Brain tumor: types, symptoms, treatment and brain cancer treatment cost

Medically reviewed: 7, February 2024

Brain tumor: overview of the disease

Brain tumor is a serious condition that affects millions of people around the world. It occurs when abnormal cells grow and form masses or tumors in the brain or near it. Brain cancer can cause various symptoms and complications, depending on the type, size, location, and grade of the tumor. We will explain the main types of brain tumors, their causes, risk factors, symptoms, diagnosis, treatment, and prognosis. We will also discuss some of the latest advances and research in the field of brain cancer.

Brain tumors may start in the brain (primary tumors) or they may start elsewhere in the body and be carried to the brain in the blood (secondary tumors). Secondary brain tumors are more common, only about 10% of brain tumors actually start in the brain.

Primary brain tumors may arise from several different kinds of tissue. The actual brain nerve cells themselves rarely form tumors.

Key takeaways

1. Varied Types: Brain tumors encompass diverse types, classified according to their cellular origins, behavior, and locations. Examples include gliomas, meningiomas, pituitary adenomas, acoustic neuromas, medulloblastomas, and metastatic brain tumors.
2. Diverse Symptoms: Depending on the tumor’s size, location, and progression, signs and symptoms may differ significantly among individuals. Common manifestations include persistent headaches, seizures, cognitive impairment, sensory disturbances, balance issues, and changes in personality or mood.
3. Multidisciplinary Treatments: Effective management of brain tumors necessitates a multifaceted approach involving specialized teams comprising neurosurgeons, radiologists, pathologists, oncologists, neurologists, rehabilitation therapists, and supportive care providers. Comprehensive treatment plans typically incorporate surgery, radiation therapy, chemotherapy, targeted drug delivery systems, immunotherapies, and symptomatic relief measures tailored to each patient’s unique circumstances.

Types of brain tumors

There are many types of brain tumors, but they can be broadly classified into two groups: primary and secondary. Primary brain tumors originate from the cells or tissues of the brain or its surroundings, while secondary brain tumors (also called metastatic brain tumors) spread to the brain from other parts of the body, such as the lungs, breast, or skin.

Primary brain tumors can be further divided into benign and malignant. Benign brain tumors are noncancerous and usually grow slowly. They may not cause any symptoms or problems, unless they press on the brain tissue or block the flow of cerebrospinal fluid (the fluid that surrounds and protects the brain and spinal cord). Malignant brain tumors are cancerous and tend to grow quickly and invade the surrounding brain tissue.

The type of brain tumor is determined by the kind of cells that make up the tumor. There are certain types of tumors that can grow in the brain, and some of the most common ones are called primary brain tumors:

• Gliomas:

These are tumors that arise from glial cells, which are the supportive cells of the brain and spinal cord. Gliomas can be benign or malignant, and they have different subtypes, such as astrocytoma, oligodendroglioma, ependymoma, and glioblastoma. Glioblastoma, which is prevalent among adults, is recognized as the most prevalent and aggressive form of malignant brain tumor.

• Meningiomas:

These are neoplasms that originate from the meninges, which are the membranes that cover the brain and spinal cord. Most meningiomas are benign and slow-growing, but some can be malignant and fast-growing. They are more common in women than in men, and they usually occur in middle-aged or older adults.

• Pituitary adenomas:

These are tumors that develop from the pituitary gland, which is a small organ at the base of the brain that produces hormones that regulate various bodily functions. Pituitary adenomas are usually benign and slow-growing, but they can cause hormonal imbalances and vision problems. More women have them than men, and they can happen to people of any age.

• Acoustic neuromas:

These are tumors that grow from the nerve that connects the ear to the brain. They are also called vestibular schwannomas, because they arise from the Schwann cells that cover the nerve. Acoustic neuromas are usually benign and slow-growing, but they can cause hearing loss, tinnitus (ringing in the ear), and balance problems. They are more common in middle-aged adults, and they may be associated with a genetic condition called neurofibromatosis type 2.

• Medulloblastomas:

Cerebellar tumors, originating from the region of the brain responsible for maintaining balance and coordination, are highly prevalent among children and are recognized as the predominant form of malignant brain tumors in this population. Notably, they tend to affect boys more frequently than girls and are frequently diagnosed before the age of 10.

