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Humanizing Brain Tumors: Strategies for You and Your Physician: Humanizing Brain Tumors: Strategies for You and Your Physician

Humanizing Brain Tumors: Strategies for You and Your Physician
Humanizing Brain Tumors: Strategies for You and Your Physician
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table of contents
  1. Cover Page
  2. Halftitle Page
  3. Title Page
  4. Copyright Page
  5. Dedication
  6. Contents
  7. Preface
  8. Chapter 1: Frontal Lobe: The Man Who Lost the Will to Work
  9. Chapter 2: Left Temporal Lobe: The Man Who Found Creativity
  10. Chapter 3: Right Temporal Lobe: The Woman Who Could Not Quench Her Thirst
  11. Chapter 4: Foramen Magnum and High Cervical Cord: The Woman with Rotating Paralysis
  12. Chapter 5: Brain Stem: The Nurse Who Started Having Double Vision and Headaches
  13. Chapter 6: Cerebellum: The Woman with Pigmented Lesions and Worsening Balance
  14. Chapter 7: Pituitary and Stalk: Visual Loss and Hormonal Alteration in a Young Transgender Woman
  15. Chapter 8: Tumor Afecting Hearing: Trials and Tribulations
  16. Chapter 9: Hypothalamus and Third Ventricle: The Woman Who Lost the Ability to Play Sudoku
  17. Compendium
  18. Glossary
  19. Biographies
  20. Acknowledgements

GLOSSARY

5-Aminolevulinic acid (5-ALA): a natural chemical within the body that is produced during blood cell creation; used by neurosurgeons during surgery as a real-time marker of tumor boundaries for more accurate resection; currently being studied for light activation to selectively kill cancer

Acupuncture: an alternative form of medicine in which mechanical stimulation, electrical stimulation, or heat are used to stimulate body areas

Adjuvant: after initial cancer treatment

Alkylating agent: compounds or drugs that damage the DNA of cancer cells so that they cannot grow or divide

Amygdala: a part of the brain found in the temporal lobe that controls emotion, particularly fear and aggression

Anaphylactic: related to an allergic reaction

Anosmia: a partial or complete loss of smell

Anterior: near the front in position (i.e., the kneecap is on the anterior side of the leg)

Anterolateral: a combination of two anatomical localization terms (see Anterior and Lateral)

Anti-angiogenic: interrupts tumors’ blood supply by preventing the formation of blood vessels

Anti-seizure medication (ASM): medication prescribed to treat focal epilepsy only

Antineoplastic: a classification of drugs that are used to treat cancer

Antipsychotic: a class of medication used to treat psychosis

Anxiety: a psychological condition used to describe intense worrying or fear

Aphasia: inability to create or understand speech

Art therapy: the utilization of art as a therapeutic modality

Astrocytoma: a type of brain or spinal cord tumor that arises from astrocytes

Asymptomatic: not experiencing symptoms

Ataxic: uncoordinated movement

Auditory brainstem implant (ABI): a surgically implanted device that restores hearing to people with hearing loss; a device that uses an electrode to create signals for the auditory nerve

Basal cell carcinoma (BCC): a common form of skin cancer with low metastatic potential; UV radiation is the most significant risk factor for BCC

Base pair: a unit of DNA

Belinostat (BELIODAQ®): a histone deacetylase drug

Benign: a descriptor for an abnormal growth that does not spread to other parts of the body and is noncancerous

Bevacizumab (AVASTIN®): an anti-angiogenic chemotherapy drug

Bifrontal craniotomy: a surgical procedure where the forehead and top of the head portions of the skull are opened to reach the brain

Biopsy: an examination of a sample of tissue taken from the body to be examined by a pathologist; can give insight into key molecular markers for different tumor subtypes

Birthmark: a skin abnormality that is present at birth

Bitemporal hemianopsia: loss of the outer half of each visual field in both eyes

Blood clot: coagulation of blood that may restrict blood flow within the vascular system

Brainstem: a structure that connects the bottom portion of the brain to the top of the spinal cord; contains brain centers that are critical to the maintenance of life (breathing, thirst, hunger, etc.)

