Some of the experiences of patients diagnosed with a brain tumour are: seizures, weakness, headache and change in behaviour.
A tumour, whether it's in your brain or elsewhere, is a mass of unneeded and often abnormal cells.
Brain tumours can be benign or malignant.
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Confusion, unexplained headaches upon waking, difficulty walking and talking -
these are some of the experiences of patients diagnosed with a brain tumour. Diagnosis
of a brain tumour is frightening, in part because brain tumours remain challenging
to treat, particularly in older adults.
A brain tumour is also frightening because it can have such a huge impact.
The brain controls vital functions such as memory and learning, the senses (hearing,
sight, smell, taste, and touch), and emotion. It also controls other parts of
the body, including muscles, organs, and blood vessels.
The majority of brain tumours have a poor prognosis, despite advances in radiotherapy and chemotherapy. The most dramatic intervention in terms of prognosis remains removing as much of the tumour as possible.
Unneeded cells
A tumour, whether it's in your brain or elsewhere, is a mass of unneeded and
often abnormal cells. Brain tumours are relatively rare. However, they can be
deadly. They're the second leading cause of cancer death in children under 15.
The diagnosis of brain tumours has been increasing in recent years. But experts
aren't sure whether that's due to better detection methods or an actual increase
in the number of tumours.
Tumour types
Physicians generally divide brain tumours into two main categories:
Primary — These tumours begin in brain tissue. About 25 percent of brain
tumours are primary. Primary brain tumours can be benign or malignant. About
40% percent are benign and can be treated successfully.
Although the causes of primary brain tumours are unknown, about five percent
are believed to be related to hereditary factors. Primary tumours are more common
in children under age 15 and in older adults.
Metastatic — Metastatic
brain tumours are tumours resulting from cancer that started elsewhere in the
body and then spread (metastasised) to the brain. Along with melanoma (a form
of skin cancer), cancers of the lung, colon and breast are most likely to spread
to the brain. About 75 percent of brain tumours are metastatic.
Within these two categories, there are many types of brain tumours.
Symptoms
Brain tumours, whether benign or malignant, can cause a variety of problems simply
because of their location — inside the confined space of the head. The signs and
symptoms of a brain tumour may depend on its type and location.
Signs and symptoms can include:
Seizures
Weakness or change in sensation
Headaches
Change in behaviour
The main symptom in children is headache or unsteadiness on walking or seizures. Adults mostly will have seizures, weakness and change in behaviour with or without headache.
When a headache can spell trouble
They can also signal temporal arteritis, an inflammation that affects arteries
in the scalp, brain and eyes. Temporal arthritis can lead to blindness or stroke
if left untreated: note that it has nothing to do with brain tumours.
So how do you know when to seek medical care for a headache? Talk to your doctor
about new headache pain or any headache that concerns you. Even if you have
a history of headaches, see your doctor if the pattern changes or they feel
different. Most importantly, be aware that headache alone is unlikely to be associated with a brain tumour: the main reason to see a doctor for your headache is to receive effective treatment for your headaches so that they are less troublesome.
In addition, see your doctor or go to the emergency room immediately if you
have any of these warning signs:
Sudden, severe headache pain, often like a "thunderclap."
Headache with fever, stiff neck, rash, mental confusion, seizures, double
vision, weakness, numbness, vomiting, or difficulty speaking.
Chronic, progressive headache that worsens after coughing, exertion, straining
or a sudden movement.
Diagnosis
Diagnosing a brain tumour usually involves several steps. Your physician may perform
a neurological examination, which includes checking your vision, hearing, balance, coordination
and reflexes, among other things.
You may also have a computed tomography (CT) scan or magnetic resonance image
(MRI) scan. A CT scan is a diagnostic test that uses computers and X-rays to
create pictures of the body. An MRI scan is similar, but uses magnetic waves
instead of X-rays.
Often surgery is required to determine whether a brain tumour exists and what
type of tumour it is. A small sample of tumour tissue may be surgically removed
and examined under a microscope. This is called a biopsy. Sometimes a biopsy
is done by making a small hole in the skull and using a needle to extract a
sample of the tumour.
Once the brain tumour is detected, additional tests will be performed to determine
the type of tumour. If a biopsy specimen is taken, the tumour cells will be
examined carefully under a microscope to see how different they appear from
normal cells. Cells from higher-grade, more abnormal-looking tumours usually
grow faster and are more malignant than cells from lower-grade tumours. The
doctor needs to know the type and grade of tumour in order to plan treatment.
Brain tumours are grouped according to their location within the brain and
the appearance and behaviour of the tumour tissue.
The following groupings are used:
Infratentorial tumours are those that occur in the lower part of the
brain. Tumours found in this region include:
Medulloblastoma: Occurs in children and young adults and tends to
spread down to the spinal canal and spinal cord.
Cerebellar astrocytoma: A benign tumour occurring in young adults
and children. It is frequently curable by surgery only.
Brain stem glioma: Mostly malignant tumours of the lower central
part of the brain, infiltrating the area of the brain responsible for such
vital functions as breathing, blood pressure, body temperature control and
so on.
Supratentorial tumours are those that occur in the upper part of the
brain. Common supratentorial tumours include:
Cerebral astrocytoma and oligodendroglioma: The prognosis of these
tumours depends on the exact location of the tumour (how accessible it is
for surgery) and the grade of the tumour (how malignant the cells look under
the microscope). The most malignant variant is called Glioblastoma Multiformae.
