Brain Tumors: Signs, Types and the Future of Care
Dr. Benjamin Gelber explains how a brain tumor is diagnosed, the signs and symptoms that might be worrisome, and the latest treatment options available.
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Learn more about Benjamin Gelber, MD
Benjamin Gelber, MD, Neurological and Spinal Surgery
Dr. Benjamin Gelber is a neurosurgeon in Lincoln, Nebraska and is affiliated with multiple hospitals in the area, including Bryan Medical Center. He received his medical degree from State University of New York Upstate Medical University and has been in practice for more than 20 years.Learn more about Benjamin Gelber, MD
Transcription:
Brain Tumors: Signs, Types and the Future of Care
Melanie Cole (Host): Probably the scariest word in the English language is brain tumor. But with the advent of so many new and exciting therapies; the words brain tumor do not necessarily mean a terrible outcome. My guest today is Dr. Benjamin Gelber. He’s a neurosurgeon with Neurological and Spinal Surgery. Dr. Gelber, before we begin, tell us a little bit about the brain anatomy to help us understand how a tumor can affect the function of the brain.
Benjamin Gelber, MD (Guest): Well, the brain of course in enclosed in the skull so that’s a closed box with a hole in the bottom for the spinal cord to come through. So, the first thing is that if you have something growing inside the skull; it basically has no space. That can cause sometimes headache, although that’s not that common and as increasing pressure occurs on the brain; it can cause drowsiness, and even coma and of course in the worst case, it can cause death. Also, anything growing in the brain may irritate the brain and that can cause seizures.
Host: Tell us a little bit about what a brain tumor is and what the difference between malignant and benign. When you spot a brain tumor with someone; are they all brain cancer?
Dr. Gelber: Definitely not. Some brain tumors are malignant and many of them are benign. The benign ones have long names like meningioma, and schwannoma, et cetera. These are tumors that don’t actually arise from brain tissue itself, but they arise from either the covering of the brain or covering of some of the cranial nerves. Many times, those tumors can be removed completely with a complete cure.
On the other hand, we do have tumors that arise from the brain substance. They usually arise from the cells which are called glial cells, and these are the cells that hold the nerve cells together and these are called gliomas and they come in various types of aggressiveness. The most aggressive being very malignant and the least aggressive being relatively benign although not perfectly benign. And the reason these are malignant is not because they spread to other parts of the body like cancers do, but because they sent roots into the brain and so that it’s surgically impossible to remove every last cell and affect a cure. So, these are the malignant ones.
The third category are the tumors that arise elsewhere in the body and spread to the brain. A lung cancer, a breast cancer, thyroid cancer and kidney cancer and colon cancer also; all these can spread to the brain and cause the similar problems as to the other types of tumors that I just mentioned.
Host: Are there any risk factors, and you mentioned a few signs and symptoms Dr. Gelber, fatigue, headaches. People get headaches and right away that’s the first thought oh do I have a brain tumor. Tell us some of the risk factors, who might be at risk and what signs and symptoms you might look to that would say yes, we need to check more of this out.
Dr. Gelber: Well first I have to say headache is not actually a common symptom in brain tumors, it does occur but it’s not the most common symptom. The chance that any particular headache is due to a brain tumor is very small. So, that’s really not the first thing you ought to worry about if you have a headache.
What I have used as a guideline over the years seeing these patients is that they all have something that you can see or on their neurologic exam or that you can understand as being real from their history. For example, if somebody comes in with weakness or paralysis of one side of the body; that could be from a brain tumor although it could be from a stroke also. If someone who has never had seizures before and is an adult has a new seizure; that may very well be a brain tumor. If they have a visual defect which persists; that could be a sign of a brain tumor. Although again, it could be a sign of a stroke.
So, anytime somebody comes in with something specific that you can really observe or understand from the history they tell you; then I think it’s important that they be evaluated for brain tumors more carefully with scans et cetera.
As far as risk factors, well since I said that cancers can spread to the brain. If somebody is a heavy smoker, they certainly are at risk for lung cancer that would spread to the brain. If somebody has a history of breast cancer or colon cancer and they come in with symptoms of this sort; they should be screened for brain tumor. Thyroid cancer, although it does spread to the brain, is very rare for that spread so that would be less common.
Host: Then how do you diagnose it? And you mentioned scans. Once you’ve diagnosed, are you staging it? Tell us a little bit about what the process is if someone comes to you and you say yeah, we’re going to look for this; what happens then Dr. Gelber?
