Brain and spinal cord cancers

Brain and spinal cord cancers facts

Brain and spinal cord cancers can grow in the central nervous system, which is known as a primary cancer. They can also travel from other parts of the body, like the lung or breast, and form deposits in the brain or spinal cord; this is called a secondary cancer or brain metastases. Many brain cancers are the result of metastasis (spread) of cancer from other places in the body to the brain.

The Brain and Spine Metastases Clinic at Fred Hutchinson Cancer Center specializes in treating patients whose cancer has metastasized to the brain or spinal cord.

Following the merger of long-time partners, Fred Hutchinson Cancer Research Center and Seattle Cancer Care Alliance, the organization was renamed to Fred Hutchinson Cancer Center. We are an independent, nonprofit organization that also serves as UW Medicine's cancer program.

Primary cancer The original, or first, tumor in the body. The original, or first, tumor in the body. Cancer cells from a primary cancer may spread to other parts of the body and form new, or secondary, tumors. This is called metastasis. These secondary tumors are the same type of cancer as the primary cancer. Also called primary tumor. Secondary cancer A cancer that has spread (metastasized) from the place where it first started to another part of the body. Secondary cancers are the same type of cancer as the original (primary) cancer. A term used to describe cancer that has spread (metastasized) from the place where it first started to another part of the body. Secondary cancers are the same type of cancer as the original (primary) cancer. For example, cancer cells may spread from the breast (primary cancer) to form new tumors in the lung (secondary cancer). The cancer cells in the lung are just like the ones in the breast. Also called secondary tumor.

Anatomy of the brain and spinal cord

The brain is a remarkable three-pound organ housed in, and protected by, the skull. Not only does it control all five senses (taste, smell, sight, hearing and touch), it is responsible for your emotions, thoughts and movement. The right side of the brain controls the left side of your body, and the left side of the brain controls the right side of your body.

Your brain has three main parts: the cerebrum, cerebellum and brain stem.
Brain Diagram

The cerebrum controls higher brain functions. It has four lobes, each with different tasks:

Frontal lobe: executive function (management of the brain), decision-making, personality, language, planning and movement
Parietal lobe: intelligence, reasoning, sensation and reading
Occipital lobe: vision
Temporal lobe: language, behavior, hearing, vision, emotions and memory

The cerebellum controls balance, coordination and fine muscle control.

The brain stem controls things we do without thinking, like our heartbeat, breathing and swallowing.

Spine Diagram

The spinal cord starts at the brain stem and goes to the tailbone. It is about as wide as your little finger and extends the length of your back. Messages are carried from the spinal cord to and from the brain and the rest of the body.

Nerves extend from the spinal cord on each side and go to other parts of the body.

The brain and spinal cord are protected by bony structures — the skull and spinal column.

Meninges are membranes that cover and protect the brain and spinal cord. There are three layers of meninges:

Dura mater, which is closest to the bone
Arachnoid, which is loosely around the brain
Pia mater, which is closely attached to the brain and spinal cord surface

Brain Cross Section

Cerebrospinal fluid (CSF) is a clear, watery liquid between the arachnoid and pia mater that cushions the brain and spinal cord. It is made in the four ventricles, which are large open structures in the brain. The area in the lateral ventricles that makes spinal fluid is called the choroid plexus. About 20cc of spinal fluid is made, but not absorbed, each hour. There is about 140 cc (about half a can of soda) of spinal fluid that surrounds the brain and spine. This fluid flows and circulates around your brain and spine to protect them.

Brain and spinal cord metastases

Treatments for cancers have advanced over the last several years, leading to patients surviving and living longer with cancer. As a result of more effective cancer treatments, the disease has more time to spread to the brain and spinal cord.

Some of the most common primary cancers that spread to the brain are lung, breast, skin, colon, gastrointestinal, kidney and gynecologic cancers, but almost all cancers can spread to the brain.

