Brain tumors are growths of abnormal cells in the brain. Brain tumors can be either malignant (cancerous) or benign (non-cancerous). The prognosis and treatment options for brain tumors depend on the type, size, location and stage of the tumor. Brain tumors are staged based on their growth and how far they have spread. The staging helps determine outlook and guide treatment.
What are the stages of a brain tumor?
There are four stages of brain tumors:
| Stage | Description |
|---|---|
| Stage I | The tumor is localized and has not spread to surrounding tissues. |
| Stage II | The tumor is larger than stage I, but has not spread. |
| Stage III | The tumor is larger than stage II, and has spread to surrounding tissues. |
| Stage IV | The tumor is any size and has spread to other parts of the brain or spine. |
The higher the stage, the more advanced the cancer. Stage I and II tumors are considered low grade, while stage III and IV are high grade.
Can late stage brain tumors be cured?
Whether late stage brain tumors can be cured depends on the type of tumor and other factors.
Glioblastoma, the most common and aggressive malignant brain tumor, is very difficult to cure once it reaches stage IV. Even with treatment, the 5-year survival rate for glioblastoma stage IV is less than 5%.
However, some other types of brain tumors have a better prognosis at late stages. For example, about 40% of people with stage IV medulloblastoma, a malignant brain tumor, are cured with treatment.
In general, the prognosis is better if the tumor is low-grade, localized, and treatable with surgery. Younger patients also tend to have better outcomes.
So while many late stage brain tumors remain incurable, treatment can prolong life and even cure some types of tumors. The prognosis depends on individual factors.
Treatment options for late stage brain tumors
Several treatments may help prolong survival and manage symptoms for late stage brain tumors:
Surgery
Surgery is usually the first treatment for brain tumors when possible. The goal is to remove as much of the tumor as safely possible. Debulking the tumor can help reduce symptoms and prolong survival.
However, late stage brain tumors may be too large or located in delicate areas that make surgery risky. If the entire tumor cannot be removed, debulking surgery can still provide some benefit.
Radiation therapy
Radiation uses high energy beams to kill tumor cells and shrink tumors. Traditional external beam radiation delivers radiation from outside the body.
Stereotactic radiosurgery (SRS) is a precise radiation therapy that targets the tumor while minimizing damage to surrounding tissues. SRS can sometimes treat tumors considered inoperable.
Whole brain radiation may help treat metastases at stage IV. Side effects of radiation can include fatigue, skin irritation, hair loss and cognitive decline.
Chemotherapy
Chemotherapy uses drugs to destroy cancer cells. Chemotherapy may prolong survival in some cases, especially when combined with radiation. Temozolomide is a chemotherapy drug often used for glioblastoma.
Chemotherapy side effects depend on the drugs but may include nausea, hair loss, fatigue and lowered blood counts.
Targeted therapy
Targeted therapies are drugs that specifically attack molecular abnormalities in cancer cells. Examples include bevacizumab, cetuximab and nivolumab. These may prolong progression-free survival.
Supportive care
Supportive care aims to maximize quality of life and relieve symptoms. Corticosteroids can reduce brain swelling, anticonvulsants help seizures, and pain management provides comfort. Palliative care can also help patients and families cope with emotional and practical challenges.
Prognosis and life expectancy
Prognosis and life expectancy for late stage brain tumors depend on:
– Type of tumor – Glioblastoma has worse prognosis than slower growing tumors.
– Grade of tumor – High grade tumors are more aggressive.
– Age – Younger patients often have better outcomes.
– Performance status – Better premorbid functioning predicts longer survival.
– Extent of spread – Widespread metastasis carries worse prognosis.
– Genetic markers – Some molecular markers indicate better or worse prognosis.
– Treatment – Aggressive treatment may prolong life.
Without treatment, survival is usually 3-6 months for glioblastoma. With treatment, median survival is about 12-18 months for glioblastoma stage IV. But some patients live several years with treatment.
Slow growing grade II tumors like astrocytoma may allow 5-10 years of survival at stage IV. Each patient’s outlook is unique.
Improving quality of life
While late stage brain tumors are often incurable, quality of life can still be improved with:
– Symptom management – Corticosteroids, pain medication, anticonvulsants.
– Rehabilitation – Physical, occupational and speech therapy.
– Nutritional support – Feed tubes or IV supplementation if needed.
– Emotional support – Counseling, support groups, social work.
– Palliative care – Focuses on comfort and quality of life.
– Clinical trials – Cutting edge treatments being studied.
– Complementary therapies – Acupuncture, massage, meditation may help some patients.
The goal is to optimize functioning and comfort even when a brain tumor cannot be cured. Patients should discuss options with their healthcare team. Quality of life depends on the patient’s priorities and preferences.
Conclusion
While late stage brain tumors are challenging to treat, outcomes vary greatly depending on the type and grade of tumor. Glioblastoma stage IV has a poor prognosis, with most patients surviving 12-18 months with treatment. However, some types like medulloblastoma have higher cure rates even at stage IV. Younger patients with good functional status and certain genetic markers tend to have better survival.
Treatment focuses on prolonging life while maintaining quality of life. Options include surgery, radiation, chemotherapy, targeted therapy, and symptom management. Although many late stage brain tumors remain incurable, treatment can substantially prolong survival and help patients live as well as possible. Patients should discuss personalized prognosis and treatment options with their medical team. With an individualized approach, life expectancy and quality of life can be improved even for advanced brain tumors.