Brain Tumor

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Definition

A brain tumor is an abnormal growth of tissue in the brain. Unlike other tumors, brain tumors spread by local extension and rarely metastasize (spread) outside the brain. A benign brain tumor is composed of non-cancerous cells and does not metastasize beyond the part of the brain where it originates. A brain tumor is considered malignant if it contains cancer cells, or if it is composed of harmless cells located in an area where it suppresses one or more vital functions.

Description

Each year, more than 17,000 brain tumors are diagnosed in the United States. About half of all primary brain tumors are benign, but in life-threatening locations. The rest are malignant and invasive.

Benign brain tumors, composed of harmless cells, have clearly defined borders, can usually be completely removed, and are unlikely to recur. Benign brain tumors do not infiltrate nearby tissues but can cause severe pain, permanent brain damage, and death. Benign brain tumors sometimes become malignant.

Malignant brain tumors do not have distinct borders. They tend to grow rapidly, increasing pressure within the brain (IICP) and can spread in the brain or spinal cord beyond the point where they originate. It is highly unusual for malignant brain tumors to spread beyond the central nervous system (CNS).

Primary brain tumors originate in the brain. They represent about 1% of all cancers and 2.5% of all cancer deaths.

Approximately 25% of all cancer patients develop secondary or metastatic brain tumors when cancer cells spread from another part of the body to the brain. Secondary brain tumors are most apt to occur in patients who have:

• breast cancer.
• colon cancer.
• kidney cancer.
• lung cancer.
• melanoma (cancer) of the skin. These metastatic brain tumors can develop on any part of the brain or spinal cord.
• cancer within the nasal passages and/or throat that follow the nerve pathways into the skull, and metastasize to the brain.

Brain tumors can develop at any age, but are most common in children between the ages of 3-12, and in adults aged 55-65. Primary brain cancer is the second most common cause of cancer death between birth and the age of 34, and the fourth most common cause of cancer death in men aged 35-54. Primary tumors of the brain and central nervous system are often associated with HIV infection. Men and caucasians have a higher risk of developing brain tumors. Other risk factors being studied include children with a history of previous radiation treatment to the head for cancer; parents with certain cancers (nervous system, salivary gland, colon); having an older father; having well-educated parents; occupational exposure to vinyl chloride, lead, and pesticides; history of epilepsy; history of certain genetic conditions (tuberous sclerosis, neurofibromatosis, von Hippel Lindau, familial polyposis, Osler-Weber-Rendu, Li-Fraumeni).

The name of a brain tumor describes where it originates, how it grows, and what kind of cells it contains. A tumor in an adult is also graded or staged according to:

• how malignant it is
• how rapidly it is growing and how likely it is to invade other tissues
• how closely its cells resemble normal cells. (The more abnormal a tumor cell looks, the faster it is likely to grow)

Low-grade brain tumors usually have well-defined borders. Some low-grade brain tumors form or are enclosed (encapsulated) in cysts. Low-grade brain tumors grow slowly, if at all. They may spread throughout the brain, but rarely metastasize to other parts of the body.

Mid-grade and high-grade tumors grow more rapidly than low-grade tumors. Described as "truly malignant," these tumors usually infiltrate healthy tissue. The growth pattern makes it difficult to remove the entire tumor, and these tumors recur more often than low-grade tumors.

A single brain tumor can contain several different types of cells. The tumor's grade is determined by the highest-grade (most malignant) cell detected under a microscope, even if most of the cells in the tumor are less malignant. An infiltrating tumor is a tumor of any grade that grows into surrounding tissue.

Glioma is the term used to refer to the most prevalent primary brain tumors. Gliomas arise from glial tissue, which supports and nourishes cells that send messages from the brain to other parts of the body. These tumors may be either malignant or benign. Astrocytomas, ependymomas, and mixed gliomas are three of the most common gliomas.