• Pineal tumors:

These are tumors that develop from the pineal gland, which is a small organ in the center of the brain that produces melatonin, a hormone that regulates the sleep-wake cycle. Pineal tumors can be benign or malignant, and they can cause headaches, vision problems, and hormonal changes. They are rare, and they can occur at any age.

Some brain tumors are benign. Benign tumors are those that never seed off to other parts of the body and always remain at the site of origin. In this situation, however, “benign” may be a misleading term.

Because the brain is enclosed in a rigid bone casing, anything growing inside is very likely to do harm by pressing on brain structures. However, if diagnosed early enough, benign tumors are often easier to remove.

Types of brain tumor in adults

Although brain tumors can affect people of any age, some types are more common in adults than in children. Let’s look at adult brain tumors closely.

According to the American Brain Tumor Association, the most common types of primary brain tumors in adults are:

Glioblastoma brain tumor

This is the most common and aggressive type of malignant brain tumor in adults, accounting for about 15% of all primary brain tumors. It usually occurs in the cerebral hemispheres, which are the two halves of the brain that control thinking, memory, speech, and movement. It can also occur in other parts of the brain, such as the brainstem or the cerebellum. Glioblastoma grows rapidly and invades the surrounding brain tissue. It can also form new blood vessels to supply itself with oxygen and nutrients.

Tumor can also affect vision, speech, and coordination. It is more common in men than in women, and it usually affects older adults, with an average age of diagnosis of 64 years.

Meningioma brain tumor

This is the most common type of benign brain tumor in adults, accounting for about 36% of all primary brain tumors. It usually occurs in the meninges, which are the membranes that cover the brain and spinal cord. It can also occur in other parts of the skull or the spine. This neoplasm grows slowly and does not invade the brain tissue. It can cause symptoms by pressing on the brain tissue or the cranial nerves, which are the nerves that control the senses and the facial muscles. It can cause headaches, vision problems, hearing loss, facial numbness, and seizures. It can also affect memory, mood, and personality. Meningioma is more common in women than in men, and it usually affects middle-aged or older adults, with an average age of diagnosis of 62 years.

The specific reason behind the development of meningioma remains uncertain, although several factors that may increase the risk have been identified. These factors encompass exposure to radiation, hormonal influences, obesity, and specific inherited conditions such as neurofibromatosis type 2 or Gorlin syndrome.

Pituitary adenoma brain tumor

This is the third most common type of primary brain tumor in adults, accounting for about 15% of all primary brain tumors. It occurs in the pituitary gland, which is a small organ at the base of the brain that produces hormones that regulate various bodily functions. Neoplasm grows slowly and does not invade the brain tissue. It can cause symptoms by pressing on the optic nerves, which are the nerves that connect the eyes to the brain, or by producing too much or too little of certain hormones.

Pituitary adenoma can cause vision problems, headaches, nausea, vomiting, fatigue, weight changes, sexual dysfunction, and menstrual irregularities. It can also affect growth, metabolism, blood pressure, and mood. Typically it is more common in women than in men, and it can occur at any age, but it is more frequent in adults between 30 and 60 years.

We don’t know for sure why people get pituitary adenoma, but some things that might make it more likely are changes in genes that you get from your parents, if others in your family have had it, or if you have certain conditions that run in your family.

Glioblastoma brain tumor

Glioblastoma is an exceptionally prevalent and highly aggressive form of cancerous brain tumor that primarily affects adults. It usually occurs in the cerebral hemispheres, which are the two halves of the brain that control thinking, memory, speech, and movement. It can also occur in other parts of the brain, such as the brainstem or the cerebellum. Glioblastoma grows rapidly and invades the surrounding brain tissue. It can also form new blood vessels to supply itself with oxygen and nutrients. It can cause various symptoms, such as headaches, nausea, vomiting, seizures, confusion, personality changes, and weakness. It can also affect vision, speech, and coordination.

Glioblastoma is more common in men than in women, and it usually affects older adults, with an average age of diagnosis of 64 years.

The specific reason behind the development of glioblastoma remains uncertain; however, several factors that potentially increase the risk of this condition have been identified. These include instances of exposure to radiation, genetic mutations, and the presence of certain inherited syndromes like Li-Fraumeni syndrome or Turcot syndrome.

