skull and bulging of the fontanelles.

Depending on the tumor location and the damage it may have caused to surrounding brain structures, either through compression or infiltration, any type of focal neurologic symptoms may occur, such as cognitive and behavioral impairment, personality changes, hemiparesis, hypoesthesia, aphasia, ataxia, visual field impairment, facial paralysis, double vision, tremor etc. These symptoms are not specific for brain tumors—they may be caused by a large variety of neurologic conditions (e.g. stroke, traumatic brain injury). What counts, however, is the location of the lesion and the functional systems (e.g. motor, sensory, visual, etc.) it affects.

A bilateral temporal visual field defect (bitemporal hemianopia—due to compression of the optic chiasm), often associated with endocrine disfunction—either hypopituitarism or hyperproduction of pituitary hormones and hyperprolactinemia is suggestive of a pituitary tumor.

Diagnosis

Micrograph of an oligodendroglioma, a type of brain cancer. Brain biopsy. H&E stain.

Although there is no specific clinical symptom or sign for brain tumors, slowly progressive focal neurologic signs and signs of elevated intracranial pressure, as well as epilepsy in a patient with a negative history for epilepsy should raise red flags. However, a sudden onset of symptoms, such as an epileptic seizure in a patient with no prior history of epilepsy, sudden intracranial hypertension (this may be due to bleeding within the tumor, brain swelling or obstruction of cerebrospinal fluid's passage) is also possible.

Glioblastoma multiforme and anaplastic astrocytoma have been associated in case reports on PubMed^[who?] with the genetic acute hepatic porphyrias (PCT, AIP, HCP and VP), including positive testing associated with drug refractory seizures. Unexplained complications associated with drug treatments with these tumors should alert physicians to an undiagnosed neurological porphyria.

Imaging plays a central role in the diagnosis of brain tumors. Early imaging methods—invasive and sometimes dangerous—such as pneumoencephalography and cerebral angiography, have been abandoned in recent times in favor of non-invasive, high-resolution modalities, such as computed tomography (CT) and especially magnetic resonance imaging (MRI). Benign brain tumors often show up as hypodense (darker than brain tissue) mass lesions on cranial CT-scans. On MRI, they appear either hypo- (darker than brain tissue) or isointense (same intensity as brain tissue) on T1-weighted scans, or hyperintense (brighter than brain tissue) on T2-weighted MRI. Perifocal edema also appears hyperintense on T2-weighted MRI. Contrast agent uptake, sometimes in characteristic patterns, can be demonstrated on either CT or MRI-scans in most malignant primary and metastatic brain tumors. This is because these tumors disrupt the normal functioning of the blood-brain barrier and lead to an increase in its permeability.

Electrophysiological exams, such as electroencephalography (EEG) play a marginal role in the diagnosis of brain tumors.

The definitive diagnosis of brain tumor can only be confirmed by histological examination of tumor tissue samples obtained either by means of brain biopsy or open surgery. The histological examination is essential for determining the appropriate treatment and the correct prognosis. This examination, performed by a pathologist, typically has three stages: interoperative examination of fresh tissue, preliminary microscopic examination of prepared tissues, and followup examination of prepared tissues after immunohistochemical staining or genetic analysis.

Another possible diagnosis would be neurofibromatosis which can be in type one or type two.

Treatment and prognosis

Many meningiomas, with the exception of some tumors located at the skull base, can be successfully removed surgically. In more difficult cases, stereotactic radiosurgery, such as Gamma knife, Cyberknife or Novalis Tx radiosurgery, remains a viable option.^[4]

Most pituitary adenomas can be removed surgically, often using a minimally invasive approach through the nasal cavity and skull base (trans-nasal, trans-sphenoidal approach). Large pituitary adenomas require a craniotomy (opening of the skull) for their removal. Radiotherapy, including stereotactic approaches, is reserved for the inoperable cases.

Although there is no generally accepted therapeutic management for primary brain tumors, a surgical attempt at tumor removal or at least cytoreduction (that is, removal of as much tumor as possible, in order to reduce the number of tumor cells available for proliferation) is considered in most cases.^[5] However, due to the infiltrative nature of these lesions, tumor recurrence, even following an apparently complete surgical removal, is not uncommon. Several current research studies aim to improve the surgical removal of brain tumors by labeling tumor cells with a chemical (5-aminolevulinic acid) that causes them to fluoresce ^[6]. Postoperative radiotherapy and chemotherapy are integral parts of the therapeutic standard for malignant tumors. Radiotherapy may also be administered in cases of "low-grade" gliomas, when a significant tumor burden reduction could not be achieved surgically.

Survival rates in primary brain tumors depend on the type of tumor, age, functional status of the patient, the extent of surgical tumor removal, to mention just a few factors.^[7]

UCLA Neuro-Oncology publishes real-time survival data for patients with this diagnosis. They are the only institution in the United States that shows how brain tumor patients are performing on current therapies. They also show a listing of chemotherapy agents used to treat high grade glioma tumors.

Patients with benign gliomas may survive for many years,^[8][9] while survival in most cases of glioblastoma multiforme is limited to a few months after diagnosois if treatment is ignored.

