More than 17,000 people in the United States each year are diagnosed with a brain tumor. Some tumors are benign (noncancerous), and they can usually be removed and are not likely to recur. Others are malignant (cancerous); they interfere with vital functions and are life-threatening. Malignant brain tumors usually grow rapidly, crowding and invading tissue.

Primary brain tumors are cancers that arise in the brain and affect the central nervous system (CNS). Secondary brain tumors, which are 10 times more common, are cancers that originated elsewhere in the body and have metastasized (spread) to the brain.

A brain tumor can be accompanied by the following signs and symptoms.

• Headaches that often are worse in the morning
• Seizures (convulsions)
• Nausea or vomiting
• Weakness or loss of feeling in the arms or legs
• Stumbling or lack of coordination when walking
• Abnormal eye movements or changes in vision
• Drowsiness
• Changes in personality or memory
• Changes in speech

People with the following conditions or characteristics may be at risk for developing a brain tumor.

• Radiation exposure
• Increased age
• Exposure to pesticides, herbicides, fertilizer
• Certain occupations, such as lead, petroleum, plastic, rubber, and textile workers, as well as aircraft and vehicle operators
• Exposure to electromagnetic fields
• Certain viruses, especially Epstein-Barr virus
• People who have had transplants and individuals with AIDS

If you are experiencing symptoms associated with a brain tumor, you should see your health care provider immediately. Your provider will ask about your personal and family medical history, and will perform a complete physical and neurologic exam. This includes checks for alertness, muscle strength, coordination, reflexes, and response to pain, and an eye exam to look for swelling caused by a tumor pressing on the nerve that connects the eye and the brain. The provider may send you for a computed tomography (CT) scan and/or magnetic resonance imaging (MRI). Additional tests may include skull X ray, brain scan, angiogram or arteriogram, and a myelogram (X ray of the spine, using dye). If cancer is present, others who may become involved in your care include a neurosurgeon, medical oncologist, radiation oncologist, nurse, dietitian, social worker, physical therapist, occupational therapist, and speech therapist.

Treatment for a brain tumor depends on the type, location, and size of the tumor, as well as the person's age and general health. Treatment generally involves surgery, radiation therapy, and/or chemotherapy.

Your provider may prescribe the following therapies.

• Steroids, to relieve swelling
• Anticonvulsants, to prevent or control seizures
• Radiation therapy, to destroy tumor tissue that cannot be removed with surgery or to kill cancer cells that may remain after surgery, or when surgery is not possible
• Chemotherapy, to kill cancer cells

Surgery is the most common treatment. To remove a brain tumor, a neurosurgeon performs a craniotomy, which involves making an opening in the skull. If the tumor cannot be at least partially removed, the surgeon may do only a biopsy, in which a small piece of the tumor is removed so that a pathologist can examine it under a microscope to determine the type of cancer cells. This necessary information helps determine other forms of treatment.

Another procedure sometimes used is insertion of a shunt to drain cerebrospinal fluid. A shunt is a long, thin tube placed in the brain and then threaded under the skin to another part of the body, usually the abdomen. It works like a drainpipe, allowing excess fluid to be carried away from the brain and absorbed in the abdomen.

A comprehensive treatment plan for brain cancer may include a range of complementary and alternative therapies. Nutrients and herbs may protect against side effects from conventional therapies as well as enhance chemotherapy and support anticancer activities. Mind-body therapies such as meditation, relaxation techniques, yoga, and qi gong may reduce the effects of stress and enhance your quality of life and your response to treatment. Ask your team of health care providers about the best ways to incorporate these therapies into your overall treatment plan.

Eat only organically-raised foods. Include sea vegetables, garlic, onions, green tea, whole grains, fresh vegetables (especially dark green, yellow, and orange vegetables), legumes, protein, and anti-inflammatory oils (i.e., nuts, seeds, and cold-water fish) in your diet. Eliminate processed meats, refined foods, additives, sugar, artificial foods, alcohol, caffeine, saturated fats, and nitrosamines

Potentially beneficial nutrient supplements include the following.

