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Neuro-oncology

The UK Neuro-oncology clinic offers an integrated, multispecialty program for the diagnosis and treatment of patients with primary and secondary central nervous system tumors.

The clinic allows quick evaluation, treatment expertise and access to new therapies and clinical trials all under one roof. The multispecialty program allows for a neurosurgeon, a neuro-oncologist and radiation medicine experts to see patients in one visit, creating more time for the patient as well as the doctors.

The clinical programs and services of the neuro-oncology program are integrated with the Markey Cancer Center. The Markey specialty teams work together with UK Chandler Hospital departments and divisions to provide primary patient care and support services as well as advanced specialty care with applicable clinical trials. All diagnostic services, clinical and pathology laboratories, operating rooms, emergent and intensive care, and radiation therapy services are also provided to cancer patients through UK Chandler Hospital.

Due to the complexity of cancer, the Markey Cancer Center takes a team approach to cancer treatment. Our teams include a dedicated primary nurse, an oncology nurse care manager, a dietitian, a social worker, a pharmacist, a chaplain, volunteers and a physical or enterostomal therapist if necessary. However, the most important members of our teams are our patients and their families.

  • Locations

    Clinics

    Kentucky Neuroscience Institute

    Kentucky Clinic building

    UK Kentucky Clinic

    First Floor, Wing C
    740 S. Limestone
    Lexington KY 40536
    Fax 859-323-1127

    Monday - Friday: 8:00 am-5:00 pm

    (across from Starbucks)

  • Motor & Sensory Abnormalities

    The specific neurological abnormalities that a person with a brain tumor experiences vary from person to person and depend on where in the brain the tumor is located. For example, if the tumor invades the motor regions of the brain (areas responsible for movement of the skeletal muscles, such as those in the arms and legs), patients can show signs of motor weakness on the opposite side of the body (one side of the brain controls the opposite side of the body). The arms and legs on the opposite side of the body may be stiff or move awkwardly.

    When the areas of the brain responsible for sensing the environment - the sensory structures - are damaged, a person may feel tingling, numbness or other odd sensations.

    People may not be able to recognize parts of their environment. For example, if the tumor obstructs the visual pathways, in addition to vision loss, patients may not be able to recognize objects by looking at them. If the tumor is in the temporal lobe of the brain, a person may see hallucinations or experience other unusual perceptions. If the tumor is in the frontal lobe, a patient may have bowel and bladder problems.

  • Neuro-oncology Treatment Options

    Different types of treatments are available for patients with brain tumors. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials.

    Surgery is used, when possible, to treat adult brain tumor. The tumor is first diagnosed and next removed in surgery. If a brain tumor is suspected, a biopsy is done by removing part of the skull and using a needle to remove a sample of the brain tissue. A pathologist views the tissue under a microscope to look for cancer cells. If cancer cells are found, the doctor will remove as much tumor as safely possible during the same surgery. An MRI may then be done to determine if any cancer cells remain after surgery. Tests are also done to find out the grade of the tumor.

    Radiation therapy uses high-energy X-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy:

    • External radiation therapy uses a machine outside the body to send radiation toward the cancer.
    • Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires or catheters that are placed directly into or near the cancer. How the radiation therapy is given depends on the type and stage of the cancer being treated.

    There are also several newer methods of delivering radiation therapy, including:

    • Radiosensitizers: Drugs that make tumor cells more sensitive to radiation. Combining radiation with radiosensitizers may kill more tumor cells.
    • Hyperfractionation: Radiation therapy given in smaller-than-usual doses two or three times a day instead of once a day.
    • Stereotactic radiosurgery: A radiation therapy technique that delivers radiation directly to the tumor with less damage to healthy tissue. The doctor uses a CT scan or MRI to find the exact location of the tumor. A rigid head frame is attached to the skull and a high dose of radiation is directed to the tumor through openings in the head frame, reducing the amount of radiation given to normal brain tissue. This procedure does not involve surgery. This is also known as stereotaxic radiosurgery or Gamma Knife therapy.

    Chemotherapy uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). A dissolving wafer may be used to deliver an anticancer drug directly into the brain tumor site after the tumor has been removed by surgery. How the chemotherapy is given depends on the type and stage of the cancer being treated.

