Receiving the diagnosis of a brain tumor may be the most frightening news anyone can get. It's only natural to begin searching for all the information you can about brain tumors - causes, symptoms, treatments. We hope you will find some answers at University of Florida Health.
At UF Health, adult brain tumors are treated by neurosurgeons and neurologists. Our multidisciplinary team is dedicated to providing comprehensive care, from accurate diagnosis to advanced treatment options. We also understand that a brain tumor diagnosis by itself can be overwhelming, and it’s only natural to begin learning all one can about brain tumors.
Lodging, transportation, and insurance counseling options for adult and pediatric patients.
What are brain tumors?
University of Florida Health physicians provide specialized care for adult patients and children with brain tumors. Receiving the diagnosis of a brain tumor may be the most frightening news anyone can get. It's only natural to begin searching for all the information you can about brain tumors - causes, symptoms, treatments. We hope you will find some answers at University of Florida Health.
Brain tumors occur when abnormal cells form growth within brain tissue or from surrounding structures. Tumors can be classified as primary brain tumors, originating in the brain itself, or metastatic brain tumors, spreading to the brain from cancers elsewhere in the body.
Currently, it's unclear why brain tumors occur. Although multiple large epidemiologic studies have been undertaken, no specific risk factors for brain cancer have been found. Risk certainly increases with age, but otherwise, no specific environmental or genetic factor has been linked to these tumors. The exception is prior radiation therapy, which has been shown to increase the risk of glioma and meningioma formation. Primary brain tumors are diagnosed in about 17,000 patients every year, including 3,500 pediatric brain tumor cases in children under the age of 20.
Primary tumors vs. metastatic tumors
Tumors are generally separated into two categories:
primary brain tumors (those arising in the head itself) or
metastatic brain tumors (those that spread from different areas of the body)
A primary brain tumor is differentiated based on the cell type from which it originates, including glial cells (cells that separate and support the central nervous system called astrocytes, oligodendrocytes and ependymal cells), neuronal cells (nerve cells themselves), meningeal cells (cells that line the central nervous system) or Schwann cells (cells that line peripheral nerves).
Most primary brain tumors, specifically astrocytomas, are then further classified in a four-stage grading system based on World Health Organization (WHO) criteria. Grading ranges from I (benign and surgically curable) to IV (malignant).
A metastatic brain tumor is considered malignant, and the behavior of these tumors varies widely according to the type of tumor from which they arose. The most common types of metastatic tumors in order of frequency are: 1) lung cancer, 2) breast cancer, 3) renal cell cancer, 4) melanoma and 5) colon cancer.
Every tumor that originates in the brain or spinal cord is classified as a central nervous system, or CNS, tumor. A CNS tumor can manifest in various forms. Some of the more common ones are described below.
Types of primary brain tumors
Primary brain tumors originate from different cells within the brain, including:
Astrocytomas
These tumors form from astrocytes, or cells that support brain tissue. Brain tumor treatment typically involves surgery, and the long-term outlook can vary significantly based on the tumor grade. Low-grade astrocytomas represent 15% of primary tumors and tend to occur in patients in their 30s and 40s. The 10-year survival for low-grade astrocytomas is around 50%.
Colloid cysts
Usually benign, colloid cysts can block fluid movement within the brain, leading to increased pressure andhydrocephalus. UF Health neurosurgeons use minimally invasive techniques to remove colloid cysts.
Choroid plexus tumors
These rare tumors are primarily found in children under the age of 2. It can cause fluid buildup (hydrocephalus) and can be benign or malignant.
Ependymomas
These tumors form from ependymal cells that line fluid-filled spaces in the brain and spinal cord. Treatment involves surgery, radiation oncology, and chemotherapy. The five-year survival for these tumors ranges from 40% to 60%.
Epidermoid/dermoid
Epidermoids usually occur in the posterior fossa and are benign lesions that form keratin. Dermoids are found in the midline of the CNS and are typically associated with some form of dermal sinus (small connection to the skin). They include skin elements such as hair, sweat glands and oil glands. Both of these types of tumors are curable with surgical resection.
A highly aggressive form of astrocytoma common in adults over 55. GBMs represent 25% of primary tumors and are the most commonly diagnosed tumors in those aged 55 to 75. Treatment typically includes surgery, radiation therapy, and chemotherapy. The average survival for these patients is about 14 to 18 months.