ASTROCYTOMAS. Named for the star-like shape of their cells, astrocytomas can develop on any part of the brain or spinal cord. Non-infiltrating astrocytomas grow slowly, and rarely spread to nearby tissue. Mild-to-moderately anaplastic astrocytomas with well-differentiated borders do not grow as slowly as non-infiltrating astrocytomas, and they do spread to surrounding tissues.

Anaplastic astrocytomas, which are also called Grade III astrocytomas, look more abnormal and grow more rapidly than non-infiltrating or mild-to-moderately anaplastic tumors.

Grade IV astrocytomas are also called glioblastoma multiforme (GBM) tumors. Accounting for 30% of all primary brain tumors, GBMs are the most common brain tumors in middle-aged adults. GBMs are the most malignant of all brain tumors. Because they contain a greater mixture of cells than any other brain tumor, they are the most difficult to treat.

EPENDYMOMAS. Also called ependymal tumors, ependymomas account for 9% of all gliomas, and 5% of all intracranial tumors. These tumors, which are most common in children and adolescents, begin in the very thin membranes that help form cerebrospinal fluid (CSF) and line the brain cavities (ventricles) that contain it.

Ependymomas are usually benign, have well-differentiated borders, resemble normal cells, and grow very slowly. The cells of anaplastic (malignant) ependymomas look abnormal and grow more rapidly than the cells of benign tumors.

MIXED GLIOMAS. These heterogeneous tumors contain elements of astrocytomas and ependymomas and/or oligodendrogliomas. These are rare tumors that usually occur in middle-aged adults, grow slowly, and do not usually spread beyond the part of the brain where they originate. Mixed gliomas behave like tumors composed of the highest-grade cells they contain.

The most common brain tumors that do not develop from glial cells are medulloblastomas, meningiomas, and Schwannomas.

MEDULLOBLASTOMAS. Scientists once thought medulloblastomas (MDLs) developed from glial cells. These fast-growing, malignant tumors are now believed to originate in developing cells not normally present in the body after birth. They are sometimes called primitive neurodectal tumors (PNET).

MDL tumors are most common in children and are more common in boys than in girls. Only 30% of MDL tumors occur in adults. MDL tumors usually originate in the cerebellum (the part of the brain that controls coordination and some muscle activity), and are often carried to other parts of the brain by cerebrospinal fluid. MDL tumors rarely metastasize beyond the brain and spinal cord.

MENINGIOMAS. Meningiomas, which represent more than 20% of all primary brain tumors, originate in the membranes that enclose the brain and spinal cord (meninges). These tumors are usually benign and most often occur in women aged 30-50 years old. Meningiomas grow so slowly that the brain can sometimes become accustomed to their presence. Meningiomas compress, rather than invade, brain tissue and may grow to be quite large before any symptoms appear.

SCHWANNOMAS. Schwannomas originate in the Schwann cells. These cells produce myelin, material that protects the acoustic nerve, which controls hearing. These benign tumors are twice as common in women as in men, and are most often diagnosed in patients between the ages 30-60.

Schwannomas grow very slowly, and many people adapt to the slight hearing loss and balance problems that are the tumors' earliest symptoms. A pear-shaped Schwannoma can cause sudden or gradual loss of hearing in an ear. As the tumor progresses, it can press on the nerves that control movement and feeling in the face, and cause headaches and facial numbness or tingling. The patient may have trouble walking, swallowing, or controlling eye movements, and the sense of taste can be affected. A Schwannoma that grows large enough to press on the brainstem can be deadly.

CHILDHOOD BRAIN TUMORS. Brain tumors that occur in children are described as supratentorial (in the upper part of the brain) or infratentorial (in the lowest part of the brain). Astrocytomas and ependymomas are common supratentorial tumors. Infratentorial tumors include medulloblastomas, astrocytomas, and ependymomas.

— Rosalyn Carson-DeWitt, M.D.

Key Terms: Angiogram, Anti-convulsant drugs, Brain scan, Computerized tomography (CT) scan, Magnetic resonance imaging, Myelogram, Neurological exam, Seizures, Steroids.