• Vitamin E (400 to 800 IU per day), vitamin C (250 to 500 mg twice per day), selenium (200 mcg twice per day), coenzyme Q10 (100 mg three times per day), and vitamin A (25,000 IU twice per day)
• Glutathione 500 mg twice per day
• Melatonin (20 mg four times per day)
• Methionine (100 mg three times a day), zinc (20 mg per day), vitamin C (250 to 500 mg twice per day), and selenium
• Shark and bovine cartilage (controversial)

Herbs are generally available as dried extracts (pills, capsules, or tablets), teas, or tinctures (alcohol extraction, unless otherwise noted). Dose for teas is 1 heaping tsp. per cup of water steeped for 10 minutes (roots need 20 minutes).

• Garlic (Allium sativum): Drink ginger (Zingiber officinale) and garlic tea, two to three cups daily.
• Hawthorn (Crataegus monogyna): 200 mg two times per day and bilberry (Vaccinium myrtillus) 120 mg two times per day
• Commercial Hoxsey-like formulas or trifolium compounds: 60 drops two to three times per day to tid for six months or longer
• Herbal mixes containing burdock root (Arctium lappa), sheep sorrel (Rumex acetosella), slippery elm (Ulmus fulva), turkey rhubarb (Rheum palmatum), and other herbs: for brand name products, follow dosing instructions on the product labeling
• Mistletoe (Viscum album): 60 drops tincture three times per day, or 250 mg capsules three times per day
• Combine essential oils of bergamot (Citrus bergamia), chamomile (Matricaria recutita), and lavender (Lavendula angustifolia) in aromatherapy applications. Place several drops in a warm bath, or four to six drops in 1 tbs. of vegetable oil for massage.

Homeopathy may help relieve symptoms and strengthen overall well-being.

While acupuncture is not used as a treatment for cancer itself, evidence suggests it can be a valuable therapy for cancer-related symptoms (particularly nausea and vomiting that often accompanies chemotherapy treatment). There have also been studies indicating that acupuncture may help reduce pain and shortness of breath. Acupressure (pressing on rather than needling acupuncture points) has also proved useful in controlling breathlessness; this is a technique that patients can learn and then use to treat themselves.

Some acupuncturists prefer to work with a patient only after the completion of conventional medical cancer therapy. Others will provide acupuncture and/or herbal therapy during active chemotherapy or radiation. Acupuncturists treat cancer patients based on an individualized assessment of the excesses and deficiencies of qi located in various meridians. In many cases of cancer-related symptoms, a qi deficiency is usually detected in the spleen or kidney meridians.

The outlook varies greatly depending on the type of tumor and a variety of other factors. Some types of brain cancer have a five-year survival rate above 80 percent. Brain cancer has significant emotional and psychological effects. Patients who receive radiation therapy to large areas of the brain or certain anticancer drugs may have a higher risk of developing leukemia or a second tumor at a later time. Radiation that affects the eyes may lead to the later development of cataracts.

Regular follow-up is very important after treatment, to make sure the tumor has not returned. Checkups usually include physical and neurologic exams and occasional CT scans or MRIs.

Alimi D, Rubino C, Leandri EP, Brule SF. Analgesic effects of auricular acupuncture for cancer pain [letter]. J Pain Symptom Manage. 2000;19(2):81-82.

Birdsall TC. The biological effects and clinical uses of the pineal hormone melatonin. Alt Med Rev. 1996; 1(2):94-102.

Bluementhal DT, DeAngelis LM. Aging and central nervous system neoplasms. Neurologic Clinics. 1998;16(3):671-678.

Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Boston, Mass: Integrative Medicine Communications; 1998: 171.

Carr AC, Frei B. Toward a new recommended dietary allowance for vitamin C based on antioxidant and

health effects in humans. Am J Clin Nutr. 1999;69(6):1086-1107.

Cocco P, Dosemeci M, Heineman. Brain cancer and occupational exposure to lead. J Occup Environ Med. 1998; 40(11): 937-942.

