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BRAIN TUMOURS

The brain is an important organ in the body. It controls how we learn, feel, think and move including breathing.

A brain tumour is a growth of abnormal cells in the tissues of the brain. These cells can grow into tumours.

Brain tumours can be benign and malignant. They can also be classified into primary and secondary brain tumours. Primary brain tumours start in the brain while secondary or metastatic brain tumours are tumours that spread from other parts of the body  

According to research, the incidence of brain cancer is increasing on a global scale. Africa was the only continent with the lowest number of patients of brain cancer. The research also concluded that Caucasians were more affected than African Americans. The death rate due to brain cancer in the African region is 2.1% 

Types of Brain cancer

There are many types of brain cancer are usually named after the cell  they develop from in the brain. They include:

Gliomas

More than half of primary brain tumours fall into this category. They start from the gluey supportive cells (glial cells) that surround nerve cells and help them function. There are three types of Glioma and they are Astrocytomas, Ependymomas and Oligodendrogliomas.

Acoustic Neuroma

It is a benign tumour that grows very slowly. Also called  vestibular schwannoma, it starts from the main (cranial) nerve leading from the inner ear to the brain. Having a genetic disorder called Neurofibromatosis type 2 is a confirmed risk for getting acoustic neuroma. Each child of an affected parent has a 50-50 chance of inheriting it.

Meningioma

They start in  the membranes that cover and protect the brain and spinal cord (the meninges) It is most common type of tumour that forms in the head. They are usually slow-growing tumours, but a minority may be faster growing.

Medulloblastoma

This cancerous tumour, is a type of  embryonal tumour, that develops in the lower back part of the brain, called the cerebellum. It is most common in children, though some adults could get it.

Pineal region tumour

They are rare brain tumours that start in the pineal gland or the tissues around it. Types of pineal region tumours include pineal gland tumours and germ cell tumours

Spinal cord tumours

These are very rare tumours that start in the spinal cord and include meningiomas, tumours of the spinal nerves and ependymomas.

Haemangioblastomas

These are rare benign tumours that start cells lining the blood vessels in the brain. Most of them start in the back of the brain.

 

Symptoms of Brain tumours

Brain tumour symptoms depend on the size and location of the tumour. The rate of growth of cancer is also an important factor. Cancers that grow rapidly–produce side effects that are more serious. Patients may experience some of the following signs and symptoms 

  • Headaches. These are a common symptom of many illnesses including stress and tension. It is highly unlikely you have a brain tumour if this is your only symptom
  • Seizures: This is a common symptom  of brain tumours experienced by about 80% of patients.
  • Nausea and vomiting due to unexplained reasons 
  • Problems with vision. Some people report blurry vision or double vision which does not get better with glasses.
  • There may be a loss of sensation in the arms or legs. Some patients even report loss of movement. 
  • Difficulty to maintain balance and speaking
  • Difficulty with speech. 
  • There may be confusion in performing daily activities. 
  • Alteration in the personality of the patient. Some people may have issues with their memory.
  • Problem with hearing.

Causes/risk factors of Brain Cancer

The main cause of brain cancer remains unclear. However, there are some risk factors 

Inherited Genetic Susceptibility

According to research,  a minority of brain cancers are due to genetic susceptibility. Genetic conditions that can increase the risk include neurofibromatosis type 1 and type 2 (NF1 and NF2), Turcot’s syndrome, Cowden’s disease, Gorlin syndrome and some others.

Gender

They seem more common in men than women

Radiotherapy

Previous radiotherapy treatment to the head can increase the risk of developing a brain tumour later in life.

Diagnosis

Brain cancer is difficult to diagnose. This is because many of the symptoms may correlate with other diseases. The only conclusive diagnostic method is by imaging tests.  

Neurological Exam

The doctor may perform a neurological exam. It includes checking vision, balance, reflexes, strength, and much more. If the patient has any concerns, then the doctor may suggest an imaging test. 

Imaging Tests

A brain CT or MRI scan can help in the diagnosis of the brain tumour. During the MRI procedure, the doctor injects a dye in a vein. This will help provide detailed 3D and magnetic images of the brain.  A PET scan may be combined with CT scans (PET-CT scans) to provide more detailed images of your brain and other parts of your body

Biopsy

This involves removing a sample of tissue from the tumour to test for cancer. A biopsy can be performed as part of an operation to remove the brain tumour, or a biopsy can be performed using a needle.

Staging

A distinguishing character about brain cancer is in the stages. Experts classify other cancers in the form of ‘stages.’ Whereas brain cancer is based on ‘grades.’ Grades of brain cancer are as follows; 

Grade I

This is the non–cancerous form of brain cancer. It grows very slowly and may resemble healthy brain cells. Surgery is usually the only treatment needed.

Grade II

This can be a benign or  cancerous form of brain tumour. It grows very slowly and the cells of the brain may look abnormal microscopically. These tumours  usually grow slowly but tend to spread to nearby tissues. They are likely to return after treatment.

Grade III

These grow faster than Grade 1 and 2 tumours. They look like cancerous cells and can spread to other parts of the brain and spinal cord. You are more likely to need radiotherapy and chemotherapy after surgery. 

Grade IV

 These are the fastest–growing cancerous cells. They may affect other organs of the body. This tumour can form its blood vessels. They also often come back after treatment  and are usually treated with  radiotherapy and chemotherapy after surgery.  

Brain tumours can be low-grade – benign tumours and high-grade – cancer, also called malignant tumours.

Treatment

Treatment of brain cancer depends upon the type and stage of brain cancer. Moreover, it also depends on other health conditions that the patient may have.  

Surgery

The option of surgery is only possible if the tumour is in a region of the brain that the surgeon can easily reach. In some of the cases, the tumour is so small that it is easily operable. However, in some cases, it is present near delicate tissues and may make removal very risky. 

Recently, minimally invasive surgical techniques also help to remove the tumour. It has minimum risks and short recovery time.  

Radiation Therapy

External radiation therapy focuses on high energy X-rays on the brain. It helps to destroy the cancer cells from the brain. In some of the cases, focusing radiation on the location of the brain tumour is also possible. Whole-brain radiation is most often used to treat secondary brain cancer.

Radiosurgery

In this type of surgery, high focused beams from different angles are placed on the brain. This is a powerful form of radiation. This type of treatment does not require post-surgery care. The patient can even go home after surgery. 

Chemotherapy

Chemotherapy uses high dose drugs to kill cancer cells. The most common chemotherapeutic drug is temozolomide which is taken orally. Your doctor may test to see if chemotherapy would be suitable for the brain tumour you have. The side effects of chemotherapy are quite extensive.  

Targeted drug therapy

These drugs alter specific abnormalities within cancer cells. They block these abnormalities which can cause the cancer to die.  These drugs can work for some types of brain tumours

Rehabilitation 

The patient generally requires rehabilitation after successful treatment. It is because sometimes, the extensive treatment strategies affect motor skills. The doctor may refer to another physiotherapist. They may help you make up with the motor deficits.  

 

REFERENCES 

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