Cancer that has spread to the brain and spinal cord can be found in the brain, the cerebrospinal fluid or the lining of the brain and spinal cord, which is called the leptomeninges.

Metastatic brain and spinal cord diseases include:

Leptomeningeal disease, or metastatic cancer that is in the cerebral spinal fluid surrounding the brain and spinal cord
Brain metastases

Symptoms

Symptoms vary by patient and depend on the location of the brain or spinal cord metastases. Some people may experience only one symptom, while others may have several. Your care team will evaluate your symptoms and help to identify ways to manage them as part of your treatment plan. Common symptoms include:

Headaches
Seizures
Speech difficulty
Changes in mood or personality
Changes in sense of touch or other senses
Loss of balance or coordination
Other stroke-like symptoms

Gastrointestinal Refers to the stomach and intestines. Also called GI. Metastatic A metastatic cancer is a cancer that has spread to other areas of the body by way of the lymph system or bloodstream. Symptom A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. Some examples of symptoms are headache, fatigue, nausea and pain. Symptom A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. Some examples of symptoms are headache, fatigue, nausea and pain. Treatment plan A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A treatment plan may also include information about how much the treatment is likely to cost and about regular follow-up care after treatment ends.

Primary brain cancer types

Gliomas are cancers that grow from glial cells (also called glia cells), which are supportive cells that hold brain cells called neurons in place. Glial cells provide nutrition and form myelin, which is a covering for nerve cells. Glial cells include astrocytes, oligodendrocytes and ependymal cells.

About half of all primary brain cancers are from glial cells. About one-fifth of all primary spinal cord cancers are from glial cells. Gliomas occur more often in men than women.

Meningiomas are cancers that grow from the brain covering (meninges). About 15 to 25 percent of all primary brain cancers are meningiomas. Meningiomas occur more often in women than men.

Primary cancers from glial cells (gliomas)

Astrocytomas start from brain cells called astrocytes (star-shaped cells). They are the most common type of glioma, slow-growing, and can be anywhere in the brain, but are most often in the cerebrum. If found early, they can often be surgically removed.

There are different grades of astrocytomas:

Pilocytic astrocytoma (Grade I) grows slowly and usually does not grow into surrounding tissues.
Low-grade (glioma) astrocytoma (Grade II) grows faster than pilocytic astrocytomas and spreads into surrounding tissues.
Anaplastic astrocytoma (Grade III) grows faster than low-grade astrocytoma and often recurs.
Glioblastoma multiforme (Grade IV) is the most common brain cancer. It grows faster than low-grade astrocytomas and mainly occurs in the cerebrum.
Brain stem gliomas(any grade) are located where the brain and spinal cord meet.

Ependymomas (any grade) grow slowly from the lining of the ventricles of the brain and the hollow central canal of the spinal cord. Well-differentiated ependymomas look much like normal cells and grow slowly. Anaplastic ependymomas do not look like normal cells and grow more quickly than well-differentiated ependymal cancers.

Oligodendrogliomas begin in brain cells called oligodendrocytes, which provide support around nerves by building a sheath of myelin to cover the nerve cells and pass along electrical nerve impulses.

Genetic testing is important for these cancers because it helps us predict prognosis and treatment response. There are different grades of oligodendroglial cancers:

Well-differentiated oligodendrogliomas (Grade II) are slow-growing cancers that look very much like normal cells.
Anaplastic oligodendrogliomas (Grade III) grow more quickly, and the cells do not look like normal cells.

Mixed gliomas start from two types of glial cells, usually astrocytes and oligodendrocytes. Treatment is based on whichever cell type is the most aggressive.

Primary cancers from non-glial cells

Meningiomas grow from the meninges, which are coverings for the brain and spinal cord. They are usually slow-growing and can be one of three grades. Surgery is often used as a treatment, but radiation therapy may also be used.

