To the Brain
Types of Tumors Treated with
Brain tumors, both benign and
Metastatic brain lesions. These are
cancers that start in another part of the
body and spread to the brain.
Vestibular schwannomas or acoustic
Before your Treatment
Before treatment can begin, you will need a
facemask and a CAT (CT) scan. This
process takes about 30 minutes.
The Face Mask
The facemask takes about 10-15 minutes to
make. You lie back on the table with a head
mold in place. A mesh film is placed across
the top of your head, forehead, and nose,
ending below your chin. The mesh is flexible
plastic that is placed in warm water. As it
molds to your face, it becomes stiff. The
facemask will be molded to fit the contours of
your eyes and your nose. It is important that
the mask fit snugly around these features.
The mask takes about 10-15 minutes to
harden around your face. As it hardens you
will feel the mask tighten slightly. It will not
hurt, but you will notice it. We need to lightly
press on your eyes and mold the mask to the
bridge of your nose. If you are
claustrophobic or afraid of being in
confined spaces, please let us know.
The CAT (CT) Scan
If IV contrast is needed, an IV will be placed
before the facemask is made.
The CT scan will be done right after the
facemask is made. About midway thru the
CT scan, the contrast will be injected. Some
people feel a warm flush or have a strange
taste in their mouth. This is normal and will
go away after the CT is finished.
If you have never had a CT scan before please
let your nurse know so they can explain it.
The scan is the final step before we can begin
planning your treatment. If IV contrast is
needed, a blood test called a creatinine level
may be done before the CT. This is to make
sure that your kidneys are working well. Your
local doctor can do the test or it can be done
If you have an allergy to the CT contrast or
are allergic to shellfish or iodine products
please let your doctor or nurse know.
If you have IV contrast during your CT
scan and take certain oral medicines for
your diabetes, please let your nurse or
doctor know. If you take Glucovance®,
metformin, Metaglip®, Avandamet® or
Glucophage® please let us know. You will
be told if you should not take this the day of
your scan and for 48 hours after the injection
of contrast. We may need to find a short-term
plan to manage your blood sugars until you
can resume this medicine. This may involve
talking to your primary doctor. If you do not
need the CT contrast, you will not need any
changes in your medicines.
If you have diabetes and use insulin, please
let your nurse or doctor know. We may
need to adjust your medicine if you are told
not eat or drink prior to your CT scan.
Remember: You should have nothing to eat
or drink for 4 hours before the CT scan. If
IV contrast is used, once the MRI and CT
are finished, we ask you to drink extra
fluids that day. This will help flush the dye
out of your system.
The mask will be removed once the CT scan
is done. If you have an MRI after the CT, the
IV will be left in. If not, it will be removed at
You will receive 2 – 7 weeks of radiation
treatments based on the type of tumor you
Your first treatment will take about 45
minutes. The therapists will position you on
the treatment table and put marks on your
facemask. The rest of your treatments will
take about 15 minutes. If you receive
TomoTherapy® or re-treatment radiation,
these treatments can take up to 60 minutes for
each treatment. Your doctor will discuss the
type of treatment you are receiving and how
long it will take.
During your treatments you will see your
doctor or nurse once a week to watch for side
effects. If you have questions at any time
during your treatment, please let the therapist
know. He or she will arrange for you to meet
with a doctor. During the last weeks of
treatment you will discuss follow-up care.
Most of the time there are few side effects.
Some may appear shortly after starting
treatment. Others may takes months or years
to develop. The most common side effects
are listed below.
Brain swelling/brain edema - patients
may have brain swelling during treatment
or weeks to months after treatment is over.
If you develop swelling, you will be
treated with a steroid medicine. If you
have issues with brain swelling or are
taking steroids, please ask your nurse or
doctor for a handout (HFFY #6382). This
will have more information about the side
effects of steroids.
Symptoms of brain swelling can vary
based upon the location and type of tumor
or lesion you have. A few of the more
common things to watch for are listed
below. If you have any of these, tell your
Increasing or severe headaches
that are not relieved by Tylenol®.
Headaches that occur daily or
several times a day, even if
relieved by Tylenol®.
Headaches with nausea and
Nausea or vomiting.