Brivaracetam (BRIVIACT®, BRIVAZEN®): a medication that is used to treat partial seizures

Broca’s area: area of the brain located in the frontal lobe that is responsible for the production of speech

Cachexia: a wasting syndrome where a patient experiences weight and muscle loss

Carbamazepine (TEGRETOL®): an anti-seizure medication that can have a strong effect on drug metabolism

Cardiology: medical specialization associated with the heart and vascular system

Cataract: Clouding of the naturally clear lens of the eye

Central nervous system: the brain, spinal cord, and associated connective tissue

Cerebellar hemisphere: the left or right divisions on either side of the vermis

Cerebellum: a part of the brain that coordinates muscular activity and balance

Cerebral blood volume (CBV): The amount of intravascular blood within a specific area of brain tissue; can be helpful in determining extent of damage to a brain area

Cerebral cortex: the outer layer of the brain

Cerebrum: largest part of the brain, located superiorly and anteriorly in relation to the brainstem

Cervical spine: the area of the spine in the region of the back of the neck

Charley horse: a term used to describe cramping

Chemoradiation: a term used to describe chemotherapy and radiation in combination to treat cancer

Chemotherapy: treatment of a disease, such as cancer, using chemical substances

Chordoid glioma: a rare intraventricular tumor which may arise in the third ventricle

Choroidal fissure: a c-shaped cleft in the brain that is directly above the hypothalamus

Chronic: lasting for a long time

Clinical trial: research studies used to investigate medical intervention; typically involves multiple stages during which the proposed therapeutic undergoes extensive safety, dosing, and efficacy testing

Cochlear implant: a surgically implanted electronic device that stimulates the cochlear nerve to aid hearing

Cognition: mental processes involved in thinking, learning, knowledge, and being self-aware

Comorbid: conditions that occur simultaneously or at the same time

Computed tomography (CT): series of x-rays taken together to yield a detailed 3D image

Concussion: a brain injury caused by trauma to the head

Consortium to Establish a Registry for Alzheimer’s Disease (CERAD): a verbal cognitive assessment given by a medical professional to test evaluate cognitive abilities

Coronal: A vertical plane which divides the body into anterior and posterior.

Corticospinal tract (CST): tract that consists of axons which carry motor control information from the brain to the spinal cord

Craniopharyngioma: rare, benign tumor located within the skull that results from cancerous transformation of Rathke’s pouch

Craniotomy: surgical opening of the skull to reach the brain

Cystic: resembling a cyst; abnormal pocket-like area of tissue

Cytopenia: low blood counts

Deaf: complete loss of hearing

Debulk: remove as much of the bulk of tumor as possible

Dentist: a specialist in oral care and teeth

Depression: a psychological condition defined as a persistent feeling of sadness and loss of interest

Dermatology: a field of medicine that specializes in skin

Desensitization: gradually increasing the dose of chemotherapy drug to avoid negative reactions

Dexamethasone (DECADRON®): a steroid used to decrease inflammation

Diabetes insipidus: disease in which the body cannot regulate how it handles fluids due to issues with the production or reception of the hormone, ADH, causing intense thirst and heavy urination; common complication of craniopharyngioma surgery when the pituitary stalk must be cut to remove all the tumor

Diabetes mellitus: a disease in which the body has lost its ability to produce or respond to insulin, causing abnormal metabolism and elevated glucose levels in the blood and urine

Dura mater: tough outermost layer of the meninges covering the brain and spinal cord

Dysmetria: problems with controlling speed and range of motion needed to perform coordinated movements when judging distance to a target

Dyspnea: difficulty breathing

Edema: swelling due to fluid accumulation

Electrocardiogram (EKG): a medical test that measures the electrical activity in the heart to identify heart conditions

Electroencephalogram (EEG): a medical test that measures the electrical activity in the brain; commonly used to diagnose epileptic conditions

Endocrine: a system of glands that produce hormones regulating metabolism, growth and development, tissue function, sexual function, reproduction, sleep, mood, and other areas of human behavior

Enhancing lesion: an area that appears bright on MRI due to increased uptake of the contrast agent gadolinium; enhancement typically denotes increased vascularity