Definition

Like all other parts of the body, the brain and central nervous system are made up of cells that ordinarily grow and divide to create new cells as needed. This is usually an orderly process; but when cells lose their ability to grow normally or to die off naturally, they divide too often and produce tumors that are made up of these extra cells.

Description

The brain and spinal cord together comprise what is known as the central nervous system (CNS). Like all tumors in the body, CNS tumors are either benign or malignant. Benign tumors are called non-cancerous because they have precise borders, are not invasive, and the cells that make up the growth are similar to other normal cells and grow relatively slowly. However, benign CNS tumors can press on a specific region of the spinal cord or brain and, thereby, cause symptoms. However, when such a benign tumor develops in an area that interferes with essential nervous system functioning, it is treated as malignant.

Malignant, or cancerous, tumors of the central nervous system are likely to be fast-growing, are invasive into surrounding healthy tissue, and the cells are very different from normal cells. These tumors can create a life-threatening situation by stopping vital functions of the brain. Some cancerous CNS tumors do not put out roots nor do they grow rapidly. These tumors are described as being encapsulated.

Another way that brain and central nervous system tumors are classified is by site of origin. Those that actually develop in the brain or spinal cord are called primary CNS tumors. Metastasis to the brain or spinal cord is, for the most part, a one-way street, meaning these tumors almost never metastasize to other areas in the body. The tumors that develop elsewhere in the body and metastasize, or spread, to the central nervous system are considered to be secondary CNS tumors. Such metastatic cells do not resemble other CNS cells. Instead, they have the same appearance as the cancer cells at the original cancer site elsewhere in the body.

Frequently observed signs of a brain tumor are the following:

• severe headaches
• an ataxic, or stumbling, gait
• nausea and vomiting
• lack of coordination
• unusual drowsiness
• weakness or loss of feelings in the arms and legs
• changes in personality or memory
• changes in speech
• changes in vision or abnormal eye movements
• seizures

Approximately 1 1/2% of all diagnosed cancers are CNS cancers, and they account for about 2 1/2% of all cancer deaths. The American Cancer Society (ACS) estimates that in 2001 17,200 malignant tumors of the brain or spinal cord will be diagnosed in adults and children in the United States. Of those people diagnosed, ACS projects that 13,100 will die from malignant CNS tumors.

Typically, diagnosis of CNS tumor is made by a physician who does a complete physical examination, including a family history and neurological examination. Computerized tomography (CT) scans, magnetic resonance imaging (MRI) scans, skull x rays, brain scans, angiograms, or myelograms are among the means of visualizing the brain or spinal cord to search for tumors.

General categories of treatment methods for CNS tumors include surgery, radiation therapy, and chemotherapy, with surgery being the single most commonly used therapy. Steroids are usually given prior to treatment to decrease swelling, and anti-convulsant drugs may be given to prevent seizures.

Types of Cancers

Primary brain tumors are also classified by their site of origin. Gliomas, occurring in the glial, or supportive tissues around the brain, are the most common. Gliomas are further broken down into the following variations:

• Astrocytomas are named for the star-shaped, small cells that they are comprised of. Children may develop these in their brain stem, cerebrum, or cerebellum, while adults commonly develop them in the cerebrum.
• Brain-stem gliomas are usually astrocytomas that originate in the bottom, stem-like portion of the brain. Because this area controls many essential bodily functions, such tumors often cannot be removed.
• Ependymomas occur in the linings of the four brain ventricles, or chambers, or along the spinal cord. These are more common in children.
• Oligodendrogliomas are very rare and, when seen, are usually found in middle-aged adults. They grow slowly and ordinarily do not invade surrounding brain or spinal cord tissue. They originate in the cells responsible for the manufacture of myelin, a fatty covering for nerve tissue.

