World Brain Tumor Day | 8 June

Dr. Dilip Panikar
Senior Consultant,
Neurosurgeon,
Aster Medcity, Kochi

"I never had a headache in my life! But now I am getting a headache almost every few days, with flashes of light blurring my vision,” were Mr. Pai’s complaints when he first came to me at the hospital. “The neighbourhood physician diagnosed it as a migraine and started me on pain killers but there was no relief. After a particularly severe episode of headache, I was referred here for further tests.”

The symptoms were quite dramatic and as often happens were confused with other causes of headaches, but the diagnosis after tests and scan showed that it was a brain tumor. Mr.Pai and his family were devastated on hearing this diagnosis. “But do not lose hope”, I explained to them.

Brain tumors are not common like many other tumors in the body; but its impact is more critical. It can arise in any age group and gender. Outcome of treatment is better if detected early and treated. June 8th is observed as World Brain Tumor day to promote early detection and treatment.

The brain is the master centre for the body, it directs activities like walking and talking, as also takes care of things our body does without thinking, like breathing. The brain is also in charge of our senses of sight, hearing, touch, taste and smell, memory, emotions, and personality.

Tumors of the brain are not very common, with an incidence of around 12 cases per 100,000 population. But it is the 8th leading cause among cancer deaths, overtaking leukemia. Due to it’s location and effects on the brain, it can have a significant effect on the quality of life for the patient. Doctors characterize tumors based on the type of cell from which it arises, and whether they are malignant or benign.

Primary malignant tumors start in cells of the brain and may spread to other parts of the brain or to the spine, but very rarely to other organs. Secondary or Metastatic brain tumors are more common and begin in another part of the body and then spread to the brain. These types are more common than primary brain tumors. Around 20-40% of cancers elsewhere in the body can develop a brain metastases.

Benign tumors are slower growing and less aggressive than malignant brain tumors. They originate from cells within or surrounding the brain, and typically have clear borders that do not spread into adjacent tissue. Benign tumors can press on sensitive areas of the brain and cause serious health problems or even become life threatening in late stages. In rare cases, a benign brain tumor may become malignant.

The causes of brain tumors are not clearly known. Causes which are debatable and not proven to be a risk factor include the role of radiation from power lines, cell phones and wireless devices. Some inherited conditions like neurofibromatosis increase the risk of brain tumors. At times conditions like tuberculosis in the brain may also mimic a tumor.

Diagnosis of the brain tumor at an early stage is critical in successful treatment. Warning signs like early morning recurrent headaches with vomiting and blurring of vision, short term memory loss, changes in personality, seizures, poor coordination and difficulty in speaking or understanding spoken words usually alert the doctor about an underlying brain tumor. Impairment of vision, weakness of the arms or legs may also be the initial symptoms. An occasional patient can present acutely like a stroke. CT and or MRI scans are generally used to confirm the diagnosis. Apart from identifying the presence of a tumour, these scans also provide information that is crucial to treatment, often using specialized scan sequences in selected patients.

The aim of treatment has changed over time from preservation of life to restoration of function and improvement of the quality of life. Treatment involves specialists across multiple departments working together, including Neurosurgery, Medical and Radiation Oncology, Neuropsychology, Neurology, Physiotherapy, Anaesthesiology and Critical care, Pain and palliative care, and many others.

For the majority of patients the first step of treatment involves a surgery. This could either be a major surgery aimed at removing the tumour , or in selected cases, a limited biopsy. Advances in instrumentation and surgical technology have made tumors anywhere in the brain accessible to surgery. Techniques like image guided surgery and intraoperative electrophysiological monitoring have significantly improved the safety and accuracy of surgery. Minimally invasive surgery is rapidly increasing its reach and can now be used for selected tumours like those arising from the pituitary gland at the base of the brain. If the tumour is malignant there may be a need to follow this with other treatment like radiation and chemotherapy. Rehabilitation, both physical and mental are essential to help patients get back to their lives and work. Almost all of them need long term surveillance with periodic clinical evaluation and scans.

From the days in the past where the diagnosis of a brain tumour meant near certain disability and often death, the outcomes have transformed over the years to a very bright future for many of these patients, with a reasonable chance of leading a normal life. Ongoing research will ensure that outcomes will continue to improve in the days to come. A complete cure may not always be possible in some, but a long term control of the disease will ensure that patients and their families continue to enjoy a good quality of life.

Mr.Pai had surgery and the tumour could be completely removed. It was a type of tumour called a meningioma, which is a benign tumour. He and the family were relieved and after a few days in the hospital and a brief period of convalescence, he was able to return to his life and work.