Brain tumor: A patient guide from a Neurosurgeon

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Brain tumor meaning | What is a brain tumor?

A tumor is caused because of the abnormal growth of cells in an organ. A brain tumor is usually caused because of the abnormal growth of a cell belonging to the brain or the coverings of the brain. Many times, a brain tumor may be due to the spread of a tumor from some other part of the body. This is called a metastasis (brain mets is used as a common term by doctors).

 

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Brain tumor symptoms | What are the symptoms of a brain tumor?

 

Symptoms of brain tumors depend on the kind of tumor the patient suffer from and the location of the tumor in the brain.

 

1. Brain tumor Headache symptoms: This is the most common symptom of a brain tumor. Headaches in brain tumors are usually progressive, which means that they resolve only temporarily with medications. The headaches always come back and they often keep rising in intensity. Headaches can be localised to one side or one site or may be of the entire head.

2. Vomiting: Vomiting is commonly associated with headaches. Vomitings in brain tumors may be different from those due to other causes. In patients of brain tumors, vomiting occurs often without nausea, suddenly and is often uncontrollable. It’s often not associated with what you’ve eaten.

3. Blurring of vision: Brain tumors may cause blurring of vision for two reasons. The first is that a brain tumor anywhere may cause a rise in the pressure within the brain, which directly affects the nerves that carry vision. Alternatively, the tumor might press on the nerves that carry vision directly, therefore blocking their capacity to transmit current, leading to blurring of vision and even blindness.

4. Seizures: Seizures are another common symptom of brain tumors. In a seizure, the patient may experience uncontrollable jerky movements of the hands and legs, twitching of the face with and without losing consciousness. Patients may froth from the mouth, have uprolling of eyes, pass urine or stool and bite their own tongue.

5. Weakness, paralysis, numbness, tingling: Tumors that block or destroy the nerves that carry signals to any specific region of the body can cause that function to be affected. A tumor that blocks signals to the muscles of the body can cause weakness or paralysis. Similarly a tumor blocking the sensations to the brain can cause numbness or a tingling sensation in parts of the body.

6. Hormonal deficits: Brain tumors that compress on the pituitary gland, pituitary tumors themselves and certain brain tumors that secrete their own hormones can reek havoc on a persons hormonal control often leading to an increase or decrease in one or more types of hormones. Hormones affected include- thyroxine, cortisol, Vasopressin and Growth hormone.

7. Functional deficits like memory and cognition: Brain tumors can affect the functional capacity of a person. They might have memory deficits, loss of mathematical ability, they might forget what time of the day it is or where they are. They might lose insight into their own problems and show neglect towards their own care. Functional deficits due to brain tumors are often location based, varied and complex and require a detailed examination to determine.

 

Examples of functional deficits in brain tumors are:

• clumsiness

• memory loss

• confusion

• difficulty writing or reading

• changes in the ability to hear, taste, or smell

• decreased alertness, which may include drowsiness and loss of consciousness

• difficulty swallowing

• dizziness or vertigo

• eye problems, such as drooping eyelids and unequal pupils

• uncontrollable movements

• hand tremors

• loss of balance

• loss of bladder or bowel control

• numbness or tingling on one side of the body

• trouble speaking or understanding what others are saying

• changes in mood, personality, emotions, and behavior

• difficulty walking

• muscle weakness in the face, arm, or leg

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Brain tumor causes | What are the causes of a brain tumor?

Unlike tumors of the lung and stomach, causes of brain tumors are less clear. A large amount of research is being conducted to find out the causes of brain tumors. Some of the definite causes that have been found are:

 

1. Genetic / familial causes: These include genetic diseases passed on from parents to the children including Neurofibromatosis (Von Recklinghausen’s disease) and Tuberous sclerosis.

2. Radiation exposure: Victims of radiation exposure have been studied for long periods including victims of the nuclear explosions in Hiroshima and the Chernobyl tragedy. They have been found to be predisposed to the development of brain tumors.

3. Chemical exposure: Exposure to certain chemicals, particularly those used in the Dye industry have been known to be associated with higher chances of having a brain tumor.

