Neuro-Oncology
Neuro-oncology is a specialized multidisciplinary field focused on the diagnosis, treatment, and management of primary and metastatic tumors affecting the central nervous system (CNS), including the brain, spinal cord, and surrounding meninges.
Primary Categories of CNS Tumors
Gliomas: Tumors arising from glial support cells. These range from low-grade astrocytomas and oligodendrogliomas to high-grade Glioblastoma Multiforme (GBM), the most common and aggressive primary brain malignancy.
Meningiomas: Typically benign, slow-growing tumors arising from the meningeal layers surrounding the brain and spinal cord.
Pituitary Adenomas: Tumors originating in the pituitary gland that can cause endocrine dysfunction and vision changes due to compression of the optic chiasm.
Acoustic Neuromas (Vestibular Schwannomas): Benign tumors arising from the schwann cells of the vestibular nerve, causing hearing loss, tinnitus, and balance issues.
Metastatic Brain Tumors: Secondary brain tumors that spread to the CNS from primary cancers located elsewhere in the body (most commonly lung, breast, melanoma, or renal cell carcinoma).
Key Treatment Modalities in Neuro-Oncology
| Modality | Primary Applications | Mechanism / Objective |
| Microsurgical Resection | Gliomas, Meningiomas, Pituitary Adenomas, Solitary Metastases | Maximum safe surgical debulking to relieve mass effect while preserving functional neurological tissue. |
| Stereotactic Radiosurgery (SRS) | Brain Metastases, Acoustic Neuromas, Recurrent/Deep Tumors | High-precision targeted radiation (e.g., Gamma Knife, CyberKnife) delivered in single or few fractions without surgical incisions. |
| Radiation Therapy (EBRT) | High-grade gliomas, diffuse infiltration, incomplete resections | External beam radiation delivered over several weeks to disrupt tumor cell DNA and prevent growth. |
| Systemic & Targeted Therapy | Glioblastomas, specific genetic mutations (IDH-1, BRAF) | Chemotherapy (e.g., Temozolomide), anti-angiogenic agents (Bevacizumab), and targeted molecular inhibitors. |
| Tumor Treating Fields (TTFields) | Newly diagnosed and recurrent Glioblastoma | Alternating electrical fields delivered via wearable scalp transducers to disrupt cancer cell mitosis. |
Multi-Disciplinary Management Workflow
Diagnosis & Molecular Subtyping
High-resolution contrast MRI, PET scans, and molecular profiling (e.g., IDH mutation status, MGMT promoter methylation) to establish tumor classification
↓
Surgical Resection / Biopsy
Image-guided craniotomy, awake functional mapping, or frame-based stereotactic biopsy to obtain tissue and reduce tumor burden
↓
Adjuvant Chemoradiation Protocol
Targeted radiation therapy combined with systemic chemotherapy (e.g., the Stupp protocol for GBM) initiated post-operatively
↓
Surveillance & Maintenance
Serial MRI monitoring, cognitive rehabilitation, symptom management, and maintenance therapies (e.g., TTFields) long-term