Brain Tumour

Primary Brain Tumours

Primary brain tumors are tumors originating within the brain and are named as per their location in the brain as well as on the basis of the type of brain cell the tumor is made of. Most primary tumors that begin in the glial cells of the brain are called gliomas. Some types of gliomas seen in adults are meningiomas, astrocytomas, and oligodendrogliomas. Brainstem glioma, ependyma, medulloblastoma, or grade I or grade II astrocytoma are the types of gliomas seen in children.

Primitive neuroectodermal tumors, pituitary tumors, pineal tumors, choroid plexus tumors, and tumors of the nerves and nerve sheaths in the brain are all part of primary brain tumors.

Secondary or Metastatic Brain Tumours
Secondary or metastatic tumors typically occur at the meeting point of the grey matter and the white matter of the brain. These tumors originate in different organs of the body such as the kidneys, lungs, breasts, and then travel to the brain. Some examples of metastatic tumors are:

• Neuroma
• Neurocytoma
• Optic nerve glioma
• Pilocytic astrocytoma
• Pineal cyst
• Pineoblastoma
• Pineocytoma
• Pituitary adenomas
• Neurinoma

Staging simply refers to the extent of the spread of a tumor. There is, at present, no standard staging system for primary brain tumors, as they do not spread beyond the brain (central nervous system). Grading, on the other hand, refers to the aggressiveness of a tumor and suggests how a tumor appears under a microscope when examined by a pathologist. 

Tumors that have a fast growth are given a higher grade and, in most brain tumors, the lower the grade, the better the diagnosis. At present, the following grading system is used for brain tumors:

Grade 1
The tumors are not likely to spread, and they grow slowly. Often, they can be cured with surgery.

Grade 2
The tumors are less prone to grow and spread, but they have a high possibility of coming back after treatment.

Grade 3
These tumor cells often show rapid cell division but no dead cells. They can develop rapidly.

Grade 4
Tumor cells of this grade are actively dividing. In addition, the tumor has areas of dead tissue and blood vessel growth. These tumors can grow and spread quickly.

Symptoms of a brain tumor vary according to the type of the tumor and the location of the tumor. Since different parts of the brain are responsible for different body functions, the area affected by the tumor will manifest symptoms accordingly. Here are some common symptoms of a brain tumor:

• Headaches
  A headache is an initial symptom in about 20% of the patients with a brain tumor. Headaches in a person with a brain tumor can be irregular, worse in the early morning, may be followed by vomiting or could be aggravated by activities that increase the pressure inside the skull such as coughing or a change in the posture.
   
• Seizures
  In some people with brain tumors, seizures can be the first sign of a brain tumor. Seizures occur due to unusual electrical activities in the brain. In a person with a brain tumor, these seizures can occur in the form of sudden loss of consciousness, a total loss of control of bodily functions or short periods of lack of breathing (30 seconds) resulting in bluish discoloration of the skin.
   
• Memory loss
  A brain tumor can cause problems with the patient's memory. Radiation or treatment like surgery can also lead to memory problems. Fatigue can make the memory problems even worse in patients with brain tumors. Short-term memory of a patient is affected more (like forgetting a phone number when dialing) than the long-term memory. (Read more: Memory loss causes)
   
• Depression
  Researchers suggest that more than 1 in 4 patients with a brain tumor has a major depressive disorder. Depression is commonly seen in both, the patients and their loved ones. Symptoms like loss of pleasure/interest in things that used to be fun, insomnia (lack of sleep), reduced energy levels, feelings of worthlessness, feelings of sadness irrespective of the situation, and even thoughts of suicide may be observed and are indicative of depression.
   
• Personality changes and mood swings
  Brain tumors can also cause changes in a person's personality. A person who was once motivated and driven can become inhibited and passive. Tumour can affect the way a person thinks and acts. Also, treatment procedures like chemotherapy and radiation disrupt the brain function further. Mood swings are unexplained, sudden and are commonly seen in patients with brain tumors.
   
