Approximately one-third of brain tumors start in glial cells. Most of the brain is composed of glial cells, not neurons. Glial cells act as supportive tissue in the brain. They also play a big part in brain cell communication.

When glial cells become abnormal or stop working, this type of cancer is called a glioblastoma. A glioblastoma is a type of glioma. Glioblastomas are usually highly malignant (cancerous) but rarely spread in the body. These cancers often occur in the cerebral hemispheres of the brain, but they can grow anywhere in the brain or spinal cord.

Types of Glioblastomas:

• Astrocytic Tumors: These tumors begin in brain cells called astrocytes. Astrocytes help keep nerve cells healthy. Astrocytomas are the most common childhood brain cancer. Types of astrocytic tumors include brain stem glioma, pineal astrocytic tumors, pilocytic astrocytoma, diffuse astrocytoma and anaplastic astrocytoma.
• Oligodendroglial Tumors: An oligodendroglial tumor begins in brain cells that make the fatty substances that protect nerves in our brain and central nervous system. Types of these tumors include oligodendroglioma and anaplastic oligodendroglioma.
• Mixed Gliomas: A mixed glioma, or oligoastrocytoma, is a brain tumor that has two types of tumor cells in it: oligodendrocytes and astrocytes. Oligoastrocytoma and anaplastic oligoastrocytoma are other names for these tumors.
• Gliosarcoma A rare type of brain tumor that accounts for only 2-8% of glioblastomas. It is characterized by a biphasic tissue pattern consisting of areas of glial (brain cell) differentiation alternating with areas of mesenchymal (connective tissue) differentiation. Gliosarcoma may develop after getting treatment for a glioblastoma or arise de novo (on its own). It can also appear in conjunction with other brain tumors, such as ependymoma and oligodendroglioma. Gliosarcomas that are mostly sarcomatous may look like a meningioma and enhance homogeneously on imaging studies.

Tests

During the diagnostic stage, we will discover the tumor's location, size, and if it is benign, malignant, a primary or secondary tumor.

• Benign tumors are non-cancerous but can grow and press on nearby areas of the brain or spine. They may severely impair brain or spinal cord function. They rarely spread into other tissues, but they can recur (come back).
  
  
• Primary tumors are those that started in the brain or spine. Primary tumors may spread to other parts of the brain or spine but rarely spread elsewhere.
  
  
• Secondary, or metastatic tumors started somewhere else in the body, then spread to the brain or spine. Secondary tumors in the brain are much more common than primary brain tumors.

Tests include:

Neurological Exam
An exam that uses tests and questions to check a patient's spinal cord, brain, and nerve function. The exam (also called a neuro exam or a neurologic exam) evaluates a person's coordination and mental health. Neuro exams also can tell us how well your muscles, senses, and reflexes work.

Visual Field Exam
This exam assesses your field of vision. The field of vision is the total area in which you can see objects. Central vision (looking straight ahead) and peripheral vision are tested. Vision loss may signal a tumor has damaged or pressed on parts of a brain that affect eyesight.

Tumor Marker Test
Blood, tissue and urine samples are studied to look at the amounts of several substances linked to specific types of cancer. These are called tumor markers.

Gene Testing
Samples of tissue or blood are tested for any chromosome changes linked to brain tumors. We can also diagnose an inherited syndrome with genetic tests.

CT (CAT) Scan
CT scans create a series of detailed digital x-rays taken from various angles. A colored dye may be injected into a vein or swallowed to make organs or tissues show up brighter. Also called computed tomography, computerized axial tomography or computerized tomography.

MRI (magnetic resonance imaging)
A magnet, radio waves and a computer create detailed pictures of the brain and spinal cord. Gadolinium, injected into a vein, collects around cancer cells and makes them shine brightly in the images. Nuclear magnetic resonance imaging (NMRI) is another name for an MRI. Magnetic resonance spectroscopy (MRS) also can be done during an MRI scan. MRS diagnoses tumors, based on their chemical make-up.

SPECT (Single Photon Emission Computed Tomography) Scan
In this diagnostic test, a special camera and computer make a 3-D picture of the brain. Patients get a small amount of a radioactive substance put into a vein or inhaled through the nose. The SPECT camera rotates around the head. Body metabolism and blood flow are measured to see if cancer is present.

PET (Positron Emission Tomography) Scan
You will lie down on the PET scan machine, as the scanner rotates around your body. A small amount of radioactive glucose gets injected into a vein. The PET scanner makes a picture of where the glucose is in your brain. Malignant tumor cells will show up brighter in the picture. Cancer cells ingest more glucose than normal cells because the cancer cells are very active. This test can detect if a cancer is a primary tumor or if cells have spread from other places in the body.

Biopsies
If imaging tests show that there may be a brain tumor, we will conduct a biopsy. Computed tomography (CT), ultrasound or magnetic resonance imaging (MRI) help surgeons during a biopsy. Cells or tissue are removed and viewed under a high powered microscope. Biopsies can tell us the type and grade of a brain tumor. The grade shows how fast a tumor might grow and spread.

