Brain Tumor FAQs

A brain tumor is a group of abnormal cells in the brain. Some tumors are cancerous (also called “malignant”), while others are not cancerous (also called “benign”).

Primary brain tumors originate in the brain. Metastatic brain tumors (also called “metastases”) are cancerous tumors that have spread to the brain from another part of the body (such as the breast, lung, or colon).

A tumor grade is a way to classify a tumor based on how its cells look under a microscope. This classification is an indicator of how likely the tumor is to grow and spread.

• Grade I (low-grade) — Grade I tumor cells look more like normal cells under a microscope and grow and spread more slowly than grade II, III, or IV tumor cells do. They rarely spread into nearby tissues. Grade I brain tumors may be cured if they are completely removed by surgery.
• Grade II (low-grade) — Grade II tumor cells grow and spread more slowly than grade III or IV tumor cells do. They may spread into nearby tissue, and the tumor may come back (called a “recurrence”). Some grade II tumors may grow to become a higher-grade tumor over time.
• Grade III (high-grade) — Grade III tumor cells look very different from normal cells under a microscope and grow more quickly than grade I and II tumors do. They are likely to spread into nearby tissue.
• Grade IV (high-grade) — Grade IV tumor cells do not look like normal cells under a microscope and will grow and spread very quickly. There may be areas of dead cells in the tumor.

According to the National Cancer Institute, there are nine types of primary brain tumors:

1. Astrocytic Tumors – Tumors that arise from star-shaped cells in the brain called astrocytes. Astrocytic tumors include:
   • Glioblastoma –An aggressive and highly invasive grade IV tumor, also called GBM or glioblastoma multiforme. Glioblastoma is the most common primary brain tumor diagnosed in American adults.
   • Brain stem glioma – A tumor that forms in the brain stem, which connects the brain and spinal cord. This is a rare tumor in adults and is often a high-grade tumor.
   • Pineal astrocytic tumor – A tumor of any grade that forms in the tissue around the pineal gland, a tiny organ that makes melatonin and is located deep inside the brain.
   • Pilocytic astrocytoma – A slow-growing, grade I tumor of the brain or spinal cord that can often be cured.
   • Diffuse astrocytoma – Typically a slow-growing, grade II tumor that can spread into nearby healthy tissue. Also known as a low-grade diffuse astrocytoma.
   • Anaplastic astrocytoma – A fast-growing, grade III tumor that quickly spreads into nearby healthy tissue. Also known as a malignant astrocytoma or high-grade astrocytoma.

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2. Oligodendroglial Tumors – Tumors that form from oligodendrocytes, which are cells in the brain and spinal cord that help protect nerve cells. These tumors include:
   • Oligodendroglioma – A grade II tumor that grows slowly but often spreads into nearby healthy tissue. In some cases, it can be cured.
   • Anaplastic oligodendroglioma – A grade III tumor that grows and spreads quickly into nearby healthy tissue.
3. Mixed Gliomas – Brain tumors that are made up of two different types of tumor cells. The most common types are:
   • Oligoastrocytoma – A grade II, slow-growing tumor that can be cured in some cases.
   • Anaplastic oligoastrocytoma – A fast-growing grade III tumor that easily spreads into nearby healthy tissue.
4. Ependymal Tumors – Tumors that begin in the cells that line fluid-filled spaces in the brain and spinal cord. Also known as ependymoma tumors. Specific types include:
   • Ependymoma – A low-grade tumor (grade I or grade II) that is slow to grow. A grade II ependymoma grows within the ventricles of the brain and its connecting pathways.
   • Anaplastic ependymoma – A grade III tumor that grows quickly and spreads easily into nearby healthy tissue.
5. Medulloblastomas – Tumors that grow rapidly in embryonic (fetal) tissue. Most common in children or young adults.
6. Pineal Parenchymal Tumors – Intermediate-grade (grade II or grade III) tumors that arise from the pineal gland and may occur at any age.
7. Meningeal Tumors – Tumors that form in the meninges: the thin layers of tissue covering the brain. They can be formed from different types of brain cells and are most common in adults. The most common type is a meningioma, a grade I tumor that typically forms in the dura mater (the outer layer of tissue that protects the brain). Grade II and grade III meningeal tumors are rare, can grow quickly, and tend to spread within the brain and spinal cord.
8. Germ Cell Tumors – Tumors that form in germ cells, which are the cells that develop into men’s sperm and women’s ova (eggs). Types of germ cell tumors include: germinomas, teratomas, embryonal yolk sac carcinomas, and choriocarcinomas. These tumors can be benign or malignant.
9. Craniopharyngiomas – Rare grade I tumors found in the center of the brain above the pituitary gland. They can be formed from different types of brain or spinal cord cells.

Once a brain tumor is discovered, you will likely be referred to several brain tumor specialists. Members of your brain tumor treatment team may include:

• Neurosurgeon – A surgeon who specializes in surgery of the brain and spinal cord
• Neuro–Oncologist – An oncologist specifically trained to diagnose and treat patients with brain tumors and other types of central nervous system tumors
• Radiation Oncologist – A doctor trained to treat and manage cancer with radiation therapy
• Neuropathologist – A doctor who specializes in diagnosing diseases of the brain and central nervous system by examining tissues and cells under a microscope

Have questions about your current medical team? Wondering if you should be seeing a specialist? Speak with a navigator now.

The standard of care is a specific set of clinical practice guidelines published by the National Comprehensive Cancer Network (NCCN). These evidence-based guidelines are specific to each diagnosis and are recognized as the most effective course of treatment currently available.

For glioblastoma patients the Stupp protocol has been the standard of care since its publication in 2005. This protocol consists of:

1. Surgical resection or biopsy (if possible)
2. Radiation therapy – daily radiation treatments five days a week for six weeks
3. Chemotherapy (during radiation therapy) – daily temozolomide (TMZ) seven days a week for six weeks
4. Chemotherapy (after radiation therapy) – daily temozolomide for five days out of a 28-day cycle for six to 12 months

A second opinion is the professional opinion of a doctor other than your own. Getting another doctor’s perspective can help you feel confident in the care you are receiving. Seeking a second opinion can help to confirm your diagnosis, endorse a current treatment approach, and possibly open up new treatment options you may have been unaware of. It is very common to ask for a second opinion, and your doctor should encourage you to get one if you would like to.

Interested in seeking a second opinion? Your navigation team can help you get access to the top brain tumor centers of excellence across the nation. Speak with a navigator today to get connected.

Molecular testing develops a profile of a brain tumor at the cellular level. According to the National Institutes of Health, molecular testing can result in a more accurate diagnosis, can help your care team develop a prognosis, and can identify molecular targets in the tumor that may respond to treatment. Targeted therapy has become one of the most promising treatment options for many brain tumors.