The main treatment option for single metastatic tumors is surgical removal, followed by radiotherapy and/or chemotherapy. Multiple metastatic tumors are generally treated with radiotherapy and chemotherapy. Stereotactic radiosurgery (SRS), such as Gamma Knife, Cyberknife or Novalis Tx, radiosurgery, remains a viable option. However, the prognosis in such cases is determined by the primary tumor, and it is generally poor.

Radiotherapy is the most common treatment for secondary cancer brain tumors. The amount of radiotherapy depends on the size of the area of the brain affected by cancer. Conventional external beam whole brain radiotherapy treatment (WBRT) or 'whole brain irradiation' may be suggested if there is a risk that other secondary tumors will develop in the future.^[10] Stereotactic radiotherapy is usually recommended in cases of under three small secondary brain tumors.

In 2008 a study published by the University of Texas M. D. Anderson Cancer Center indicated that cancer patients who receive stereotactic radiosurgery (SRS) and whole brain radiation therapy (WBRT) for the treatment of metastatic brain tumors have more than twice the risk of developing learning and memory problems than those treated with SRS alone.^[11][12]

A shunt operation is used not as a cure but to relieve the symptoms.[1] The hydrocephalus caused by the blocking drainage of the cerebrospinal fluid can be removed with this operation.

Research to treatment with the vesicular stomatitis virus

In 2000, researchers at the University of Ottawa, led by John Bell PhD., have discovered that the vesicular stomatitis virus, or VSV, can infect and kill cancer cells, without affecting healthy cells if coadministered with interferon. ^[13]

The initial discovery of the virus' oncolytic properties were limited to only a few types of cancer. Several independent studies have indentified many more types susceptible to the virus, including glioblastoma multiforme cancer cells, which account for the majority of brain tumors.

In 2008, researchers artificially engineered strains of VSV that were less cytotoxic to normal cells. This advance allows administration of the virus without coadministration with interferon. Consequently administration of the virus can be given intravenously or through the olfactory nerve. In the research, a human brain tumor was implanted into mice brains. The VSV was injected via their tails and within 3 days all tumor cells were either dead or dying.

Research on virus treatment like this has been conducted for some years, but no other viruses have been shown to be as efficient or specific as the VSV mutant strains. Future research will focus on the risks of this treatment, before it can be applied to humans.^[14]

Brain tumors in infants and children

A brain-stem glioma in four year old. MRI sagittal, without contrast

In the US, about 2000 children and adolescents younger than 20 years of age are diagnosed with malignant brain tumors each year. Higher incidence rates were reported in 1975–83 than in 1985–94. There is some debate as to the reasons; one theory is that the trend is the result of improved diagnosis and reporting, since the jump occurred at the same time that MRIs became available widely, and there was no coincident jump in mortality. The CNS cancer survival rate in children is approximately 60%. The rate varies with the type of cancer and the age of onset: younger patients have higher mortality.^[15]

In children under 2, about 70% of brain tumors are medulloblastoma, ependymoma, and low-grade glioma. Less commonly, and seen usually in infants, are teratoma and atypical teratoid rhabdoid tumor.^[16] Germ cell tumors, including teratoma, make up just 3% of pediatric primary brain tumors, but the worldwide incidence varies significantly.^[17]

See also

• Craterization
• List of notable brain tumor patients
• Radiosurgery
• Stereotactic surgery
• Radiation therapy
• Grading of the tumors of the central nervous system
• Visualase