Pineal tumors occur near the pineal gland, which is located deep inside the brain and produces melatonin. There are several types of pineal tumors; some are cancerous. Some pineal tumors are fast-growing. Surgery may be recommended for these tumors.

Pituitary tumors affect the pituitary gland, which is located at the base of the brain and is responsible for hormones, growth and metabolism. Surgery and radiotherapy are often used for these tumors.

Schwannomas are tumors from schwannoma cells, which form the myelin sheath that covers and protects the nerves. They are usually benign (non-cancerous). There are several types, including the acoustic schwannoma, which is a benign tumor of the nerve that is responsible for hearing. Surgery is the primary treatment, but if a patient has more than one schwannoma, a doctor may recommend surgery followed by radiation therapy.

Primary central nervous system lymphoma is a cancer that develops out of lymphocytes, which are a type of white blood cell. Lymphomas of the brain are a form of non-Hodgkin lymphoma, a cancer that is often associated with the lymph nodes. These cancers are usually near the ventricles of the brain, and there may be multiple tumors. It is quite common for this type of cancer to spread.

Benign Not cancer. Benign tumors may grow larger but do not spread to other parts of the body. Genetic testing Tests that can be done to see if a person has certain gene changes known to increase cancer risk. Grade In cancer, a grade is a description of a tumor based on how abnormal the cancer cells and tissue look under a microscope and how quickly the cancer cells are likely to grow and spread. In cancer, a grade is a description of a tumor based on how abnormal the cancer cells and tissue look under a microscope and how quickly the cancer cells are likely to grow and spread. Low-grade cancer cells look more like normal cells and tend to grow and spread more slowly than high-grade cancer cells. Grading systems are different for each type of cancer. They are used to help plan treatment and determine prognosis. Also called histologic grade and tumor grade. Lymphocyte A type of immune cell that is made in the bone marrow and is found in the blood and in lymph tissue. The two main types of lymphocytes are B lymphocytes and T lymphocytes. A type of immune cell that is made in the bone marrow and is found in the blood and in lymph tissue. The two main types of lymphocytes (white blood cells) are B lymphocytes and T lymphocytes. B lymphocytes make antibodies, and T lymphocytes help kill tumor cells and help control immune responses. Lymphoma Cancer that begins in the cells of the immune system. There are two basic categories of lymphomas: Hodgkin lymphoma and non-Hodgkin lymphomas. Cancer that begins in cells of the immune system. There are two basic categories of lymphomas. One is Hodgkin lymphoma, which is marked by the presence of a type of cell called the Reed-Sternberg cell. The other category is non-Hodgkin lymphomas, which includes a large, diverse group of cancers of immune system cells. Non-Hodgkin lymphomas can be further divided into cancers that have an indolent (slow-growing) course and those that have an aggressive (fast-growing) course. These subtypes behave and respond to treatment differently. Both Hodgkin and non-Hodgkin lymphomas can occur in children and adults, and prognosis and treatment depend on the stage and the type of cancer. Nonmalignant Not cancer. Nonmalignant tumors may grow larger but do not spread to other parts of the body. Also called benign. Prognosis A statement about the likely outcome of a disease in a patient. Radiation therapy The use of high-energy radiation from X-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. The use of high-energy radiation from x-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Radiation therapy The use of high-energy radiation from X-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. The use of high-energy radiation from x-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. White blood cell A type of blood cell that is made in the bone marrow and found in the blood and lymph tissue. White blood cells are part of the body’s immune system and help the body fight infection and other diseases. A type of blood cell that is made in the bone marrow and found in the blood and lymph tissue. White blood cells are part of the body’s immune system. They help the body fight infection and other diseases. Types of white blood cells include granulocytes (neutrophils, eosinophils and basophils), monocytes and lymphocytes (T cells and B cells). Checking the number of white blood cells in the blood is usually part of a complete blood cell (CBC) test. It may be used to look for conditions such as infection, inflammation, allergies and leukemia. Also called leukocyte and WBC.

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