Generally, cells in our body ages die and are replaced by the new ones. But with cancer and tumors, this cycle is disrupted. tumor cells grow and unlike other normal cells, they don’t die. Eventually, tumor continues to grow more as more and more cell are added to this abnormal mass of tissue. Similarly, brain tumor is an abnormal growth of tissue in the brain or spine that can disrupt the proper functioning of the organ.
Before we to brain tumor causes, symptoms and treatment, let us first understand the types of brain cancer.
Types of Brain Tumors
When diagnosed with brain cancer, learning in detail about it can help in choosing the right neurosurgeon and deciding on the brain tumor treatment. Most of the hospitals across the globe use World Health Organization (WHO) brain tumor classification system. Depending on the origin of brain cancer cells and how cells behave, WHO classifies the tumor from benign (least aggressive) to malignant (most aggressive). Depending on the cell activity and how abnormal the cancerous cells are, the tumor is also graded.
Depending on the where the tumor has started and spread, there are 2 general groups:
- Primary: Cancerous cells that begin in brain tissue are known as primary brain tumors. They can be benign (non-cancerous) or malignant (cancerous). Most of the primary brain tumors are named after the part of the brain or the type of brain cell from which they originate.
- Benign: They are the least aggressive type and originate from cells within or surrounding the brain. They do not contain cancer cells and grow very slowly.
- Malignant: They contain cancer cells and are life-threatening as they grow rapidly and invade brain tissue
- Secondary: Brain tumors which are caused by cancer which originates from another part of the body are known as a Metastatic tumor. These tumors are more aggressive as compared to the Primary Brain tumors. When cancer cells spread to the brain from another tumor, the process is called metastasis.Treatment for metastatic brain tumors depends on where the cancer originated and how far it has spread as well as other factors, including the patient’s age, type, size and location of the tumor general health, and response to previous treatment.
Tumors are typically graded on the basis of how normal or abnormal the cells are. Grade of the tumor gives an idea about rate of growth and spread. Basis the grade of the cancerous cells, brain tumor treatment is planned.
- Grade 1 means the cells are growing very slowing. Long term survival of the patient is very likely.
- Grade 2 means the growth of tumor cells is slow. However, the tumor may spread to nearby tissues or has higher probability of recurrence even after treatment.
- Grade 3 means the brain cancer is actively growing and spreading to the nearby tissues. This type of tumor are likely to have recurrence.
- Grade 4 means the cancerous cells are rapidly growing and spreading. The cell structure is also very abnormal.
Remember: Some tumors may change if the brain tumor treatment is not started at right time. A lower grade tumor may get converted to a higher grade tumor.
For understanding of a common man, the treating doctor would typically classify the brain tumor in following categories:
- Astrocytomas – Brain tumor arising from the cerebrum, the largest part of the brain, is known as astrocytomas. They can be of any grade. Seizure or abnormal changes in behaviour are typical brain tumor symptoms and characteristics. Grade 4 atrocytomas, are also known as Glioblastomas. Almost 80% of malignant primary brain tumors in adults are Glioblastomas.
- Meningiomas – Most common type of brain cancer in adults. Commonly seen in adults in the age group of 40 to 70 years. Meningiomas arise from the layer of tissue covering the brain and spinal cord, are usually benign and slow growing. Meningiomas can be of grade 1,2 or 3. Typical brain tumor symptoms are related to compression of adjacent brain tissues, affecting cranial nerves and blood vessels.
- Schwannoma or Acoustic Neuroma – The cancer cells that arise from the protective layer around nerve fibers cause acoustic neuroma. Commonly seen in the age group of 40 to 70 years. Typical brain tumor symptoms include hearing loss, vertigo and lack of co-ordination.
The above mentioned are commonly found brain tumors in adults. In addition, a few rare types of brain tumors include pitutary tumors and ependymomas.