References

1. ^ ^{a b} Greenlee RT, Murray T, Bolden S, Wingo PA (2000). "Cancer statistics, 2000". CA Cancer J Clin 50 (1): 7–33. doi:10.3322/canjclin.50.1.7. PMID 10735013. http://caonline.amcancersoc.org/cgi/reprint/50/1/7. 
2. ^ ^{a b} American Cancer Society. Accessed June 2000.
3. ^ Chamberlain MC, Kormanik PA (Feb 1998). "Practical guidelines for the treatment of malignant gliomas". West J Med. 168 (2): 114–20. PMID 9499745. 
4. ^ Radiosurgery treatment comparisons - Cyberknife, Gamma knife, Novalis Tx
5. ^ Nakamura M, Konishi N, Tsunoda S (Feb 2000). "Analysis of prognostic and survival factors related to treatment of low-grade astrocytomas in adults". Oncology 58 (2): 108–16. doi:10.1159/000012087. PMID 10705237. http://content.karger.com/produktedb/produkte.asp?typ=fulltext&file=ocl58108. 
6. ^ Clinical trials in brain tumors.. Accessed June 2000.
7. ^ Nicolato A, Gerosa MA, Fina P, Iuzzolino P, Giorgiutti F, Bricolo A (Sep 1995). "Prognostic factors in low-grade supratentorial astrocytomas: a uni-multivariate statistical analysis in 76 surgically treated adult patients". Surg Neurol 44 (3): 208–21; discussion 221–3. doi:10.1016/0090-3019(95)00184-0. PMID 8545771. http://linkinghub.elsevier.com/retrieve/pii/0090-3019(95)00184-0. 
8. ^ Janny P, Cure H, Mohr M (Apr 1994). "Low grade supratentorial astrocytomas. Management and prognostic factors". Cancer 73 (7): 1937–45. doi:10.1002/1097-0142(19940401)73:7<1937::AID-CNCR2820730727>3.0.CO;2-G. PMID 8137221. 
9. ^ Piepmeier J, Christopher S, Spencer D (May 1996). "Variations in the natural history and survival of patients with supratentorial low-grade astrocytomas". Neurosurgery 38 (5): 872–8; discussion 878–9. doi:10.1097/00006123-199605000-00002. PMID 8727811. http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0148-396X&volume=38&issue=5&spage=872. 
10. ^ Treating secondary brain tumours with WBRT
11. ^ Whole Brain Radiation increases risk of learning and memory problems in cancer patients with brain metastases
12. ^ IRSA - International RadioSurgery Association - Metastatic brain tumors
13. ^ Researchers Find Cancer-Killing Virus; July 24, 2000.
14. ^ Yale Lab Engineers Virus That Can Kill Deadly Brain Tumors; February 21, 2008.
15. ^ Gurney, James G; Smith, Malcolm A; Bunin, Greta R. "CNS and Miscellaneous Intracranial and Instraspinal Neoplasms" (PDF). SEER Pediatric Monograph. National Cancer Institute. pp. 51–52 (incidence); pp. 56–57 (trends); p. 57 (survival). http://seer.cancer.gov/publications/childhood/cns.pdf. Retrieved 4 December 2008. "[re incidence] In the US, approximately 2,200 children and adolescents younger than 20 years of age are diagnosed with malignant central nervous system tumors each year. More than 90 percent of primary CNS malignancies in children are located within the brain." 
16. ^ Infantile Brain Tumors by Brian Rood for The Childhood Brain Tumor Foundation (accessed July 2007)
17. ^ Echevarría ME, Fangusaro J, Goldman S (June 2008). "Pediatric central nervous system germ cell tumors: a review". Oncologist 13 (6): 690–9. doi:10.1634/theoncologist.2008-0037. PMID 18586924. 

External links

• Brain Tumor ( Cyst) Endoscope Video
• The Brain Tumor Trials Collaborative: Brain Tumor Research
• Brain and CNS cancers at the Open Directory Project
• WebMD: Brain Cancer Health Center
• Seattle's Ivy Center for Advanced Brain Tumor Treatment
• Medical Encyclopedia MayoClinic: Brain tumor
• Brain Tumor: Definitions Neurosurgery UCLA
• Medline Plus: Brain Cancer – Interactive Health Tutorials
• Visualase Laser Technology For Thermal Tumor Ablation

v • d • e Pathology: Tumor, Neoplasm, Cancer, and Oncology (C00-D48, 140-239) Benign tumors Hyperplasia · Cyst · Pseudocyst · Hamartoma Malignant progression Dysplasia · Carcinoma in situ · Cancer · Metastasis Topography Oral · Head/Neck · Nasopharyngeal · Digestive system · Respiratory system · Bone · Skin · Blood · Urogenital · Nervous system · Endocrine system Histology Carcinoma · Sarcoma · Papilloma · Adenoma Misc. Tumor suppressor genes/oncogenes · Staging/grading · Carcinogenesis · Carcinogen · Research · Precancerous condition · Paraneoplastic syndrome · List of oncology-related terms

v • d • e Nervous tissue tumors/nervous system neoplasm/Neuroectodermal tumor (ICD-O 9350-9589) (C70-C72/D32-D33, 191-192/225) Endocrine/ sellar (9350-9379) sellar: Craniopharyngioma · Pituicytoma other: Pinealoma CNS (9380-9539) Neuroepithelial (brain tumors, spinal tumors) Glioma Astrocyte Astrocytoma (Pilocytic astrocytoma, Glioblastoma multiforme) Oligodendrocyte Oligodendroglioma Ependyma Ependymoma · Subependymoma Choroid plexus Choroid plexus tumor (Choroid plexus papilloma, Choroid plexus carcinoma) Multiple/unknown Oligoastrocytoma · Gliomatosis cerebri · Gliosarcoma Mature neuron Ganglioneuroma: Ganglioglioma · Retinoblastoma · Neurocytoma · Dysembryoplastic neuroepithelial tumour · Lhermitte-Duclos disease PNET Neuroblastoma (Esthesioneuroblastoma, Ganglioneuroblastoma) · Medulloblastoma · Atypical teratoid rhabdoid tumor Meningiomas (meninges) Meningioma Hematopoietic Primary central nervous system lymphoma PNS: NST (9540-9579) cranial and paraspinal nerves: Neurofibroma (Neurofibrosarcoma, Neurofibromatosis) · Neurilemmoma/Schwannoma (Acoustic neuroma) · Malignant peripheral nerve sheath tumor note: not all brain tumors are of nervous tissue, and not all nervous tissue tumors are in the brain central nervous system navs: anat/physio/dev, noncongen/congen/neoplasia, symptoms+signs/eponymous, proc peripheral nervous system navs: anat/histo/physio/dev, noncongen PNS somatic/autonomic/congen/neoplasia, symptoms+signs/eponymous, proc

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