More than 18,000 new cases of primary brain tumors are treated each year in the United States. Metastases are even more frequent and contribute considerably to suffering and death from systemic cancer. The diversity of brain tumors makes it important to attend to what is characteristic about each histologic type. Biologic specificity guides therapy to some extent now, and will be the key to successful treatment in the future.

The classification of brain tumors is a subject with confusing terminology. This text employs the simple approach of classifying brain tumors into metastatic, primary extra-axial, and primary intra-axial . These categories include all of the primary brain tumors listed in the World Health Organization classification , and adds pituitary and metastatic tumors. Although obviously simple, it follows practical clinical thinking. This chapter deals with the general biology, clinical features, and treatment of brain tumors as an overall problem.

GENERAL CONSIDERATIONS

“Is it benign or malignant?” is invariably the first question asked by patients, families, and physicians when confronted with a diagnosis of brain tumor. About a third of primary brain tumors can be called benign. Meningiomas and acoustic neuromas are good examples. They grow slowly, often can be removed completely, and rarely recur.

The concept of malignancy in the central nervous system (CNS) has a different meaning from that which applies to systemic cancers. The term “malignant” has nothing to do with metastasis out of the CNS, which is extraordinarily rare. It has everything to do with anatomic location and the possibility of complete surgical removal. Unless a tumor can be completely excised to the last cell, all intracranial neoplasms are potentially malignant in that they may recur, and often do.