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Brain Tumor Center

Patient and Family Education

Adult Brain Tumor

Staging

The American Cancer Society predicts that 22,070 new cases of malignant brain and other nervous system tumors will be reported in 2009. If a brain tumor is found, tests will be done to determine the type of tumor. To plan treatment, the doctor needs to know the type, the grade of brain tumor, and how different the tumor cells are from the cells that are near it (called the histologic grade of the tumor).

The following types are used to group adult brain tumors:

Astrocytomas

Tumors that start in brain cells (or astrocytes) are called astrocytomas. There are four different kinds of astrocytomas, defined by how the cancer cells look under a microscope:

1. Noninfiltrating astrocytomas are tumors that grow slowly and that usually do not grow into the tissues around them. Treatment may be one of the following:
   • Surgery to remove the cancer
   • Surgery followed by external-beam radiation therapy
     
     
2. Well-differentiated mildly and moderately anaplastic astrocytomas are slow-growing tumors, but they grow more quickly than noninfiltrating astrocytomas. They start to grow into other tissues around them. Treatment may be one of the following:
   • Surgery followed by external-beam radiation therapy
   • Surgery alone
   • A clinical trial of surgery followed by radiation therapy and chemotherapy
     
     
3. Anaplastic astrocytomas are tumors that have cells that look very different from normal cells and that grow more rapidly. Treatment may be one of the following:
   • Surgery followed by external-beam radiation therapy
   • Surgery followed by external-beam radiation therapy and chemotherapy
   • A clinical trial of new forms of radiation therapy, such as internal radiation, radiation given during surgery, or radiation given with drugs to make the cancer cells more sensitive to radiation
   • A clinical trial of chemotherapy or biological therapy following radiation therapy
     
     
4. Glioblastoma multiforme (GBM) are tumors that grow very quickly and have cells that look very different from normal cells. Glioblastoma multiforme is also called grade IV astrocytoma. Treatment may be one of the following:
   • Surgery followed by external-beam radiation therapy and chemotherapy
   • Surgery followed by external-beam radiation therapy alone
   • A clinical trial of new forms of radiation therapy, such as internal radiation, radiation given during surgery, or radiation given with drugs to make the cancer cells more sensitive to radiation
   • A clinical trial of chemotherapy or biological therapy following radiation therapy

Brain Stem Gliomas

Tumors located in the bottom part of the brain that connects to the spinal cord (the brain stem). Because of their critical location, substantial resection is not feasible. Treatment may be one of the following:

1. External-beam radiation therapy
2. A clinical trial of chemotherapy or biological therapy

Cerebellar Astrocytomas

Cerebellar Astrocytomas occur in the area of the brain called the cerebellum, which is just above the back of the neck. Cerebellar astrocytomas usually grow slowly and do not usually spread from where they began to other parts of the brain or body.

Ependymal Tumors

Tumors that begin in the ependyma, the cells that line the passageways in the brain where special fluid that protects the brain and spinal cord (called cerebrospinal fluid) is made and stored. There are different kinds of ependymal tumors, defined by how their cells look under a microscope:

1. Well-differentiated ependymoma have cells that look very much like normal cells and grow quite slowly. Treatment may be one of the following:
   • Surgery to remove the cancer
   • Surgery to remove the cancer followed by external-beam radiation therapy
   • A clinical trial of chemotherapy or biological therapy
     
     
2. Anaplastic ependymoma are ependymal tumors that do not look like normal cells and grow more quickly than well-differentiated ependymal tumors. Treatment may be one of the following:
   • Surgery to remove the cancer followed by external-beam radiation therapy
   • A clinical trial of external-beam radiation therapy with chemotherapy
   • A clinical trial of chemotherapy or biological therapy
     
     
3. Ependymoblastoma are rare cancers that usually occur in children. They may grow very quickly.

Oligodendroglial Tumors

Tumors that begin in the brain cells, called oligodendrocytes, which provide support and nourishment for the cells that transmit nerve impulses. There are different types of oligodendroglial tumors, and they are defined by how the cells look under a microscope:

1. Well-differentiated oligodendroglioma are slow-growing tumors that look very much like normal cells. Treatment may be one of the following:
   • Surgery to remove the cancer followed by external-beam radiation therapy
   • Surgery to remove the cancer
   • A clinical trial of radiation plus chemotherapy
     
     
2. Anaplastic oligodendroglioma - Grow more quickly, and the cancer cells look very different from normal cells. Treatment may be one of the following:
   • Surgery to remove the cancer followed by external-beam radiation therapy
   • Surgery followed by external-beam radiation therapy and chemotherapy
   • A clinical trial of new forms of radiation therapy, such as internal radiation, radiation given during surgery, or radiation given with drugs to make the cancer cells more sensitive to radiation
     

Mixed Gliomas

Brain tumors that occur in more than one type of brain cell, including cells of astrocytes, ependymal cells, and/or oligodendrocytes. Treatment may be one of the following:

1. Surgery followed by external-beam radiation therapy
2. Surgery followed by external-beam radiation therapy and chemotherapy
3. A clinical trial of new forms of radiation therapy, such as internal radiation, radiation given during surgery, or radiation given with drugs to make the cancer cells more sensitive to radiation

Medulloblastoma

Brain tumors that begin in the lower part of the brain. They are almost always found in children or young adults. This type of cancer may spread from the brain to the spine. Treatment may be one of the following:

1. Surgery to remove the cancer plus external-beam radiation therapy, plus chemotherapy
2. A clinical trial of surgery plus external-beam radiation therapy and chemotherapy, or high-dose chemotherapy for selected high-risk patients
   

Pineal Parenchymal Tumors

Tumors that are found in or around a tiny organ located near the center of the brain (the pineal gland). The tumors can be slow growing (pineocytomas) or fast growing (pineoblastomas). Astrocytomas may also start here. Treatment may be one of the following:

1. Surgery plus external-beam radiation therapy
2. Surgery plus external-beam radiation therapy plus chemotherapy
3. A clinical trial of new forms of radiation therapy, such as internal radiation, radiation given during surgery, or radiation given with drugs to make the cancer cells more sensitive to radiation

Germ Cell Tumors

Germ Cell Tumors are tumors that arise from the sex cells. There are different kinds of germ cells, including germinomas, embryonal carcinomas, choriocarcinomas, and teratomas. Treatment depends on whether the cancer can be removed in an operation, the kind of cells, the location of the tumor, and other factors.

Craniopharyngioma

Tumors that occur near the pituitary gland. The pituitary gland is a small organ about the size of a pea located just above the back of the nose that controls many of the body's functions. Treatment may be one of the following:

1. Surgery to remove the cancer
2. Surgery to remove the cancer followed by radiation therapy

Meningioma

Tumors that occur in the membranes that cover and protect the brain and spinal cord (the meninges). Meningiomas usually grow slowly. Treatment usually consists of surgery to remove the tumor. If all of the tumor cannot be removed in an operation, a patient may also receive external-beam radiation therapy after surgery.

Malignant Meningioma

Rare tumors that grow more quickly than other meningiomas. Treatment may be one of the following:

1. Surgery followed by external-beam radiation therapy
2. A clinical trial of new forms of radiation therapy, such as internal radiation, radiation given during surgery, or radiation given with drugs to make the cancer cells more sensitive to radiation
3. A clinical trial of chemotherapy or biological therapy following radiation therapy

Choroid Plexus Tumors

The choroid plexus is tissue located in the spaces inside the brain called ventricles. The choroid plexus makes the fluid that fills the ventricles and surrounds the brain and spinal cord. Tumors of the choroid plexus can grow slowly (choroid plexus papilloma) or grow more rapidly (anaplastic choroid plexus papilloma). The rapidly growing tumors are more likely to spread to other places in the brain and to the spinal cord.

Recurrent Brain Tumor

Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the brain or in another part of the body. Treatment depends on the type of tumor and the initial course of treatment.

This page was last updated on: November 12, 2009.

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