Craniopharyngioma: These tumours generally occur just above the pituitary
gland. Located at the bottom of the brain, the pituitary gland is about the
size of a pea and controls many vital functions. Craniopharyngiomas do not
spread, but may interfere with important structures near them, causing serious
problems.
Central nervous system germ cell tumour: Germ cell tumours arise
from the sex cells found in the brain. There are different types of germ cell
tumours, including germinomas, embryonal cell carcinomas, choriocarcinomas,
and teratomas. These tumours usually occur in the centre of the brain, and
can spread to other parts of the brain and spinal cord.
Supratentorial primitive neuroectodermal and pineal tumours: Very
malignant tumours similar to medulloblastoma originating from primitive brain
cells. They tend to spread along the spinal canal to other structures of the
brain and the spinal cord.
Visual pathway and hypothalamic glioma: These are tumours arising
from the optic nerves (nerve that conduct the image from the eyes to the brain).
They usually occur in children and can cause blindness.
Meningioma: Usually benign tumours arising from the envelope of the
brain. These tumours rarely infiltrate the brain; rather they compress the
underlying brain structures.
Pituitary gland tumours: These are generally benign growths of cells
from the pituitary gland. The pituitary gland (or hypophysis) secretes hormones
that are responsible for functions of other glands such as:
thyroid gland (energy level),
adrenal glands (general well being and body salt balance),
testes and ovaries,
lactation.
The major symptoms, besides headache, are accelerated or stunted growth, lack
of energy, metabolic disturbances, irregular menstrual periods among many others.
As the optic nerves are very close to the gland, tumours of the pituitary gland
can cause blindness as a result of nerve compression.
Recurrent brain tumour
Recurrent disease means that the cancer has come back (recurred) after it has
been treated. It may recur in its original location, in another part of the
central nervous system, or systemically (throughout the body).
Treatment
Treatment depends on the type of brain tumour. The three main treatment methods
are: Surgery, Radiation and Chemotherapy.
Surgery — This is the mainstay of brain tumour treatment. It involves
removing as much of the tumour as possible while trying to minimize damage to
the healthy tissue. The aim could be either complete removal of the tumour (complete
resection) or removing only a part of it in order to facilitate the radiotherapy
thereafter (debulking). Complete resection of malignant tumours is usually not possible.
Radiation — By careful aiming and regulation of the dose, high-energy
radiation can be used to destroy cancer cells. The X-rays are either produced
by a special machine outside the body and are directed to the place of the tumour
in the brain (this is called External Beam Radiotherapy), or are produced by
radioactive material that is inserted surgically into the tumour (this is named
Brachytherapy). Unfortunately, radiation of the whole brain, which is often given in the case of malignant tumours, has side effects such as cell damage with change in personality and loss of intelect in some cases.
Chemotherapy — Drugs are used to kill cancer cells and shrink tumours.
Chemotherapy may be taken by pill, or it may be put into the body by inserting
a needle into a vein or muscle. Chemotherapy is called a systemic treatment
because the drugs enter the bloodstream and can kill cancer cells throughout
the body. Although chemotherapy is highly effective in treating some cancers,
it is less successful in treating brain tumours. However it has a very well
established place in palliative settings (when the major objective is not a
cure, but the alleviation of symptoms). Chemotherapy is also very important
in treating of some childhood brain tumours. As always with chemotherapy, patients need to carefully examine the risks and benefits of treatment: in the event that the prognosis is grave, chemotherapy may adversely affect quality of life at a time and require hospitalization when patients need to make the most of their time with their families and loved ones.
Many brain tumours are treated with a combination of therapies.
Novel and experimental treatments New technology is evolving and helping to make the treatment of tumours more
precise. One of the most important advances is stereotactic localisation. This
technique utilises a three-dimensional MRI scan to map the tumour's exact location.
New techniques using lasers and ultrasound also make actual removal of the
tumour more precise, reducing the risk that cancer cells will be left behind
and that healthy tissue will be harmed.
Some of the most intriguing new methods in brain tumour treatment involve the
use of radiation. A treatment that precisely focuses radiation beams to the
tumour is called stereotactic radiosurgery. No scalpels are involved. Stereotactic
radiosurgery delivers radiation beams in the exact size and shape of the tumour.
New ways to deliver cancer-fighting drugs to the brain tumours are also being
studied. Chemo "wafers" implanted in a tumour during surgery have
shown promise for some types of cancer. The wafers are biodegradable chips containing
cancer-fighting drugs.
Experimental treatments under investigation include gene therapy, drugs
that cut off a tumour's blood supply and agents that may be able to interrupt
tumour growth or seek out and kill cancer cells.
Many of these are being tested in clinical research trials. If you have a brain
tumour, participating in a clinical trial can help you have access to the newest
experimental treatments and, at the same time, play an important role in helping
to define the role of these new treatments.
Summary
Newly appeared headache is a symptom deserving careful investigation; this
however does not mean that all headaches are symptomatic of brain tumours, there are
thousands of reasons for headache, most of which are not tumour related.
Even when "cure" is not possible due to the location or type of the tumour, modern medicine has many things to offer in terms of alleviating the symptoms,
preserving functions such as vision and prolonging the life. Patients with malignant brain tumours need to carefully weigh up their options, and should routinely obtain second opinions about treatment. Chemotherapy and radiotherapy may be of benefit in terms of extending duration of survival, but may adversely affect quality of life.
Reviewed by Dr J. Carr, FCP(SA) Neurology, MSc(Med)
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