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Ask the Expert: All About Brain Tumors

David Lin, MD David Lin, MD
Board-certified Neurosurgeon at Suburban Hospital

I have bad headaches that don’t go away with medication. Do I have a brain tumor?

Don’t worry. Most headaches are not due to a brain tumor. There are many causes of headaches. However, if the headache is new (that is, you never had this kind of a headache before), and if the headache is persistent no matter what medicine you take, please do talk to your primary care doctor to discuss getting an MRI of the brain. An MRI will unequivocally show whether there is a brain tumor.

My husband fell accidentally and hit his head.  When we went to the hospital, they did a scan and told him that they think his fall was a result of a brain tumor.   What should our next steps be?

First of all, find and call a neurosurgeon to set up an appointment. A brain tumor is best evaluated by a neurosurgeon. A neurosurgeon is likely to provide guidance regarding: Is it a serious condition that needs surgery right away? Is it something that can be watched? Is it something that caused the fall? What are the options for treating such a tumor?

Secondly, a tumor found after a fall (or trauma) is often what is called an incidental finding. This means it was not the cause of the trauma, but was picked up because of the standard protocol of evaluating traumas by doing CT scans which showed the tumor. In a lot of instances, the tumor was an innocent bystander, and can be followed. But again, contact a neurosurgeon soon. If only a CT scan was done, which is standard for trauma, your neurosurgeon may order an MRI, which provides more details.

What problems can my brain tumor cause me?

Brain tumors cause problems in the following ways: a) It is too big, causing pressure to the surrounding brain (so called mass effect); b) It is irritating the brain around it, even though it may not be that big, causing the brain to swell, or causing the brain to have seizures.

The types of problems a brain tumor can cause, through either or both of these ways, depend on its location within the brain. Our brain has many distinct areas that are responsible for different functions. For example, there are areas in charge of motor function, that is, how our arms or legs move. There are areas in charge of sensory function, that is, how we feel things. There are areas that are in charge of our speech.

On the other hand, it is not uncommon that a brain tumor causes very little or no symptoms at all. This can happen because either the tumor is too small, the tumor is not irritating the brain, or it is in a location where symptoms can be very minimal.

Do you always have to have a brain tumor removed?

A neurosurgeon, based on the findings on MRI and/or CT, history of the patient, and also physical and neurological findings, can often provide a tentative diagnosis of what a particular brain tumor is, and whether immediate surgical intervention is necessary, or whether a regular follow-up would suffice.

The gold standard of having a diagnosis for any tumor, brain tumors included, requires pathologic confirmation. A sample of the tumor must be removed (by biopsy or resection) and then examined by pathologists under a microscope to tell us what type the tumor truly is. In cases of brain tumor, there are two common scenarios that prevent a routine biopsy/resection to be performed: a) The tumor is located in an area of the brain that can be dangerous to approach, meaning neurologic troubles can arise after such surgery; or b) It is one of the most common brain tumors, a benign (non-cancer) tumor called meningioma, which can remain dormant for many years without troubling the patient.

So a neurosurgeon, using his/her many years of training followed by years in practice with experience in reading all brain-related imaging studies, will provide consultation regarding whether a tumor should be removed immediately or can be watched over time.

My sister has a brain tumor. Does that mean she has cancer?

Not necessarily. The most common brain tumor, meningioma, is usually considered benign (non-cancer). If your sister has a history of other cancers, then the likelihood of her brain tumor being a cancer is increased. Your sister should certainly discuss her case with a neurosurgeon and, if she has not already done so, have an MRI done, which will give her neurosurgeon invaluable information especially in narrowing down the possibility of whether her tumor is cancerous.

My wife has a brain tumor. Is surgery her only option to remove it? What are some other options for her to consider?

There are many types of brain tumors, and therefore each type indicates a different, most optimal way of treatment. It is also not uncommon that some tumors may need more than one type of treatment.

If indeed, your wife’s tumor is the type that is better treated actively than being watched, then, in general, treatment of the brain tumor includes the following options: surgical resection, focused radiation (also known as stereotactic radiosurgery, or SRS), whole-brain radiation, or chemotherapy.

The most optimal treatment of your wife’s tumor is best tailored to the type of tumor she has. To know her type with 100% certainty, it does often require a sample, through a surgical resection, which removes the bulk or the entirety of the tumor, or through a biopsy, which does a more limited sampling of the tumor tissue. There are some exceptions to this tissue sample/biopsy requirement.

My dad was told he needs brain surgery. How dangerous is the process?

Brain surgery has been continuously improved for more than 100 years, and continues to be at the forefront of medical innovation. New technologies constantly emerge to improve the safety and efficacy of such surgeries. These days, surgical mortality is well below 1%, and, if carefully planned, problems after surgery are less than 5 percent.

However, our brains remains the most complex things known to human beings, and are considered the most fragile and delicate organs that we have. Our brain performs many functions, and these functions “reside” in various parts of the brain. There are areas of the brain where doing surgery can be problematic, and neurosurgeons would avoid those areas, or find an alternate way to perform surgeries if needed.

Your dad and your family should discuss thoroughly with his neurosurgeon the associated risks. His specific tumor, due to its location within the brain, can have its own specific risk profile.

Are brain tumors genetic? Should I have my family checked?

Most brain tumors are not hereditary, that is, they don’t run in the family.

There is, however, one scenario that, if applicable to your condition, should raise the concern of the tumor being hereditary: multiple same-type, or different-type, tumors within the brain or elsewhere in the body.

There are also other generally uncommon hereditary syndromes that would involve brain tumors. Due to the variety of brain tumors, it is best to discuss this concern with a neurosurgeon.

I take very good care of myself. How did I develop a brain tumor? Is there anything that helps prevent them?

Most of the time, a brain tumor does not have a cause that can be identified.

On the other hand, there are a few causes that we are aware of. For example, if a person had a history of radiation to the head, the same person does have a higher chance of developing a brain tumor about 10-20 years after the radiation. Here, the radiation we are talking about is high-dose, such as those from cancer treatment or nuclear fall-out, not from a chest X-ray one would get to check whether he/she had pneumonia.

Another increasingly more common scenario is from patients who had a history of other cancers in their bodies. Due to improved survival from advancement in cancer treatment, more and more patients with advanced stage cancer survive for many years. Advanced-stage cancer has a hallmark, metastasis (the spreading of the cancer), which can also happen to the brain. As a neurosurgeon, I am certainly seeing more patients with brain metastases over the years.
None of the above scenarios are exactly preventable. However if you do have a history of other cancers, be sure to follow up with your doctor so he or she can closely watch for any signs of recurrence or metastasis.