Boik J. Cancer & Natural Medicine: A Texbook of Basic Science and Clinical Research. Princeton, Minn:Oregon Medical Press; 1996: 28, 29, 76, 182, 183, 251.

Brinker F. The Hoxsey treatment: cancer quackery or effective physiological adjuvant? J Naturopathic Med. 1996; 6(1):9-23.

DeVita VT, ed. Cancer: Principles and Practice of Oncology. 5^th ed. Philadelphia, PA: Lippincott-Raven Publishers; 1997.

Ezzo J, Berman B, Hadhazy VA, Jadad AR, Lao L, Singh BB. Is acupuncture effective for the treatment of chronic pain? A systematic review. Pain. 2000;86:217-225.

Fauci AS, Braunwald E, Isselbacher KJ, et al, eds. Harrison's Principles of Internal Medicine. 14^th ed. New York, NY: McGraw-Hill; 1998.

Filshie J, Penn K, Ashley S, Davis CL. Acupuncture for the relief of cancer-related breathlessness. Palliat Med. 1998;10:145-150.

Furlong JH. Acetyl-L-Carnitine: metabolism and applications in clinical practice. Alt Med Rev. 1996; 1(2):85-93.

JAMA Patient Page. How much vitamin C do you need? JAMA. 1999;281(15):1460.

Johnston CS. Recommendations for vitamin C intake. JAMA. 1999;282(22):2118-2119.

Kheifets LI, Afifi AA, Buffler PA, et al. Occuptional electric and magnetic field exposure and brain cancer: a meta-analysis. J Occup Environ Med. 1995; 37(12):1327-1341.

Kidd PM. Phosphatidylserine; membrane nutrient for memory. A clinical and mechanistic assessment. Alt Med Rev. 1996; 1(2):70-84.

Lawless J. The Encyclopaedia of Essential Oils. The Complete Guide to the Use of Aromatics in Aromatherapy, Herbalism, Health & Well-being. New York, NY: Barnes & Noble, Inc.; 1992.

Levine M, Rumsey SC, Daruwala R, Park JB, Wang Y. Criteria and recommendations for vitamin C intake. JAMA. 1999;281(15):1415-1453.

Maa SH, Gauthier D, Turner M. Acupressure as an adjunct to a pulmonary rehabilitation program. J Cardiopulm Rehabil. 1997;17(4):268-276.

Moss RW. Alternative pharmacological and biological treatments for cancer: Ten promising approaches. J Naturopathic Med. 1996; 6(1):23-32.

Murray M. The Healing Power of Herbs. Rocklin, CA:Prima Publishing; 1991:90-95

Nicholas JS, Lackland DT, Dosemeci M, et al. Mortality among US commercial pilots and navigators. J Occup Environ Med. 1998; 40(11): 980-985.

NIH Consensus Statement: Acupuncture. National Institutes of Health, Office of the Director. 1997;15(5):1-34. Accessed at http://odp.od.nih.gov/consensus/cons/107/107_statement.htm on September 24, 2001.

Pan CX, Morrison RS, Ness J, Fugh-Berman A, Leipzig RM. Complementary and alternative medicine in the management of pain, dyspnea, and nausea and vomiting near the end of life: a systematic review. J Pain Symptom Manage. 2000;20(5):374-387.

Rakel RE, ed. Conn's Current Therapy. 51^st ed. Philadelphia, PA: W.B. Saunders; 1999.

Scalzo R. Naturopathic Handbook of Herbal Formulas. 2^nd ed. Durango, Colo: Kivaki Press; 1994: 52.

Sellick SM, Zaza C. Critical review of five nonpharmacologic strategies for managing cancer pain. Cancer Prev Control. 1998;2(1):7-14.

Shen J, Wenger N, Glaspy J, et al. Electroacupuncture for control of myeloablative chemotherapy-induced emesis. JAMA. 2000;284(21):2755-2761.

Vickers AJ. Can acupuncture have specific effects on health? A systematic review of acupuncture antiemesis trials. J R Soc Med. 1996;89:303-311.