Other CNS tumors do not originate in glial tissue. Among these are:

• Medulloblastomas, tumors of the cerebellum, are most common in male children. Studies have shown these to originate in primitive nerve cells that normally would have disappeared soon after birth.
• Meningiomas are usually benign. They develop in the meninges, or brain linings, and grow very slowly. Because of this slow growth, they may go undetected for years. Meningiomas are more common in women between the ages of 30 and 50.
• Schwannomas are also benign tumors, specific to the myelin-producing cells (Schwann cells) for the acoustic, or hearing, nerve. These, too, are more common in women than men.
• Craniopharyngiomas are usually benign, but because of their location near the pituitary gland and hypothalmus, they can easily affect vital functions and are therefore treated as if malignant. They occur more frequently in children and teenagers.
• Germinomas, or germ cell tumors, develop from primitive sex cells called germ cells.
• Pineal-region tumors originate in the area near the pineal gland, a small central brain gland that secretes melatonin, a brain chemical. These can be either fast-growing pineoblastoma, or slow-growing pineocytoma.

Resources

Organizations

The American Cancer Society's Resource Center for Brain/Central Nervous System Tumors in Children. (800) ACS-2345.

Cancer Care, Inc. (800) 813-4673. .

National Cancer Institute. .

—Joan Schonbeck, R.N.

The noun has one meaning:

Meaning #1: a tumor in the brain
  Synonym: brain tumour

Brain tumor
Classification & external resources

CT scan of brain showing brain cancer to left parietal lobe in the peri-ventricular area.
ICD-10	C71, D33.0-D33.2
ICD-9	191, 225.0
DiseasesDB	30781
MedlinePlus	007222 000768
eMedicine	emerg/334

A brain tumor is any intracranial tumor created by abnormal and uncontrolled cell division, normally either in the brain itself (neurons, glial cells (astrocytes, oligodendrocytes, ependymal cells), lymphatic tissue, blood vessels), in the cranial nerves (myelin-producing Schwann cells), in the brain envelopes (meninges), skull, pituitary and pineal gland, or spread from cancers primarily located in other organs (metastatic tumors). Primary (true) brain tumors are commonly located in the posterior cranial fossa in children and in the anterior two-thirds of the cerebral hemispheres in adults, although they can affect any part of the brain. In the United States in the year 2005, it was estimated that there were 43,800 new cases of brain tumors (Central Brain Tumor Registry of the United States, Primary Brain Tumors in the United States, Statistical Report, 2005 - 2006) ^[1], which accounted for 1.4 percent of all cancers, 2.4 percent of all cancer deaths^[2], and 20–25 percent of pediatric cancers^[2][3]. Ultimately, it is estimated that there are 13,000 deaths/year as a result of brain tumors^[1].

Classification

Primary tumors

Tumors occurring in the brain include: astrocytoma, pilocytic astrocytoma, dysembryoplastic neuroepithelial tumor, oligodendrogliomas, ependymoma, glioblastoma multiforme, mixed gliomas, oligoastrocytomas, medulloblastoma, retinoblastoma, neuroblastoma, germinoma and teratoma.

Most primary brain tumors originate from glia (gliomas) such as astrocytes (astrocytomas), oligodendrocytes (oligodendrogliomas), or ependymal cells (ependymoma). There are also mixed forms, with both an astrocytic and an oligodendroglial cell component. These are called mixed gliomas or oligoastrocytomas. Plus, mixed glio-neuronal tumors (tumors displaying a neuronal, as well as a glial component, e.g. gangliogliomas, disembryoplastic neuroepithelial tumors) and tumors originating from neuronal cells (e.g. gangliocytoma, central gangliocytoma) can also be encountered.

Other varieties of primary brain tumors include: primitive neuroectodermal tumors (PNET, e.g. medulloblastoma, medulloepithelioma, neuroblastoma, retinoblastoma, ependymoblastoma), tumors of the pineal parenchyma (e.g. pineocytoma, pineoblastoma), ependymal cell tumors, choroid plexus tumors, neuroepithelial tumors of uncertain origin (e.g. gliomatosis cerebri, astroblastoma), etc.