Enzyme: a protein responsible for speeding up a biochemical reaction

Ependymal: pertaining to the inner lining of the ventricles

Epidermal growth factor receptor (EGFR): receptor involved in cell growth

Epilepsy: a brain condition that results in seizures

Epileptologist: a physician who specializes in epilepsy

Executive function: mental skills such as memory, attention, and planning that are used to manage daily life

Existential distress: describes the psychological distress that is felt when faced with the possibility of death

Eye movement desensitization and reprocessing (EMDR): a psychotherapy treatment used to alleviate stress

Family medicine: a branch of medicine within primary care that focuses on treating people of all ages and genders

Fatigue: tiredness

Fibroblast growth factor receptor (FGFR): cellular receptors that are important for cell growth and distinction

Focal seizure: a seizure that begins in one area of the brain

Foot drop: the inability to pick up the front of the foot which can cause one’s foot to drag on the ground during walking

Frontal horn: A subdivision of the lateral ventricles which extends anteriorly from the foramen of Monro

Frontal lobe: major lobe in the front part of the cerebral cortex that regulates higher order function

Fusiform face area: a part of the visual system in the brain that is responsible for recognizing faces

Gait: limb movements made during walking

Gastroesophageal reflux disease (GERD): acid reflux disease that occurs when stomach acid flows up into the esophagus and irritates the outer cell lining.

Gastrointestinal: a system of the body which consists of the stomach and intestines

Gender: the behavioral characteristics of women, men, girls, and boys, that are socially constructed

Gene regulation: mechanisms that control gene expression

Gene: a hereditary unit which is passed from generation to generation and the expression of which can manifest as a physical characteristic

Generalized tonic-clonic seizure: a type of seizure that occurs due to disturbance in both hemispheres of the brain; loss of consciousness and violent muscle contractions are common presentations

Germ cell: a cell that contributes to gonad formation in sexually reproducing organisms

Glaucoma: increased pressure within the eyeball resulting in the loss of sight

Glioblastoma multiforme: a malignant tumor that arises from glial cells (see

accessory/glial cell) in the brain; a very common adult primary brain tumor

Gout: a disease characterized by arthritis, especially in the feet; the abnormal metabolism of uric acid creates crystals that deposit in joints causing episodes of acute pain

Gross total resection: surgical removal of all the tumor as defined on MRI

Hemisphere (left or right): halves of the brain

Hippocampus: structure in temporal lobe that plays a key role in learning and memory

Histone deacetylase (HDAC) inhibitor: a class of drug used to alter gene expression of cancer cells, instigating their death

Histone protein: proteins that help support the structure of chromosomes

Hormones: class of signaling molecules produced by endocrine glands that are transported in blood vessels to regulate human bodily functions and behavior

Hospice: a branch of healthcare focused on providing palliative care to patients toward the end of life

Hydrocephalus: abnormal buildup of fluid in the ventricles

Hyperglycemia: high blood sugar levels

Hypertension: elevated blood pressure

Hyponatremia: low blood sodium

Hypothalamus: a brain region that secretes certain hormones, body temperature, hunger, thirst, sleep, and some emotional activity

Hysterectomy: surgical removal of the uterus

Immunotherapy: a form of cancer treatment that helps the immune system fight off cancer

Infammation: pain or swelling due to white blood cells responding to a harmful infection

Insomnia: a sleep disorder in which it is difficult to fall and stay asleep

Integrative medicine: a specialty of medicine which focuses on the entire person to achieve health and healing

Intracranial: inside of the skull

Intraocular: inside of the eye

Intravenous (IV): inside of the vein

Intraventricular: inside of the ventricle

Isocitrate dehydrogenase (IDH) mutant: a classification of tumor based off molecular characteristics; normal IDH is expressed within cells and plays a role in metabolism, however, when IDH is mutated, it leads to genetic changes which have the capability of promoting tumor growth; mutant suggests there is a mutation in the function of the IDH protein which is common in low-grade gliomas or secondary GBMs

Isocitrate dehydrogenase (IDH) wild-type: a classification off tumor based of molecular characteristics; wild-type suggests primary GBMs

Lacosamide (VIMPAT®): an anti-convulsant medication

Lamotrigine (LAMICTAL®): an anti-seizure medication

Lateral: toward the side (i.e., the arms are lateral to the chest)

