The pituitary gland located at the base of the brain can develop tumors that are diagnosed using tests like MRI, CT scans, and biopsy. Pituitary tumors make up 9-12% of primary brain tumors and can occur at any age but are more common in older people and women. Signs include headaches, vision issues, and hormone-related symptoms. Treatment involves surgery to remove the tumor if possible as well as radiation therapy such as stereotactic radiation or brachytherapy to deliver high doses directly to the tumor. Side effects of radiation therapy include fatigue and short-term cognitive changes.
The pituitary gland located at the base of the brain can develop tumors that are diagnosed using tests like MRI, CT scans, and biopsy. Pituitary tumors make up 9-12% of primary brain tumors and can occur at any age but are more common in older people and women. Signs include headaches, vision issues, and hormone-related symptoms. Treatment involves surgery to remove the tumor if possible as well as radiation therapy such as stereotactic radiation or brachytherapy to deliver high doses directly to the tumor. Side effects of radiation therapy include fatigue and short-term cognitive changes.
The pituitary gland located at the base of the brain can develop tumors that are diagnosed using tests like MRI, CT scans, and biopsy. Pituitary tumors make up 9-12% of primary brain tumors and can occur at any age but are more common in older people and women. Signs include headaches, vision issues, and hormone-related symptoms. Treatment involves surgery to remove the tumor if possible as well as radiation therapy such as stereotactic radiation or brachytherapy to deliver high doses directly to the tumor. Side effects of radiation therapy include fatigue and short-term cognitive changes.
The pituitary gland located at the base of the brain can develop tumors that are diagnosed using tests like MRI, CT scans, and biopsy. Pituitary tumors make up 9-12% of primary brain tumors and can occur at any age but are more common in older people and women. Signs include headaches, vision issues, and hormone-related symptoms. Treatment involves surgery to remove the tumor if possible as well as radiation therapy such as stereotactic radiation or brachytherapy to deliver high doses directly to the tumor. Side effects of radiation therapy include fatigue and short-term cognitive changes.
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Collette Stephens
Radiation Oncology II September 9, 2014 Topic: Pituitary Tumors
The pituitary gland is a pea-sized structure located at the base of the brain, just below the hypothalamus and attached to it by nerve fibers. It is part of the endocrine system and produces hormones which control other glands as well as various bodily functions. Diagnosis Neurological examination. An evaluation of the patients central nervous system may include testing a persons reflexes, motor and sensory skills, balance and coordination, and mental status. Laboratory tests. Magnetic resonance imaging (MRI) Computed tomography (CT or CAT) scan Visual field exam. A large pituitary gland tumor may press on the optic nerves, which are located above the pituitary gland. In this test, the patient is asked to find points of light on a screen, using each eye separately. Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that a tumor is present, but only a biopsy can make a definite diagnosis. Lumbar puncture (spinal tap) Epidemiology Pituitary tumors account for 9% to 12% of all primary brain tumors. They can occur at any age, but they are more common in older people. Women are more affected than men, particularly during the childbearing years. Etiology
Like many tumor types, the exact cause of pituitary tumors is not known. Signs/Symptoms
Headaches
Vision problems
Changes in menstrual cycles in women
Impotence (the inability to achieve or maintain an erection) in men, caused by hormone
changes
Infertility (the inability to have children)
Inappropriate production of breast milk
Cushings syndrome (a combination of weight gain, high blood pressure, diabetes, and easy bruising), caused by overproduction of ACTH
Acromegaly (enlargement of the extremities or limbs and thickening of the skull and jaw), from too much growth hormone
Unexplained tiredness
Mood changes
Irritability
Staging /Grading The extent or spread of cancer is usually described as stages. There is no standard staging system for pituitary tumors. Once a pituitary tumor is found, tests are done to find out if the tumor has spread into the brain or to other parts of the body. Pituitary tumors are described by their size and grade, whether or not they make extra hormones, and whether the tumor has spread to other parts of the body. The following sizes are used:
Microadenoma: The tumor is smaller than 1 centimeter.
Macroadenoma: The tumor is 1 centimeter or larger.
Most pituitary adenomas are microadenomas.
