Left-Sided Skull Base Tumors: Insights and Treatment Options

Left-sided skull base tumor

Dear Dr.
Chen,
My mother has been diagnosed with a left-sided skull base tumor.
Although it is not a recurrence or metastasis of the nasopharyngeal carcinoma she had 23 years ago, it is still caused by epithelial cancer cells and has expanded to invade the adjacent skull bone.
I would like to seek your advice on the following:
1.
I have asked the doctors about the stage of the cancer, but they have not provided a clear answer.
Is it because the biopsy report does not indicate the stage, or are they concerned about causing anxiety for the family? How does the prognosis of this tumor compare to that of nasopharyngeal carcinoma?
2.
Given that my mother has significant post-radiation complications from her previous cobalt-60 treatment (she can currently only consume liquid food), and considering her frail condition (weighing 39 kg), we have decided to start with oral chemotherapy using UFUR capsules.
If there is no effect, we may need to switch to intravenous chemotherapy.
However, is oral chemotherapy likely to be effective in her situation?
3.
I am quite worried that my mother may not be able to tolerate chemotherapy.
Is this tumor unsuitable for treatment with Gamma Knife or other stereotactic radiosurgery techniques?
4.
Despite taking pain medication, my mother continues to experience severe headaches that make it difficult for her to sleep.
Would it be appropriate to ask the doctor for a prescription for sleeping pills?
I sincerely appreciate your guidance.
Sincerely,
Ms.
Zhao

Ms. Zhao, 30~39 year old female. Ask Date: 2013/11/23

Dr. Chen Sirong reply Oncology

Ms.
Zhao / 32 / 1 Hello 1.1 When asked what stage the cancer is, the answer is: If it has reached the skull, it is at least stage 3, possibly stage 4.
1.2 Is the survival rate for this tumor the same as that for nasopharyngeal cancer? A: It is not nasopharyngeal cancer, so the survival rates are different.
We need to identify the primary site of origin to determine the survival rate for this type of cancer based on the literature.
The survival rate reflects the outcomes of standard treatments.
If your mother cannot tolerate the standard treatments that may potentially cure this type of cancer, then she cannot use that survival rate for predictions.
For example, oral UFUR cannot cure this type of cancer, so her prognosis would naturally be worse than the general survival rates.
2.
Is oral chemotherapy of limited benefit for her condition? A: Oral chemotherapy has limited benefits, and intravenous chemotherapy is also not very effective for this type of cancer.
Additionally, your mother's physical condition may not be able to tolerate it.
Generally, head and neck tumors can only be cured through surgery or radiation therapy.
3.
Given the significant concern that my mother cannot tolerate chemotherapy, is this tumor unsuitable for Gamma Knife or other stereotactic radiosurgery? A: It should be worth trying.
Take the imaging to a hospital that has that type of equipment for evaluation.
4.
Even after taking pain medication, my mother still experiences severe headaches that make it difficult for her to sleep.
Would it be appropriate to ask the doctor for a prescription for sleeping pills? A: That would be the only option, so it is appropriate.
Thank you for your letter.
Taoyuan Medical Center, Dr.
Chen Si-Rong.

Reply Date: 2013/11/23

More Info

Dear Ms. Zhao,
I’m sorry to hear about your mother’s diagnosis of a left-sided skull base tumor. This is undoubtedly a challenging situation for both her and your family. I will address your questions one by one, providing insights based on current medical knowledge regarding skull base tumors and their treatment options.

1. Cancer Staging and Prognosis: The stage of cancer is typically determined by the size of the tumor, the extent of its spread, and whether it has invaded nearby tissues or lymph nodes. In your mother’s case, the fact that the tumor is composed of epithelial cancer cells and has invaded adjacent skull bone suggests a more aggressive behavior. The absence of a clear stage may be due to the complexity of the tumor's characteristics or the limitations of the biopsy. It’s also possible that the medical team is cautious about providing a prognosis to avoid causing undue distress. Generally, the prognosis for skull base tumors can vary significantly based on their type, location, and the patient’s overall health. Comparing survival rates with those of nasopharyngeal cancer may not be straightforward, as the biological behavior of different tumors can vary widely.