From a histological perspective, astrocytomas, oligondedrogliomas, oligoastrocytomas, and teratomas may be benign or malignant. Glioblastoma multiforme represents the most aggressive variety of malignant glioma. At the opposite end of the spectrum, there are so-called pilocytic astrocytomas, a distinct variety of astrocytic tumors. The majority of them are located in the posterior cranial fossa, affect mainly children and young adults, and have a clinically favorable course and prognosis. Teratomas and other germ cell tumors also may have a favorable prognosis, although they have the capacity to grow very large.

Another type of primary intracranial tumor is primary cerebral lymphoma, also known as primary CNS lymphoma, which is a type of non-Hodgkin's lymphoma that is much more prevalent in those with severe immunosuppression, e.g. AIDS.

In contrast to other types of cancer, primary brain tumors rarely metastasize, and in this rare event, the tumor cells spread within the skull and spinal canal through the cerebrospinal fluid, rather than via bloodstream to other organs.

There are various classification systems currently in use for primary brain tumors, the most common being the World Health Organization (WHO) brain tumor classification, introduced in 1993.

Secondary tumors and non-tumor lesions

Secondary or metastatic brain tumors originate from malignant tumors (cancers) located primarily in other organs. Their incidence is higher than that of primary brain tumors. The most frequent types of metastatic brain tumors originate in the lung, skin (malignant melanoma), kidney (hypernephroma), breast (breast carcinoma), and colon (colon carcinoma). These tumor cells reach the brain via the blood-stream.

Some non-tumoral masses and lesions can mimic tumors of the central nervous system. These include tuberculosis of the brain, cerebral abscess (commonly in toxoplasmosis), and hamartomas (for example, in tuberous sclerosis and von Recklinghausen neurofibromatosis).

Symptoms of brain tumors may depend on two factors: tumor size (volume) and tumor location. The time point of symptom onset in the course of disease correlates in many cases with the nature of the tumor ("benign", i.e. slow-growing/late symptom onset, or malignant (fast growing/early symptom onset).

Many low-grade (benign) tumors can remain asymptomatic (symptom-free) for years and they may accidentally be discovered by imaging exams for unrelated reasons (such as a minor trauma).

New onset of epilepsy^[4] is a frequent reason for seeking medical attention in brain tumor cases.

Large tumors or tumors with extensive perifocal swelling edema inevitably lead to elevated intracranial pressure (intracranial hypertension), which translates clinically into headaches, vomiting (sometimes without nausea), altered state of consciousness (somnolence, coma), dilatation of the pupil on the side of the lesion (anisocoria), papilledema (prominent optic disc at the funduscopic examination). However, even small tumors obstructing the passage of cerebrospinal fluid (CSF) may cause early signs of increased intracranial pressure. Increased intracranial pressure may result in herniation (i.e. displacement) of certain parts of the brain, such as the cerebellar tonsils or the temporal uncus, resulting in lethal brainstem compression. In young children, elevated intracranial pressure may cause an increase in the diameter of the skull and bulging of the fontanelles.

Depending on the tumor location and the damage it may have caused to surrounding brain structures, either through compression or infiltration, any type of focal neurologic symptoms may occur, such as cognitive and behavioral impairment, personality changes, hemiparesis, (hemi) hypesthesia, aphasia, ataxia, visual field impairment, facial paralysis, double vision, tremor etc. These symptoms are not specific for brain tumors - they may be caused by a large variety of neurologic conditions (e.g. stroke, traumatic brain injury). What counts, however, is the location of the lesion and the functional systems (e.g. motor, sensory, visual, etc.) it affects.

A bilateral temporal visual field defect (bitemporal hemianopia—due to compression of the optic chiasm), often associated with endocrine disfunction—either hypopituitarism or hyperproduction of pituitary hormones and hyperprolactinemia is suggestive of a pituitary tumor.

Brain tumors in infants and children

In 2000 approximately 2.76 children per 100,000 will be affected by a CNS tumor in the United States each year. This rate has been increasing and by 2005 was 3.0 children per 100,000. This is approximately 2,500-3,000 pediatric brain tumors occurring each year in the US. The tumor incidence is increasing by about 2.7% per year. The CNS Cancer survival rate in children is approximately 60%.^[5] However, this rate varies with the age of onset (younger has higher mortality) and cancer type.

