• Symptoms & Diagnosis

    Brain cancer can cause a number of symptoms depending on the location of the tumor within the brain. Symptoms can be due to direct
    pressure or infiltration of the involved brain structure. Symptoms can also be due to swelling or edema in the surrounding brain.
    Symptoms usually develop gradually, sometimes so gradually that they might not be noticed. Weakness, sensory loss, visual changes,
    speech disturbance, and coordination problems are common neurologic symptoms associated with brain cancer. Occasionally a brain
    tumor will bleed resulting in a more sudden onset of symptoms. Seizures of any type can also occur suddenly and be the first sign
    of brain cancer.

    Headaches are a less common presentation but can be concerning if progressive or associated with nausea and vomiting. Headaches can
    be due to direct pressure, a build-up of fluid within the brain (hydrocephalus), or infiltration of the lining of the brain
    (carcinomatous meningitis).

    The diagnostic workup of brain cancer usually starts with an imaging study. Magnetic resonance imaging (MRI) provides the most
    detailed view of the brain but occasionally a computed tomography scan (CT) is the first study that is obtained. CT scans are
    particularly useful for visualizing bleeding or hydrocephalus. In cases where the imaging studies are normal but there is a strong
    suspicion of brain cancer based on symptoms, your doctor may recommend a spinal tap to sample the cerebrospinal fluid. Cancer cells
    can sometimes be detected in cerebrospinal fluid.

    If there is no known source of cancer, your doctor may order a CT scan of the chest, abdomen and pelvis as well as blood tests and
    a thorough physical exam. Occasionally, a nuclear medicine bone scan or PET study will also be ordered to assess the extent of disease.

  • Tumor Grades:

    Brain tumors are named after the type of cell they arose from and where they formed. They are also graded on a scale of I to IV, based on their
    appearance under the microscope and likelihood of growing and spreading. In general, the higher the grade, the more aggressive and dangerous the
    tumor. Overtime, tumor cells often change becoming more malignant, and when tumors recur, they often come back as a high, more aggressive grade.
    As scientists learn more about the genetics of tumors, they are able to identify subtle differences between tumors of the same type and grade that
    affect how these tumors behave and how they may respond to different treatments. Your doctors may use such genetic information to help draw up a
    treatment plan.

    Tumor Grading System (from PDQ patient):

    • Grade I (low-grade) . The tumor grows slowly, has cells that look a lot like normal cells, and rarely spreads into nearby tissues. It may be possible to remove the entire tumor by surgery.
    • Grade II . The tumor grows slowly, but may spread into nearby tissue and may recur (come back). Some tumors may become a higher-grade tumor.
    • Grade III. The tumor grows quickly, is likely to spread into nearby tissue, and the tumor cells look very different from normal cells.
    • Grade IV (high-grade). The tumor grows and spreads very quickly and the cells do not look like normal cells. There may be areas of dead cells in the tumor. Grade IV brain tumors are harder to cure than lower-grade tumors.

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  • Genetic and chromosomal analysis:

    As we learn more about the role of genes in brain tumor development, analysis of genetic mutations and changes in the chromosomes of tumor cells is
    playing an increasingly important role in treatment planning. These changes can help assess the tumor’s aggressiveness, guide the choice of treatment,
    and provide information about the tumor’s response to treatment.

  • Tumor Types:

    ACTH-producing adenomas:

    ACTH, which stands for adrenocorticotropic hormone, stimulates the adrenal glands to produce cortisol. Excessive amounts of ACTH from these tumors can cause a condition called Cushing’s disease, which can cause a wide variety of
    problems including, muscle weakness, thinning of the skin, high blood pressure, and diabetes mellitus.

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    Anaplastic astrocytoma (WHO grade III):

    Anaplastic astrocytoma is also called malignant astrocytoma and high-grade astrocytoma. They most commonly appear in men and women between the ages of 30 and 50 years.
    With time, they tend to progress to the more aggressive glioblastoma form. Standard treatment includes surgery and radiation with or without chemotherapy. Cure rate with
    standard treatment, however, is low, and patients with anaplastic astrocytoma are often invited to participate in clinical trials of new approaches.