Brain Tumor Causes
The exact cause of brain tumors is yet unknown! However, there are several risk factors that increase a person’s chances of contracting these cancerous cells. The risk factors include:
- Age: They are common in children and older individuals.
- Gender: Men have increased predisposition to developing cancer, but there are few types which are found more in women.
- Genetic Background: There are few of them that show increased linkage to genetic inheritance.
- Environmental Exposure: This is one of the most crucial risk factors that leads to the brain cancer. Exposure to chemicals likes solvents, pesticides (through inhalation or indirectly by consuming them) either at home or at work is one of the primary risk factors. Other environmental causes like allergens, viruses and infections might also lead to this disease.
- Exposure to Electromagnetic and Ionising Radiations: EM radiations that emit from cell phone use or power lines have not yet been proven to increase the chances of getting this cancer disease; however it is controversial. Exposure to ionising radiations like X-rays also increases the chances.
- People with compromised immune system such as those suffering from AIDS are more likely to suffer from brain tumor
- Radiation Therapy to the head received previously for any treatment can predispose a person towards developing brain tumor
Did you know? Cell phone usage is one of the main brain tumor causes, is a NOT true. Although the usage of cell phone has grown drastically in last 10 years, the incidence of brain tumor has not seen a significant rise.
Brain Tumor Symptoms
Brain tumor symptoms vary according to type and location of the tumor. In some cases, there are minimal or no visible brain tumor symptoms, until the tumor becomes large in size and starts making its way to other parts of the brain and alters their functioning. In symptomatic cases, the beginning of these brain tumor symptoms is very gradual and may be missed sometimes. While in other cases, these symptoms appear more frequently and can be confused with symptoms of stroke. The only way to be assured about the reason behind these symptoms is to undergo diagnostic testing after consultation with an experienced neurologist.
Common brain tumor symptoms of include:
- Difficulty walking; loss of balance
Other brain tumor symptoms and signs include:
- Changes in concentration, memory, attention or alertness
- Nausea or vomiting, especially early in the morning
- Abnormalities in vision; blurred vision
- Headaches which are severe in the morning
- Weakness or paralysis on one side of the body
- Difficulty in thinking, speaking or recalling words
- Gradual changes in intellectual or emotional capacity
Diagnosis of Brain Tumor
Diagnosing the tumor can be a complicated process and making a decision about the brain tumor treatment process can also be overwhelming. It can be very confusing and frightening given a short of time to make critical decisions.
Brain tumor may be diagnosed and evaluated using one or more of the following tests:
- MRI: Magnetic resonance imaging (MRI), is a medical imaging technique used in radiology to visualise internal structures of the body in detail.
- CT: Computed tomography (CT scan) is a medical imaging procedure that utilises computer-processed X-rays to produce tomographic images or ‘slices’ of specific areas of the body. Tomography refers to imaging by sections or sectioning.
- PET: Positron Emission Tomography (PET) is a unique type of imaging test that helps doctors see how organs and tissues inside the body are actually working. It helps to differentiate between new tumor growth and cells killed by radiation.
- Biopsy through surgery or Stereotactic brain biopsy
Brain Tumor Treatment
Brain tumor treatment can be based on different factors:
- Age, overall health and medical history
- The type, location and size of the tumor
- Nature of recurrence
- Tolerance level of the patient to certain medications, procedures or therapies
Specialists who treat brain tumors include neurosurgeons, medical oncologists and radiation oncologists. In addition to the specialist, the treatment team may include other professionals such as a nurse, dietitian, mental health counsellor, physical therapist, occupational therapist, and/or speech therapist.
Treatment for the primary brain tumor may include:
- Steroids: Steroids are often used to reduce the buildup of fluids around a tumor (edema) sometimes caused by the brain tumor or other treatments.Steroids can temporarily relieve brain tumor symptoms (eg, edema), improve neurological symptoms, promote a feeling of well-being, and increase appetite.