In children under 2, about 70% of brain tumors are medulloblastoma, ependymoma, and low-grade glioma. Less commonly, and seen usually in infants, are teratoma and atypical teratoid rhabdoid tumor.^[6]

Diagnosis

Although there is no specific clinical symptom or sign for brain tumors, slowly progressive focal neurologic signs and signs of elevated intracranial pressure, as well as epilepsy in a patient with a negative history for epilepsy should raise red flags. However, a sudden onset of symptoms, such as an epileptic seizure in a patient with no prior history of epilepsy, sudden intracranial hypertension (this may be due to bleeding within the tumor, brain swelling or obstruction of cerebrospinal fluid's passage) is also possible.

Symptoms include phantom odors and tastes. Often, in the case of metastatic tumors, the smell of vulcanized rubber is prevalent. ^{[citation needed]}

Imaging plays a central role in the diagnosis of brain tumors. Early imaging methods—invasive and sometimes dangerous—such as pneumoencephalography and cerebral angiography, have been abandoned in recent times in favor of non-invasive, high-resolution modalities, such as computed tomography (CT) and especially magnetic resonance imaging (MRI). Benign brain tumors often show up as hypodense (darker than brain tissue) mass lesions on cranial CT-scans. On MRI, they appear either hypo- (darker than brain tissue) or isointense (same intensity as brain tissue) on T1-weighted scans, or hyperintense (brighter than brain tissue) on T2-weighted MRI. Perifocal edema also appears hyperintense on T2-weighted MRI. Contrast agent uptake, sometimes in characteristic patterns, can be demonstrated on either CT or MRI-scans in most malignant primary and metastatic brain tumors. This is due to the fact that these tumors disrupt the normal functioning of the blood-brain barrier and lead to an increase in its permeability.

Electrophysiological exams, such as electroencephalography (EEG) play a marginal role in the diagnosis of brain tumors.

The definitive diagnosis of brain tumor can only be confirmed by histological examination of tumor tissue samples obtained either by means of brain biopsy or open surgery. The histologic examination is essential for determining the appropriate treatment and the correct prognosis.

Treatment and prognosis

Meningiomas, with the exception of some tumors located at the skull base, can be successfully removed surgically, but the chances are less than 50%. In more difficult cases, stereotactic radiosurgery, such as Gamma Knife radiosurgery, remains a viable option.

Most pituitary adenomas can be removed surgically, often using a minimally invasive approach through the nasal cavity and skull base (trans-nasal, trans-sphenoidal approach). Large pituitary adenomas require a craniotomy (opening of the skull) for their removal. Radiotherapy, including stereotactic approaches, is reserved for the inoperable cases.

Although there is no generally accepted therapeutic management for primary brain tumors, a surgical attempt at tumor removal or at least cytoreduction (that is, removal of as much tumor as possible, in order to reduce the number of tumor cells available for proliferation) is considered in most cases^[7]. However, due to the infiltrative nature of these lesions, tumor recurrence, even following an apparently complete surgical removal, is not uncommon. Postoperative radiotherapy and chemotherapy are integral parts of the therapeutic standard for malignant tumors. Radiotherapy may also be administered in cases of "low-grade" gliomas, when a significant tumor burden reduction could not be achieved surgically.

Survival rates in primary brain tumors depend on the type of tumor, age, functional status of the patient, the extent of surgical tumor removal, to mention just a few factors^[8].

Patients with benign gliomas may survive for many years^[9][10] while survival in most cases of glioblastoma multiforme is limited to a few months after diagnosis.

The main treatment option for single metastatic tumors is surgical removal, followed by radiotherapy and/or chemotherapy. Multiple metastatic tumors are generally treated with radiotherapy and chemotherapy. Stereotactic radiosurgery, such as Gamma Knife radiosurgery, remains a viable option. However, the prognosis in such cases is determined by the primary tumor, and it is generally poor.