Glioblastoma multiforme

Glioblastoma multiforme (GBM) is the most common and aggressive subtype of glioblastoma. It is also called grade 4 astrocytoma, because it originates from astrocytes, which are the star-shaped cells that support and connect the nerve cells in the brain. GBM is characterized by a high degree of cellular and genetic diversity, which makes it difficult to treat and predict. Glioblastoma multiforme can have different patterns of growth, such as diffuse, nodular, or ring-like. It can also have different molecular features, such as mutations in genes like IDH1, EGFR, PTEN, or TP53.

These features can influence the response to treatment and the prognosis of GBM. It is usually treated with a combination of surgery, radiation therapy, chemotherapy, targeted therapy, or immunotherapy, depending on the size, location, and grade of the tumor, as well as the patient’s overall health and preferences.

Nevertheless, this specific tumor has a poor prognosis, with a median survival of about 15 months, and a five-year survival rate of less than 10%.

Medulloblastoma

Medulloblastoma is the most common type of malignant brain tumor in children, and it accounts for about 20% of all pediatric brain tumors. It arises from the cerebellum, which is the part of the brain that controls balance and coordination. It can also spread through the cerebrospinal fluid. Medulloblastoma can cause symptoms such as headaches, nausea, vomiting, dizziness, ataxia (lack of coordination), nystagmus (rapid eye movements), and hydrocephalus (buildup of fluid in the brain).

Medulloblastoma has a higher prevalence in males compared to females, with the majority of cases typically appearing before the age of 10. Several factors can contribute to the development of this condition, including acquiring genetic mutations, or having certain inherited syndromes like Gorlin syndrome or Turcot syndrome.

Medulloblastoma can be classified into different subtypes, based on the appearance, behavior, and molecular characteristics of the tumor cells. Some of the subtypes are:

WNT medulloblastoma

This is the most favorable subtype of medulloblastoma, with a high rate of cure and a low risk of recurrence. It is characterized by the activation of the WNT signaling pathway, which is involved in cell growth and differentiation. WNT medulloblastoma, which makes up approximately 10% of total cases, tends to occur more frequently in older children and adults, as well as in females. This specific type of medulloblastoma typically manifests in the central region of the cerebellum and rarely exhibits the tendency to spread to other parts of the body.

SHH medulloblastoma

This is a subtype of medulloblastoma that is associated with the activation of the SHH signaling pathway, which is involved in embryonic development and tissue repair. SHH medulloblastoma, which makes up approximately 30% of cases, can develop at any age but is more prevalent in infants, adults, and males. It typically originates in the lateral or posterior regions of the cerebellum but can also spread to other areas.

Group 3 medulloblastoma

This is the most aggressive subtype of medulloblastoma, with a high rate of recurrence and a poor prognosis. It is characterized by the amplification of the MYC gene, which is involved in cell proliferation and survival. Group 3 medulloblastoma accounts for about 25% of all cases, and it is more common in young children and males. It usually occurs in the midline of the cerebellum, and it often spreads.

Group 4 medulloblastoma

This type of neoplasm that is intermediate in terms of aggressiveness and prognosis. Group 4 medulloblastoma is a type of brain cancer that happens when a gene called MYCN gets too strong. This gene helps our cells grow and change. About 35% of all cases of medulloblastoma are group 4. It can happen to anyone, but it’s more common in older kids and boys. This cancer usually happens in the middle part of the brain called the cerebellum.

Medulloblastoma has a variable prognosis, depending on the subtype, stage, and response to treatment. The overall five-year survival rate for medulloblastoma is about 70%, but it can range from 90% for WNT subtype to 40% for Group 3 subtype.

Astrocytoma

Astrocytoma is a type of brain tumor that originates from astrocytes, which are the star-shaped cells that support and connect the nerve cells in the brain and spinal cord, it can be benign or malignant, and it can occur in any part of the brain or spinal cord, but it is more common in the cerebrum, which is the largest and most complex part of the brain that controls thinking, memory, emotion, and movement. This particular cancer can cause symptoms such as headaches, seizures, weakness, numbness, vision problems, speech problems, and personality changes. Astrocytoma is more common in adults than in children, and it can occur at any age.

There are several risk factors associated with astrocytoma, which is a type of brain tumor. These risk factors include being exposed to ionizing radiation, having certain genetic mutations, and having specific inherited syndromes, such as neurofibromatosis type 1 or tuberous sclerosis.