 

 IMPORTANT note on Brain tumor causes:

It is important to note that there has been no conclusive evidence that brain tumors are caused by tobacco consumption or alcohol. However, these have been very well known to cause tumors in other locations like the lung and liver, which spread commonly to the brain.

 

Also, many of my patients want to know if exposure to mobile phone usage and electrical wires close to the house has anything to do with brain tumors. There is no evidence yet that the use of mobile phones, microwave ovens or electrical wires over the place of living has any connection with the development of brain tumors.

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Brain tumor treatment | How are brain tumors treated?

 

The treatment of brain tumors depends on the type and location of the tumor. Treatment may be medical or surgical. It is important to understand that surgery is the first step or primary treatment for the majority of brain tumors with chemotherapy and radiation usually playing a supportive role.

 

Brain tumors medical treatment:

 

There are a few brain tumors in which the first line of treatment is through medical therapy or Chemotherapy. Examples of such tumors are:

 

1)Lymphomas of the brain.

2)Prolactinomas, which are a special kind of tumor of the pituitary.

 

Medical therapy has an important role in reducing recurrence of tumor after surgery. With the help of medical therapy and radiation, there is evidence that patients with aggressive cancerous tumors of the brain live longer. Examples of such tumors are High grade glioma(HGG) and Glioblastoma Multiforme(GBM).

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Commonly used Medical drugs (Chemotherapy) for Brain tumors are:

 

1)Temozolomide – one the most commonly used drugs.

2)Platinum based chemotherapies like Cisplatin

3)Vincristine

4)New types of drugs called Monoclonal antibodies like Bevacizumab specially for recurrent tumors.

 

Medical therapy also has a role in controlling the growth and spread of tumors from other parts of the body to the brain. These brain metastases are some of the commonest brain tumors, with the lung being the most common source of tumor cells. In these cases, depending on the number and location of metastases, the patient might be offered surgery followed by chemotherapy and radiation, or chemotherapy as the first option itself.

 

Other than these specific tumor reducing agents, general medicines for controlling seizures and steroids like Dexamethasone to control tumor related brain swelling are essential medicines in many patients suffering from brain tumors.

 

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Brain tumor Surgery | Brain tumor operation | What is surgery for brain tumors?

 

Surgery for brain tumors is now far more advanced than it was even 30 years ago, with rapid strides being made in equipment, technique and safety every year.

 

Important note: The results of brain tumor surgery depend as much on the nature of the tumor as the location, the surgeon and the set-up available. Sometimes, despite the best surgery and care, the nature of the tumor is bad and results in a poor life span and quality of life.

 

Brain tumor surgery is most commonly done using a Craniotomy (an opening made in the skull). For some tumors, particularly tumors of the pituitary, an endoscope of microscope may be used to remove the tumor from the nose, without any external scar.

 

Brain tumor surgery requires intense skill, a trained team and specific equipment. As important, is the post operative setup, the ICU care and the follow up.

 

The majority of brain tumors are treated with surgery as the first step in the management process.

 

Thanks to great scanning and imaging techniques, tumor locations can be well picked before the surgery. This helps decide the plan, prepare the patient and choose the approach to the tumor.

 

Awake brain surgery is a special way of performing surgery used for certain tumor types in certain locations. In this method, the patient remains awake during the procedure and the surgical team constantly asks the patient to perform tasks during the surgery to be able to assess if there is a sensitive location during the tumor location. It helps preserve the patients functions.

 

Recovery from brain tumor surgery takes time. While hospital stay has become significantly reduced with recent advances to just a few days for most of the brain tumor procedures, the result will depend on the how the surgery has gone and any complication arising due to the procedure.

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Radiation for brain tumors | Is radiation given for brain tumors?

Like chemotherapy, radiation treatments are important in extending the life span of patients with high grade brain tumors (called tumor free survival). While there are many side-effects to radiation therapy for brain tumors, this treatment is recommended when the benefits outweigh the risks.

 

There are three types of radiation treatments for brain tumors:

 

1)Whole Brain radiation therapy (WBRT): Radiation is given to the whole brain.