    With Gamma Knife radiosurgery, our neuroscience team can treat neurological (brain) disorders and diseases without invasive surgery. The system's leading-edge technology allows our specialists to operate on the brain without general anesthesia or incisions.

    Hyperthermia therapy exposes body tissue to high temperatures to damage and kill cancer cells or to make cancer cells more sensitive to the effects of radiation and certain anticancer drugs.

    Biologic therapy uses the patient's immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct or restore the body's natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.

    Treatment in a Clinical Trial

    For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.

    Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.

    Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

    Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from coming back or reduce the side effects of cancer treatment.

    Tumors that have spread to the brain from somewhere else in the body are usually treated with radiation therapy and/or surgery. Chemotherapy may be used if the primary tumor is the kind that responds well to chemotherapy. Clinical trials are under way to study new treatments.

  • Symptoms of Brain Tumors

    A brain tumor is a mass of cells that grows over time and expands inside the brain. This expansion causes two general types of symptoms:

    • Increased pressure inside the head (intracranial pressure)
    • Disrupted brain function

    The increased intracranial pressure can result from the growing tumor itself, swelling associated with metastatic tumors, or hydrocephalus (a swelling caused by the accumulation of too much cerebrospinal fluid) obstructing the normal flow of cerebral spinal fluid.

    Common symptoms patients notice include 

    • Headache
    • Nausea and vomiting
    • General confusion
    • Lethargy

    Headaches

    A new pattern or type of headache is the first noticeable symptom for about 20 percent of all people with brain tumors. Eventually, headaches will occur in more than 60 percent to 70 percent of all patients at some point in the course of their illness.

    The headache often is on the same side of the tumor but may be located anywhere on the head. Many headaches associated with brain tumors tend to be located on the frontal areas of the head (forehead/top of head). This happens not because the tumor is there, but rather because that is where the pain is referred (referred pain is pain that is felt somewhere different from where it originates).

    Headaches caused by brain tumors are usually non-throbbing and worse in the morning after lying flat all night, because pressure in the brain increases when the head is down. They may be worse with exertion. Most patients describe nausea and vomiting with the headache. If the tumor is obstructing the ventricles, the structures that contain the cerebrospinal fluid, the headache may get worse when a person changes position.

    These tumors occur in the glial cells, which help support and protect critical areas of the brain. Gliomas are the most common type of brain tumor in adults, responsible for about 42 percent of all adult brain tumors. Brain stem gliomas that are high-grade or spread widely throughout the brain stem are difficult to treat successfully. To prevent damage to healthy brain tissue, brain stem glioma is usually diagnosed without a biopsy. Gliomas are further characterized by the types of cells they affect:

    Seizures

    A seizure is a sudden, brief attack of uncontrolled motor activity or altered consciousness. Seizures occur in approximately 35 percent of all brain tumor patients. The probability of having a seizure depends on the location of the tumor, as some parts of the brain are more prone to seizure activity than others. Some seizures may be partial and involve only a single site in the brain. Others can affect the whole brain and result in loss of consciousness.

    Nausea and Vomiting

    When a person develops a new pattern of headaches in the morning coupled with vomiting, they should be further evaluated for the presence of a brain tumor. Even if this particular pattern doesn't develop, many people with brain tumors eventually develop chronic nausea and loss of appetite, which are presumably associated with the increased intracranial pressure (pressure within the skull compartment).

    Change in Cognitive Status

    Patients with tumors often develop changes in their cognitive abilities. These include difficulties remembering things, changes in personality or mood, lack of initiative, and poor judgment.

    Depending on where the tumor is located, a person may have reading, writing or speaking difficulties. It may be very difficult for some folks to engage in abstract reasoning, and some people may not be able to make decisions. Many people with brain tumors suffer from sleep disorders and restlessness and are unable to concentrate.

    When the function of the brain is disrupted by localized problems associated with a tumor, symptoms include:

    • Seizures
    • Speech and language problems
    • Visual problems
    • General weakness

    The particular symptom often reflects where in the brain the tumor is located.

    The various symptoms of neurological dysfunction occur no matter how slowly or quickly the tumor grows. In slow-growing tumors, however, the brain can sometimes accommodate for the growth of the tumor, and the symptoms may be less pronounced. When the tumor grows rapidly, the symptoms may occur very suddenly and intensely.