2. Chemotherapy Options: The decision to use oral chemotherapy, such as UFUR (which is a prodrug of 5-fluorouracil), is often based on the tumor type and the patient's overall condition. While oral chemotherapy can be effective, it may not be as potent as intravenous options, especially in cases of advanced disease. Given your mother’s frailty and past treatment history, the medical team is likely weighing the benefits against the potential side effects. If oral chemotherapy does not yield the desired results, transitioning to intravenous chemotherapy may be necessary, but this should be closely monitored due to her weakened state.

3. Surgical Options: Regarding the use of Gamma Knife radiosurgery or other forms of stereotactic radiosurgery, these techniques are often used for tumors that are well-defined and not extensively infiltrative. If the tumor has invaded surrounding structures significantly, surgical resection may be more appropriate. The decision will depend on the tumor's specific characteristics, its location, and your mother’s overall health. A multidisciplinary team, including neurosurgeons and radiation oncologists, should evaluate the best approach for her case.

4. Management of Pain and Sleep Issues: Persistent headaches, especially in the context of a tumor, can be distressing and may require more than over-the-counter pain relief. If your mother is experiencing severe headaches that interfere with her sleep, it is reasonable to discuss the use of prescription medications, including stronger analgesics or even sedatives, with her physician. However, it’s essential to ensure that any medication prescribed does not interact negatively with her ongoing treatments.

In conclusion, I encourage you to maintain open communication with your mother’s healthcare team. They can provide the most accurate information tailored to her specific situation. It may also be beneficial to seek a second opinion if you feel uncertain about the treatment plan. Support for both your mother and your family during this time is crucial, and consider involving palliative care specialists who can assist with symptom management and improve her quality of life.

Wishing you and your family strength during this difficult time.

Best regards.

Similar Q&A

Effective Treatments for Skull Base Pseudotumors: Chemotherapy, Surgery, and More

How should a physician treat a pseudotumor at the skull base, which is characterized by fibrosis (also known as scarring), in order to achieve healing? Is chemotherapy, radiation therapy, or surgery recommended? Thank you!

Dr. Xie Bojun reply Neurosurgery
Hello, WANG~ Currently, our hospital does not offer chemotherapy combined with surgical procedures. We recommend that you consult with other medical centers. Thank you.

Understanding Left Temporal Brain Tumors: Symptoms, Treatment, and Prognosis

A few months ago, family members began to experience declines in memory and cognitive abilities. After imaging studies, the doctor diagnosed dementia caused by a stroke. They have been taking medication, but within less than a month, there has been a noticeable decrease in mobili...

Dr. Chen Sirong reply Oncology
Alice / 33 years old / Female 1. Is it malignant? A1. A biopsy is necessary to determine if it is truly malignant. A2. If it is located in the brain, surrounded by bone, and causing pressure on the cranial nerves, even if the pathology is benign, the symptoms can be unbear...

Understanding Meningioma: Treatment Options and Surgical Alternatives

What are the treatment options for meningiomas? Are there any methods that can cure it without surgery? What is the likelihood of a complete cure?

Dr. Ding Xianwei reply Neurosurgery
Hello: Meningiomas are primarily treated with surgery, while other treatments serve as adjuncts. There are no non-surgical methods that can cure them. However, it is essential to know the tumor's location; if it is situated at the skull base, surgery may sometimes be unmanag...

Understanding Acoustic Neuroma: Concerns and Treatment Options

Hello, I underwent X-rays and MRI at the hospital and discovered a tumor in my left ear. The doctor informed me that it is an acoustic neuroma, but since the tumor is small, only about 0.9 centimeters, I only need to have annual follow-up examinations, and there are no other medi...

Dr. Hu Kexin reply Otolaryngology
Hello, acoustic neuromas are generally treated with surgical intervention. The specialty involved (neurosurgery or otolaryngology) may vary depending on the hospital. Sincerely, Dr. Huke Xin.