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    Anaplastic oligoastrocytoma (WHO grade III):

    Anaplastic oligoastrocytoma is most common in adults. Standard treatment is surgery plus radiation or surgery plus radiation and chemotherapy.

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    Astroblastoma:

    These are rare glial tumors that typically appear in young adults, but can develop at any age. Most of these tumors appear in the cerebrum. Headache, seizures, and focal neurologic deficits are common
    symptoms. Treatment is usually surgery with the goal of removing all or as much of the tumor as possible. If tumor remains after surgery or if the tumor contains more aggressive cell
    types, radiation and chemotherapy may be recommended.

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    Astrocytoma (WHO grade II):

    These tumors, also called low-grade infiltrating astrocytoma, tend to be diagnosed in younger adults and are slightly more common in men. They most often involve the
    frontal or temporal lobes and often cause seizures. Symptoms can include headache, lethargy, personality changes and focal neurologic deficits, depending on the size
    and location of the tumor. Over time, these tumors tend to evolve into a more malignant form.

    The best course of treatment of these tumors has not been determined. Because these tumors tend to be slow growing, your doctor may recommend observation with close
    follow up. Surgery is performed to obtain a biopsy, to reduce the size of the tumor, and protect other tissues. Surgery is also often performed to control seizures
    caused by the tumor. Radiation is often recommended when some tumor remains after surgery that is causing symptoms. Chemotherapy is usually reserved for tumors that
    progress after radiation treatments.

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    Astrocytoma:

    The cells of the brain can be thought of as coming in two types: the neurons, the cells that are involved in the work of the brain “thinking, remembering,
    etc” and the neuroglia or glial cells that support and nurture the neurons. The name, glial comes from the Greek word meaning “glue”.

    Astrocytes are glial cells that have a characteristic star shape. Tumors that arise from, astrocytes are therefore called astrocytes tumors, astrocytoma and
    gliomas. Depending on their grade and where they arise from astrocytic tumors can range from being relatively benign to very aggressive. Radiation treatments
    to the brain appear to increase the risk of developing astrocytoma.

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    Brain stem glioma:

    These tumors arise in the brain stem, a structure at the base of the brain. They can range from low- to high-grade and tend to occur in children. Because of their location near
    crucial brain centers that control breathing, heart rate, and other vital functions surgery often difficult to perform. Radiation treatments can reduce symptoms and slow tumor
    growth, but not cure these tumors.

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    Brain Tumors:

    Primary brain tumors are divided into a number of different groups on the basis of the appearance to tumor cells, genetic, chromosomal and molecular
    markers, and other characteristics that identify the cells origin and likely behavior. In some cases, doctors use different classification systems
    when they describe a tumor in which case the same kind of tumor may be called by different names. On BrainCancer.Org, we usually use the classification
    developed by the World Health Organization.

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    Capillary hemangioblastoma (WHO grade I):

    This rare tumor is associated with an inherited familial tumor syndrome called von Hippel-Lindau disease but also occasionally develops in people with no known risk factors. These tumors tend to occur in young adults and often
    appear in multiple sites. For people without risk factors for this tumor surgery can often be cured. But among patients with von Hippel-Lindau disease, hemangioblastomas is difficult to cure. Therefore, regular MRI screening to
    detect these tumors is recommended for these patients.

    Chordoid glioma of the third ventricle:

    Chordoid glioma is a rare, slow-growing tumor. Only a few cases have been reported. They typically appear in the third ventricles of adults. Treatment is surgery with the goal of complete
    removal, but because they are often attached to important structures at the base of the brain, complete surgical removal may not be possible.

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    Choroid plexus tumors:

    • Choroid plexus papilloma (WHO grade I):
    • Choroid plexus carcinoma (WHO grade III):

    These rare, childhood tumors arise from cells of the choroid plexus, structures found in the ventricles of the brain that make the cerebral spinal fluid, a fluid that fills the ventricles and
    surrounds the brain and spinal cord. Choroid plexus papilloma is slower growing and often can be cured with surgery. Choroid plexus carcinomas, on the other hand, are more aggressive tumors, and
    often have spread by the time they are diagnosed, in which case complete surgical resection may be impossible. This makes choroid plexus carcinomas much more difficult to treat.

