The broad topic of brain cancer encompasses both primary brain tumors and tumors metastatic to the brain. The primary brain tumors are neoplasms arising from various cranial sites and affecting the central nervous system (CNS). Tumors reviewed here include astrocytoma, oligodendroglioma, ependymona, medulloblastoma, primary CNS lymphoma, and germinoma. These tumors are bimodal with peaks from birth to age 4 and from 65 to 79 years. The primary characteristics of these tumors vary.

Astrocytoma:

• Most frequent primary tumor
• Low-grade tumors—often benign but may convert; focal neurologic deficit, uncontrolled epilepsy

Oligodendroglioma:

• May have both astrocytic or ependymal elements
• Seizures common (70% to 90%)

Ependymona:

• Headache
• Nausea, vomiting
• Ataxia
• Vertigo
• Focal neural deficits

Medulloblastoma:

• Most frequent brain tumor in children (ages 5 to 9)
• Primitive neuroectodermal tumors (PNET)—medulloblastomas in children or supratentorially in adults (ages 20 to 30)
• Frequently metastasizes

CNS lymphoma:

• Focal cerebral deficits
• Headache
• Personality and level of alertness changes

Germinoma:

• Hypothalamic–pituitary dysfunction—diabetes insipidus, visual deficits, memory or mood disturbances, hydrocephalus

Metastatic brain tumors are approximately 10 times more prevalent than primary and are the most common intracranial tumor for adults. They usually are a result of a known systemic cancer, occurring in 20% to 40% of adult cancer and 6% to 10% of childhood cancer. They are characterized by the following:

• Headache—especially early morning
• Vomiting
• Seizure
• Neurologic dysfunction—cognitive, confusion, memory problems, mood change, gait, speech, vision blurring
• Stroke

Primary tumors:

• Unknown etiology
• Higher among certain occupations: lead, petroleum, plastic, rubber, aircraft factory, and textile workers; aircraft and vehicle operators; risk extends to family members
• Genetic mutations

Metastatic tumors, general:

• Hematogenous spread through the arterial circulation
• Lung (adenocarcinoma and small cell) and cancers metastatic to the lung—most common source (60%)
• Breast—especially ductal carcinoma
• Germ cell tumors
• Thyroid cancer
• Melanoma
• Tumor source unknown—30% of patients

• Radiation exposure
• Increased age, increased exposure to risk factors
• Pesticides, herbicides, fertilizer exposure
• Occupational prevalence
• Strong and/or sustained electromagnetic fields
• Viruses—especially Epstein-Barr virus for CNS lymphoma
• Transplant and AIDS patients—for CNS lymphoma

• Varies with histology and location
• Increased cranial pressure—headache pain
• Loss of appetite
• Nausea, vomiting
• Syncope or near-syncope, ataxia
• Seizures
• Dementia
• Diminished concentration and mental capacity
• Personality or mood change
• Psychomotor slowing
• Visual or auditory deficits
• Longer sleep time
• Hallucinations

Primary tumors:

• Depression
• Neurasthenia
• Multiple sclerosis
• Metastatic tumors—usually multiple lesions

Metastatic tumors:

• Radiation necrosis
• Granulomas
• Stroke
• Infection, abscess
• Cerebral infarcts or hemorrhage
• Demylinating processes
• Head trauma
• Primary tumors—usually one lesion

Complete history and physical examination required to rule out infection, infarct, and other insults. Heavy emphasis on radiologic studies for diagnosis.

• Astrocytoma—proliferation index of mitotic activity correlates with malignancy
• Metastatic tumor—cytologic examination of cerebral spinal fluid (CSF), except for CNS lymphoma, or carcinoembryonic markers generally unhelpful

Astrocytoma:

• Hypercellularity, nuclear, and cytoplasmic atypia, mitosis, endothelial proliferation, necrosis
• High-grade tumors—neoplastic and normal tissue without clear margin; cells migrate from tumor infiltrating white matter fibers; may metastasize along CSF pathways

Oligodendroglioma:

• Oligoastrocytoma—mixtures of astrocytic and oligodendroglial cells; less infiltrating than astrocytomas

