Brain Tumors, Part 2 — Treatment, Side effects and Restrictions
Treatment
Like symptoms, the treatment for a brain tumor is dependent upon the
site, type of tumor and size of the tumor. One thing that all brain tumors
have in common is that they should be treated promptly to ensure the chance
of a good outcome.
The goals of treatment may be cure of the disorder, relief of symptoms
or improvement of function or comfort. There are three main types of treatment:
surgery, radiation therapy and chemotherapy. Other medications may also
be used to treat the tumor and/or symptoms caused by the brain tumor.
Most brain tumors require some sort of surgery. If a tumor is completely
removed, it is said to be excised. If the tumor is very deep in the brain
tissue or if it infiltrates surrounding brain tissue, it is said to be
debulked (removal of as much of the mass of the tumor as possible, to
reduce the size). Some brain tumors are biopsied, which means that a piece
of tissue is removed form the tumor to test to determine what kind of
tissue makes up the tumor. Surgery may result in reduced intracranial
pressure or relieve symptoms in cases where the tumor cannot be removed.
Sometimes a special surgery technique, called stereotactic surgery (guided
by a CT scanner) may be helpful in removing deep tumors.
Radiation therapy consists of the use of high-energy radiation from x-rays,
gamma rays, neutrons, and other sources to kill cancer cells and shrink
tumors. Radiation comes from a machine that emits what is called external
beam radiation therapy. Radiation therapy is only used with some types
of tumors that are sensitive to this treatment. There are sometimes side-effects
of radiation therapy, including tiredness, burns and possible damage to
surrounding brain tissue.
Chemotherapy refers to many types of anticancer medications. These strong
medicines are used for some brain tumors that are sensitive to chemotherapy
drugs. They may be taken by mouth (orally), in a shot in the muscle (IM),
or through an intravenous line (IV). Some chemotherapy drugs have strong
side effects (as discussed in the next section).
Other medications that might be used are corticosteroids (dexamethasone)
to reduce brain swelling, osmotic diuretics to reduce brain swelling,
anticonvulsants to reduce seizures, analgesics to control pain, and antacids
or histamine blockers to control stomach ulcers.
Treatment for a brain tumor may also include support and/or therapeutic
services. Physical therapy, occupational therapy and speech therapy may
be appropriate due to effects of the tumor or effects of the surgery.
Support from a psychologist or social worker may be indicated to help
with adjustment issues, as a brain tumor may result in a variety of changes
in the ability, behavior, and other aspects of the life of the person.
Possible medication side effects
In addition to side effects that result from brain swelling, increased
pressure inside the skull, and surgery, a person with a brain tumor may
also experience significant side effects of radiation therapy and/or chemotherapy.
The degree and intensity of side effects depends on several factors, including
the age of the person with a brain tumor, the site of the tumor, the type
and dosage of radiation therapy and the type and dosage of chemotherapy.
Some people will experience minimal side effects, while others will encounter
side effects from treatment that seem more devastating than the tumor
itself.
Most of the side effects of radiation go away soon after the treatment
is over. However, some may persist after treatment is complete. Nausea,
fatigue, dry mouth, and skin reactions in the treatment area are usually
temporary side effects. Sometimes, radiation therapy affects blood counts,
but this is not usually the case in patients with brain tumors. Hair loss
may be temporary or permanent. Sometimes, hair is darker when it grows
back. A major side effect of radiation for brain cancer is neurologic
damage to normal tissues. This can lead to mild, moderate, or severe brain
damage. This can often be limited by newer techniques of radiation therapy.
Chemotherapy ("chemo") may cause a variety of side effects. Some drugs effect the
bone marrow, or blood producing tissue, thus impacting blood counts. White
blood cells (which fight off infections), red blood cells (which contain hemoglobin to
carry oxygen to other parts
of the body), or platelet cells (which help in forming
clots) may be affected by chemo. The result may
be increased risk of infection,
anemia
or fatigue, or increased risk of bruising
and/or bleeding. Other side effects of chemotherapy
may include:
- Nausea & Vomiting
- Weight Change
- Diarrhea & Constipation
- Mouth Sores
- Fever
- Pain
- Temporary Hair Loss
- Depression & Anxiety
Certain medications, called steroids, are often prescribed to reduce
inflammation in the brain. Common side effects of steroids include increased
appetite and weight gain, swelling of the face and feet, restlessness,
mood swings, burning indigestion and acne. As the doctor works to adjust
the dosage of the steroid, the child may experience some fatigue and difficulty
with concentration. This is usually eliminated when the dosage is “fine-tuned”
to the child’s needs.
Physical/dietary/other restrictions
Some children with brain tumors are unable to fully participate in physical
activities due to the side effects of treatment. They may have times when
they are very fatigued, or may experience significant weight gain due
to steroids. However, the child should be encouraged to participate to
the greatest extent possible in physical activities at school. He may
also need snacks in the morning or afternoon, especially if he is taking
steroids. Other restrictions may be indicated by the parents or the child’s
physician, depending on individual circumstances. Typically, the child
should be integrated into activities with other students as much as possible.
Part 1 — Introduction, Incidence, and Symptoms
Part 2 — Treatment, Side effects and Restrictions
Part 3 — Implications for school
For more information, please contact:
Kathy Davis, MSEd, PhD
kdavis2@kumc.edu
(913) 588-6305