Neuro-oncology is a medical field focused on cancers affecting the nervous system. It addresses tumors originating in the brain and spinal cord, and those that spread to these structures from elsewhere. Due to the central nervous system’s complexity, these conditions can significantly impact neurological function and overall well-being. Its purpose is to diagnose, treat, and provide ongoing care for individuals with these diseases.
What Neuro-Oncology Encompasses
Common types of gliomas include glioblastoma, a particularly aggressive form, and astrocytomas, which vary in growth rate. Other primary brain tumors include meningiomas, benign growths arising from the membranes surrounding the brain, and ependymomas, developing in the lining of fluid-filled spaces. Pituitary tumors and acoustic neuromas are also managed within this specialty.
Neuro-oncology also addresses tumors originating in the spinal cord, such as astrocytomas, ependymomas, and meningiomas, benign or malignant. They can develop within spinal cord tissue or in surrounding membranes and nerve roots. Metastatic cancers, which spread to the central nervous system from primary sites elsewhere, constitute a significant portion of cases. Lung, breast, and prostate cancers are common types that metastasize to the brain or spine.
Beyond tumor management, neuro-oncology addresses neurological complications from cancer or its treatments. Complications include seizures, headaches, and cognitive changes caused by the tumor or interventions. Chemotherapy, for instance, can lead to peripheral neuropathy, causing pain, numbness, or weakness. Managing these conditions is part of neuro-oncology’s comprehensive care.
How Neuro-Oncology is Diagnosed
Diagnosis involves detailed evaluations to identify tumor presence, type, and location. The process begins with a thorough neurological examination, where specialists assess functions like hearing, strength, coordination, and reflexes. Abnormalities in these areas provide initial clues about neurological involvement.
Advanced imaging visualizes tumors within the brain and spinal cord. MRI is the gold standard, offering detailed images to determine tumor size, location, and interaction with tissues. CT scans are often used, particularly in emergencies, to quickly identify masses or complications. PET scans provide information about a tumor’s metabolic activity, aiding diagnosis and treatment planning.
To confirm diagnosis and characterize the tumor, a biopsy is frequently performed. This involves obtaining a tissue sample, either through a stereotactic biopsy using precise image-guided techniques, or an open surgical biopsy. A liquid biopsy, analyzing cerebrospinal fluid, may also detect tumor cells or genetic markers. Molecular testing of tissue or fluid identifies genetic mutations or biomarkers, guiding personalized treatment.
Treatment Approaches in Neuro-Oncology
Treatment plans in neuro-oncology are individualized, often combining modalities for tumor removal, symptom management, and improved quality of life. Surgical removal is a primary treatment, aiming to resect as much tumor as safely possible without damaging brain functions. Common procedures include craniotomy (temporary skull removal) and neuroendoscopy (a minimally invasive approach using a thin tube with a camera). For tumors near the pituitary gland, transsphenoidal surgery through the nose may be used.
Radiation therapy uses high-energy beams to destroy cancer cells or slow growth. Techniques like external beam radiation therapy deliver external radiation, while stereotactic radiosurgery (SRS) delivers highly focused, high dose radiation in fewer sessions, often for smaller tumors. Intensity-modulated radiation therapy (IMRT) allows for precise radiation delivery, minimizing exposure to healthy tissue.
Chemotherapy uses drugs to kill cancer cells, administered systemically or directly into cerebrospinal fluid. Temozolomide and lomustine are common chemotherapy drugs for brain tumors. Targeted therapies attack cancer cells with specific genetic alterations, while immunotherapy boosts the body’s immune system to fight cancer cells. While immunotherapy shows promise in many cancers, its effectiveness in brain tumors faces challenges due to the blood-brain barrier and tumor immune suppression, though research advances.
The Multidisciplinary Care Team
Comprehensive neuro-oncology care relies on a collaborative team of specialists with diverse expertise. At the center is the neuro-oncologist, a physician specializing in the medical treatment of nervous system cancers, including chemotherapy and targeted therapies. Neurosurgeons perform surgical interventions, removing tumors while preserving neurological function. Radiation oncologists design and deliver precise radiation treatments.
Neuropathologists analyze tumor tissue samples obtained during biopsy or surgery to provide a definitive diagnosis and molecular profile. Neuroradiologists interpret complex imaging studies, offering detailed insights into tumor characteristics and location.
The team also includes rehabilitation therapists (physical, occupational, and speech) who help patients regain functions and improve quality of life. Social workers provide psychosocial support, assisting patients and families with practical and emotional challenges. Palliative care specialists manage symptoms and improve comfort throughout the disease course, working alongside curative treatments. This integrated approach ensures all aspects of a patient’s condition are addressed.