Ependymona:

• Highly cellular with ependymal rosettes, well demarcated from adjacent tissue, tend to occur in spinal cord, filum terminale, white matter adjacent to ventricular surface
• In adult sacrum, myxopapillary histology

Medulloblastoma:

• Highly cellular
• Probably from germinative neuroepithelial cells in roof of fourth ventricle

CNS lymphoma:

• No evidence of systemic lymphoma
• Periventricular lesions allow tumor cell access to CSF
• Leptomeningeal invasion

Germinoma:

• With or without well-defined borders

Metastatic tumors:

• Usually located in junction of gray and white matter or border of middle cerebral and posterior cerebral artery distributions
• Necrotic tumor core; edema surrounding tumor; less margin irregularity than primary tumors

Important both for diagnosis and measuring treatment response

Primary tumor:

• MRI—best suited to evaluate edema, hydrocephalus, hemorrhage; high-resolution and contrast images in any plane make it superior to CT; especially effective for evaluation of skull base and posterior fossa
• Contrast-enhanced MRI—quantitates the uptake of gadolinium, highly sensitive
• Functional MRI—reveals small localized changes in blood flow
• CT—higher specificity than MRI; delineates vascular structure; used with iodine contrast material; 50% of low-grade gliomas do not exhibit contrast enhancement

Metastatic tumors:

• MRI—with three times the usual gadolinium dose, allows more sensitive enhancement than CT; can reveal multiple lesions
• CT—less sensitive; iodinated contrast material may precipitate a seizure with leaky tumor vessels
• Chest radiograph—to search for primary tumor

• Diagnostic biopsy for all types—by needle biopsy with MRI or CT guidance, by craniotomy
• Cerebral angiography—used for surgical planning (e.g., avoid blood vessels encircled by tumor)

Primary brain tumors—surgery is the mainstay for most types of tumor; radiation and chemotherapy possibly used, depending on the type and stage of tumor

Chemotherapy:

• BCNU or combination of CCNU, procarbazine, and vincristine commonly used agents (can cross the blood-brain barrier)
• Acitinomycin, tamoxifen, mifepristone—for aggressive or infiltrating tumors
• Delivery by intra-CSF therapy, intra-arterial infusion, intratumoral therapy
• Used before and/or after surgery
• Not effective for all tumor types

Glucocorticoids:

• Modifies many of the generalized signs (e.g., dexamethasone 64 mg/d)
• Often begun before surgery—prevents transdural herniation from edema
• With radiation treatment—reduces edema
• Taper when surgical decompression is established; use lowest effective dose for management
• Side effects—proximal muscle weakness, insomnia, hyperglycemia, gastritis

Radiation:

• Improves neurologic symptoms
• May be administered instead of, before, or after surgery, or repeated with recurrence
• Stereotaxic radiosurgery—very high, focused single dose for well-defined tumors; only for tumors < 3 cm; effective without craniotomy; less toxic than whole-brain radiation
• Interstitial brachytherapy—radioactive beads implanted into tumor; high toxicity; used with recurrence
• Dose—for example, 6000 cGy in daily fractions of 200 cGy in five to six weeks
• Radiation is mainstay for CNS lymphoma and metastatic tumors
• May be potentiated by chemotherapy, simultaneously increasing neurotoxicity
• Often recommended for elderly patients
• Symptoms of radiation injury range from edema, headache, nausea, vomiting, fever, alopecia, and fatigue, to severe neurologic symptoms

Craniotomy:

• Complete excision cures well-circumscribed tumors, but often microscopic metastasis remain
• Reduces tumor bulk and intracranial pressure
• Does not work well for infiltrating tumors
• Distinguishes between metastatic and primary tumor
• Side effects—bleeding, infection, neurologic injury, thrombosis, pulmonary embolism, seizure, death

Nutrients and herbs may protect against side effects from conventional therapies as well as potentiate chemotherapeutic agents and support anticancer activities. Body/mind therapies such as meditation, relaxation techniques, yoga, and qi gong may reduce the effects of stress and enhance treatment response and quality of life.