    Because choroid plexus carcinomas are so rare, the role of radiation and chemotherapy in treatment is uncertain, but are often used when tumor remains after surgery or when the tumor has already
    spread. Because they are located in the ventricles, these tumors often block the flow of cerebrospinal fluid, causing hydrocephalus. Headache, nausea, irritability are common symptoms. Often a shunt
    will be placed to relieve the pressure caused by the blockage of the cerebrospinal fluid.

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    CNS Lymphomas:

    Lymphomas are cancers of the lymphatic system which produces infection-fighting white cells called lymphocytes. CNS (Central Nervous System) lymphomas may arise in the brain or spread from elsewhere in the body. People who have
    weakened immune systems are at higher risk of developing CNS lymphomas and in recent years, CNS lymphomas have become more common as the number of people with compromised immune systems, such as those with AIDS or those who are
    receiving immunosuppressant drugs, have grown. Most people who develop these tumors, however, appear to have otherwise normal immune systems. CNS lymphomas tend to be aggressive and appear in multiple locations in the brain and
    spinal cord. Treatment includes radiation therapy, chemotherapy and corticosteroids. Because they arise in multiple sites, surgery is usually not an option.

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    Craniopharyngiomas (WHO grade I):

    Craniopharyngiomas are benign, but can grow into the pituitary, affecting its function. This can cause hypothyroidism, hypogonadism, and growth retardation. When the tumor impinges on the optic nerve it can affect vision.

    Treatment: Surgical removal is the ideal treatment, but often this is difficult because the tumor involves critical nearby structures. When tumor remains, radiation therapy is usually given. This reduces the risk of
    recurrence. Prognosis is good, but recurrence is common.

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    Diffuse astrocytoma (WHO grade II):

    Diffuse astrocytoma typically affects young adults. They grow slowly, but do invade nearby brain structures. They are called “diffuse” because they do not have clear
    borders and tend to grow into and infiltrate adjacent brain tissue. With time, diffuse astrocytoma tends to progress to anaplastic astrocytoma, a more aggressive tumor
    type, and ultimately, glioblastomas, the most aggressive form of astrocytic tumors. Diffuse Astrocytoma tumors are usually treated with surgery followed by radiation.
    In general, they are harder to cure than pilocytic astrocytoma. Should the tumor recur, additional surgery with radiation and/or chemotherapy may be required.

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    Embryonic tumors:

    These tumors first form during fetal development. They often begin in the cerebellum, but may spread from the brain to the spine. There are usually diagnosed in the first decade of life.

    Ependymal Tumors:

    Ependymal tumors, also called ependymomas, are the most common brain tumor in children younger than 5 years and the third most common brain tumor in patients younger than 20. Ependymal
    cells are also a type of glial cell and, so, these tumors are also sometimes called gliomas. Patients with neurofibromatosis type 2, an inherited condition, are at particular risk of
    developing these tumors, but in most cases the cause is unknown.

    Ependymal tumors typically arise from cells that line the fluid-filled cavities of the brain, structures called the ventricles, and in spaces around the spinal cord. Symptoms caused by
    ependymal tumors are often due to obstruction of these spaces, which blocks the flow of the cerebrospinal fluid, causing a condition called hydrocephalus. But these tumors can also
    compress nearby structures, such as the brainstem, and invade normal tissue nearby. Patients with these tumors often complain of headaches that are worse at night.

    The World Health Organization classifies them into four groups:

    • Ependymomas II
    • Anaplastic ependymomas III
    • Subependymomas I
    • Myxopapillary ependymomas

    Treatment: Surgery is performed with the aim of completely removing the tumor if possible. Often a shunt is put in place to relieve blockage of cerebrospinal fluid. Targeted radiation
    may be used if a small amount of tumor remains after surgery. If the tumor has spread, radiation of the whole brain may be recommended. With complete surgical removal and radiation therapy
    it is possible to cure these tumors, but treatment is not always successful.