• Cognitive functions
  Changes in concentration and attention, communication and language, and decreased intellectual abilities are seen in patients with brain tumors. Tumors formed in different lobes of the brain, like the parietal, frontal or temporal lobes can affect the behavior of a person.
   
• Focal symptoms
  Focal symptoms, or localized symptoms, are symptoms that affect only a particular part of the brain. These symptoms can help in identifying the tumor location. Double vision, feeling clumsy, weakness, feeling tingly or numb, are some examples of focal symptoms. These symptoms are explicitly due to a tumor and its location in the brain.
   
• Mass effect
  Due to the growth of a tumor within the tight space of the skull, the tumor starts exerting pressure on the healthy tissue around it, resulting in what is known as mass effect. As a result of fluid build-up near the tumor, there is an increase in the pressure within the brain. Symptoms of mass effect include behavior changes, drowsiness, vomiting, and headaches.
   
• Fatigue
  The typical symptoms of fatigue such as sleeplessness, weakness, irritability, a sudden feeling of tiredness and difficulty in concentration are commonly seen in patients with brain tumors.

Causes

The exact cause of most brain tumors not completely understood. However, researchers suggest that changes in the healthy brain cells may be the cause of brain tumor formation.

The DNA is the carrier of all our genetic information and decides the characteristics or qualities of an individual. The DNA does not just decide the way we look but determines every function of our body. The cells in our body function according to the information stored in each cell's DNA. Genes also control when our cells divide and grow into new cells and also when the cells die.

Genes that help the body cells develop and divide and keep them active are called oncogenes. Genes that control the cell division and ensure that the cells die at the right time are called tumor suppressor genes. If the DNA of the oncogenes changes or the tumors suppressor genes mutate or their function is reduced, cancer tumors are formed. These genetic changes are either hereditary or can occur at any point in a person's lifetime.

Risk Factors

Risk factors are any factors that can increase your chance of getting a disease. Some risk factors like alcohol consumption, smoking, and obesity can be changed by an individual; however, risk factors such as a family history of illness or a person’s age cannot be changed. Having one or many risk factors for a disease does not always mean that an individual will have the disease. Most brain tumors are not connected with any known risk factors or specific causes, but some factors are known to increase the risk of brain tumor:

• Radiation
  The most common environmental risk factor for a brain tumor is an exposure to radiation. This can occur either due to radiation therapy used for the treatment of some other health condition or while getting tests such as x-rays, computed tomography (CT) scans done. The radiation from the tests is quite less but repeated and frequent exposure could increase the risk.
  Brain tumors caused due to radiation are quite rare. However, there are many side effects of radiation which also include the risk of developing a brain tumor years after radiation therapy. Therefore, radiation is given keeping in mind its risk-benefit ratio.
   
• Family history
  Many patients with brain tumors do not have a family history of the disease. Although rarely a brain tumor can run in the family. Some families have genetic disorders such as neurofibromatosis (a common syndrome connected to spinal or brain tumors), Li-Fraumeni syndrome (there is a high risk of people with this condition developing glioma) and many more that tend to occur at a young age.
   
• Weak immune system
  A weak immune system can be present at birth or can be due to diseases such as Acquired Immunodeficiency Syndrome (AIDS), treatment of other cancers, or immunosuppressive treatment for organ transplant patients. People with a weak immune system have a higher risk of developing cancers such as lymphoma, a cancer of the lymphocytes, which are a type of white blood cell responsible for fighting diseases.
   
• Other risk factors
  Exposure to certain chemicals like petroleum products, vinyl chloride (a chemical substance used to make plastics) and other chemicals have been connected to an increased risk of brain tumors in some studies. Other possible risks are certain virus infections and exposure to an electromagnetic field from power lines. Research continues on these and some other possible risk factors.

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Other than radiation exposure, there are no confirmed environmental or lifestyle-related causes that can be avoided to prevent a brain tumor. Thus, there are no known ways to protect against brain tumors.