Any change in strength or
sensation (numbness or tingling).
Clumsiness or coordination
problems of a hand or leg.
Vision, hearing or speech changes
Balance or walking problems.
New onset of confusion.
New seizures or worsening of
Skin irritation - Red, dry skin, like a
sunburn, may occur. While you are
having treatments we will check your
skin. We can give you a cream and talk
with you about ways to protect and
maintain your skin. Pay special attention
to the tops of the ears or areas where hair
loss has occurred.
Remember to keep your head covered
when you are outside. You want to limit
the sun exposure to the head as much as
possible. We strongly suggest you use a
sunscreen with an SPF of at least 30.
Remember: Your skin needs to be
clean and dry before each treatment.
Moisturizers and creams should be
applied 2 – 3 times per day, but
onlyAFTER the day’s treatment. If
your treatment is late in the day, you
may apply moisturizer before your
treatment if it will be fully absorbed by
the time your treatment is given. As a
guide, we ask you not to apply creams
for 4 hours before treatment.
Hair loss – hair loss can occur to the
whole scalp (if you receive whole brain
radiation) or in patches. Often hair loss
starts around the 2nd week of treatment
for whole brain radiation. Others will
notice hair loss around the 4th or 5th week
of treatment. Sometimes, with our newer
techniques, people may not notice loss
until the final week of treatment or the
week after treatment ends.
For most people hair will begin to re-grow
about 3 months after radiation treatment
has finished. It may come back thinner or
a different texture than before. In some
cases, hair loss may be permanent. Use a
mild shampoo and avoid daily washing,
hot rollers, curling irons etc., if you can.
You may want to use scarves, turbans or
caps during and after your treatment. You
can make an appointment with our
specialists to discuss what options are
available at 608-266-6025.
Fatigue (tiredness) – Fatigue does not
mean that your tumor is getting worse. It
can be a side effect of treatment. Many
find that they are able to carry on their
normal routines with little problem. Some
find that they begin to feel more tired
about week 3 of treatment and near the
end of treatments and may need to rest.
Taking rest breaks is very important. You
will need to listen to your body and rest as
needed. For most people the fatigue
begins to go away 2-6 weeks after
treatment. Weight loss can make this
worse. Many people find that rest and
exercise can help with this symptom.
Taste Changes – Sometimes radiation
can change how foods taste. This can be a
side effect of radiation. It will improve
after radiation is finished. Sometimes, the
taste changes are because you have thrush.
See the information below about thrush.
Thrush – You should look at your tongue
and the inside of your mouth daily. It
should be pink and smooth. If you notice
any red or white patches on your tongue or
develop a “funny or strange” taste in your
mouth, please let your doctor or nurse
know. Sometimes a yeast infection
(thrush) occurs. This will be treated with
ξ Cognitive and Memory Changes: People
living with a brain tumor can have many
kinds of mental changes. Sometimes these
are called “chemo brain,” yet they occur in
people who have never had chemotherapy.
Some of these changes are a result of
injury by the tumor on normal tissue. This
may be why you went to your doctor in
the first place. Some changes are caused
by the treatments to remove or destroy the
tumor, such as surgery, chemotherapy or
You may have some of these issues:
ξ Trouble concentrating or focusing
ξ Feeling “foggy”
ξ Problems multitasking
ξ Slower thinking speed or
processing of information
ξ Trouble remembering things
ξ Trouble completing tasks or
ξ Mood or behavior changes
When do they appear and how long will
ξ Some of these changes appear
during or shortly after treatment.
They may be temporary and will
improve over time. Some may be
ξ Some changes may occur many
months to years afterward.
ξ Along with the tumor treatments,
there can also be non-tumor
causes, like medicines,
imbalances, aging, depression,
stress and hormone imbalances.
ξ We will discuss these issues with
you as they may occur.
How do I deal with these changes?
Here are a few things we suggest to help
you cope with these changes:
ξ Review medicines.
ξ Keep notes and set alarms to
remind you when important things
ξ Use a daily calendar.
ξ Place sticky notes around the
house with reminders or
ξ Play games such as Sudoku or
puzzles that engage your memory.
ξ Get plenty of rest.
