The prognosis for patients with tumors involving the brain is
A) poor.
B) always death.
C) good.
D) difficult to project.

Question

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Regardless of the tumor cell type, symptoms and signs result from displacement and compression of normal brain tissue by the tumor, causing progressive neurologic deficits, expansion of the brain (cerebral edema), and increased ICP (see Figure 13-26), leading to possible herniation. Common symptoms include headache (usually dull, constant, and worse at night), focal or generalized seizures (common in gliomas and secondary tumors), nausea and vomiting, syncope, cognitive dysfunction (including memory problems and personality changes), muscle weakness, sensory loss, aphasia, or visual dysfunction. Cerebellar tumors such as medulloblastoma often have the classic symptoms of gait disturbance, nystagmus, lethargy, dysarthric speech pattern, and balance difficulty. The evaluation of a patient with a suspected brain tumor includes a detailed history, a neurologic examination, and diagnostic neuroimaging studies. Neurologic examination findings are associated with particular regions affected by destruction of neural tissue. Cranial magnetic resonance imaging (MRI) is the diagnostic imaging modality of choice. A functional MRI, which measures blood flow through regions of the brain during various activities, or a positron emission tomography scan can be helpful for preoperative planning. Tissue obtained during surgery or from a stereotactic biopsy is necessary for correct histologic diagnosis of the tumor type. Only tumor grade and histologic classification are taken into account to estimate the malignant potential of the tumor. (Refer to Chapter 1 for staging and grading of cancer.)
Although brain tumors can be malignant or benign, the distinction is blurred in the brain. Unlike benign neoplasms in other locations of the body, benign brain tumors may cause the same symptoms as malignant cancers, such that distinguishing between benign and malignant on clinical grounds can be very difficult. Even a benign tumor with little to no metastatic potential can be lethal if it occurs in a region of the brain that precludes full surgical resection.
Benign and malignant neoplasms are often treated similarly. Patients with primary brain tumors must be treated for their symptoms and for their neoplasm. Symptomatic treatment includes use of anticonvulsants to treat seizures and corticosteroids to help decrease ICP. Surgery is the initial treatment for most tumors. It provides tissue samples for definitive diagnosis and relieves symptoms by reducing tumor bulk. The extent of surgery is limited by the goal of not inflicting incapacitating neurologic damage on the patient. Surgery is usually followed by radiotherapy and/or chemotherapy, depending on the tumor type and stage. Staging of most brain tumors uses a modified tumor, node, and metastasis system. The N component of the staging system is not very informative because the CNS does not contain lymphatic structures. Although still experimental, immunotherapy is showing promise as an additional modality to treat brain tumors.
Treatment of secondary brain tumors focuses on relief of neurologic symptoms and long-term tumor control. Treatment choice is based upon location, size, and number of metastases; patient age; neurologic status; and extent of systemic cancer. In general, patients with solitary brain lesions and no other sites of metastasis are candidates for treatment with surgery and whole brain radiation therapy. Although the patient may still be affected by extracranial disease, this treatment improves quality of life and reduces the likelihood of death resulting from neurologic causes. Patients with multiple or recurrent metastases are often treated with surgery or radiation with palliative intent.
It is important to remember that patients may be affected by the long-term complications of surgery, radiation, and chemotherapy in the years following treatment, especially children. Problems include neurocognitive defects, growth hormone deficiency, learning disability, loss of vision, and second malignancies.
Prognosis
The overall 5-year survival rate for all types of brain tumors combined is around 30% for adults and over 70% for children. Poor prognostic indicators include a high tumor grade, presence of mental changes at the time of diagnosis, large tumor size, and inability to fully resect the tumor during surgery.
Prevention
No methods are known to prevent intracranial neoplasms, and no screening programs are available for early detection.
Discuss that insults to the brain may result in neurocognitive functional deficits; in children, delayed growth and learning disabilities may occur.

The Prognosis for Patients with Tumors Involving the Brain Is