Brain & Spinal Cancer
Tumors of the brain and spine affect the parts of you that run everything else — movement, memory, speech, balance. Radiation therapy is aimed carefully so it treats the tumor and spares as much healthy tissue as possible.
About brain and spinal cancer
The Central Brain Tumor Registry of the United States estimates that more than 612,000 people are living with some form of primary brain or central nervous system tumor. Because the brain is the center of thought, emotion and movement, even a small tumor can affect daily life — not by spreading, but by pressing on the cells around it.
There are two general kinds. A primary tumor starts in the brain or spinal cord. It can be benign (not cancerous) or malignant (cancerous), and it rarely spreads to distant organs. A metastatic tumor is caused by cancer that began elsewhere in the body and traveled to the brain. Metastatic brain tumors are always cancerous.
Brain metastases are common. About 170,000 cases are diagnosed each year — more than the roughly 62,000 primary brain tumors diagnosed annually. Metastasis can appear long after a person has finished treatment for the original cancer, which is one reason your follow-up scans matter.
Tumors in the spinal cord and spinal column behave much the same way. They may be primary or metastatic, and they cause trouble by pressing on the cord and the nerves branching off it — producing pain, weakness or numbness. Radiation therapy is often used here to shrink the tumor, relieve that pressure and protect nerve function.
Brain metastasis usually cannot be cured, but it can very often be controlled. Treatment relieves symptoms and improves quality of life. How well it works depends on where the cancer started, whether it has spread elsewhere, how many metastases there are, and how the cells respond to treatment. Your physician will tell you plainly what the goal of your treatment is.
Signs and symptoms
Symptoms depend on where the tumor sits and how large it is, and some people have no symptoms at all. Seizures are one of the clearest warning signs, whether full-body or localized. So are headaches that are worst in the morning and changes in personality or behavior.
- Seizures, either full-body convulsions or more localized
- Headaches, especially severe in the morning
- Changes in personality, behavior or memory
- Sudden nausea or vomiting
- Difficulty with speech
- Difficulty with balance, or dizziness
- Difficulty hearing
- Blurred or double vision
- Sudden onset of confusion
- Numbness or weakness in part of your body
When to call
These symptoms have many possible causes, most of them not cancer. But they are worth a conversation. If something has changed and hasn't resolved, contact your primary care physician — early evaluation is what makes treatment straightforward.
How we treat it
Brain and spinal tumors are treated with radiation therapy, surgery and chemotherapy — often in combination. The right approach depends on the type, location, size and grade of the tumor and on your overall health. Radiation works by damaging the tumor cells' ability to multiply; once damaged they cannot repair themselves, while healthy tissue can. When surgery comes first, radiation is commonly given afterward to lower the risk of the tumor coming back.
External Beam Radiation Therapy
A machine outside your body delivers precisely aimed beams of radiation to the tumor. For brain metastases, external beam radiation can treat the whole brain, or target only the affected areas. Sessions last just a few minutes and are completely painless. Radiation is particularly useful for brain metastases because it reaches through the blood-brain barrier that limits some medications.
Stereotactic Radiosurgery
Despite the name, this is not surgery. It concentrates a high dose of radiation on a small, precisely mapped target in one to a few sessions, sparing the surrounding brain. It is often used for a limited number of brain metastases or a small primary tumor, and it can be combined with whole brain treatment when your physician recommends both.
Radiation Therapy for Spinal Tumors
Radiation aimed at a tumor in or near the spinal cord can shrink it, ease the pressure causing pain or weakness, and help preserve nerve function. It is used for primary spinal tumors and for cancer that has spread to the spine, either on its own or after surgery.
Brachytherapy
A form of internal radiation. In a minor procedure, small tubes are placed directly next to or into the tumor, and small amounts of radioactive material are inserted into the tubes. This delivers radiation directly to the tumor with very little exposure to tissue further away.
What treatment involves
Your physician will meet with you first to review your options and explain what each one is meant to accomplish. If external beam radiation is right for you, the next step is a planning session called simulation, which maps the treatment area using X-rays and a CT scan.
For treatment to the brain, a custom plastic mask is usually made to hold your head gently in the same position each day. It is fitted to you, and it is what allows the beams to be aimed as precisely as they are. Most people find it takes a session or two to get used to.
Treatment sessions last only a few minutes and are painless. The length of the full course varies widely — stereotactic radiosurgery may take one to a few sessions, while other plans run daily over several weeks. Your radiation oncologist will give you your schedule before you start.
Possible side effects
Side effects are usually temporary and typically resolve shortly after treatment ends. Tell your care team about any discomfort — managing it is part of the treatment, not an interruption to it.
- Fatigue, which is the most common effect and usually builds gradually
- Hair loss in the area being treated
- Skin or scalp that becomes pink, dry or itchy
- Headache, or a temporary increase in existing symptoms as swelling changes
- Nausea
- Trouble concentrating or short-term memory changes
Caring for yourself during treatment
- Rest when you need to, and don't hesitate to ask for help.
- Follow your care team's advice — and ask when anything is unclear.
- Tell us about every medication, vitamin and supplement you take.
- Eat a balanced diet and drink plenty of fluids.
- Treat skin in the treatment area gently: no sun, no hot or cold packs, and only lotions your team has approved.
- Lean on support groups, family and friends. Coping is part of treatment.
Trusted resources
- American Brain Tumor Association — www.abta.org
- National Brain Tumor Society — www.braintumor.org
- Brain Tumor Foundation — www.braintumorfoundation.org
- RT Answers (American Society for Radiation Oncology) — www.rtanswers.org
Clinical background adapted from materials by the American Society for Radiation Oncology (rtanswers.org) and the American Cancer Society.
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