Dr. Gelber: Well, we’ll get a scan either a CAT scan or an MRI scan. And if the scan shows something growing in the brain; then the decision has to be made about how to best make the diagnosis and the treatment. Many times from the scans, we can do both. We can look and say that this particular tumor is outside the brain, it’s on the edge of the brain, it’s pushing the brain out of the way. The term for that is extra axial tumor and it’s probably a benign meningioma. If that’s the case, we usually do surgery and remove it.
If we see a tumor that’s arising within the brain, and distorting the brain and especially if we think that there’s a reasonable chance it’s going to be malignant meaning that we can’t cure it with an operation; we may just do a biopsy and using our computerized image guidance, place a needle through the skull into the tumor, take out a small piece of it and then give it to the pathologist to look at under the microscope and they can usually make the diagnosis.
If the tumor growing within the brain is so big as to cause a lot of pressure on the brain; then we might do surgery rather than a biopsy in order to relieve the pressure. But if the tumor is growing in an area that we call an eloquent area where removing it would cause terrible disability; then we often will not do surgery for that. For example, you wouldn’t want to remove a large tumor from someone’s brain if it is going to leave them unable to speak.
Host: How interesting. So, how do neurosurgeons get accuracy when surgically removing a tumor? Is there really exciting equipment that you’re using? Speak about some of the novel treatment therapies and what you feel is on the horizon as far as combination treatments, chemo, radiation, stem cells. What are you looking to Doctor?
Dr. Gelber: We for the past almost 20 years now have been using what’s called computerized image guidance. We can take a CT or an MRI scan and place it into a device which allows us to track our instruments on a computer screen and so we can see if we are working within the tumor, if we are getting to the edge of the tumor, if we are getting close to normal brain. We’ve had that for about 20 years and that’s been very helpful.
There are places that are using scans during the surgery like such as intraoperative MRI to see how much tumor say is left over so that we know whether we can terminate the surgery or whether we have to continue. We’ve actually done that here at Bryan, although the device we had was kind of cumbersome and it’s now been superseded by better devices.
We also, if we have discovered at surgery that the tumor is highly malignant; we can place chemotherapy directly onto the tumor at surgery and that has been shown to increase the survival, not as much as we’d like, but it does help. Chemotherapy is not really generally that effective for brain tumors but there is one drug called Temodar which has been used for several years, which does seem to help quite a bit.
We have our gamma knife which is a focused radiation device and that can be used for tumors, in the case of the malignant tumors that I just finished talking about. We really don’t know if giving a dose of radiation in addition to the surgery and chemotherapy helps; but it doesn’t seem to do any harm so, we’ve done it on many occasions.
In the case of certain benign tumors, such as meningiomas or schwannomas of the 8th nerve; depending on the location, the condition of the patient and on the size of the tumor; some of these can be treated with focused radiation and can be stabilized or managed without doing any surgery at all.
Host: Isn’t that fascinating? Dr. Gelber wrap it up for us with what you would like the listeners to take home from this segment; what you want them to know about brain tumors, when not to worry, when you feel it’s important to see a neurologist or a neurosurgeon and what you think is exciting in the future.
Dr. Gelber: Well brain tumors are rare. And so, if you got a headache, the first thing you should think of is not a brain tumor. If you had headaches chronically or intermittently for years, if you have a history of migraine and you have a recurrence of the similar headaches that you had before; the likelihood that that is a brain tumor is very small. On the other end of the spectrum is if you or a loved one has a new onset of seizures; then that needs to be evaluated for brain tumors.
As far as the future, and we’ve been doing this in spine surgery; we have a robotic device we use in spine surgery for localization and placement of stabilizing hardware in the spine. We are using the robot for what we call deep brain stimulation which we use to control tremor in the brain. The point is that the robotic devices allow us to very accurately localize and get to a specific area in the brain. We are not using that yet for brain tumors, but it won’t be long before that’s coming.
And then finally, there is software which can be used with MRI scanner which allows us to visualize the tracts within the brain. This is essentially the wiring of the brain which connects one part of the brain to the other and by knowing where these are, we can plan a way to get to tumors without disrupting the function of the surrounding brain or at least disrupting it as little as possible.
Host: Fascinating, Dr. Gelber. Thank you so much for coming on today. And you are such a good educator. Thank you for sharing your expertise with us today and explaining a little bit more about brain tumors. and thanks to our Bryan Foundation partner, Davis Design.