A shunt operation is used not as a cure but to relieve the symptoms.[1] The hydrocephalus caused by the blocking drainage of the cerebrospinal fluid can be removed with this operation.

References

1. ^ ^{a b} Greenlee RT, Murray T, Bolden S, Wingo PA. Cancer statistics, 2000. CA Cancer J Clin 2000;50:7-33. PDF. PMID 10735013.
2. ^ ^{a b} American Cancer Society. Accessed June 2000.
3. ^ Chamberlain MC, Kormanik PA. Practical guidelines for the treatment of malignant gliomas. West J Med 1998;168:114-120. PMID 9499745.
4. ^ Lopez MBS, Laws ER Jr. Neurosurgical Focus 12(2), Article 1, 2002.
5. ^ See Table 11.2 Survival Rate
6. ^ Infantile Brain Tumors by Brian Rood for The Childhood Brain Tumor Foundation (accessed July 2007)
7. ^ Nakamura M, Konishi N, Tsunoda S, Nakase H, Tsuzuki T, Aoki H, Sakitani H, Inui T, Sakaki T. Analysis of prognostic and survival factors related to treatment of low-grade astrocytomas in adults. Oncology 2000;58:108-16. PMID 10705237.
8. ^ Nicolato A, Gerosa MA, Fina P, Iuzzolino P, Giorgiutti F, Bricolo A. Prognostic factors in low-grade supratentorial astrocytomas: a uni-multivariate statistical analysis in 76 surgically treated adult patients. Surg Neurol 1995;44:208-21; discussion 221-3. PMID 8545771.
9. ^ Janny P, Cure H, Mohr M, Heldt N, Kwiatkowski F, Lemaire JJ, Plagne R, Rozan R. Low grade supratentorial astrocytomas. Management and prognostic factors. Cancer 1994;73:1937-45. PMID 8137221.
10. ^ Piepmeier J, Christopher S, Spencer D, Byrne T, Kim J, Knisel JP, Lacy J, Tsukerman L, Makuch R. Variations in the natural history and survival of patients with supratentorial low-grade astrocytomas. Neurosurgery 1996;38:872-8; discussion 878-9. PMID 8727811.

See also

• List of notable brain tumor resources
• List of notable brain tumor patients

Pathology: Tumors, neoplasia, and oncology (C00-D48, 140-239)
Benign tumors	Hyperplasia - Cyst - Pseudocyst - Hamartoma - Benign neoplasm
Malignant progression	Dysplasia - Carcinoma in situ - Invasive cancer - Metastasis
Topography	Anus - Bladder - Blood - Bile duct - Bone - Brain - Breast - Cervix - Colon/rectum - Endometrium - Esophagus - Eye - Gallbladder - Head/Neck - Liver - Kidney - Larynx - Lung - Mediastinum (chest) - Mouth - Ovaries - Pancreas - Penis - Prostate - Skin - Small intestine - Stomach - Tailbone - Testicles - Thyroid
Misc.	Tumor suppressor genes/oncogenes - Staging/grading - Carcinogenesis - Carcinogen - Research - Paraneoplastic syndrome - List of oncology-related terms

Nervous tissue tumors (ICD-O 9350-9589)
Miscellaneous tumors (9350-9370)	Craniopharyngioma - Pinealoma
Glioma (9380-9480)	Gliomatosis cerebri - Oligoastrocytoma - Ependymoma - Astrocytoma (Pilocytic astrocytoma, Glioblastoma multiforme) - Dysembryoplastic neuroepithelial tumour - Oligodendroglioma - Medulloblastoma - Primitive neuroectodermal tumor
Neuroepitheliomatous (9490-9520)	Ganglioneuroma - Neuroblastoma - Atypical teratoid rhabdoid tumor - Retinoblastoma
Meningiomas (9530)	Meningioma
Nerve sheath tumor (9540-9570)	Neurofibroma (Neurofibrosarcoma, Neurofibromatosis) - Schwannoma - Neurinoma - Acoustic neuroma - Neuroma
see also brain tumors (though not all brain tumors are of nervous tissue)

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