Typically benign tumors originating from membranes covering the brain. Meningiomas account for 25% of primary tumors and increase in incidence with age. They can often be successfully treated with surgery or targeted radiation.
Neurocytomas
Generally benign tumors that form within the nervous tissue occurring within brain cavities that may cause increased pressure.
Oligodendrogliomas
Arising from myelin-producing cells, these tumors often respond well to cancer treatment, particularly when specific genetic markers are present. Oligodendrogliomas account for 15% to 20% of primary tumors and occur in two peaks, around the ages of 35 and 55.
Pituitary adenomas
An adenoma is a common benign tumor of the pituitary gland. Approximately 10% of people will have a pituitary adenoma by the time of their death. A pituitary tumor can form at any age. Some tumors secrete excess hormones that cause bodily imbalances, hyperprolactinemia, acromegaly (enlargement of the extremities, face and soft tissues) or Cushing’s disease.
Benign tumors of the pituitary gland affecting hormone levels, potentially causing hormonal disorders.
Schwannomas
Schwannomas originate from Schwann cells, which produce the myelin that covers peripheral nerves. They account for 8% to 10% of primary tumors. The most common location for Schwannomas is on the eighth cranial nerve (vestibular schwannoma), followed by the fifth nerve. These tumors are almost always benign and can be cured with surgical removal. Radiosurgery can successfully treat these lesions when they are small in size.
Tumor grading
What is the difference between cancer grades and cancer stages?
Solid organ cancers like lung, breast, prostate and colon cancers are staged. Staging tells us about the degree of spread. However, since primary brain tumors rarely “spread” outside the brain and spinal cord, they are graded. Grading can tell us the aggressiveness of the cancer.
Grades range from one to four, with one being the least aggressive and four being the most aggressive. Grade one tumors are commonly benign and can be cured through surgery. However, benign tumors can still be troublesome, depending on their location and operability. Tumors with a grade of three or four are commonly referred to as malignant.
Grading also assists in determining the prognosis for the patient and helps us assess treatment options, which might include:
Surgery alone
Surgery followed by radiation treatment
Surgery followed by radiation and chemotherapy
What to expect
When you come for your visit, please bring your imaging results as your physician will review them with you in person. The treatment plan may include follow-up imaging, medical management or surgery.
Before surgery, you will need lab work, an anesthesia preop visit and potentially more imaging. You will need to stop your blood thinner medications if you take them. The night before surgery, you will be instructed to stop eating at midnight. After surgery, you may be sent home the same day or be admitted to the 4th or 5th floor of the HVN hospital.
When you are discharged, you will be given instructions on wound care, when you can shower and any new medications. You will have access to the care team through EPIC MyChart and our office at (352) 273-9000. You will have a follow-up appointment with your physician and/or the APP to ensure you are healing well and recovering as expected. Once your tumor is sent to the pathologist during surgery, it will take them 10 days to six weeks to return a final pathology report that will come to your MyChart for review and to develop a further treatment plan.
Treatment
Primary brain tumor treatment
Treatment for primary brain tumors and metastatic tumors may include surgery, radiation and chemotherapy. The mainstay of this treatment is surgical resection whenever possible, depending on the size and location of the tumor. Brain tumor surgery involves an incision on the scalp, removal of bone over the area of the tumor (craniotomy) and removal of the tumor. Most patients remain in the hospital for two to three days after surgery.
Tumors such as astrocytoma, GBM, oligodendroglioma, ependymoma, and medulloblastoma are infiltrative, and thus, even with the removal of all visualized tumors, microscopic disease will remain. Fractionated radiation therapy, with or without a clinical trial, may be used after surgery to address any remaining disease.
Radiosurgery is another treatment option, most often for benign lesions (meningioma, schwannoma) or metastatic tumors. This technique allows for a very high one-time dose of radiation to be delivered to the tumor while sparing surrounding brain tissue and structures. This treatment is only acceptable for lesions less than 3 cm in diameter, separate from the brain and easily delineated on an MRI or CT scan.
Metastatic tumor treatment
Metastatic tumors are slightly more circumscribed but also tend to recur in the location of previous treatment or elsewhere in the brain. Surgery, radiosurgery, fractionated radiation, chemotherapy, and clinical trials are all options and often used in combination. Each patient and their doctor should discuss each individual’s ideal option(s).
Follow-up
Following brain tumor treatment, most patients will need serial follow-up, including exams and MRI brain imaging, to evaluate for recurrence or other long-term effects of the tumor or treatment.