    Neuroepithelial tumors of uncertain origin:

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    Ependymoblastoma (WHO grade IV):

    This is a rare, aggressive brain tumor seen in newborns and young children.

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    Functioning and non-functioning adenomas:

    The term adenoma comes from Greek aden “g” + -oma. Some of these tumors secrete hormones. Such tumors are called functioning or secreting pituitary adenomas. Other tumors do not produce hormones. These are called non-functioning
    or non-secretory. About 25 percent to 30 percent of pituitary adenomas are non-functioning.

    The symptoms caused by pituitary adenomasend on whether they non-secreting or secreting tumors. Secreting tumors often produce too much of a particular hormone. Among the hormones they may over produce are: growth hormone,
    adrenocorticotropic hormone, thyroid-stimulating hormone, and prolactin. Some tumors secrete more than one hormone.

    However, even when tumors do not secrete hormones, they can still impair the function of normal pituitary tissue shutting down normal hormone secretion. This can lead to a condition called hypopituitarism. Symptoms of hypopituitarism
    are fatigue, weakness, loss of libido, and hypothyroidism. The tumor can also impinge on an adjoining structure, called the hypophysis, impairing its ability to produce a critical hormone called antidiuretic hormone and causing a
    condition called diabetes insipidus. Pituitary adenomas can also press on the optic nerves and cause a loss of peripheral vision.

    Secreting pituitary adenomas are classified by the hormone they produce.

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    Germ cell tumors:

    Germ cells are the cells that form the reproductive system during embryonic development. In men, for example, these cells form the sperm, and in women, the ova, or eggs. The tumors that arise from these cells
    are rare and primarily affect the young. Individuals with a chromosomal disorder called Klinefelter syndrome (47 x YY) are at higher risk for developing germ cell tumors. The germ cell tumors include:

    • Germinomas
    • Teratomas
    • Yolk sac tumors
    • Embryonal carcinoma
    • Choriocarcinoma

    Treatment varies depending on the type and location of the tumor and may include surgery, radiation therapy, and chemotherapy.

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    Glioblastoma (WHO grade IV):

    Glioblastoma, also known as glioblastoma multiforme, is the most common malignant primary brain tumor. It is fast-growing, invasive and generally incurable. These tumors
    tend to arise in older individuals but can occur at any age. They are more common among people with certain inherited genetic disorders, such as Li-Fraumeni syndrome and
    neurofibromatosis. Exposure to ionizing radiation increases the risk of developing these tumors, but in most cases the cause is unknown. Symptoms are often not specific
    and may include headache, nausea, blurred or double vision. About one in three will develop seizures. Personality changes occur, but these are often subtle.

    Treatment includes dexamethasone to reduce swelling and an anti-seizure medicine. Surgery is performed to confirm the diagnosis, reduce the size of the tumor, and, if
    necessary, place shunts to relieve blockage of normal cerebrospinal fluid flow. Surgery is usually followed with radiation therapy. Some tumors respond well to chemotherapy.
    Treatment can improve neurologic symptoms, prolong life, but usually cannot cure glioblastomas. There are many clinical trials underway to find new treatments for this disease.

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    Gliomatosis cerebri (WHO grade III):

    Gliomatosis cerebri is a rare, aggressive glial tumor that has often spread throughout the brain by the time it is diagnosed. It tends to appear in adults between the age of 40 and 50. These
    tumors may be more common among patients with neurofibromatosis type 1 but in most cases the cause is unknown. Treatment typically involves stereotactic brain biopsy to confirm the diagnosis
    or open craniotomy in order to obtain a biopsy and to relieve pressure caused by the tumor on other parts of the brain. Radiation is usually recommended with or without chemotherapy.

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    Growth hormone-producing adenomas:

    In children and adolescents, pituitary adenomas that produce excess growth hormone cause giantism. Children with giantism will be excessively large for their age. In adults, however, because their long bone growth has halted,
    the excess growth hormone causes abnormal growth of the soft tissue of the jaw, hands and feet as well as heart disease and abnormal blood glucose levels.

