About 24,000 malignant tumors of the brain or spinal cord are diagnosed in U.S. men and women each year. These tumors can be difficult to treat because surgery or radiation can destroy nearby healthy cells. But precision medicine technology may provide a drug based solution to target specific cells in a patient's body and leave the rest of the cells untouched. Doctors and researchers at Yale Medicine are working across departments to find an individualized solution for adults and children with brain or spinal cord tumors.
What are the different types of adult and pediatric brain and spine tumors?
Tumors can be defined in several ways. If they are benign, they will not spread onto other tissues, but they may come back. If the tumors are malignant, they're considered cancerous, because they can grow quickly and spread onto other tissue.
There are several classifications of brain tumors, all stemming from where they first start growing:
- Metastatic brain tumors begin as cancer in another part of the body, and they spread to the brain. (Lung cancer, melanoma, breast cancer, colon cancer, kidney cancer, nasopharyngeal cancer, and unknowns, can all spread to the brain.)
- Metastatic brain tumors are more common than primary brain tumors, which begin in the central nervous system.
Tumors are also graded by their intensity:
- Grade 1 and Grade II grow more slowly, and they may spread more slowly.
- Grade III and Grade IV tumors grow and spread quickly and often require an immediate response.
What are the symptoms of adult and pediatric brain and spine tumors?
The location of the tumor will affect the patient in several different ways, depending on its size, and whether it’s interfering with the function of the central nervous system. It’s a good idea to check with your doctor if these common symptoms occur.
Symptoms of brain tumor:
- Headaches that become worse and more frequent over time
- Clumsiness, trouble walking, or decreased coordination
- Emotional or personality changes
- Memory loss, trouble thinking, or speech difficulties
- Vomiting, fever, or a general feeling of illness or lethargy
- Numbness, tingling, pain, or weakness
Symptoms of spinal tumor:
- Back pain
- A change in bowel habits or difficulty urinating
- Weakness or numbness in the arms or legs
- Difficulty walking
How is a brain or spinal cord tumor diagnosed?
If you are showing symptoms, doctors will perform a physical exam, a neurological exam, and then a visual field exam, which tests the visual pathways from the eyes to the brain and can reveal where a tumor might be located.
From there, blood samples can be taken as part of a tumor marker test, which can also indicate the presence of cancer in the body.
The patient may then get a computerized tomography (CT) scan or magnetic resonance imaging (MRI). Both procedures take photos of the inside of the body and do a good job of showing whether a tumor is present.
Additionally, there’s the SPECT scan (single photon emission computer tomography scan), which can take a photo of the inside of the brain.
If a tumor is found, a neurosurgeon will usually perform a biopsy to take a sample of the tumor and determine its type and grade.
How is a brain or spinal cord tumor treated?
If a tumor is causing pressure on the brain or spine and resulting in seizures or impairment (vision, speech, or otherwise) or if there's concern that the tumor is malignant or aggressive, surgeons will try to remove the growth.
If the tumor is small or a lower grade, physicians may opt instead for what we call active surveillance, where we monitor your tumor.
Radiation therapy and chemotherapy are other options, where the tumor is either attacked or its growth is slowed through radiation or drugs that attach themselves to the cancer cells. But this traditional, one-size-fits-all approach can destroy healthy cells in the process and expose some patients to adverse, even toxic, side effects.
That is why precision medicine is so promising: By identifying the specific gene mutation that has caused the tumor, we can try new or experimental drugs designed to target those particular cells—or to stimulate the patient’s personal, disease-fighting capacity.
At Yale Medicine, children with pediatric brain and spine tumors are given access to the same resources as our adult patients. They are treated by pediatric neurosurgery staff, which offers the most advanced medical care available.
What makes Yale Medicine's approach to treating adult and pediatric brain and spine tumors unique?
Murat Gunel, MD, director of Yale Medicine's neurovascular surgery department, calls this innovation an “almost complete catalog of all cancers.”
This can help our physicians tailor medications and treatments to each patient's particular cancer, which can give them the best possible outcome.
“When a patient comes in, we treat the disorder,” says Dr. Gunel. “But we are also thinking in partnership with them. Together we are making advances into treating disease so we can serve the next patient better.”