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Did you know that a recurrent headache, vomiting, new onset of epilepsy,
weakness or numbness of any part of the body, and difficulty with memory or
concentration can be a sign of a brain tumor? Well, brain tumors can also lead
to difficulty in walking, controlling urine and stool. Basically, it can
severely impact a persons quality of life.
According to published data from India, Central nervous system tumors occur with
a frequency of 5-10 per 100,000 population and account for 2% of all
malignancies occurring in our population. In regular clinical practice, it is
common to come across patients coming with complaints arising from a tumor
inside the skull and they can occur in all age groups. Our brain is central to
our existence- both for the physical functioning of our body and to determine
our mental state. The presence of a tumor can impact our health by directly
affecting the body by producing a variety of weakness or numbness, difficulty
with walking, and difficulty with dexterity. It can also impact our quality of
life by causing primary mental changes- forgetfulness, speech defects,
depression and by loss of bladder or bowel control.
Early detection and timely intervention are therefore key to save lives. But it
is also important to note that not all brain tumors are cancerous. Hence,
education and awareness on the different kinds of brain tumors are also crucial.
Lets begin with understanding what a brain tumor is all about and how it impacts
a persons health and quality of life.
What is a brain tumor?
A brain tumor is a mass of abnormal cells within the skull and may arise in any
part of the skull and the brain itself- the membranes that surround the brain
(ie. the meninges), the bones that surround the brain, and the blood vessels of
the brain. Tumors that originate outside the brain but spread to the brain from
other sites like the lung, breast, kidney, skin, etc., may also be categorized
as brain tumors.
What are the different types of brain tumors?
Tumors that arise from the brain tissue or its covering are called
Primary brain tumors. These tumors are named according to the cell type
from which they originate. Among the primary brain tumors, the commonest are
Astrocytoma, Meningioma, Oligodendroglioma, Pituitary adenoma,
Schwannoma, Chondrosarcoma, Chordoma (arising from astrocytes,
meningeal cells, pituitary gland, cranial nerves, cartilaginous elements within
the bone, primitive developmental elements within mature bone respectively).
The larger group of brain tumors is constituted by tumors that originate
elsewhere but spread to the brain alongside its blood supply. These are called Secondary
brain tumors or metastatic tumors.
Another way of grouping brain tumors is into malignant (cancerous) and
benign (non-cancerous) tumors.
Which of the most common benign tumors of the brain?
Among the most common benign tumors are Meningiomas, Schwannomas, and Pituitary
adenomas. Unfortunately, malignant tumors of the brain are more common. The
common malignant tumors are metastases followed by gliomas.
What are the symptoms of brain tumors?
Symptoms of brain tumors depend on the tumor and its location. Different areas
of the brain serve different functions and the location of the tumor determines
the symptoms.
Tumors in the brain often produce no symptoms in the early stages. As they
enlarge, they can present with symptoms due to their physical mass resulting in
raised pressure inside the skull. The most common symptom is a headache that
does not respond to analgesics and worsens in the evening or early morning.
Vomiting, visual problems, change in the level of consciousness and even coma
are other symptoms of rising pressure within the brain.
Tumors that arise from eloquent areas of the brain may have more dramatic
symptoms like loss or impairment of speech/language functions, weakness of one
side of the body, disturbance of gait and balance (drunken gait), loss or
impairment of vision, changes in behavior and personality, different types of
epileptic fits, milk discharge from the breast, change of voice, difficulty in
swallowing, deafness, etc.
How is the diagnosis of a brain tumor made?
The first guide to the presence of a brain tumor is the detailed history and
clinical examination of the individual. This is followed by investigations,
mainly imaging studies including CT scan and MRI along with a battery of blood
tests as indicated.
What is the treatment of brain tumors?
Treatment usually depends on the kind of brain tumor. The mainstay of treatment
is the microsurgical removal of the tumor. Surgery for brain tumors is complex.
Safety and outcome of brain surgery is improved using several technological
advances in this field like Neuro-Navigation, Intraoperative Neuro
Monitoring, Ultrasonic aspirator and Endoscopic surgery. Micro
neurosurgery involves using an operating microscope for the surgery. Endoscopic
surgery and minimally invasive brain surgery techniques are also available. How
the surgery is performed will depend on the training and expertise of the
surgeon and the type, location and extent of the tumor.
Surgery may need to be followed by adjuvant radiotherapy and chemotherapy if
required, based on the biopsy report. In some varieties of tumors like
prolactinoma arising from the pituitary gland treatment goals may be attained
with only medicines.
Why is early detection crucial?
As a brain tumor enlarges, it affects the normal functioning of that part of the
brain. Early detection and early treatment of a brain tumor can safeguard the
normal surrounding brain. It may also increase the treatment options. For
example, some tumors can be treated by radiosurgery. As tumors enlarge, they may
invade parts of the brain and skull that may make curative treatment difficult.
Larger tumors often have a higher risk from surgery. Also, remember that benign
tumors of the brain are by and large curable by surgical removal. Unfortunately,
the long term outcome of the common malignant brain tumors is not that good,
with limited survival despite optimal treatment with surgery, radiotherapy and
chemotherapy. Therefore early detection that can lead to timely intervention
becomes crucial.
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