This is Bryan Health Podcast. For more information please visit www.bryanhealth.org, that’s www.bryanhealth.org. And if you’d like to learn more or hear more Bryan Health Podcasts please visit www.bryanhealth.org/podcasts. I’m Melanie Cole. Thanks so much for tuning in.
Brain Tumors: Signs, Types and the Future of Care
Melanie Cole (Host): Probably the scariest word in the English language is brain tumor. But with the advent of so many new and exciting therapies; the words brain tumor do not necessarily mean a terrible outcome. My guest today is Dr. Benjamin Gelber. He’s a neurosurgeon with Neurological and Spinal Surgery. Dr. Gelber, before we begin, tell us a little bit about the brain anatomy to help us understand how a tumor can affect the function of the brain.
Benjamin Gelber, MD (Guest): Well, the brain of course in enclosed in the skull so that’s a closed box with a hole in the bottom for the spinal cord to come through. So, the first thing is that if you have something growing inside the skull; it basically has no space. That can cause sometimes headache, although that’s not that common and as increasing pressure occurs on the brain; it can cause drowsiness, and even coma and of course in the worst case, it can cause death. Also, anything growing in the brain may irritate the brain and that can cause seizures.
Host: Tell us a little bit about what a brain tumor is and what the difference between malignant and benign. When you spot a brain tumor with someone; are they all brain cancer?
Dr. Gelber: Definitely not. Some brain tumors are malignant and many of them are benign. The benign ones have long names like meningioma, and schwannoma, et cetera. These are tumors that don’t actually arise from brain tissue itself, but they arise from either the covering of the brain or covering of some of the cranial nerves. Many times, those tumors can be removed completely with a complete cure.
On the other hand, we do have tumors that arise from the brain substance. They usually arise from the cells which are called glial cells, and these are the cells that hold the nerve cells together and these are called gliomas and they come in various types of aggressiveness. The most aggressive being very malignant and the least aggressive being relatively benign although not perfectly benign. And the reason these are malignant is not because they spread to other parts of the body like cancers do, but because they sent roots into the brain and so that it’s surgically impossible to remove every last cell and affect a cure. So, these are the malignant ones.
The third category are the tumors that arise elsewhere in the body and spread to the brain. A lung cancer, a breast cancer, thyroid cancer and kidney cancer and colon cancer also; all these can spread to the brain and cause the similar problems as to the other types of tumors that I just mentioned.
Host: Are there any risk factors, and you mentioned a few signs and symptoms Dr. Gelber, fatigue, headaches. People get headaches and right away that’s the first thought oh do I have a brain tumor. Tell us some of the risk factors, who might be at risk and what signs and symptoms you might look to that would say yes, we need to check more of this out.
Dr. Gelber: Well first I have to say headache is not actually a common symptom in brain tumors, it does occur but it’s not the most common symptom. The chance that any particular headache is due to a brain tumor is very small. So, that’s really not the first thing you ought to worry about if you have a headache.
What I have used as a guideline over the years seeing these patients is that they all have something that you can see or on their neurologic exam or that you can understand as being real from their history. For example, if somebody comes in with weakness or paralysis of one side of the body; that could be from a brain tumor although it could be from a stroke also. If someone who has never had seizures before and is an adult has a new seizure; that may very well be a brain tumor. If they have a visual defect which persists; that could be a sign of a brain tumor. Although again, it could be a sign of a stroke.
So, anytime somebody comes in with something specific that you can really observe or understand from the history they tell you; then I think it’s important that they be evaluated for brain tumors more carefully with scans et cetera.
As far as risk factors, well since I said that cancers can spread to the brain. If somebody is a heavy smoker, they certainly are at risk for lung cancer that would spread to the brain. If somebody has a history of breast cancer or colon cancer and they come in with symptoms of this sort; they should be screened for brain tumor. Thyroid cancer, although it does spread to the brain, is very rare for that spread so that would be less common.
Host: Then how do you diagnose it? And you mentioned scans. Once you’ve diagnosed, are you staging it? Tell us a little bit about what the process is if someone comes to you and you say yeah, we’re going to look for this; what happens then Dr. Gelber?
Dr. Gelber: Well, we’ll get a scan either a CAT scan or an MRI scan. And if the scan shows something growing in the brain; then the decision has to be made about how to best make the diagnosis and the treatment. Many times from the scans, we can do both. We can look and say that this particular tumor is outside the brain, it’s on the edge of the brain, it’s pushing the brain out of the way. The term for that is extra axial tumor and it’s probably a benign meningioma. If that’s the case, we usually do surgery and remove it.