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    Hemangiopericytomas:

    In the past, hemangiopericytomas have been considered to be meningioma but are now known to be derived from other tissues. They usually arise in muscle and skin and only rarely in the brain. These tumors
    tend to recur and to metastasize. Unlike meningioma, which is more common in women, hemangiopericytomas appear more commonly in men. Signs and symptoms vary depending on the size and location of the tumor.
    Treatment is surgery followed by radiation. The goal of surgery is complete removal of the tumor, but this can be difficult because of the risk of bleeding. Unlike most other primary tumors of the brain,
    hemangiopericytomas can spread outside the central nervous system with bones, lung, and liver being the most common sites.

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    Medulloblastoma (WHO grade IV):

    This is a very rare, aggressive tumor of the cerebellum affecting primarily young children, but is also seen in young adults. People with Turcot syndrome type 2 or nevoid basal cell carcinoma
    syndrome are at higher risk of developing these tumors. Medulloblastomas often arise in the cerebellum, but can spread via the cerebrospinal fluid to the spine. Symptoms are often due to
    obstruction of the cerebrospinal fluid, which can cause headache, fatigue, nausea and personality changes. Treatment usually involves surgery to relieve the obstruction of the CSF flow,
    obtain a biopsy and remove as much of the tumor as possible, followed by radiation therapy. Because radiation therapy poses particular dangers to the developing brain, patients under the age
    of three are often given chemotherapy instead. Chemotherapy is also often recommended to patients with more malignant-appearing, high-risk tumors. Recurrence, however, is common. If the recurrence
    is located in single spot, repeat surgery and directed radiation therapy is often used. If the tumor recurs at several locations, either in the central nervous system or elsewhere, chemotherapy
    is usually recommended.

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    Melanocytic lesions:

    Melanocytic lesions are rare tumors that arise from melanocytes of the leptomeninges. The tumors can be benign or malignant. Primary malignant melanomas of the central nervous system are very rare. Unlike
    metastatic melanomas, which are usually found within the brain, primary melanomas typically arise from the meninges. Treatment may include surgery, radiation therapy, and chemotherapy.

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    Meningeal sarcomas:

    Sarcomas are malignant tumors that arise from mesenchyme tissue, such as bone and muscles. The name comes from the Greek word “sarx”, meaning “flesh”, and “oma” meaning “tumor”. Signs and symptoms depend on
    the tumor size and location. They are classified by the type of tissue they resemble:

    • Fibro sarcomas (connective tissue)
    • Chondromas (cartilage)
    • Condrosarcomas (cartilage/muscle)
    • Leiomyosarcomas (smooth muscle)
    • Rhabdomyosarcoma (striated muscle)
    • Osteosarcomas (bone)
    • Lip sarcomas (fat)
    • Angiosarcomas (blood vessels)

    Treatment: Surgery to remove all or as much of the tumor as possible, followed by radiation and/or chemotherapy. Prognosis depends on tumor type and the success of surgical removal.

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    Meningeal tumors:

    The brain and spinal cord are covered by a thin layer of tissues called the meninges. The name, meninges, comes from the Greek word meninx, meaning “membrane”. Tumors that arise from these tissues are called
    meningeal tumors. The most common type of meningeal tumors is meningioma. These tumors account for about one in seven to one in five intracranial tumors. They typically appear in adults, more often in
    women than men. They rarely occur during childhood. Symptoms include headache, paresthesias, seizures, personality changes, confusion and visual impairment. Surgery can cure meningioma, if the entire
    tumor is removed. Radiation therapy is added if tumor remains after surgery or if the meningioma is high-grade, recurrent or disseminated.

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    Meningioma (WHO grades I-III):

    Meningioma account for as much as 26 percent of primary brain tumors. Most are slow growing and benign. They most commonly occur in adults, particularly in women. They arise from the dura, the outer most
    layers of the meninges. Exposure to radiation increases the risk of developing a meningioma. Many adults with these tumors, for example, were treated with low-dose radiation to treat tinea capitis, the
    fungal infection of the scalp also known as ringworm. Patients who have undergone high-dose radiation for primary brain tumors are also at risk for developing meningioma. Patients with the inherited
    disorder neurofibromatosis 2 are at risk of developing multiple meningiomas as well. Treatment is surgery, but meningioma often recurs.