2)Regional Radaition therapy (RRT) or Tumor Bed radiation: Radiation is given to the region of the brain that contained the tumor, particularly when the tumor has been removed by surgery. This therapy reduces local recurrence of the tumor in the region where the tumor was removed.

3)Radiation wafers/Local radiation leads: This technique is employed in some centres, where materials impregnated with radioactive substances in placed in the cavity of the tumor after surgery. Not all centres and surgeons recommend this treatment, with results still very variable and long term evidence still pending.

 

 Important Note: Gamma Knife / Cyber Knife radiation therapy is different from the rest of Radiation therapy. Kindly read below.

 

Gamma Knife Radiation therapy (GKRS) for brain tumors | Cyberknife for Brain tumors | What is Gamma knife for brain tumors?

 

Gamma Knife and Cyberknife are special radiation therapies that are often used as first line treatments for brain tumors of limited size and in locations that would be dangerous for surgery. While evidence for these therapies is still building, they are now used widely to treat brain tumors as first line and second line therapies.

 

Unlike other radiation therapies, in Gamma knife and Cyber Knife, fine beams of radiation are used to deliver a set dose to a previously outlined area. It is therefore a very concentrated radiation treatment to smaller tumors.

 

Gamma Knife and Cyber knife differ in the accessibility of the tumor for radiation. While Gamma Knife is limited to tumors of the brain, Cyberknife can be used to provide focussed radiation anywhere in the body.

 

Proton beam therapies are also coming up in some centres. Again, long term benefit is still to be assesed but these therapies have shown results in certain tumors that are resistant to conventional radiation, such as Chordomas.

 

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Brain tumor Classification | How are brain tumors classified | What are the types of brain tumors?

The general idea among people is that all brain tumors are the same. This couldn’t be farther from the truth. There are many different kinds of brain tumors with different treatment success rates. Also, the location of a tumor is a very important factor that further contributes to treatment success. Some of the common types of brain tumors are:

 

1. Meningiomas

2. Gliomas

3. Schwannomas

4. Pituitary tumors

5. Craniopharyngiomas

6. Lymphomas

7. Brain metastasis

8. Neurocytomas

9. Pineal region tumors

10. Medulloblastomas

11. Ependymomas

12. Choroid plexus tumors

13. Chordomas

14. Chondrosarcomas

15. Hemangioblastomas

 

Don’t be surprised if the tumor you are interested to know about isnt on this list as it is far from exhaustive.

 

The most common tumors of the brain are meningiomas and gliomas which are very different from each other in their location and nature. Among the gliomas themselves there are many types.

 

It is important to note that while we talk about Staging of tumors for most of the tumors in other parts of the body, in brain tumors rarely spread from the brain to other parts of the body. When it comes to brain tumors, we are more bothered about how aggressive they are within the brain and so in brain tumors, we talk about GRADING OF BRAIN TUMORS.

 

There are generally four grades of gliomas: From 1 to 4. Grade 1 and 2 gliomas are generally considered low grade tumors, while Grade 3 and Grade 4 tumors are considered high grade with poor results despite best efforts of treatment.

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Brain tumor cure rates | Are Brain tumors curable?

 

Many people still believe there is no cure for brain tumors. This is a common misconception that needs to be eradicated from the mind of the general public. In reality, there are many brain tumors that can now be removed by surgery safely and with good  long-term results, some even being cured completely.

 

Tumors such as meningiomas are often completely surgically removable if they’re in a favorable location. Similarly Grade 1 gliomas like Pilocytic Astrocytomas are considered cured if the whole tumor is removed.

 

On the other hand, some tumors will surely come back despite best surgical and medical efforts, because they’re of a higher grade. The worst of these is the Glioblastoma Multiforme, a Grade IV brain tumor considered to be a Brain tumor Cancer.

 

The life span of the patient as well as the quality of life of the patient depends a lot on the nature or pathology or grade of the tumor. In cases of lower grade tumors, it depends a lot on the location of the tumor as well and whether the surgeon was able to remove the tumor completely or to a satisfying amount.