Treatment for brain tumors depends on a number of factors, including the size, location and type of tumor. In addition, the patient’s age and overall health are important factors. Treatment for brain tumors is complex and is handled by a cancer care team, typically headed by a medical oncologist. 

There are a number of treatment options for brain tumors. The main treatment methods for brain tumors include surgery, radiation therapy and chemotherapy. In most cases, treatment will include a combination of these treatments, such as surgery followed by radiation therapy.

Whenever possible, surgery is the first line of treatment for brain tumors. The goal is to remove as much of the tumor as possible without causing severe damage to surrounding tissues. Even if the entire tumor cannot be removed, doctors will often take out as much as possible to reduce pressure in the brain and relieve symptoms. Prior to surgery, many patients may receive a cortisone-related steroid drug to relieve swelling and an anticonvulsant drug to relieve or prevent seizures. In some cases, a thin plastic tube, called a shunt, may be placed in the skull to drain excess fluid around the brain.

Some brain tumors, such as anaplastic astrocytomas and glioblastomas, cannot be cured by surgery. The cells from these tumors usually spread far into the normal brain tissue. However, surgical removal of the tumor reduces the amount of tissue that needs to be treated by radiation therapy or chemotherapy. Surgery can help make these treatments more effective and may prolong life even though the entire tumor cannot be removed.

The types of surgery used for brain tumors include:

• Craniotomy. This most common type of surgery for brain tumors involves removal of portion of the cranium, the part of skull that surrounds the brain. This removal of a skull fragments allows the surgeon to view various sections of the brain. The skull portion is replaced after the tumor is removed. Recovery time from craniotomy depends on the extent of the surgery.
  
  
• Image-guided stereotactic surgery. This surgery is similar to stereotactic biopsy and is used primarily with small tumors. Tumor cells are removed with a fine needle with the use of MRI or CAT scan for proper needle placement. This procedure is less invasive than a craniotomy and has a shorter recovery period.

Radiation therapy may be used after surgery to destroy any remaining tumor cells and can help prevent or delay recurrence of brain tumors. Most brain tumors are not cured by radiation because the therapy can damage normal cells as well. However, the therapy may be used when the cancer is inoperable.

Chemotherapy may be another option for certain patients with brain tumors. This treatment uses a series of powerful drugs that interfere with the growth process of tumor cells. By disrupting the division process, the tumor is no longer able to grow. Many of the chemotherapy drugs are given in combination to effectively treat any tumor cells present in the body. Like radiation therapy, chemotherapy is often given after surgery to destroy any remaining cancer cells. Chemotherapy has been shown to be beneficial in treating some of the more aggressive brain tumors. Chemotherapy drugs may be provided in several different ways, including directly into the tumor, into the cerebrospinal fluid and intravenously.

One of the biggest challenges in treating brain tumors with chemotherapy is the blood-brain barrier. This network of blood vessels and cells naturally protects the brain from foreign, harmful chemical agents. The same barrier that protects the brain also prevents the chemotherapy drugs from effectively reaching the brain to target the tumor. For this reason, interstitial chemotherapy (implanted chemotherapy)  or intrathecal chemotherapy (injected into the spinal fluid) may be more effective than systemic chemotherapy in destroying the cancer cells.  Researchers are continuing to test medications that may be able to break through the blood barrier.

The same medications that are given prior to surgery may be given following surgery. Medications to reduce swelling in the brain and prevent seizures may be given for treatment. Often these drugs help relieve symptoms, such as headaches, in brain tumor patients.

Although chemotherapy may be more successful in treating children with brain tumors, it can decrease the chance of a brain tumor spreading to other tissues in the brain or outside of the central nervous system. It is most effective when used in combination with surgery and/or radiation.

After a brain tumor has been diagnosed and treated, the patient will be followed closely by the cancer care team. Patients may need treatment from various healthcare professionals for problems that result from surgery. Physical therapy may be needed for movement problems, and speech therapy may be needed for communication difficulties. Often brain tumor patients and their families seek psychological and emotional support. The cancer care team is in place to help brain tumor patients and their caregivers handle all aspects of treatment.

In general, people with brain tumors have an increased risk of developing additional medical problems. Patients must follow the physician recommendations for follow-up appointments and testing. The close monitoring is to ensure that any recurrence of cancer or long-term effects of treatment is identified promptly and treated appropriately.

There is no known way to prevent brain tumors. Early diagnosis and treatment of other cancers in the body may reduce the risk of metastatic brain tumors. Also, if individuals have any of the inherited conditions that increase the risk of brain tumors, they should be carefully monitored by professionals for signs of brain cancer.