Neuro-Oncology | Specialists and Information

Neuro-oncologists primarily treat patients with brain and spinal cord tumors. They also care for patients with brain and spinal cord metastases.

The conditions treated by neuro-oncology include, among others, the following brain tumors:

• Gliomas (the most common type of brain tumor; the most common subtype is astrocytoma)
• Medulloblastomas (cerebellar tumors)
• Meningiomas (tumors of the meninges)
• Neurinomas (tumors of the sheath cells of the brain and spinal cord nerves), for example, acoustic neuroma (tumor of the auditory nerve)
• Lymphomas (tumors originating from lymphocytes)
• Pituitary adenomas (mostly benign tumors of the pituitary gland)
• Brain metastases (usually originating from lung cancer, breast cancer, kidney cancer, or malignant melanoma)

Neuro-oncology experts are also the right point of contact for patients with paraneoplastic syndrome.

Paraneoplastic neurological syndromes (PNS) are complications that arise not from the tumor itself but from other causes.

These do not necessarily have to be neurological tumors. Rather, lung cancer, breast cancer, or ovarian cancer, for example, are common causes of this syndrome.

PNS can manifest, for example, as disorders of the central or peripheral nervous system or of the muscles.

Glioblastoma is the most common malignant brain tumor in adults @ Richman Photo /AdobeStock

Doctors working in the field of neuro-oncology are typically:

• Specialists in neurosurgery
• Specialists in internal medicine, hematology, and oncology, and/or
• Specialists in neurology

Together with other experts (radiologists), they develop a treatment strategy tailored to the individual patient during a tumor board meeting.

In addition, other professional groups are involved in the care and support of cancer patients, such as:

• Physical therapists
• Occupational therapists
• Speech-language pathologists
• Psychologists and
• Social workers

A neuro-oncology center is a clinic that treats patients with tumors of the central nervous system.

Care includes:

• Diagnostics
• Treatment and
• Follow-up care

The physicians come from various specialties, such as:

• Oncology
• Neurology and
• Neurosurgery

These centers are equipped with state-of-the-art technology. They are also capable of performing complex surgeries.

Clinical trials are also conducted at neuro-oncology tumor centers. In these trials, doctors test new medications or procedures for their effectiveness.

Ideally, the neuro-oncology center is certified by the German Cancer Society as a neuro-oncology tumor center.

Certification requires strict quality standards for patient care (staffing, facilities, and equipment). These clinics must also demonstrate that they perform a minimum number of treatments each year.

The following steps are important for diagnosis in order to determine the extent of neurological deficits:

• Review of medical history and symptoms (anamnesis)
• Clinical examination
• Neurophysiological tests

Diagnosing a tumor of the nervous system often requires multiple diagnostic procedures.

Imaging techniques play a crucial role here, such as:

• X-ray
• Computed tomography (CT) and
• Magnetic resonance imaging (MRI) with and without contrast

Another imaging technique is positron emission tomography (PET). Unlike CT and MRI, PET also provides information about the tumor’s metabolic activity.

Cerebrospinal fluid (CSF) analysis can be important for ruling out an inflammatory condition. In this procedure, doctors collect cerebrospinal fluid (CSF) via a lumbar puncture.

For certain symptoms, such as seizures, an electroencephalogram (EEG) can provide further clues about the disease and aid in treatment planning.

Especially in the case of an initial diagnosis, doctors do not forego a stereotactic biopsy (tissue sample) even when the tumor is clearly visible.

Doctors plan this procedure in detail using a computer. It is considered one of the safest procedures in neurosurgery.

The pathologist examines the removed tissue and assesses whether there are any pathological cellular changes. The pathologist determines the type of tumor and its degree of differentiation. The pathologist also determines whether the tumor is primary or metastatic.

The results of this histological examination are crucial for treatment planning. Not every type of tumor responds equally to different treatment options.

For this reason, molecular genetic analyses of the tumor cells are often used to identify specific genetic alterations.

A PET/CT scan of the brain shows metabolic activity in the brain as bright highlights @ Maxim /AdobeStock

The type of therapy depends on the following factors:

• Tumor type
• Tumor location
• Tumor stage and
• Patient-specific factors

Depending on the type, location, size, age, and general and neurological condition of the patient, surgical removal is the primary treatment approach.

Neurosurgical procedures on the brain can be performed using stereotactic (minimally invasive) or open surgical techniques. This depends on the location and size of the tumor, as well as the patient’s age and condition.

With the help of computer-assisted intraoperative neuronavigation, surgical procedures in critical regions of the brain and spinal cord can now be performed safely.

Following surgery, depending on the results of the histological examination and the surgical procedure, chemotherapy and/or radiation therapy are administered.

In some cases, chemotherapy or radiation therapy is administered before surgery. The goal is to shrink the tumor so that doctors can operate on it at all.

Chemotherapy is one of the central pillars of cancer treatment. In this process, patients receive medications that stop the proliferation of cancer cells. These medications are also called cytostatic drugs.

A modern method of tumor treatment is targeted therapy using monoclonal antibodies, which specifically inhibit tumor growth.

Unlike traditional cytostatic drugs, these do not act nonspecifically on the entire body. For example, doctors can stop tumor growth in glioblastoma (the most common type of malignant brain tumor in adults) using combination therapy.

Another important treatment method is radiation therapy (radiotherapy). Unlike chemotherapy, it does not act systemically (on the entire body) but rather locally. 

The high-energy radiation damages the cancer cells to such an extent that the tumor shrinks or, ideally, disappears completely.