Astrocytoma can be classified into different grades, based on the appearance, behavior, and aggressiveness of the tumor cells. The grades of astrocytoma are:

Astrocytoma Grade 1

This is the least malignant and most benign grade of astrocytoma, and it is also called pilocytic astrocytoma. It is characterized by slow growth and low invasion of the surrounding brain tissue. It can cause symptoms by compressing the brain tissue or blocking the flow of cerebrospinal fluid. It is more common in children and young adults, and it usually occurs in the cerebellum, the optic nerve, or the brainstem. It can be cured by surgery, and it has a very good prognosis, with a 10-year survival rate of more than 90%.

Astrocytoma Grade 2

This is a low-grade or diffuse astrocytoma, and it is characterized by slow growth and moderate invasion of the surrounding brain tissue. It can cause symptoms by compressing the brain tissue or infiltrating the nerve fibers. Grade 2 astrocytoma is more common in adults, and it usually occurs in the frontal or temporal lobes of the cerebrum. It has a variable prognosis, depending on the age and health of the patient, and the response to treatment. The five-year survival rate for grade 2 astrocytoma is about 65%, but it can range from 90% for young patients to 30% for older patients.

Astrocytoma Grade 3

This is a high-grade or anaplastic astrocytoma, and it is characterized by rapid growth and high invasion of the surrounding brain tissue. It can cause symptoms by compressing the brain tissue or destroying the nerve cells. Grade 3 astrocytoma is more common in adults, and it usually occurs in the frontal or temporal lobes of the cerebrum. Unfortunately, it has a poor prognosis, with a five-year survival rate of about 25%, and a 10-year survival rate of less than 10%.

Astrocytoma Grade 4

This is the most malignant and aggressive grade of astrocytoma, and it is also called glioblastoma. It is characterized by rapid growth, high invasion, and high vascularization of the surrounding brain tissue. It can cause symptoms by compressing the brain tissue, destroying the nerve cells, or causing bleeding or edema in the brain. Grade 4 astrocytoma is more common in adults, and it usually occurs in the cerebral hemispheres. Prognosis with a median survival is about 15 months, and a five-year survival rate of less than 10%.

Symptoms of brain tumor

The signs and symptoms of a growing tumor within the skull are mainly caused by a progressive rise in the internal pressure, either from the growing mass itself or from its interference with the normal circulation of the cerebrospinal fluid, which surrounds and permeates the brain.

The tumor itself causes pressure inside the skull, which causes the symptoms. These include:

• Changes in mental function that may be subtle.
• They may include irritability, lethargy, indifference, apathy, forgetfulness, lack of insight, or drowsiness
• Severe, persistent headache
• Vomiting, an involuntary bodily reaction characterized by the forceful expulsion of stomach contents through the mouth, can occur unexpectedly and without any discernible cause.
• Dizziness, either major seizures or local twitching
• Experiencing a reduction in the visual field or a decline in auditory perception.
• Hallucinations
• Drowsiness
• Personality changes
• Abnormal and uncharacteristic behavior.

Let’s explore why people may get such symptoms if they have a brain cancer and what exactly can cause it.

• Headaches:

These are one of the most common and earliest symptoms of brain tumors, especially if they are persistent, severe, or worsen over time. They may be more noticeable in the morning, or when changing positions, coughing, sneezing, or straining.

• Seizures:

These are sudden episodes of abnormal electrical activity in the brain, that can cause involuntary movements, sensations, emotions, or changes in consciousness.

Seizures have the potential to impact various regions of the body, and the specific areas affected depend on the precise location of the brain tumor. These seizures can manifest in different forms, either as partial seizures that solely impact one side or a specific region of the body, or as generalized seizures that affect the entire body.

Additionally, seizures can be characterized as either simple, where they do not disrupt the affected person’s awareness or memory, or complex, which result in confusion, memory impairment, or even loss of consciousness. It is important to note that seizures can occur unpredictably at any given time, and they may be triggered by factors such as stress, fatigue, fever, or exposure to flickering lights.

• Weakness:

This is a loss of strength or coordination in one or more parts of the body, such as the arms, legs, face, or speech.
The presence of a tumor in the brain can lead to weakness when it applies pressure or causes damage to the motor regions responsible for controlling voluntary muscle movements. Additionally, weakness may arise if the tumor interferes with the blood flow or oxygen delivery to the brain, potentially resulting in a stroke or a transient ischemic attack (TIA). The degree of weakness can vary, ranging from mild to severe, and its duration can span from a temporary state to a permanent condition.