If we see a tumor that’s arising within the brain, and distorting the brain and especially if we think that there’s a reasonable chance it’s going to be malignant meaning that we can’t cure it with an operation; we may just do a biopsy and using our computerized image guidance, place a needle through the skull into the tumor, take out a small piece of it and then give it to the pathologist to look at under the microscope and they can usually make the diagnosis.
If the tumor growing within the brain is so big as to cause a lot of pressure on the brain; then we might do surgery rather than a biopsy in order to relieve the pressure. But if the tumor is growing in an area that we call an eloquent area where removing it would cause terrible disability; then we often will not do surgery for that. For example, you wouldn’t want to remove a large tumor from someone’s brain if it is going to leave them unable to speak.
Host: How interesting. So, how do neurosurgeons get accuracy when surgically removing a tumor? Is there really exciting equipment that you’re using? Speak about some of the novel treatment therapies and what you feel is on the horizon as far as combination treatments, chemo, radiation, stem cells. What are you looking to Doctor?
Dr. Gelber: We for the past almost 20 years now have been using what’s called computerized image guidance. We can take a CT or an MRI scan and place it into a device which allows us to track our instruments on a computer screen and so we can see if we are working within the tumor, if we are getting to the edge of the tumor, if we are getting close to normal brain. We’ve had that for about 20 years and that’s been very helpful.
There are places that are using scans during the surgery like such as intraoperative MRI to see how much tumor say is left over so that we know whether we can terminate the surgery or whether we have to continue. We’ve actually done that here at Bryan, although the device we had was kind of cumbersome and it’s now been superseded by better devices.
We also, if we have discovered at surgery that the tumor is highly malignant; we can place chemotherapy directly onto the tumor at surgery and that has been shown to increase the survival, not as much as we’d like, but it does help. Chemotherapy is not really generally that effective for brain tumors but there is one drug called Temodar which has been used for several years, which does seem to help quite a bit.
We have our gamma knife which is a focused radiation device and that can be used for tumors, in the case of the malignant tumors that I just finished talking about. We really don’t know if giving a dose of radiation in addition to the surgery and chemotherapy helps; but it doesn’t seem to do any harm so, we’ve done it on many occasions.
In the case of certain benign tumors, such as meningiomas or schwannomas of the 8th nerve; depending on the location, the condition of the patient and on the size of the tumor; some of these can be treated with focused radiation and can be stabilized or managed without doing any surgery at all.
Host: Isn’t that fascinating? Dr. Gelber wrap it up for us with what you would like the listeners to take home from this segment; what you want them to know about brain tumors, when not to worry, when you feel it’s important to see a neurologist or a neurosurgeon and what you think is exciting in the future.
Dr. Gelber: Well brain tumors are rare. And so, if you got a headache, the first thing you should think of is not a brain tumor. If you had headaches chronically or intermittently for years, if you have a history of migraine and you have a recurrence of the similar headaches that you had before; the likelihood that that is a brain tumor is very small. On the other end of the spectrum is if you or a loved one has a new onset of seizures; then that needs to be evaluated for brain tumors.
As far as the future, and we’ve been doing this in spine surgery; we have a robotic device we use in spine surgery for localization and placement of stabilizing hardware in the spine. We are using the robot for what we call deep brain stimulation which we use to control tremor in the brain. The point is that the robotic devices allow us to very accurately localize and get to a specific area in the brain. We are not using that yet for brain tumors, but it won’t be long before that’s coming.
And then finally, there is software which can be used with MRI scanner which allows us to visualize the tracts within the brain. This is essentially the wiring of the brain which connects one part of the brain to the other and by knowing where these are, we can plan a way to get to tumors without disrupting the function of the surrounding brain or at least disrupting it as little as possible.
Host: Fascinating, Dr. Gelber. Thank you so much for coming on today. And you are such a good educator. Thank you for sharing your expertise with us today and explaining a little bit more about brain tumors. and thanks to our Bryan Foundation partner, Davis Design.
This is Bryan Health Podcast. For more information please visit www.bryanhealth.org, that’s www.bryanhealth.org. And if you’d like to learn more or hear more Bryan Health Podcasts please visit www.bryanhealth.org/podcasts. I’m Melanie Cole. Thanks so much for tuning in.