ξ Keep hydrated and drink plenty of
ξ Seek health psychology as stress
and coping can make some
ξ You can also find more
information on dealing with these
o American Brain Tumor
Association- www.abta.org -
Memory and Cognitive
o American Brain Tumor
Association- www.abta.org -
Caregiving Tips: Managing the
o American Cancer Society -
What is Chemo Brain
Cognitive changes after cancer
o Cancer.net- www.cancer.net -
Attention, Thinking, or
ξ Nausea and Nutritional Needs –
Although rare, some patients may have
nausea or vomiting during treatment. If
you do, please let your doctor or nurse
know. Medicines can be ordered to help
you. Nutrition is very important. Avoid
alcohol and smoking. We do not want
you to lose weight at this time. Try to eat
3 servings of protein and drink at least 6-8
glasses of water every day. Fatigue
(tiredness) can decrease your appetite and
you may want to eat 6 small meals a day
rather than 3 large meals. Good eating and
drinking habits will help lessen the side
effects of treatment. If you have further
questions about nutrition please discuss
them with your nurse. A dietician can
help with any questions or concerns.
Hearing Problems – Some people with
tumors near the ear or those receiving
whole brain radiation may develop
hearing problems. These symptoms may
be caused by earwax or excess skin
shedding from the radiation. They usually
go away after time.
Changes in vision – Radiation given for
tumors near the eye or tumors that require
whole brain radiation can produce eye
irritation. This can cause tearing, redness,
or dryness. These often go away or at
least get better after several weeks. If the
tumor is on or near the eye nerves, vision
loss can occur and eye dryness may be
permanent. In rare cases, some people can
get cataracts after radiation. Please
discuss these issues with your doctor.
Other Concerns – A diagnosis of cancer
brings concerns other than the need to
manage the acute side effects of treatment.
It can affect many other areas of your life.
You may feel its impact on your emotions,
marriage, family life, jobs, finances,
thoughts, and feelings about the future.
The nurses and social workers can help
you cope with these issues. They can
suggest support services and resources.
Feel free to speak to them at any time
Your doctor will discuss the immediate and
long-term risks of this treatment with you.
The risks vary from patient to patient and
depend on a number of factors.
Questions or Concerns
While you are having treatments, you will see
your doctor or nurse weekly. If you have any
questions at any time during your treatments,
please let the therapist working with you
know. They will arrange for you to meet with
If you have any questions or problems, please
feel free to call the Radiotherapy Clinic at
608-263-8500. If the clinic is closed, your
call will transfer to the hospital paging
operator. Ask for the radiotherapy doctor on
call. Leave your name and phone number
with the area code. The doctor will call you
If you live outside of the area, call 1-800-323-
Cancer Resource Services
Cancer Connect is a service of the UW
Comprehensive Cancer Center. The staff can
answer your questions about local treatments.
Cancer Connect can also connect you with
community resources and support services.
The number is (608) 262-5223.
Cancer Information Service is a phone
service of the National Cancer Institute. It is a
resource for local cancer care as well as
cancer care around the country. The toll free
number is 1-800-422-6237.
American Brain Tumor Association
ABTA is a complete source of information
about brain tumors, treatment options, clinical
trials, and living with a brain tumor. A
variety of social work resources and services
are also available. 1-800-886-2282
National Brain Tumor Society
NBTS offers information about benign and
malignant brain tumors, treatment centers,
treatment options, the latest clinical trials and
a survivors’ network
Madison Area Brain Tumor Support
All brain tumor survivors and their family or
support persons are invited to share their brain
tumor experiences in an effort to provide a
supportive and educational experience.
Meetings take place at UW Hospital on the
third Tuesday of the month. 1-608-265-1192
Website: www.uwhealth.org search for
“Brain Tumor Support group” for a list of
dates and times.
Your health care team may have given you this information as part of your care. If so, please use it and call if you have
any questions. If this information was not given to you as part of your care, please check with your doctor. This is not
medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because each person’s
health needs are different, you should talk with your doctor or others on your health care team when using this
information. If you have an emergency, please call 911. Copyright © 5/2017 University of Wisconsin Hospitals and
Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#4469