Brain Tumors
with Bryan Mason, MD
Are there brain tumors that don’t need to be removed?
Brain tumors are clusters of abnormal tissue that can be either benign (non-cancerous) or malignant (cancerous). According to Bryan Mason, MD, Neurosurgeon at GBMC, “There is a very large spectrum of types of brain tumors. Often, people are referred to us with benign tumors that don’t require treatment. But there are others that are malignant and located in very eloquent, or difficult to operate on, parts of the brain.”
Most brain tumor patients are referred to a neurosurgeon by a primary care physician or oncologist. Treatment decisions are based on size and location of the tumor, risk of neurological side effects and patient’s overall health. The most common treatments include surgery and radiation as well as watchful waiting, which involves close monitoring of the tumor but requires no immediate medical treatment.
Some brain tumors originate in the cells of the brain, while others have metastasized (spread) from elsewhere in the body such as the lungs, breast or prostate. For cancers that have spread to the brain, treatment is often based on the multidisciplinary care plan for the original site of the cancer.
When a lesion starts in the brain, the first step is to determine the type of tumor. “We want to know if the tumor is coming from the brain itself, or if it is coming from the lining surrounding the brain,” says Dr. Mason. Typically, tumors that originate in the lining surrounding the brain are benign. They may still prevent a risk, however, because they put pressure on the brain and can actually move healthy tissue out of place. Medium to large tumors in the lining of the brain are removed through open surgery, while small benign tumors are usually only observed through watchful waiting.
Tumors that arise in the brain itself are less predictable. Dr. Mason says some are fairly benign, while others can be very malignant and essentially untreatable. If a tumor on the brain is still in its early stages, a CT- or MRI-guided biopsy is performed. From there, the neurosurgeon decides what type of treatment is required. CT and MRI are common types of computer-guided imaging techniques, often used to help in the diagnosis and treatment of brain tumors and other types of cancer.
“If the biopsy shows a small, benign lesion in an accessible area in the brain, many times we’ll elect to remove it and that will be the end of treatment,” says Dr. Mason. “If it is a very large or highly malignant lesion, we may or may not do surgery.” If the tumor is in an accessible part of the brain and removal will cause only minimal neurological side effects, it will be taken out surgically. If it is a highly malignant tumor in a non-accessible part of the brain, surgery is not an option and radiation therapy is required.
One type of radiation, stereotactic radio surgery, is often used to treat small lesions that are less than three centimeters in size. This procedure delivers targeted radiation directly to the tumor through the use of computer-guided imaging.
Unlike for many other types of cancer, chemotherapy for brain tumors is still mostly experimental. “There are only a handful of chemotherapy drugs for brain tumors and in many instances, they are not very effective,” says Dr. Mason.
In addition to surgery and radiation, neurosurgeons at GBMC perform less-invasive treatments with the Stealth System. “With the use of MRI, this system allows us to very accurately localize exactly where the tumor is so we can minimize the incision and brain exposure,” says Dr. Mason.
GBMC has the latest Stealth model on site, so patients do not need to be referred to another location for this specialized treatment. “We are able to perform all the diagnostic and operative techniques for brain tumor removal right here. We are full-service and if a patient needs to see us, they usually can get an appointment either that day or the next day,” says Dr. Mason.
In rare cases, GBMC neurosurgeons may refer brain tumor patients for experimental treatment. “If the case presents a lot of possibility for complication, we may send them to the National Institutes of Health or another national organization,” says Dr. Mason. These decisions are based strictly on what is best for each individual patient.
