MR KEITH GOMES

Melbourne Brain and Spinal Neurosurgeon

Brain Tumours

Cranial Conditions

Brain tumours can be defined as an abnormal growth of tissue in or around the brain. A brain tumour can occur in the brain tissue, the lining of the brain or its’ associated glands such as the pituitary. There are multiple different types of brain tumours and specific causes remain unknown.

A brain tumour may be a primary or secondary. Primary brain tumours originate in or next to the brain. Most common adult primary brain tumours are meningiomas and gliomas such as astrocytoma and glioblastoma (GBM). Secondary brain tumours or metastasis are tumours that have spread to the brain from somewhere else in the body. Secondary brain tumours have started as cancer elsewhere in the body. For example, metastatic breast cancer began as cancer in the breast which has spread to the brain.

Tumours in other parts of the body are often classified as benign or malignant. The terms ‘malignant’ and ‘benign’ are not used in the official classification of primary brain tumours. Instead, brain tumours are graded I-IV based on how the tissue looks under a microscope and their molecular characteristics. The term ‘benign’ may be used to describe some brain tumours such as meningiomas because this type of brain tumour has a distinct border and does not spread. The term ‘benign’ and ‘malignant’ are not used to describe gliomas. A low-grade glioma for example is a type of brain tumour that grows slowly but does spread through the brain. Rapidly growing gliomas are called high-grade.

Grades of primary brain tumours

The grades of primary brain tumours are linked to outcomes and prognosis related to that tumour type. The grades help determine what treatment is used.

Grade I

Unlikely to spread to other parts of the brain
Distinct and well-defined border.
Treated with observation, surgery or radiotherapy alone, this treatment is usually curative. Complete removal of the tumour may be the only treatment required.

Grade II

Referred to as low grade
Grows slowly and can spread through the brain
Treatment may include observation, surgery, radiotherapy, chemotherapy, or a combination of these.

Grade III

Tends to grow more quickly than grade II tumours.
Spreads to adjacent normal brain tissue
Often referred to as anaplastic
Treatment usually includes a combination of surgery, radiotherapy, and chemotherapy.

Grade IV

Rapidly- growing
Treatment usually includes a combination of surgery, radiotherapy, and chemotherapy.

Symptoms

Patients with brain tumours can present with a variety of signs and symptoms. The most common symptoms include seizure, headache, nausea and vomiting, arm or leg weakness, visual problems, speech problems, confusion and balance or coordination problems.

Diagnosis of brain tumours

There are a number of types of imaging available to help with diagnosis of brain tumours.

The two main types of imaging used are computed tomography (CT) and magnetic resonance imaging (MRI). When a patient presents with signs and symptoms that may be caused by a brain tumour, the first scan performed is usually a CT. If an abnormality is seen, your doctor will usually order an MRI scan. An MRI scan can provide a radiological diagnosis of a presumed brain tumour, it cannot provide a definitive diagnosis. An accurate diagnosis can only be made with a tissue sample that is examined and reported by a neuropathologist.

If a secondary brain tumour (metastasis) is suspected other investigations including a CT chest, abdomen and pelvis may be performed to pick up tumours elsewhere in the body.

Treatment of brain tumours

The treatment of brain tumours can range from observation to other treatment options including surgery, radiotherapy, chemotherapy or specific combinations of these over a variable period of time. Treatments are comprehensively planned with the involvement of the patient, patients’ general practitioner (GP), neurosurgeon, radiation oncologists and medical oncologists. Treatment used is based on patients’ individual circumstances such as overall health and type of brain tumour.

Surgery

Surgery is usually the first treatment used for a brain tumour. The aims of surgery include removal of as much of a tumour as possible, while preserving function and establishing a definitive diagnosis.

Surgical options may include a craniotomy or a biopsy. A craniotomy is an open operation to usually remove as much of the tumour as possible. A biopsy is an operation where a piece of tissue is taken for diagnosis. Benefits, risks, duration and post-operative care of surgery will be discussed at the time of consultation.

Radiotherapy

Radiation can destroy tumour cells or delay tumour growth. It may be given to the entire brain or to a specific region of the brain. Radiotherapy is usually given in small doses over several weeks. For high-grade tumours, radiotherapy is given in combination with chemotherapy, usually following surgery

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells and can involve a various combination of drugs. The goals of chemotherapy in the treatment of brain tumours are to destroy the cancer cells left after surgery and slow tumour growth. Chemotherapy is typically given after surgery and may be given in combination with radiotherapy. The most common form of oral drug generally used for high-grade tumours is called temazolamide.

Follow up after surgery

Post-surgery you will be reviewed by Mr Keith Gomes approximately eight weeks post discharge. This can be shorter if deemed necessary. We usually recommend one review with your GP 7-10 days post discharge from hospital for a wound and medication check. A discharge summary will be provided by the hospital for you to give to your GP, a letter from Mr Gomes’ room will also be sent to your GP.

When to refer to a neurosurgeon:

If you have a patient with a brain tumour or suspected brain tumour, please call Mr Keith Gomes to discuss these cases directly on 03 8318 4929.

For all appointments and enquiries, please phone 03 8318 4929

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Mayfair Specialist Centre
Level 7
250 Victoria Parade
East Melbourne VIC 3002

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