Letrozole (FEMARA®): a hormone-based chemotherapy drug that reduces the amount of estrogen in the body to treat breast cancer

Levetiracetam (KEPPRA®): an anti-seizure medication

Limbic cortex: area of the brain where several important structures are located, which function to control emotion, behavior, and long-term memory

Lomustine (GLEOSTINE®): an anti-cancer alkylating chemotherapy drug (see alkylating agent)

Magnetic Resonance Imaging (MRI): a form of medical imaging that uses a strong magnetic field and radio waves to produce images of the internal organs; helpful for the determining the extent of resection in gross total resection (see resection, gross total resection)

Magnetic resonance spectroscopic imaging (MRSI): imaging that uses strong magnetic field and radio waves to measure biochemical changes within the brain

Maintenance therapy: cancer care that is given to prolong remission

Malignant: cancerous; cells that spread to other parts of the body

Mass effect: effects of a growing mass that pushes on or displaces surrounding tissue

Massage therapy: a therapeutic mechanism of rubbing muscles

Mediterranean diet: a diet inspired by foods and eating habits of those living near the Mediterranean Sea; diet traditionally includes lots of fruits, vegetables, beans and whole grains with a scarcity of red meat; has been associated with better outcomes with cancer-related symptoms.

Melanoma: a form of skin cancer with common metastases to the brain

Meninges: three membranes that line the skull and vertebral canal to enclose the brain and spinal cord; from closest to the brain to the skull: pia mater, arachnoid, dura mater

Meningioma(s): benign tumor(s) arising from the meningeal tissue of the brain

Meta-analysis: a research design that analyzes data produced from several published studies

Microenvironment: the environment that surrounds and supports cells

Mindfulness meditation: meditation focusing on the state of being conscious

Music therapy: the utilization of music as a therapeutic modality

Mutation: an alteration causing change

Myelin: a substance composed of lipids that surrounds the axons of nerves to insulate them; this insulation helps speed up the electrical conductance of axons similar in theory to insulating copper electrical wiring

National Institute of Health (NIH): a medical research center of the U.S. government

Nausea: stomach discomfort resulting in the feeling of needing to vomit; the feeling of nausea is a common side effect of chemotherapy thought to be an effect of overstimulation of the area postrema within the brain

Neocortex: the part of the brain responsible for higher thinking and function such as decision-making

Neoplasm: an abnormal growth of cells in the body

Neuro-oncologist: a physician who specialized in treating brain tumors with medical therapy; coordinates care among the various specialists involved in brain tumor treatment

Neuroanatomist: an expert who studies the anatomy of the brain

Neurocognition: a term used to describe cognition and how it is impacted by the brain

Neurocognitive: the brain’s structures and processes as they relate to cognition

Neurofibroma: small benign nerve growths

Neurofibromatosis type 1 (NF1): a genetic condition that predisposes patients to developing tumors along nerves; clinical presentation includes light brown skin spots and benign skin tumors (see Neurofibroma)

Neurofibromatosis type 2 (NF2): a genetic disease that causes tumors to form from nerve cell sheaths throughout the body; clinically presents with an increased prevalence of bilateral vestibular schwannoma (see vestibular schwannoma)

Neurologist: a physician specializing in the anatomy, function, and disorders of the nerves and nervous system

Neurology: field of medicine involved in the treatment of diseases of the brain, spinal cord, and nervous system without surgery

Neurons: fundamental cells of the brain and nervous system

Neuropathy: damage to nerve endings that can manifest as pain, weakness, and/or numbness depending on the nerves involved

Neuropsychologist: a psychologist that focuses on behavior and its relation to the brain

Neurosurgeon: a surgeon who specializes in surgery of the nervous system, especially the brain and spinal cord

Neurotologist: a physician who specializes in neurological related inner ear issues

NIH Toolbox Cognition Battery: an application-based cognitive assessment administered to test cognitive abilities

Nurse navigator: a nursing professional that assists patients through the course of their diagnosis, treatment, and survivorship

O[6]-methylguanine-DNA methyltransferase (MGMT): a DNA repair enzyme; methylation of this enzyme in cancer cells inactivates it and reduces DNA repair abilities of cancer cells; this genetic modifcation confers a favorable outcome when using alkylating agents