    Atypical meningioma (WHO grade II):

    Anaplastic (malignant) meningioma (WHO grade III):

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    Those are rare but are more likely to recur and more difficult to cure.

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    Metastatic tumors:

    Metastatic tumors are tumors that spread from cancers outside of the nervous system. The most common sources of metastatic brain tumors are lung, breast and colon cancer, melanoma, and cancer from an unknown site. Patients with a
    single metastasis are typically treated with surgery followed with radiation. However, in most cases of metastatic brain cancer, the tumor cells have spread to several sites of the brain by the time of diagnosis. When this is the case,
    surgery is usually not possible and treatment is with radiation alone. Survival depends on a number of factors including the age and general health of the patient, the location of the metastases, and type of the original cancer.

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    Mixed gliomas:

    Mixed gliomas contain both astrocytes and oligodendrocytes. These include:

    • Oligoastrocytoma (grade II): a slow-growing tumor.
    • Anaplastic oligoastrocytoma (grade III): A more aggressive mixed glioma.

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    Neuronal and mixed neuronal-glial tumors:

    Neuronal and mixed neuronal-glial tumors are relatively rare. These include:

    • Gangliocytoma (WHO grade I) and ganglioglioma (WHO grade I or II)
    • Anaplastic gangliogliomas
    • Desmoplastic infantile astrocytoma (DIA) and desmoplastic infantile ganglioglioma (DIG).
    • Dysembryoplastic neuroepithelial tumor (WHO grade I)
    • Central neurocytoma
    • Cerebellar liponeurocytoma (WHO grade I or II)

    Non-Glial Tumors:

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    Oligodendroglia (WHO grade II):

    These tumors most commonly affect adults often in their 50s and 60s. Standard treatment includes surgery with or without radiation and chemotherapy. In general, these tumors respond
    better to radiation and chemotherapy than astrocytomas.

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    Oligodendroglial Tumors:

    Oligodendroglial Tumors arise from cells called oligodendrocytes, brain cells that help nurture and support neurons. These cells, like astrocytes, are also glial cells and so
    oligodendroglial tumors are also sometimes called gliomas. Oligodendrocytes are similar to astrocytes but have fewer projections. Oligo is the Greek word for “fewer”; dendro is
    the Greek word for “branches”.

    These tumors can arise in childhood but most appear in adults. They tend to form in the cerebrum but can appear anywhere in the central nervous system, including the spinal cord.
    For many patients, the first symptom is a seizure. With time, these tumors tend to evolve to more malignant forms, and, unlike most other brain tumors, they can also metastasize,
    or spread, to other parts of the body, such as the lung. The cause of oligodendroglia tumors is unknown.

    Treatment depends on the size, location and behavior of the tumor as well as the patient’s age and general health. In some cases, doctors will recommend a “wait and see” approach,
    especially with children for whom the risk of surgery and radiation is higher. Surgery is usually recommended for adults, however. If the tumor has more malignant characteristics
    or if it still threatens nearby structures after surgery, radiation and chemotherapy is usually recommended.

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    Peripheral nerve sheath tumors:

    These are tumors formed from the myelin cells that surround and insulate the nerves throughout the nervous system outside of the brain and spinal cord

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    Pilocytic astrocytoma (grade I):

    These are slow-growing tumors found in the brain and spinal cord. They tend to affect children, young adults, and people with the inherited disorder neurofibromatosis
    type 1. They typically arise in the cerebellum, the third ventricle and may involve the optic (visual) pathways, cranial nerves and brain stem. In older patients they tend
    to occur in the spinal cord.