  • Diagnosis of Brain Tumors

    Magnetic resonance imaging (MRI) has established itself as an important clinical tool in the diagnosis of central nervous system diseases. While MRI indications in the body are expanding, evaluation of central nervous system diseases remains the most common application of MRI today.

    The complete imaging evaluation of patients with central nervous system diseases includes:

    • Detection
    • Characterization
    • Determination of tumor size
    • Biopsy

    A biopsy is usually required to definitely diagnose a brain tumor. The physician needs to know the tumor type and grade to plan the proper treatment. A biopsy involves removing a piece of the tumor for viewing under a microscope. This is critical for an accurate diagnosis.

  • Types of Central Nervous System Tumors

    There are many different types of brain tumors, based on what cells are affected and how they appear under a microscope. Tumors can be classified into four general categories: gliomas, meningiomas, acoustic neuroma and medulloblastoma.

    Gliomas occur in the glial cells, which help support and protect critical areas of the brain. Gliomas are the most common type of brain tumor in adults, responsible for about 42 percent of all adult brain tumors. Brain stem gliomas that are high-grade or spread widely throughout the brain stem are difficult to treat successfully. To prevent damage to healthy brain tissue, brain stem glioma is usually diagnosed without a biopsy.

    Gliomas are further characterized by the types of cells they affect:

    • Astrocytes: These are star-shaped cells that protect neurons. Tumors of these cells can spread from the primary site to other areas of the brain, but they rarely spread outside the central nervous system. Astrocytomas are graded from I to IV depending on the speed of progression:
      • Grade I (pilocytic astrocytoma): Slow growing, with little tendency to infiltrate surrounding brain tissue. Most common in children and adolescents.
      • Grade II (diffuse astrocytoma): Fairly slow-growing, with some tendency to infiltrate surrounding brain tissue. Mostly seen in young adults.
      • Grade III (anaplastic/malignant astrocytoma): These tumors grow rather quickly and infiltrate surrounding brain tissue.
      • Grade IV (glioblastoma multiforme, GBM): An extremely aggressive and lethal form of brain cancer. Unfortunately, it is the most common form of brain tumor in adults, accounting for 67 percent of all astrocytomas.
    • Oligodendroglioma: Oligodendrocytes are cells that make myelin, a fatty substance that forms a protective sheath around nerve cells. Oligodendrogliomas, which make up 4 percent of brain tumors, mostly affect people age 45 and older. Some subtypes of this tumor are particularly sensitive to treatment with radiation therapy and chemotherapy. Half of patients with oligodendrogliomas are still alive after five years.
    • Ependymoma: These tumors affect ependymal cells, which line the pathways that carry cerebrospinal fluid throughout the brain and spinal cord. Ependymomas are rare. They make up about 2 percent of all brain tumors, but they are the most common brain tumor in children. They generally don't affect healthy brain tissue and don't spread beyond the ependyma. Although these tumors respond well to surgery, particularly those on the spine, ependymomas cannot always be completely removed. The five-year survival rate for patients over age 45 approaches 70 percent.

    Meningiomas affect the meninges, the tissue that forms the protective outer covering of the brain and spine. One-quarter of all brain and spinal tumors are meningiomas, and up to 85 percent of them are benign. Meningiomas can occur at any age, but the incidence increases significantly in people over age 65. Women are twice as likely as men to have meningiomas. They generally grow very slowly and often don't produce any symptoms. In fact, many meningiomas are discovered by accident. Meningiomas can be successfully treated with surgery, but some patients, particularly the elderly, may be candidates for watchful waiting to monitor the disease.

    Acoustic neuroma/schwannomas: Schwann cells are found in the sheath that covers nerve cells. Vestibular schwannomas, also known as acoustic neuromas, arise from the eighth cranial nerve, which is responsible for hearing. Specific symptoms of vestibular schwannoma include buzzing or ringing in the ears, one-sided hearing loss and/or balance problems. Schwannomas are typically benign and respond well to surgery.

    Medulloblastoma is a common brain tumor in children, usually diagnosed before the age of 10. These tumors occur in the cerebellum, which has a crucial role in coordinating muscular movements. Some experts believe that medulloblastomas arise from fetal cells that remain in the cerebellum after birth. Tumors grow quickly and can invade neighboring portions of the brain, as well as spreading outside the central nervous system. Medulloblastoma is slightly more common in boys.