How To Treat Pineoblastoma

Pineoblastoma is a type of cancer that starts in the pineal gland cells, which are located in the center of the brain. This type of cancer mainly affects the function of the pineal gland and other surrounding structures. The pineal gland is responsible for the production of a hormone called melatonin. Melatonin regulates an individual's natural sleep-wake cycle. Pineoblastoma patients will experience sleepiness, headaches, and changes in regular eye movements. Symptoms such as nausea, vomiting, weakness, and hearing problems can occur when pineoblastoma begins to compress other parts of the brain.

Pineoblastoma is diagnosed using medical imaging tests, a biopsy, and a spinal tap. Because it can spread throughout the brain and into the cerebrospinal fluid surrounding the brain, this type of cancer can be particularly challenging to treat. However, pineoblastoma does not typically spread outside of the central nervous system. Many methods can be utilized to treat pineoblastoma.

Relieve Fluid Buildup

Individuals affected by pineoblastoma may experience what is called hydrocephalus, or a build-up of fluid in the ventricles of the brain. Pineoblastoma may grow to the point where it blocks the flow and drainage of the cerebrospinal fluid from the brain. As a result, the extra fluid that accumulates in the ventricles causes them to become enlarged and puts too much pressure on the brain. This excess pressure on the delicate tissues of the brain results in tissue damage and numerous brain function impairments.

When hydrocephalus occurs because of pineoblastoma, a surgical procedure to relieve the build-up of this fluid is an essential part of treatment. This goal is usually accomplished by the surgical insertion of a shunt or a drainage system. A shunt is a lengthy flexible tube equipped with a valve to keep the cerebrospinal fluid flowing in the correct direction at a regular rate. One end of the shunt is placed into a ventricle in the brain, and the other end is threaded to another region of the body that can better absorb the fluid, like the abdomen. Another method of removing fluid build up in the brain is through a ventriculostomy. During this procedure, the surgeon creates a small drainage hole in the bottom of one of the brain's ventricles that allows fluid to escape.

Remove The Tumor

Surgical operation on the pineal gland for any reason can present a myriad of complications due to its central location deep within the brain. While the first and most crucial part of treating pineoblastoma is the removal of the tumor, the procedure to do so is aggressive and intrusive. The goal of pineoblastoma resection surgery is to extract as much of the tumor as possible. In many cases, complete removal is not possible because of its proximity to other critical structures. When the tumor cannot be entirely removed, the procedure is called a tumor debulking or resection instead of tumor excision.

For milder cases of pineoblastoma, an oncologist may decide to try different treatments prior to performing an excision. Often, chemotherapy and radiation are used to try and shrink the tumor so surgical resection is not necessary. If this cannot be done, the goal is to shrink the tumor enough to allow for surgical resection through the use of a small catheter. Most patients who undergo surgery to remove their pineal gland tumor will still need subsequent chemotherapy and radiation therapy to eliminate the leftover malignant cells.

Chemotherapy

Pineoblastoma patients most likely will require at least one round of chemotherapy, which is the use of one or more potent drugs to kill or stop the growth of malignant cells. Depending on the circumstances of each patient, chemotherapy may be used independently of, or before or following resection surgery. It may also be used in some patients to delay treatment with the use of radiation therapy. Chemotherapy works by attacking and damaging any cells within the body that are in the process of duplicating.

Malignant cells have a characteristic of multiplying much quicker than normal healthy cells, so chemotherapy is efficient at wiping out most cancerous cells in the body. Chemotherapy is known to be extremely effective at treating cancer, but the mechanism of how it works causes severe side effects. It also kills off any healthy noncancerous cells throughout the body that are in the process of multiplying. It is the widespread cellular damage chemotherapy inflicts on healthy tissues that causes its extreme adverse side effects.

Radiation Therapy

Radiation therapy is often used in combination with chemotherapy and surgical resection to treat pineoblastoma. Radiation therapy is able to kill malignant cells in a localized area with the use of high-energy beams. The beams of energy can be in the form of x-rays, gamma rays, electron beams, or protons. Most patients who need radiation therapy to treat their pineoblastoma will receive external beam radiation. This type of radiation therapy is performed with the use of a machine outside of the body that aims the energy beams at the area with malignant cells. The energy beams stop cancer from growing and kill malignant cells by breaking up the strands of DNA inside of the cells.

When the DNA strands are interfered with in this way, they can no longer multiply and carry out metabolic functions, resulting in apoptosis or cellular death. The most significant advantage of using radiation therapy is it only causes minimal damage to surrounding tissues, unlike the systemic effects of chemotherapy. Radiation therapy may not be an ideal treatment option for younger patients affected by pineoblastoma because it is not recommended for patients who are three years old or younger.

Stereotactic Radiosurgery

Stereotactic radiosurgery is a form of radiation therapy often utilized to treat tumors located in the brain. It works the same way traditional radiation surgery works, except for a few differences. The energy beams used in stereotactic radiosurgery deliver higher doses of radiation in greater concentrations than those used in standard radiation therapy methods. Newer three-dimensional imaging technologies are utilized to identify the exact location of the tumor within the brain. This technology also allows the physicians to precisely map out the tumor's particular size and shape.

These preparation techniques enable the physicians administering the stereotactic radiosurgery to deliver the highest doses possible while maintaining minimal damage to surrounding tissues. The intense pre-planning is done so the beams of energy can be positioned in such a way as to converge in on the tumor from multiple different planes and several different angles. Stereotactic radiosurgery usually requires fewer treatment sessions to treat pineoblastoma than traditional radiation.