    If the tumors are surgically accessible, treatment is complete surgical removal. If some tumor remains, the remnant will often remain stable for years and in some cases
    disappear on its own. If the tumor recurs, surgery is often repeated. Radiation is usually only used when the tumor cannot be removed surgically. Chemotherapy is usually
    reserved for young children whose tumors are surgically inaccessible, because radiation can harm the developing brain. In general, the prognosis is excellent especially
    if the tumor is completely removed during surgery.

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    Pilocytic astrocytoma (WHO grade I):

    Pilocytic astrocytoma, also called juvenile pilocyctic astrocytoma, primarily occur in children and young adults. They are the most common central nervous system tumors
    associated with the inherited disorder neurofibromatosis type 1. Pilocytic astrocytoma is usually slow-growing and often can be cured with surgery alone. If the tumor
    cannot completely be removed with surgery or if it is not known whether the entire tumor has been removed, radiation therapy and/or chemotherapy is typically recommended.
    Prognosis is usually very good.

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    Pineal astrocytic tumor:

    This tumor forms in tissue near the pineal gland, a small structure in the endocrine system involved in a variety of functions including the regulation of the sleep-wake cycle. See
    tumors of the pineal region in P. 240 in Berger.

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    Pineal parenchymal tumors of intermediate differentiation:

    Treatment typically includes surgery to obtain tissue to confirm the diagnosis and relieve hydrocephalus. Surgery can cure benign pineal parenchymal tumors. The decision whether to administer
    radiation therapy depends on the tumor cell type. In general, radiation therapy is reserved for higher-grade tumors. For these patients, chemotherapy may also be recommended.

    In general, patients with these tumors need long-term follow up because there is a high risk of recurrence and the formation of new tumors.

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    Pineal parenchymal tumors:

    The pineal gland is a small structure located near the center of the brain that plays an important role in regulating the sleep-wake cycle. Tumors arising from this area are very rare. Because of
    their location, pineal tumors can obstruct the normal flow of the cerebrospinal fluid, causing a condition called hydrocephalus, which in turn can cause, headaches, nausea and other generalized
    symptoms. Tumors in this area often affect brain structures that coordinate the movement of the pupils and eyes.

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    Pinoblastoma (WHO grade IV):

    A rare, aggressive tumor that primarily affects children.

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    Pinocytoma (WHO grade II):

    A slow-growing tumor that primarily affects adults aged 25 to 35 years.

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    Pituitary carcinomas:

    Most pituitary tumors are benign, but there are rare malignant pituitary cancers, or carcinomas. These tumors can spread outside of the pituitary gland to other parts of the brain and spinal cord as well as to organs outside of the
    central nervous system, such as liver, lymph nodes, bone, and lung.

    Treatment of pituitary adenomas depends on the size and type of tumor. Often these tumors can be treated with medicine alone. Prolactin production, for example, can be controlled with drugs called dopamine agonists. Two dopamine
    agonists commonly used to treat prolactinomas are bromocriptine and cabergoline. These drugs can also be used to treat growth-hormone secreting tumors. However, surgery and radiation may be required.

    Tumors of uncertain histogenesis:

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    Pituitary tumors:

    The pituitary gland is a small, bean-sized structure found at the base of the brain. It is often called the master gland because it regulates the function of many other glands, including the thyroid and adrenal glands
    and the ovary and testes. The pituitary secretes growth hormone that acts directly on the tissues of the body. Pituitary tumors account for 10 percent to 15 percent of brain tumors, making them the third most common
    after gliomas and meningioma. The risk being diagnosed with a pituitary tumor goes up with age, and they are relatively rare in children. Individuals with an inherited disorder called multiple endocrine neoplasia type
    1 (MEN 1) have about a one in four chance of developing a pituitary tumor.

