2. Disclosures
• I have no relevant personal financial
relationships
• I do not intend to discuss off-
label/investigational use of commercial
products/devices
4. Secondary brain tumors
• Non-brain origin = Cancer metastasis
– Most common
– 25-45% of cancer patients
• Lung: >50% of all; most common in men
• Breast: Most common in women
• Melanoma: Highest propensity for brain
– 50% of melanoma patients develop brain mets; Multiple
• Renal Cell
• Colorectal
• Any primary can metastasize to the brain
7. Is this cancer?
Benign
• Slow growing
• Non-invasive
• Does not spread
• Less likely to recur
Malignant
• Fast growing
• Aggressively invasive
• May spread distantly
• More likely to recur
11. Is this cancer?
Meningioma
Grade 1 2 3
92% 6% 2%
Glioma
Grade 1 2 3 4
Benign Malignant
Pilocytic astroctyoma
(surgically curable)
Glioblastoma
(15 month
median survival)
12. How do brain tumors
cause problems?
• Mass effect
– Tumor pushes on normal brain
• Local invasion
– Tumors invade normal brain
• Microscopic
• Edema
– Swelling of normal brain
13. Presentation
• Generalized symptoms and signs
→ Elevated intracranial pressure
• Headaches (50%)
– New or different
– Worsening over time
– Worse on awakening,
them improve
– Other symptoms
• Seizures (30%)
• Cognitive change (30%)
• Personality change
(25%)
• Nausea/vomiting (15%)
• Blurred
vision/papilledema
• Lethargy
15. Presentation
• Focal symptoms and signs
→ site specific to location;
Personality
Cognitition
Expressive
language
Receptive
language
Incoordination
Balance
Vision
Weakness
Incoordination
16.
17.
18. What are our options?
• Surveillance
– Serial MRI scans
19. What are our options?
• Surveillance
– Serial MRI scans – Watch it
20. What are our options?
• Surveillance
– Serial MRI scans
• Surgery
– Biopsy
• Diagnose the tumor
– Resection
• Diagnose the tumor
• Remove as much of tumor as possible
21. What are our options?
• Surveillance
– Serial MRI scans
• Surgery
– Biopsy – Pick a few weeds out
• Diagnose the tumor
– Resection – Pull as many weeds as possible
• Diagnose the tumor
• Remove as much of tumor as possible
40. Surgical tools - Navigation
• GPS system for the OR
– Pre-plan surgical
approach
– Confirm anatomic
position
• Brings radiology data
into the OR
• Functional MRI
• White mater tracks
41. Surgical tools - Robotics
• Navigation systems with
built in surgical assistant
– Pre-plan surgical
approach
– Utilize the robot to align
the instruments
• Minimally invasive
– Single stitch incision
– Maximizing precision
42. Surgical tools – Laser Ablation
• Minimally invasive
– Single stitch incision
• Pass a probe into the
tumor
– Reduced risk to normal brain
• Utilize heat to destroy
tumor cells
Pre-op
1 year
post-op
43. Radiation Therapy
• No clean margins
• Can never pull every single weed
• Whole brain radiation
– Multiple small doses to entire
brain
• Stereotactic radiosurgery (SRS)
– High dose to a small area
– Limits exposure to normal brain
SRS
44. Team Approach
• Neuro-oncology
• Radiation oncology
• Behavioral oncology
• Neurosurgery
• Neuro-radiology
• Neuro-psychology
• Neuro-pathology
• Nurse Navigator
• Research Nurse
• PT/OT/SLP
• Support services
• Make the diagnosis
• Deliver individualized
treatment
• Provide clinical trials
• Provide support for our
patients and families
• Maximize
quality of life
I don’t consider a brain tumor to mean you have brain cancer
You can’t really tell if someone where their tumor sits on this spectrum without looking at a piece of the tumor
Tumors can cause trouble regardless of their grade or aggressiveness; Signs and symptoms depend on part of brain affected. Location, location, location