• Numbness:

This is a loss of sensation or feeling in one or more parts of the body, such as the arms, legs, face, or tongue.
Numbness may arise as a consequence of a tumor exerting pressure on or causing harm to the sensory regions of the brain responsible for interpreting sensations such as touch, pain, temperature, or position.

Additionally, the tumor’s impact on the blood flow or oxygen distribution to the brain can lead to a stroke or a transient ischemic attack (TIA), both of which can induce numbness. The severity of numbness can vary from mild to intense, and its duration can range from temporary to long-lasting.

• Vision problems:

These are difficulties or changes in seeing, such as blurred vision, double vision, loss of vision, or visual hallucinations.

Tumor in the brain can lead to vision problems, as it can inflict damage upon the regions responsible for receiving and interpreting the signals from our eyes. Additionally, the tumor may interfere with the optic nerves, which serve as the crucial connection between our eyes and brain, or even impact the cranial nerves that govern the movements of our eyes. It is important to note that these vision problems can vary in intensity, ranging from mild to severe, and may persist for either a temporary or permanent duration.

• Speech problems:

Difficulties or changes in speaking, such as slurred speech, slow speech, or loss of speech. Neoplasm in the brain can lead to difficulties with speech due to its impact on the language centers responsible for both speaking and understanding. Additionally, the tumor can also interfere with the functioning of the cranial nerves that regulate the muscles involved in speech production, such as those in the mouth, tongue, and throat. These speech-related issues can vary in intensity, ranging from mild disruptions to more severe impairments, and they may either be temporary or have long-lasting effects.

• Personality changes:

It manifests like alterations or disturbances in the mood, behavior, or cognition of the person, such as depression, anxiety, irritability, aggression, apathy, or confusion.

Personality alterations may occur when a tumor exerts pressure on or harms the frontal lobes of the brain, responsible for regulating emotions, impulses, judgment, and planning. Additionally, personality changes can arise from the tumor’s impact on the hormones, neurotransmitters, or blood circulation within the brain, leading to chemical imbalances or metabolic disturbances. These alterations in personality can range from mild to severe and may persist temporarily or become permanent.

It is important to see a doctor if you start to have new, persistent and severe headache, without any obvious cause, especially if it is associated with sudden unexpected vomiting.

Causes of brain tumor

Some brain tumors are congenital (present at birth) and are due to abnormal development before birth. The cause of non-congenital cancers is not fully understood. There has been some publicity in the media about a possible connection between brain tumors and radiation from mobile phones. However, this is far from proven.

How brain tumor can be diagnosed?

The diagnosis is made on the basis of the symptoms and the findings on special forms of scanning such as computerized tomography scan (CT scan) or magnetic resonance imaging (MRI scan). Both can show the brain itself rather than just the bone which surrounds it.

Examination by your GP of the back of your eye using an instrument called an ophthalmoscope, may show changes caused by raised pressure inside the skull due to the presence of a tumor. However, A rise in the pressure in the skull does not necessarily indicate tumor.

Brain tumor treatment

Brain tumor treatment depends on many factors, such as the type, size, location, and grade of the tumor, as well as the patient’s overall health, preferences, and goals. The main treatment options for brain tumors are surgery, radiation therapy, chemotherapy, targeted therapy, and immunotherapy.

Some patients may receive only one type of treatment, while others may receive a combination of treatments.

Surgery

Surgery is the most common treatment for brain tumors, especially for benign or low-grade tumors that are small and localized. Surgery involves removing the tumor and a margin of healthy tissue around it, to ensure that all the tumor cells are eliminated.

Depending on the extent of the surgery, the patient may also need to have some of the surrounding brain tissue or the skull bone removed, to access the tumor or to relieve the pressure in the brain. Sometimes, the surgery may also involve removing a part of the brain that controls a vital function, such as speech, movement, or memory, if the tumor is located in that area. In such cases, the patient may need rehabilitation therapy, which uses exercises and activities to restore or improve the function and the quality of life of the patient.