Occipital lobe: most posterior lobe of the brain; responsible for vision processing

Occupational therapy (OT): a branch of healthcare that focuses on treating physical, sensory, and cognitive issues

Olanzapine (ZYPREXA®): an antipsychotic medication

Olfactory groove meningiomas (OGMs): benign tumors that form between the nose and the eyebrow area at the front part of the skull

Olfactory groove: the area of the skull between the nose and the eyebrow

Oligodendrocytes: a type of cell that provides support and myelination to nerves within the central nervous system (see myelin)

Oncology: a medical specialty that focuses on the treatment of cancer

Ophthalmologist: a physician who specializes in the anatomy, function, and disorders of the eye

Optic chiasm: crossing of optic nerves that carry visual signals from the outer half of both the left and right visual fields

Optic nerve: special nerve in the back of each eye that transfers visual information from the retina to the vision centers of the brain via electrical impulses

Optune® device: a form of cancer treatment that uses electrical fields to stop cancer cells from growing or dividing; it resembles a thin, white cap that is worn on the head

Ovarian cancer: cancer in the female reproductive organ ovary

Overactive bladder: condition where there are frequent or sudden urges to urinate

Oxcarbazepine (TRILEPTAL®): an anti-seizure medication; anti-convulsant medication

Parahippocampal gyrus: area that surrounds the hippocampus that plays an important role in spatial awareness

Parahippocampal place area: a part of the brain responsible for scene or place recognition

Paresthesia: burning or prickling sensation in an extremity

Parietal lobe: major lobe in the upper back part of the cerebral cortex that processes sensory information

Pathology: the typical features or behaviors of a disease; a field of medicine dedicated to the cause and nature of disease

PD-1/PD-L1 pathway: a cellular pathway that maintains immune tolerance within the cancer cell

Pediatrician: a physician who treats children

Peri-: around

Peripheral nervous system (PNS): the nervous system outside of the brain and spinal cord

Phenobarbital (SOLFOTON®): an anti-seizure medication that can have a strong effect on drug metabolism

Phenytoin (DILANTIN®): an anti-seizure medication that has a strong effect on drug metabolism

Pineal region: posterior to the third ventricle

Pituitary gland: pea-shaped gland on the base of the brain that controls multiple functions of the human body, including digestion, sexuality, and the body’s response to stress

Pituitary stalk: connection between the pituitary gland and the brain

Pons: a major division of the brainstem which contains ascending and descending neuronal tracts implicated in a wide range of processes

Pontine angle cistern: a CSF-flled space that lies anteriorly to the cerebellum and lateral to the pons; clinically important as it is a common localization of multiple tumors

Posterior: further back in position (i.e., the back is posterior to the chest)

Postoperative: after surgery

Posttraumatic stress disorder (PTSD): a psychological disorder stemming from a traumatic event that is experienced in a person’s life

Premorbid: occurring before diseases

Primary auditory cortex: a part of the brain, located in the temporal lobe, that is responsible for identifying pitch and sound

Primary brain tumor: tumors that originate within the brain

Primary care physician: a physician who practices preventative care; often this includes conducting routine physicals, annual appointments, or screenings

Primary intraventricular tumor: a tumor that stays within the third ventricle

Primary motor cortex: the most important area of the cerebral cortex for producing motor movements; located in the frontal lobe

Primidone (MYSOLINE®): an anti-seizure medication that can have a strong effect on drug metabolism

Probiotics: live microorganisms that promote digestive health

Prognosis: the likely outcome of a situation

Proinfammatory cytokines: regulatory molecules secreted by cells of the immune system that favor inflammation

Proximal: toward the center of the body (i.e., the shoulder is proximal to the hand)

Psychosocial: involving social and psychological aspects

Quetiapine (SEROQUEL®): an antipsychotic medication

Radiation mask: a plastic-like mold or cast that is uniquely made to fit a patient to keep their head and neck in place for accurate delivery of radiation therapy

Radiation oncologist: a physician who specializes in radiation as treatment for cancer

Radiation oncology: a medical specialty that focuses on radiation therapy

Radiation therapy/radiotherapy: cancer treatment that uses beams of intense energy to kill cancer cells

Radiosurgery: focused beam of radiation therapy

Recurrent: returning; coming back

Resection: surgical removal

Respiratory system: a set of organs dedicated to the task of gas exchange with the environment

Retrospective chart review: a research design that uses patient information in medical records to investigate a scientific question

Sagittal: an anatomical plane longitudinally through the middle of the body which splits the body into a left and right half.