    Most pituitary tumors are benign. Indeed as many as one in five to one in ten people have pituitary adenomas and most will never have symptoms. Many pituitary tumors are only discovered by accident when a brain scan or
    skull x-ray is performed for some other reason. These usually never cause any problems and do not need treatment

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    Pleomorphic xanthoastrocytoma (WHO grade II):

    Pleomorphic xanthoastrocytomas are rare, accounting for less than 1 percent of astrocytic tumors. They have a yellow-tan appearance, which gives them the name xantho, from
    Greek word xanthos meaning “yellow”. They typically develop in children and young adults though occasionally they are seen in older patients. These tumors generally have a
    favorable prognosis. Typically they develop on the surface (leptomeninges) of the cerebrum, particularly on the temporal lobe but these tumors can occur elsewhere. Patients
    often have a history of seizures but symptoms can include headaches, visual disturbances and focal weakness and sensory deficits. Therapy is surgical removal of all or most
    of the tumor. In some cases, based on the mitotic rate of the tumor cells, radiation or chemotherapy will be recommended. Sometimes, these tumors can transform into more
    malignant forms. In general, prognosis is good, but lifelong follow up with serial imaging studies is required.

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    Primitive neuroectodermal tumor (PNET) (WHO grade IV):

    These tumors are thought to arise from primitive neural cells in the brain. They are quite rare and primarily affect children. They are often referred to by different names, including cerebral
    medullobastoma, cerebral neuroblastoma, cerebral ganglioneuroblastoma, blue tumor, and primitive neuroectodermal tumor. These tumors can spread throughout the central nervous system. Symptoms
    depend on the size and location of the tumor. Surgery is performed to obtain tissue for biopsy and to remove as much of the tumor as possible, followed by radiation and chemotherapy. Prognosis
    depends on the type of tumor and success of surgical removal. Prognosis is better among adults than among children.

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    Prolactinomas:

    Prolactinomas are pituitary adenomas that produce the prolactin, a hormone that normally regulates the production of breast milk in women. In women, the excess production of prolactin causes inappropriate production of breast
    milk and may cause menstruation to halt, a condition called amenorrhea. In men, prolactin-secreting tumors can cause diminished sex drive and impotence.

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    Schwannoma (WHO grade I):

    Schwannomas are also known as neurilemomas and neurinomas. These are a common, benign tumor of the peripheral nerves but which account for about 8 percent of intracranial tumors and 29 percent of primary spinal tumors. These
    tumors are common in patients with the inherited disorder neurofibromatosis 2. In general, these tumors are slow growing and rarely become malignant. Schwannomas commonly affect the acoustic nerve “or eighth cranial nerve”
    the nerve that transmits signals from the ear to the brain. These tumors are usually called acoustic neuromas and they often cause ringing in the ears (or tinnitus), hearing loss, vertigo and dizziness. Because they can involve
    another nearby nerve, the seventh cranial nerve, facial numbness, tingling and movement problems may occur. Evaluation usually includes MRI scan and hearing, balance and other tests to assess the function of the acoustic nerves.

    Most are benign tumors and tend to be slow growing. As a result, your doctor may recommend simply following them with periodic brain scans, especially if you are over 65 or have other health problems that might make surgery more
    difficult. Small acoustic neuromas can often be treated with surgery alone or with stereotactic radiosurgery, a technique that allows very precise radiation treatment. In many cases hearing and balance deficits improve.

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    Sub ependymal giant cell astrocytoma (WHO grades I):

    Sub ependymal giant cell astrocytoma, or SEGAs, are benign, slow growing tumors that usually arise from fluid-filled chambers in the brain called ventricles. Almost all the
    patients with these tumors have tuberous sclerosis complex, a rare inherited disorder that affects many parts of the body including the skin, lungs and kidneys. Treatment
    often involves surgery to deal with obstruction of the flow of cerebrospinal fluid (CSF), the cause of hydrocephalus, and sometimes to control seizures that do not respond
    to medical treatment. When surgery is not possible, CSF diversion techniques may be used. In general, these tumors are benign, slow-growing and rarely recur. Radiation is usually
    reserved for recurrences, should they arise.

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    Tumors of the sellar region:

    At the base of the brain, the skull forms a saddle-shaped structure called the sella turcica. The name comes from the Latin words meaning “Turkish saddle”. Seated within this saddle is the bean-sized
    pituitary gland. This gland, often called the master gland, regulates the function of many other glands, including the thyroid, testes, ovaries, and the adrenal glands. Tumors of the sellar region can arise
    from the pituitary gland itself or neighboring tissues.

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