Radiation therapy

Radiation therapy is another common treatment for brain tumors, especially for malignant or high-grade tumors that are large or have spread to other parts of the body. Radiation therapy uses high-energy beams, such as X-rays or protons, to kill the tumor cells or stop them from growing. Radiation therapy can be given externally, by a machine that directs the beams to the tumor and the surrounding area, or internally, by placing radioactive sources inside or near the tumor.

Chemotherapy

Chemotherapy is a treatment that uses drugs to kill the tumor cells or stop them from growing. Chemotherapy can be given orally, by injection, or by infusion, depending on the type and dose of the drugs. Chemotherapy can be given alone, or in combination with surgery, radiation therapy, targeted therapy, or immunotherapy, to increase the effectiveness of the treatment and reduce the risk of recurrence.

Targeted therapy

Targeted therapy is a treatment that uses drugs that target specific molecules or genes that are involved in the growth and spread of the tumor cells. It can be given as a palliative treatment, to relieve the symptoms and improve the quality of life of patients with advanced or incurable brain tumors.

Immunotherapy

Immunotherapy is a treatment that uses drugs that stimulate the immune system to recognize and destroy the tumor cells. It can be given to your body through a shot or through a special kind of liquid, depending on the medicine you need and how much of it you need.

What are the complications of brain tumor?

The outcome depends on the location, type and degree of malignancy of the tumor. (‘Degree of malignancy’ means the speed with which it grows and spreads to other areas.) Many common brain tumors are not malignant.

What is the cost of brain tumor treatment?

Brain tumor treatment can be very expensive, depending on the type, size, location, and grade of the tumor, as well as the treatment options, the health insurance coverage, and the country or region where the treatment is done. The cost of brain tumor treatment can include various expenses, such as doctor fees, hospital charges, surgery fees, anesthesia fees, radiology fees, pathology fees, pharmacy fees, and rehabilitation fees. The cost of brain tumor treatment can also vary depending on the complications, the side effects, the recurrence, and the follow-up care.

According to CostHelper , the average in-patient, post-diagnosis costs for brain tumor treatment in the United States are $13,200, higher than breast, lung, and prostate cancers. However, this can vary widely depending on the type and extent of the treatment. For example, the cost of brain surgery can range from $50,000 to $150,000 or more, depending on the complexity and the duration of the surgery.

The cost of radiation therapy can range from $12,000 to $55,000 or more, depending on the type and the number of sessions. The cost of chemotherapy can range from $10,000 to $200,000 or more, depending on the type and the dose of the drugs. The cost of targeted therapy or immunotherapy can range from $5,000 to $50,000 or more, depending on the type and the dose of the drugs.

For patients covered by health insurance, the out-of-pocket costs for brain tumor treatment typically consist of doctor visit, lab and prescription drug copays, as well as coinsurance of 10%-50% or more for surgery and other procedures, which can easily reach the yearly out-of-pocket maximum.

Brain tumor treatment is usually covered by health insurance, but some plans may have limitations or exclusions, such as experimental or alternative treatments, out-of-network providers, or out-of-country facilities. Therefore, it is important to check with the insurance company and the health care providers before starting the treatment, and to review the bills and the statements carefully for any errors or discrepancies.

For patients not covered by health insurance, the cost of brain tumor treatment can be very high and unaffordable, especially in countries or regions where the health care system is not subsidized or regulated by the government.

However, some options may be available to help reduce or cover the cost of brain tumor treatment, such as:

1. Negotiating with the health care providers for discounts, payment plans, or charity care, based on the financial situation and the medical condition of the patient.
2. Seeking assistance from nonprofit organizations, foundations, or associations that offer financial aid, grants, loans, or scholarships to patients with brain tumors or other cancers, such as the American Brain Tumor Association , the National Brain Tumor Society , or the Brain Tumor Foundation .
3. Participating in clinical trials or research studies that offer free or low-cost access to new or experimental treatments for brain tumors, such as the National Cancer Institute , the National Institutes of Health , or the ClinicalTrials.gov.
4. Traveling to other countries or regions where the cost of brain tumor treatment is lower or more affordable, such as India, Thailand, or Mexico. However, this option may involve some risks and challenges, such as the quality and safety of the treatment, the travel and accommodation expenses, the language and cultural barriers, and the legal and ethical issues.

The cost of brain tumor treatment can be a significant burden for the patient and the family, both financially and emotionally. Therefore, it is important to plan ahead, to seek help, and to explore all the possible options, to find the best and most suitable treatment for the patient.