Schwann cells: cells that myelinate axons in the peripheral nervous system

Schwannoma: a nerve sheath tumor that originates from Schwann cells

Scoliosis: sideways curvature of the spine

Secondary intraventricular tumor: a tumor that grows adjacent to the third ventricle or the suprasellar region and spreads into the third ventricle as it grows

Seizure: uncontrolled electrical activity within the brain resulting in temporary uncontrollable muscle movements or consciousness

Serotonergic antidepressants: a form of medication that increases serotonin levels to combat depression

Sex: male or female assignment at birth

Shunt: a passageway made by surgery to redirect fluid to another area of the body; used to treat hydrocephalus

Sinus infection: an infection in the lining of the sinus cavity

Skull base: junction of where the brain meets the face

Social worker: a professional that assists patients in solving and coping with challenges from life, such as unemployment, access to care, and familial issues

Spatial memory: recalling information related to space and location; main processing center is the hippocampus

Speech therapy: an area of healthcare focused on treating speech related issues

Spinal column: the spine; bones, muscles and tissues that surround the spinal cord

Spinal cord: a long, tube-like structure that begins in the brain stem and ends near the bottom of the spine; transmits information from the brain to the rest of the body

Stereotactic radio surgery (SRS): an extremely precise form of radiation treatment

Superior: toward the head (i.e. the nose is superior to the mouth)

Suprasellar: situated or rising above the sella turcica which is a saddle-like bony prominence in the middle of the inferior skull that houses the pituitary gland; used to anatomically reference tumors of the pituitary gland

Survivorship: the period of time where a patient is surviving cancer

Suture: surgical threading used to sew incisions closed

T-cells: a component of the immune system that recognizes foreign substances

Tai chi: a form of martial arts

Temozolomide (TMZ, TEMODAR®): a DNA alkylator medication

Temporal lobe: the part of the brain that sits behind the ears; responsible for hearing, visual processes, identifying objects, and navigation

Testosterone: a male sex hormone

Therapeutic profile: the types of therapeutic options that can be used for healthcare treatment

Third ventricle: one of four connected ventricles in the brain’s ventricular system; it is filled with cerebrospinal fluid

Topiramate (TOPOMAX®): a medication used to prevent seizures

Trans-choroidal fissure: an approach to the 3rd ventricle via opening the taenia fornicis of the choroid fissure and proceeding between the two internal cerebral veins

Transducer arrays: contain ceramic discs that create tumor treating fields for the Optune® device

Transgender: a characterization for when a person’s gender identity does not match to the sex they were assigned at birth

Traumatic brain injury (TBI): a brain injury that is caused by a traumatic event that occurs to the head

Tumor treating fields (TTFs): electrical fields that can interfere with cancer cell division and replication (see Optune® device)

Urinary incontinence: loss of bladder control; can be a by-product of spinal cord impairment which allows clinicians to localize neurological issues

Urinary tract infection (UTI): an infection of the urinary system

Valproic acid (DEPAKENE®): an anti-convulsant medication prescribed to treat epilepsy or bipolar disorder

Vascular endothelial growth factor protein (VEGF): a protein that functions to signal the creation of new blood vessels; this is a common target for cancer therapy given that growing cancer cells require an extensive blood vessel network

Vermis: the central portion of the cerebellum that is responsible for coordinating movements closer to the trunk of the body

Vestibular schwannoma (VS): also termed acoustic neuroma; benign tumor of the Schwann cells surrounding CN VIII

Vestibulocochlear nerve (CN VIII): cranial nerve VIII; carries information of hearing and balance from the inner ear to the brain

Visual processing: interpreting the visual world

Wernicke area: an area of the brain that is responsible for understanding and comprehending speech; located in the temporal lobe of the brain

Wildtype: gene with no mutation

Zonisamide (ZONEGRAN®): an anti-convulsant medication used to treat adult epilepsy

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