• Eliminate processed meats, refined foods, additives, sugar, artificial foods, alcohol, caffeine, and saturated fats. Avoid nitrosamines.
• Eat only organically-raised foods. Increase whole grains, fresh vegetables (especially dark green, yellow, and orange vegetables), legumes, protein, and anti-inflammatory oils (e.g., nuts, seeds, and cold-water fish). Include sea vegetables, garlic, onions, and green tea.
• A ketogenic diet consisting of 60% medium-chain triglyceride oils may decrease glucose availability to brain tumors and inhibit tumor growth.
• Vitamin E (400 to 800 IU/day), vitamin C (1,000 mg qid), selenium (200 mcg bid), and coenzyme Q10 (100 mg tid) protect against oxidative stress. Vitamin A (25,000 IU bid) induces cell differentiation.
• Glutathione 500 mg bid provides detoxification activities.
• Melatonin (20 mg/day) decreased tumor progression in patients with brain metastasis.
• Methionine (100 mg tid), zinc (30 mg/day), vitamin C, and selenium decrease copper levels in cerebral neoplasms.
• Shark and bovine cartilage have antiangiogenic properties (controversial).

Herbs may be used as dried extracts (pills, capsules, or tablets), teas, or tinctures (alcohol extraction, unless otherwise noted). Dose is 1 heaping tsp. herb/cup water steeped for 10 minutes (roots need 20 minutes).

• Garlic (Allium sativum) helps to chelate heavy metals and inhibits angiogenesis. Drink ginger (Zingiber officinale) and garlic tea, two to three cups daily.
• Hawthorn (Crataegus monogyna) 200 mg bid and bilberry (Vaccinium myrtillus) 120 mg bid inhibit tumor invasion.
• Commercial Hoxsey-like formulas or trifolium compounds include red clover (Trifolium pratense), burdock root (Arctium lappa), Oregon grape (Mahonia nervosa), queen's delight (Stillingia sylvatica), barberry (Berberis vulgaris), licorice root (Glycyrrhiza glabra), poke root (Phytolacca americana), prickly ash bark (Xanthoxylum clava-herculis), and yellowdock (Rumex crispus). Take 60 drops bid to tid for six months or longer.
• Commercial herbal mixes in the form of teas or formulas containing herbs such as sheep sorrel (Rumex acetosella), burdock root (Arctium lappa), slippery elm inner bark (Ulmus fulva), turkey rhubarb (Rheum palmatum), red clover (Trifolium pratense), and watercress (Nasturtium officinale) may be helpful. A usual dose is one cup tea bid, or 2 tbs. formula bid for six months.
• Mistletoe (Viscum album) has cytotoxic effects and enhances natural killer cell activity. Take 60 drops tincture tid, or 250 mg capsules tid.
• Combine essential oils of bergamot (Citrus bergamia), chamomile (Matricaria recutita), and lavender (Lavendula angustifolia) in aromatherapy applications for anti-inflammatory, antitoxic, and calming effects. Place several drops in a warm bath, or four to six drops in 1 tbs. of vegetable oil for massage.

May be helpful in addressing symptomatic complaints and strengthening the individual's overall well-being. An experienced homeopath would consider the individual's constitution.

May be helpful in reducing toxicity, enhancing immunity, and increasing the overall sense of well-being.

Avoid known risks.

• Emotional and psychological impact of mental status changes and possible continued disease progression
• Stroke
• Seizures
• Dementia

• Astrocytoma—10-year survival for low-grade 6% to 10%; high-grade usually fatal within 7 to 13 months
• Oligodendroglioma—10-year survival 25% to 34%
• Ependymona—five-year survival 80%, if tumor is totally excised
• Medulloblastoma—less infiltration increases survival; 70% at five years but < 50% of children reach adulthood
• CNS lymphoma—18-month survival; as low as 3 months with immunosuppression
• Germinoma—five-year survival 85%
• Metastatic—10- to 14-month survival; prognostic factors include status of systemic disease, degree of neurologic impairment

Many treatment procedures are contraindicated during pregnancy. Therapeutic abortion and watchful waiting are considered.

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