- Surgery: Surgery usually is the first step in treating most benign and many malignant tumors. It is often the preferred treatment when a tumor can be removed without any unnecessary risk of neurological damage.
Most common types of Brain Tumor Surgeries are listed below:
Biopsy, Craniotomy, Craniectomy, Debulking, Complete Removal, Shunt, Ommaya Reservoir, Skull Base Surgery, Transsphenoidal Surgery and Laser Interstitial Thermal Therapy (LITT)
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Treatments for High-Level Tumor
Usually, tumors which are not aggressive can be treated with the watchful monitoring or the surgery alone. Grade 2 tumors are monitored closely after surgery to make sure there is no recurrence.
Malignant tumors which grow more rapidly, are more difficult to remove and need treatments high-level treatment like radiation therapy, chemotherapy etc. Most of the treatments are intended to prolong and improve life as long as possible as microscopic cancer cells can remain even after surgery which will eventually grow back.
High-Level Brain Tumor treatments are
- Radiation therapy: X-rays or other forms of radiations are used to destroy tumor cells or their growth
- Chemotherapy: In this, certain drugs are used to kill rapidly dividing cells. They can be consumed orally or through IV
- Targeted therapy: In this, a specific element of a cell is focussed, such as molecules or pathways required for cell growth in order to use them as a target
- Stereotactic Radiosurgery: As radiation cannot tell the difference between tumor cells and healthy cells so it impacts both. That’s why scientists developed SRS, a special type of radiation that allows precisely focused, high-dose x-ray beams to be delivered to a small, localised area of the brain. Because SRS focuses the beams more closely to the tumor than conventional radiation, it can deliver a higher, more effective dose of treatment to the tumor site.
- Proton Therapy: In proton therapy, beams of fast-moving protons are used to destroy tumors. In this higher doses of radiation are delivered to the tumor with limited damage to the surrounding healthy tissue and/or organs.
Latest Technologies for Brain Tumor Treatment
- Brain Suite: Brain Suite is one of a kind, latest technology used around the globe. It is an advanced operating theatre with a capability of intra-operative MR imaging and MR guided surgery. Surgeons can perform a high-resolution MRI during the surgery to assess the degree of tumor removal as well as avoid harming healthy brain tissues.
- Endoscopic Neurosurgery Theatre: Endoscopy means looking inside and typically refers to looking inside the body for medical reasons using an Endoscope an instrument used to examine the interior of a hollow organ or cavity of the body. Endoscopic Neurosurgery is done with state-of-art operation theatre for endoscopic brain and spinal surgery. It uses a slender fiber-optic camera to improve visibility and guide access to hard-to-reach tumors in the brain.
- Cyberknife: A revolutionary treatment for cancer patients, Cyberknife Robotic Radiosurgery System is world’s first such system, designed to treat tumors of all kinds anywhere in the body. With its unique precision and accuracy, it treats both static and moving Lesions and tumors, giving clinicians the power to treat patients non-invasively, with successful outcomes. It has high accuracy & efficacy for treating tumors in the brain and spine.
CyberKnife treats intracranial (skull base) benign and malignant tumors, as well as Spine tumors and lesions of the cervical, thoracic and lumbar regions. CyberKnife is less risky than traditional surgery it can be a suitable option for the elderly. Age is not a crucial factor in excluding patients from CyberKnife treatments.
- Synergy Linear System: This is a top-end highly versatile Linear accelerator designed for use in critical areas, such the brain and spine. The high accuracy, combined with a robotic couch capable of finely calibrated movements, make this a highly effective tool for Radiosurgery of the brain, the spine and other organs apart from use for fractionated treatments.
Brain Tumor Survival Rate
The major factors that influence survival of the brain tumor are its type, its location, whether it can be surgically removed or reduced in size, patient’s age, and other medical problems.
The long-term survival rate (greater than five years) for people with primary brain cancer is promising with aggressive surgery, radiation, and chemotherapy. These treatments and rehabilitation counselling improves the quality of life to a great extent.