Brain tumor

Brain Tumor — Summary

1) Disease Description (Causes and Symptoms)

• Definition: A general term for primary tumors arising from brain tissue or the membranes surrounding the brain (meninges), as well as tumors that have metastasized to the brain from other parts of the body. Histologically, they are classified as benign or malignant, and their clinical course varies according to their location, size, and histological characteristics.
• Causes and pathophysiology:
  • The exact cause is unknown. Genetic factors may play a partial role, but occurrence due to a family history is rare.
  • The key elements of the pathophysiology are the tumor’s own volume (direct compression), peritumoral brain edema, obstruction of cerebrospinal fluid flow (hydrocephalus) caused by the tumor, and, in malignant tumors, destruction of normal brain tissue through infiltrative growth.
• Main symptoms:
  • Headache (especially severe headache in the morning), nausea and vomiting
  • Seizures (new-onset seizures), focal neurological deficits (hemiplegia, decreased sensation, speech difficulties, etc.)
  • Decreased vision or double vision, decreased hearing or tinnitus
  • Gait disturbance, dizziness, cognitive or personality changes, fatigue
  • Hormonal abnormalities (in cases of pituitary-related tumors, amenorrhea, decreased sexual function, etc.)
• Diagnosis (summary): After a neurological examination, MRI (including contrast enhancement) is standard. CT, PET, MEG, electroencephalography (EEG), cerebrospinal fluid testing, and biopsy (stereotactic biopsy/craniotomy) may be used for definitive diagnosis when necessary.

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2) Treatment Methods and Precautions

• Standard treatment principles:
  • The goal is “to remove the tumor or reduce its size as safely as possible, improve symptoms, and create conditions favorable for additional treatment (radiation therapy or chemotherapy).”
• Main treatment methods:
  • Surgery
    • Diagnostic or therapeutic biopsy, partial resection, or maximal safe resection (craniotomy). The extent of surgery is determined according to the tumor’s location and functional risks.
  • Radiation therapy
    • Whole-brain or focal radiation therapy, or stereotactic radiosurgery (Gamma Knife or CyberKnife)—selected according to the size, number, and location of the lesions.
  • Chemotherapy
    • Medication is selected according to the histological type (for example, temozolomide may be used in cases such as glioblastoma). Targeted therapy or immunotherapy may be applied in specific cases.
  • Hydrocephalus treatment
    • External ventricular drainage, ventriculoperitoneal shunt (VP shunt), endoscopic third ventriculostomy (ETV), etc.
  • Symptomatic treatment (symptom control)
    • Reduction of brain edema: short-term management with steroids (for example, dexamethasone).
    • In cases of increased intracranial pressure, osmotic agents (such as mannitol), and when necessary, mechanical ventilation or hyperventilation therapy, etc.
    • Seizure prevention/treatment: anticonvulsants (for patients with a history of seizures or for prevention before or after surgery).
  • Adjunctive and experimental treatments
    • Antiangiogenic agents (such as bevacizumab), differentiation agents, immunotherapy, investigational drugs in clinical trials, etc.
  • Rehabilitation therapy
    • Support for functional recovery through physical therapy, occupational therapy, speech therapy, cognitive rehabilitation, etc.
• Lifestyle management and precautions:
  • Seizure risk: Record whether seizures occur and comply with anticonvulsant use and safety measures (driving restrictions and no use of dangerous machinery).
  • If signs of increased intracranial pressure (severe headache, vomiting, decreased consciousness, or acute neurological deficits) occur, immediate emergency evaluation is necessary.
  • With long-term steroid use, monitoring for side effects such as worsening diabetes, increased susceptibility to infection, osteoporosis, and gastrointestinal bleeding is necessary.
  • Complications after surgery, radiation therapy, or chemotherapy (such as infection, bleeding, radiation necrosis, or neurological deterioration) may occur.
  • Fertility and pregnancy: Pregnancy is contraindicated during chemotherapy or radiation therapy (contraception is recommended). Fertility preservation counseling may be necessary.
  • Regular imaging follow-up and neurological examinations are necessary for early detection of recurrence or progression.
  • Rehabilitation and psychosocial support: Management of cognitive decline, depression, and fatigue, as well as family education, is important.

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3) Checklist Before an Outpatient Visit (Items to Bring, Tests, and Example Questions)

• Items and information to bring
  • A list of current medications (including doses and administration times), and allergy information
  • Previous test results: Recent MRI/CT images (a CD or radiology report if possible), biopsy pathology results, and blood test results
  • Symptom records: When symptoms began and how they have progressed, the number and characteristics of seizures, headache patterns, and changes in vision, speech, or movement, etc.
  • Lifestyle information: Occupation, whether you drive, possibility of pregnancy (or current pregnancy), and major underlying conditions (diabetes, hypertension, heart disease, etc.)
• Items to check before the outpatient visit
  • Previous surgery and anesthesia history, bleeding tendency (whether anticoagulants are being taken)
  • Recent changes in weight, appetite, and sleep, as well as records of cognitive or personality changes
• Examples of questions to ask during the outpatient visit (questions that are useful for patients to prepare in advance)
  • “Based on the MRI I brought, what do the tumor’s location, size, and invasiveness look like?”
  • “What additional tests are needed (such as imaging, blood tests, or hormone tests)?”
  • “If surgery is possible, what are the expected goals (the possibility of complete resection) and risks?”

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4) Examples of General Questions to Ask the Doctor

• Treatment-related
  • “What is the first-line treatment recommended in my case? (What is the priority among surgery, radiation therapy, and chemotherapy?)”
  • “What is the probability of complete removal through surgery, and what are the main risks (neurological damage)?”
• Prognosis and follow-up
  • “How do the biopsy results (grade and molecular genetic markers) affect the prognosis?”
  • “What is the risk of recurrence after treatment, and what is the schedule for follow-up tests?”
• Medications and side effects
  • “What are the main side effects of the recommended chemotherapy or radiation therapy, and how can they be managed?”
  • “If I need to take steroids long term, how can the side effects be prevented and monitored?”
• Daily life
  • “When can I resume daily activities such as driving, returning to work, exercising, and sexual activity?”

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5) Examples of Disease-Specific Questions (1–2)

• “How do the possibility of resection and the expected neurological risks vary depending on the tumor’s location observed on MRI (for example, near the motor cortex, brainstem, or hypothalamus)?”
• “What are the recommended treatment plan and differences in expected survival according to the tumor grade (low-grade vs. high-grade) and molecular markers (such as IDH and MGMT) identified in the biopsy (pathology report)?”

End.