The grade of a pituitary tumor is based on how far it has grown into the surrounding area of the brain, including the sella (the bone at the base of the skull, where the pituitary gland sits). Routes of spread Malignant pituitary neoplasms spread by means of local invasion and through the venous system, the cerebrospinal fluid (CSF) pathways, and the lymphatics. The first three routes are the most common ones. Spread by local invasion has already been alluded to. Spread through the venous system occurs initially through the cavernous sinus; posterior spread can then occur through the petrosal veins all the way to the jugular vein. Retrograde spread through the cortical draining veins may affect the superior sagittal sinus. Spread by CSF pathways may involve the supratentorial, infratentorial, or spinal compartments. In the supratentorial space, the tumour may spread to the interpeduncular fossa. Spread along the cortical hemispheric surface may lead to metastases in the frontal, temporal, parietal or occipital lobes. Spread to these. lobes seems to occur more often through CSF pathways than through the bloodstream. Two observed phenomena confirm this belief. First, the lesions tend to be subpial or close to the ventricular surface rather than deep in the white matter; second, patients with intracranial metastases often do not have evidence of systemic spread; if the dissemination were through the bloodstream, one should see metastases elsewhere. Subarachnoid spread in the infratentorial compartment leads to metastases in the cerebellopontine angle, in the ependymal lining of the fourth ventricle, and in the cerebellum. Spread along the spinal subarachnoid space may lead to metastases in the spinal cord or cauda equina. The normal pituitary gland does not have any lymphatics. However, lymphatic spread of pituitary tumors can occur after the tumors has invaded the base of the skull. Systemic spread through the bloodstream has been reported to occur in the lungs. liver, kidneys. heart, bones of the spinal column, scalp, and skull. ACTH-secreting pituitary carcinomas more frequently result in systemic spread, particularly to the liver, compared to other functional
carcinomas. The hepatic metastases tend to be small and multiple. The metastatic tumors invariably resemble the primary pituitary tumors in histology, including immunohistochemical characteristics. Secretory granules may be apparent on electron microscopy. The chromogranin A stain is positive even in nonfunctional tumors, and one study 'suggests that serum chromogranin A levels may be elevated in patients harboring nonfunctioning pituitary tumors Surgery Surgery is the most common treatment for pituitary tumors. If the pituitary tumor is benign and in a part of the brain where neurosurgeons can safely completely remove it, surgery might be the only treatment needed. The patient will probably need surgery if the tumor:
Is producing hormones that medication cannot control
Is causing health problems by pressing on the pituitary gland or other parts of the nervous system. Is still growing despite previous treatment with medication or surgery
The most common types of surgery for pituitary tumors are:
Endonasal endoscopic surgery
Neuroendoscopic surgery Craniotomy
Chemotherapy Chemotherapy may be used as palliative treatment for pituitary carcinomas, to relieve symptoms and improve the patient's quality of life. Chemotherapy uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them 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 cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type of the cancer being treated. Radiation Therapy Treatment plan
For some patients, stereotactic radiation therapy (delivering a high dose of radiation directly to the tumor) is used when any part of the tumor is left after surgery. Not all patients with part of a tumor remaining after surgery need radiation therapy because some noncancerous pituitary gland tumors do not grow back even when some of the tumor is left behind after surgery. If the entire tumor is removed, then radiation therapy is not needed. Radiation Doses The dose delivered is generally 45-50Gy at 1.8-2.0Gy per fraction, and larger masses may require a boost of 54Gy. Brachytherapy is used in the treatment of newly diagnosed or recurrent brain tumors. It may be administered as the primary radiation therapy or as a boost of additional radiation delivered before or following standard external beam radiation. For boost therapy to be effective, the brain tumor must be no more than 2 inches in diameter and accessible by surgery. Larger tumors may require surgery to reduce the size of the tumor before the radiation sources are implanted. Brachytherapy is a local therapy; it is not commonly used for widely spread or multiple tumors. Critical structures/ Dose Tolerance Brain stem 6000cGy Spinal cord 4700cGy Optic nerve & chiasm 5000cGy Retina 5000cGy Eye lens 1000cGy
Radiation Side Effects
Side effects from radiation therapy include fatigue, mild skin reactions, and upset stomach. Most side effects go away soon after treatment is finished. Depending on where the radiation therapy
is directed, it may also cause vision problems and short-term memory or cognitive (thoughtprocess) changes. However, the risk of developing vision problems or short-term memory or cognitive changes from radiation treatment is small because advances in external-beam radiation therapy allow doctors to aim the radiation more directly at the pituitary gland, sparing more of the surrounding normal tissue from the effects of radiation. Radiation therapy can cause the pituitary gland to gradually lose the ability to make hormones after treatment ends Brachytherapy Brachytherapy is used in the treatment of newly diagnosed or recurrent brain tumors. It may be administered as the primary radiation therapy or as a boost of additional radiation delivered before or following standard external beam radiation. For boost therapy to be effective, the brain tumor must be no more than 2 inches in diameter and accessible by surgery. Larger tumors may require surgery to reduce the size of the tumor before the radiation sources are implanted. Brachytherapy is a local therapy; it is not commonly used for widely spread or multiple tumors.