• Stereotactic biopsy: When imaging tests show a tumor deep in the brain, this biopsy uses a computer to get 3D images that guide tissue removal. Surgeons will carefully insert the biopsy needle into a small incision in the scalp. The surgeon removes cells or tissues. A pathologist (cellular expert) views the samples under a high powered microscope.

Treatments

Surgery
Surgery removes the tumor tissue to help decrease pressure on nearby parts of your brain. Your surgeon may also recommend chemotherapy or radiation therapy after surgery. This helps destroy any additional cancer cells.

Radiation therapy
Radiation therapy destroys cancer cells or keeps them from growing. High energy X-rays, gamma rays, or proton beams are focused on a tumor. Radiation therapy is done before surgery or afterward to kill any cancer cells left after surgery. Radiation therapy may also be used as the main treatment if surgery is not an option. It can also help relieve symptoms caused by a tumor. There are two main types of standard radiation therapy:

• Internal radiation therapy: This approach uses a radioactive substance directly targets a tumor and is applied through a needle, wire or catheter. Or it might be delivered using tiny brachytherapy seeds that your surgeon would implant near the tumor.
  
  
• External beam radiation therapy: With external beam radiation therapy, you will rest comfortably, lying flat. The radiation machine will slowly rotate around your body. It will deliver a carefully pointed radiation beam at the tumor or cancerous growth. The technology we use at Sylvester Cancer Center achieves pinpoint accuracy. Minimal or no radiation exposure occurs in your healthy body tissue. Types of external beam radiation therapy include:
  
  
• 3D conformal radiation therapy (3D CRT): A computer creates a 3D picture of the brain or spinal cord tumor. The highest possible dose of radiation is applied.
  
  
• Intensity-modulated radiation therapy (IMRT): This is also a type of 3D radiation therapy. It uses thin beams of radiation of different intensities (strengths). Beams hit the tumor from many angles.
  
  
• Stereotactic radiosurgery: This therapy aims a single (larger) dose of radiation directly at a brain tumor. Stereotactic radiosurgery or radiosurgery are other names for this, but it is not technically a surgical procedure.

Chemotherapy
Chemotherapy uses medicines to stop the growth of cancer cells. The drugs either kill the cancer cells or stop them from growing and spreading. Chemotherapy used after surgery or biopsy is called adjuvant chemotherapy. Chemotherapy application types depend on the type and grade of tumor and where it is in the brain or spine. Chemotherapy is injected (as a liquid) into a vein or muscle using an IV (short for intravenous); taken orally by mouth, as pills; or delivered right into the fluid-filled space around the brain.

• Intrathecal chemotherapy: This variation of chemotherapy applies the medicine directly to the brain tumor site after tumor removal. The chemo medicine is inside a wafer that dissolves in the tumor site.

Targeted Therapy
Targeted therapies use newer drugs that can identify and attack specific cancer cells. They may also be used to treat blood vessels near the tumor. Target therapy is sometimes chosen as a therapy when surgery is not an option. These therapies are often part of a clinical trial.

• Examples of targeted therapies include monoclonal antibody therapies like Bevacizumab. This drug binds to a protein called vascular endothelial growth factor (VEGF) and helps prevent the growth of new blood vessels in tumors. Bevacizumab is a drug to treat recurrent glioblastoma.

Supportive Therapies
Supportive therapies are often provided to lessen problems or side effects caused by the disease or its treatment. They may also be given to help improve the patient’s quality of life. For brain tumors, supportive care includes drugs to control seizures, fluid buildup, or swelling in the brain.

Clinical Trials
Clinical trials enroll patients in promising studies to evaluate the newest ways to treat cancer. If you are eligible, your doctor will explain options for you to consider.

Why Choose Sylvester Comprehensive Cancer Center?

Sylvester is an NCI-designated cancer center. The National Cancer Institute has reaffirmed us as South Florida’s only NCI-designated cancer center. We have been recognized for our scientific leadership, our commitment to training the next generation of cancer researchers and providers, as well as our engagement with the communities that we serve. For patients, this designation translates into greater access to leading-edge treatment options, including clinical trials that prioritize your specific cancer.

Gamma Knife Radiosurgery for inoperable brain tumors. Small tumors can be destroyed using this innovative technology if surgery is not recommended.

More options for treatment-resistant tumors. If chemotherapy or radiation therapy do not work for your cancer, we will explore the newest clinical research breakthroughs to help you beat cancer.

More cancer clinical trials than any other South Florida hospital. If appropriate for your cancer and stage, our clinical trials provide you with the very newest ways to treat and potentially cure your cancer.

One of only six designated Cancer Centers of Excellence in Florida. The likelihood of surviving cancer five years after treatment from a Dedicated Cancer Center is 17 percent higher than at other hospitals.