If a person’s signs and symptoms suggest a brain tumor, the doctor will recommend the following diagnostic tests:

Neurological examination
This includes checking hearing, balance, vision, coordination, reflexes, and strength along with other neurological tests. If there is a difficulty in one or more of these, it may give a clue about the part of the brain that may be affected by a tumor.

Imaging tests

• MRI
  Magnetic resonance imaging (MRI) is commonly done to spot brain tumors. It helps the doctor evaluate a tumor and plan out a suitable treatment for it. Other imaging tests like positron emission tomography and CT scan are also sometimes used for brain imaging.
   
• Tests to find cancer in other parts of the body
  The doctor may advise tests to find the origin of cancer. These tests are performed to check for the possibility of a brain tumor caused by cancer spreading from another part of your body.
   
• Biopsy
  The doctor may take a biopsy or a small sample from the abnormal tissue. It helps in understanding the nature of the growth and aids in tumor diagnosis and treatment.

Treatment of a brain tumor depends on many factors such as the tumor location, size, and growth of a tumor, overall health condition of the patient and his/her treatment preferences. Following are some of the treatment procedures available for the treatment of a brain tumor:

• Surgery
  If the location of a brain tumor is such that it is accessible to surgery, the doctor will remove the tumor as much as possible. Sometimes the tumors are small and easy to separate from the other brain tissues; therefore, surgical removal becomes easy. Surgery can help reduce the signs and symptoms of a brain tumor depending on how much of the tumor was removed. There may be a risk of bleeding or infection or other risks such as the risk of hearing loss after surgery for a tumor connected to the ears.
   
• Radiation therapy
  High-energy beams like x-rays or protons are used as radiation therapy to kill tumor cells. It is performed by placing a machine either outside the patient’s body to provide external beam radiation or inside the patient’s body next to the brain tumor (brachytherapy). Proton therapy, which is a newer form of radiation, can reduce the risk of side effects linked to radiation when the tumors are close to the sensitive areas of the brain. Whole brain radiation is used to treat cancer that has spread from the other parts of the body. It is also used when cancer forms multiple brain tumors. Side effects during radiation or immediately after the therapy depend on the dose and type of radiation the patient receives.
   
• Radiosurgery
  The radiosurgery method uses multiple radiation beams to kill tumor cells in a tiny area. Gamma knife or linear accelerator is one of the many types of technologies used in radiosurgery of brain tumors. This surgery is usually a one-day treatment, and most patients go home on the same day.
   
• Chemotherapy
  Chemotherapy is a cancer treatment that uses oral pills or injections that kill the tumor cells. Depending on the type and stage of a brain tumor, chemotherapy can be recommended as a treatment option. The most commonly used drug in chemotherapy of brain tumors is temozolomide, which is given as a pill. Corticosteroids are used in brain tumor medication to help reduce the swelling caused due to the tumor or due to any ongoing treatment. The drugs and side effects depend on the dose and type of drugs used for chemotherapy.
   
• Targeted drug therapy
  This treatment focuses on specific abnormalities observed within the cancer cells. Drugs used in this therapy target the cancer cells and kill them. Different forms of drug delivery systems are under trial and are being developed.

Lifestyle management

It is quite natural for a person to feel anxious, fearful and distressed after being diagnosed with a brain tumor. However, by taking some effective measures, it is possible to manage the stress and pain associated with a brain tumor. It is best to talk to the doctor to understand the various forms of supportive and complementary treatment modalities to help cope with the stress of a brain tumor. Some of these treatment modalities include relaxation techniques, art therapy, music therapy, meditation, exercise, and acupuncture.
Here are some simple measures that can help in managing brain tumor effectively: 

• Keeping family and friends close
  Strong bonds with loved ones can give the patient the much-needed support that he/she needs, both physical and mental. Friends and family could be the support system and help in taking care of the patient at home and even at the hospital.
   
