Brain tumors are a heterogeneous group of tumors, where some brain tumors are non-cancerous (benign), and some brain tumors are cancerous (malignant). Brain tumors can begin in the brain (primary brain tumors), or cancer can begin in another part of the body and spread to the brain as a metastasis (secondary brain tumor). Glioblastoma is the most common and aggressive brain tumor that inevitably recurs despite treatment.
Symptoms of brain tumors vary and depend on the tumor's size, location, and growth rate. General symptoms include headache, nausea, confusion, memory loss, personality changes, visual problems, and balance issues. Focal symptoms, which reflect the location of the tumor, include seizures, gradual loss of sensation or movement in an arm or a leg, speech difficulties, and hearing problems. Sometimes, a brain tumor is without symptoms and is accidentally discovered during examination for other medical conditions.
Clinical information about patients, including neurological examination, is the basis of the diagnosis of brain tumors. Neuroimaging of the brain/nervous system is also an important diagnostic tool and includes computer tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET). Tissue samples obtained from biopsies or open surgery are vital to characterizing and grading the tumors. Analyses of tumor factors (biomarkers) relevant to prognosis and prediction of treatment effects provide important information for treatment decision-making. They are performed with the latest molecular techniques at our center.
Treatment of brain tumors depends on the type of tumor, its size and location, as well as patient-related factors such as general condition, age, symptoms, other diseases, and medications. The decision on treatment is made in multidisciplinary conferences where different specialties are represented, including neuro oncologists, neurosurgeons, pathologists, and radiologists. Based on the information gained from the diagnostic procedures in combination with patient characteristics, a recommendation of treatment is made and discussed with the patient.
Surgery is an essential part of brain tumor treatment and aims to achieve maximal tumor resection, decompression, and histopathological diagnosis with maintained function of the patient. In cases of difficult tumor location, a biopsy can be an option for resection. The neurosurgery at our center is performed with integrated high-technology solutions, including fluorescence microscopy, neuro navigational equipment, intraoperative MRI, and endoscopic craniofacial surgery. Methods used to preserve neurological function include functional MRI, transcranial magnetic stimulation, intraoperative neurophysiological monitoring, and awake brain surgery. Our center was the first center in the Nordic countries to treat patients with laser interstitial thermal therapy (LITT), an emerging technique using lasers to treat brain tumors that can be hard to reach with conventional surgery. Gamma Knife, a high-precision stereotactic radiation therapy technique, was developed at our center and is now widely used worldwide to treat smaller tumors with high precision, preserving function in the surrounding brain and avoiding the risks of open surgery.
Radiation therapy is a treatment option either after surgery or as a primary treatment, depending on the type of tumor and the patient's conditions. Our center offers the different techniques for radiation therapy that may be required to individualize treatment, including external beam radiation using linear accelerators, proton therapy at our national proton therapy center located in Uppsala, and stereotactic radiosurgery using the Gamma Knife.
Medical treatments are given in combination with radiation therapy and/or surgery or alone as a single treatment. Chemotherapy is the most common form of medical treatment of brain tumors, with temozolomide, lomustine, and PCV (procarbazine, lomustine (CCNU), and vincristine) commonly used as chemotherapeutic agents. In some selected patients, targeted therapies may be used based on molecular analyses of the tumors. Tumor treating fields (TTFields), or Optune, is a new treatment modality used at our center. TTFields uses low-intensity, intermediate-frequency (200 kHz) alternating electric fields via transducer arrays applied to the scalp and has been shown to be of clinical benefit in selected glioblastoma patients.
Clinical trials and research are vital to improving brain tumor care and treatment and are an important part of our activities. Participation in clinical trials may give access to new treatments or effective treatment combinations against the tumor. Our doctors lead a variety of clinical trials that test new drugs or new combinations of therapies, including medical, surgical, and radiation therapy techniques. Research also involves identifying factors to diagnose better and predict the benefit of treatments, so-called biomarkers.
Our multidisciplinary neuro-oncology team includes experts specializing in brain tumor treatment; neuro oncologists, neurosurgeons, radiologists, pathologists, nurses, and other healthcare professionals focusing on brain tumor care. We offer comprehensive care for all patients, including support for families and relatives. As one of the largest university hospitals in Europe with a great number of patients, our experts have a very high level of expertise. Together with the world-renowned Karolinska Institutet, home of the Nobel Prize, we are leaders in research and development.