Patient Guide to Brain Tumors

Every year, approximately 17,000 patients are diagnosed with cancer of the brain. For children and adolescents these tumors are among the most common cancer-related causes of death. However, most commonly affected are adults in their 5th decade of life. In this population as many as 2 in 10,000 individuals are afflicted each year - a figure which has risen over the last decades. Brain tumors are now the second fastest growing cause of cancer death among those over the age of 65. Unlike lung cancer and melanoma, which are the first and third on that list, there are no known lifestyle or behavioral changes that will reduce the risk of developing a brain tumor. High-grade gliomas account for over three-quarters of these tumors. As these tumors are rare and therapies complicated to perform, patient care has shifted to tertiary care facilities such as the Yale Brain Tumor Center able to provide multidisciplinary care including surgery, radiation and chemotherapy. In addition to patients with primary cancer of the brain there are 80,000 more diagnosed with metastatic (or secondary) tumors that have spread to the brain from elsewhere in the body. The Yale Brain Tumor Center provides not only the latest therapeutic approaches to brain metastases but also gives patients access to a large number of subspecialists at the Yale Comprehensive Cancer Center covering the whole spectrum of systemic cancer. Office visits are coordinated in a way that minimizes the number of visits to New Haven and the length of the overall stay.

Primary brain tumors are still classified based on their resemblance to normal cells and structures of the nervous system. The nervous system consists of nerve cells - the cells that form the neural network that enables us to move, feel, see, hear, smell, taste and think - and supporting cells - the so called 'glial' cells which are comprised of astrocytes, oligodendrocytes, ependymal cells and cells of the choroid plexus. Astrocytic tumors ('astrocytoma') predominate, followed by 'oligodendroglioma', and mixed tumors. Least common are growths in proximity to the ventricles and choroid plexus ('choroid plexus papilloma' and 'ependymoma'). Brain tumors are also classified into four grades according to their anticipated aggressiveness. Grade I and II are considered 'low grade', grade III and IV 'high grade'. 'Low-grade glioma' is a descriptive term and does not always imply a benign clinical course. A 'benign' infiltrating astrocytoma of the brainstem can lead to disability and death; a similar lesion in the visual pathway causes blindness and 'low-grade glioma' within the spinal cord can produce irreversible paralysis. 'High grade' tumors have a tendency to grow more rapidly and require multi-modality therapy (surgery, radiation and/or chemotherapy). 'Low grade' tumors can evolve into a high grade tumor and thus follow-up with your doctor in regular intervals is warranted.