• Learning about brain tumors and making informed decisions about treatment
  It is always best to try to gather as much information about a brain tumor as possible from the doctor and asking the doctor about the different treatment options available. By building awareness about the disease and understanding treatment options in greater detail, patients can make informed decisions.
   
• Finding someone to talk to
  A good listener who could be a family member, a medical social worker, a counselor or even a support group can help patients in coping with their illness effectively. Discussing their hopes and fears while undergoing treatment for a brain tumor can benefits patients immensely.
   
• Maintaining a healthy lifestyle
  It is critical that patients do not lose focus on their overall health while battling a brain tumor. Unhealthy habits such as smoking and drinking can be detrimental while working towards recovery. It is best to quit smoking and limit drinking. Including an exercise regimen as simple as a daily walk can help in boosting stamina. The focus should also be on eating healthy and following a better diet plan if needed. New research shows that people following a vegan or vegetarian diet show lower rates of cancers. Some researchers also suggest that a ketogenic diet (low carbohydrate diets) can slow down the tumor growth.

Prognosis

After being diagnosed with a brain tumor the outcome depends on many factors such as the type of the tumor, the treatment received and even the fitness level of the patient. As such, it is quite difficult to predict an outcome and life expectancy in patients with a brain tumor. Though statistics from large groups of patients with a brain tumor are available, they cannot predict the outcome.

Some factors that can affect the outcome and quality of life after being treated for a brain tumor are as follows:

• The Type of tumor
  Different brain tumors respond to different types of treatments. For example, some respond better to chemotherapy, and some may respond to radiation.
   
• The grade of tumor cells
  The grade of a tumor affects the type of treatment received. Fast-growing tumors are likely to come back even after the completion of treatment.
   
• Position in the brain
  The position of a tumor in the brain decides the treatment. Surgery is the primary treatment for most brain tumors; however, some tumors are challenging to operate as compared to others due to their position in the brain. The tumors may be difficult to remove due to the need to preserve the healthy tissue surrounding them or may be inoperable due to being very close to a major blood vessel or nerve. Such tumors can be treated with radiation or chemotherapy, and the outcome will depend on the response of the tumor to therapy.
   
• Size of a tumor
  Tumors that are large and have an unclear edge are hard to remove.
   
• Age
  The outlook of having a better quality of life is often better in young people.

Complications

Brain tumors are associated with many complications, especially if they are not treated completely. Here are some of the complications that may be seen after the treatment for a brain tumor or as a result of adjunctive therapy:

• Depression
• Loss of some brain capacity or mental function
• Fatigue
• Headaches
• Seizures
• Muscle paralysis
• Nutrition depletion
• Hearing loss
• Speech problems
• It is important to note that not every patient will experience all of these symptoms.
• Children who undergo brain tumor treatment at a young age can experience late effects of the treatment throughout their childhood. In addition to the previously listed complications, the following symptoms may also be seen:
• Cognitive delay
• Hormone deficiencies
• Visual and auditory problems
• Learning disabilities
• Delayed or early puberty
• Diabetes
• Emotional problems linked to the stress of diagnosis and treatment
• The possibility of developing a second cancer
• Physical disabilities

A brain tumor is a mass or growth resulting from an uncontrolled growth of brain cells. The exact cause of this uncontrolled growth of brain cells is not yet clear. However, one in 20 tumors is thought to be due to the inheritance of a gene that puts a person at a higher risk for a brain tumor.

There are more than 130 different primary brain and spinal tumors that are grouped and named on the basis of their location in the brain, the type of cells they develop from, and how quickly they grow and spread. Malignant or cancerous brain tumors are rare (almost 2% of all the cancers in adults). Many brain tumors are associated with poor survival rates, resulting in a higher loss of the number of years of life as compared to other cancers. But what exactly are brain tumors, and how do they form? What causes brain tumors? And how can they be treated? Read more to know everything about brain tumors.