Pineal tumors are a brain tumor that forms in the pineal gland of the brain. The pineal gland is located within the third ventricle, deep within the brain. It is responsible for managing and secreting specific hormones, including melatonin, within the body. The pineal gland synchronizes hormone release with phases of the light-dark cycle but the relationship with the Circadian Rhythm remains unclear. The pineal gland creates cells, called pinocytes. These normal cells sometimes form into tumors.
There are three main types of pineal tumors: pineocytoma, pineoblastoma, and mixed pineal tumors. Pineocytoma is a Grade II tumor and is slow-growing. Pineoblastoma is Grade IV and is a much more aggressive malignant tumor.
Pineal tumors only account for less than 1% of all brain tumors, but occur more commonly in children and adults between 20-40 years old. Pineal tumors are considered rare and only comprise 8% of discovered tumors. Most of these tumors are never considered cancerous, although treatment is very similar.
Causes
As with most brain tumors, the cause of pineal tumors is unknown. Research is being conducted to locate the cause and there have been some links associated with chromosomal abnormalities.
Symptoms
These tumors block the flow of cerebrospinal fluid which is what commonly causes the symptoms. Headaches are the most common symptom and occur within 50% of individuals with pineal tumors, but less than 1% of headaches are caused by tumors.
In addition to headaches, many individuals suffer from other symptoms such as seizures, nausea, and vomiting. Hearing problems including ringing or buzzing, and vision problems including erratic eye movement and blurred vision, are also common among those that suffer from a pineal tumor. They may also experience changes in speech, weakness in their limbs, lack of coordination or stumbling when walking, and drowsiness. Many of these symptoms are similar to a stroke and should be checked out by your medical doctor immediately.
Several of the symptoms are caused by the tumors blocking the flow of cerebrospinal fluid and the pressure that this causes. This fluid flows between the brain and spine and is absolutely vital. It provides cushion for the cortex as well as immunological protection. It also serves to rid the brain of metabolic waste when it circulates through the blood-brain barrier.
Testing
Testing will include a panel of neurological tests, including vision, hearing, coordination, reflexes, and balance. From there the doctor will request a CT scan, MRI, angiogram, Xray or various other scans.
A Computerized Tomography scan, or CT scan, is a type of advanced Xray connected to a computer that creates a two-dimensional image of the brain. This is done in a large machine that resembles a donut. Dye may be injected to make the scan more prominent and easier for the doctor to read.
A Magnetized Resonance Imaging scan, commonly known as a MRI, uses radio waves and magnetic fields to create images. These scans show soft tissue as well as bone surfaces and provide more detailed information. They also allow doctors to monitor brain activity and the impact of the tumor. Dye may also be injected for this procedure so that the tumor may be more visible.
Other tests that may be conducted include Single-Photon Emission Computerized Tomography (SPECT), Magnetic Resonance Spectroscopy (MRS), or Positron Emission Tomography (PET) scanning. These tests can be combined with the other tests to provide an more accurate depiction of the tumor.
After testing has been completed the doctor may request a biopsy of the tumor. This is the only way to accurately identify and diagnose a tumor. A biopsy is done by removing a small sample of the tissue which is retrieved by creating a very small hole drilled in the skull. A needle is then injected to retrieve the sample. Once obtained, the tissue is observed under microscope and additional testing may be done to verify the identity of the tumor.
The cerebrospinal fluid may also require testing through a lumbar puncture, commonly known as a spinal tap.
Treatment
Treatment is based on the type of pineal tumor. A doctor will recommend the method that is best to treat the specific tumor.
Standard treatment would consist of radiation therapy. This procedure is a highly targeted method of destroying the damaged cells with the use of a specialized machine that delivers high doses of radiation.
Some types of tumors will require chemotherapy before radiation can begin. This is typically done when a tumor has had the chance to spread throughout the body. Chemotherapy is a whole body treatment delivered through medication. It is meant to weaken and slow the tumored cells so that radiation therapy will be beneficial.
Benign tumors can be treated with surgery that completely removes the tumor from the body. Pineocytomas are treated with surgery because radiation has been found to have no effect. The area undergoing surgery is numbed before surgery begins. The surgery could be a full removal but in some cases, the doctor may opt for only a partial removal. This would be contingent on the situation. A shunt may be required to drain fluid from the area. Because of the introduction of these surgical procedures the mortality rate is 0-8%, compared to 90% in the beginning of the 20th century.
Newer techniques are being tested, including stereotactic techniques which are a more specialized form of radiation therapy.
After the tumor is eliminated, the patient will need to see an endocrinologist to ensure there are no hormone deficiencies. These intense treatments are known to cause harm to the hormonal systems so it is imperative to ensure the body has a complete balance of the proper hormones. Most conditions can be treated and controlled with various medical therapies.
There are also support groups for those who have dealt with pineal tumors. These groups provide comfort by uniting people who currently have tumors with those who have successfully removed their pineal tumors.
As with most medical conditions, the key to being free of the tumor is early detection through symptom recognition. The patient who is aware of changes in their body will be able to process the information and recover faster.