Dr Sandeep Vaishya| Executive Director, Neurosurgery
Fortis Memorial Research Institute and Fortis Flt lt Rajan Dhall Hospital, Vasant Kunj
You have a brain tumor.” These words alone are sufficient to strike fear in the heart of the patient. Not necessarily so. There are many types of brain tumors and only highly malignant ones are bad. Benign and low grade malignant tumors are eminently treatable.
Brain tumors are growths of abnormal cells in tissues of the brain. Tumors that start in the brain are called primary brain tumors. A tumor that starts in another part of the body and spreads to the brain is called a metastatic brain tumor. Most primary tumors are caused by uncontrolled growth among cells that surround and support neurons. In a small number of individuals, primary tumors may result from specific genetic disease or from exposure to radiation or cancer-causing chemicals. The cause of most primary tumors remains a mystery. They are not contagious and, at this time, not preventable. Brain tumors may be either benign (not cancer) or malignant (cancer). Benign brain tumors usually arise outside the brain and press on nearby areas of the brain but rarely spread into other parts of the brain. Malignant ones are likely to grow quickly and spread into other parts of the brain. Both benign and malignant tumors cause signs and symptoms and need treatment.
Brain tumors can affect a variety of brain functions which can have a significant impact on social, physical, functional and emotional well-being of an individual. Awareness of patient and family is mandatory as it affects regardless of age, sex or history.
Signs and symptoms
One of the most common symptoms of brain tumors is increasing severity of headaches, which is more severe in the morning. Other symptoms include nausea and vomiting, weakness in the hands and legs, loss of balance while walking, seizures, vision or hearing problems, behavioural and cognitive problems and epilepsy.
Brain tumors can occur in both adults and children. The types of tumors that form and the way they are treated are different in children and adults. The first test to diagnose brain tumors is a neurological examination. Special imaging techniques (computed tomography and magnetic resonance imaging) are also employed.
According to the guidelines released by WHO, the primary malignant tumors are categorized into four grades based on the abnormality of the cells. The primary malignant tumors of the brain don’t spread to other parts of the body. The three most commonly used treatments are surgery, radiation, and chemotherapy. Steroids are prescribed to reduce the swelling inside the brain.
The treatment
Depends on the type/grade of the tumour, age and general fitness of patient. For grade I brain tumors, surgical removal may suffice which will reduce the size of the tumor and curb symptoms. In case of Grade II,Grade III and IV, radiation therapy and chemotherapy are used to kill the remaining cancerous cells. Chemotherapy could be done either orally or IV (through a vein). The chance of recovery depends on many factors, including age, tumor size, tumor type, and where the tumor is in the brain.
Post treatment care
Benign tumors will need surgery if they are large in size, while if they are small then they can be treated by radiosurgery which is a single day treatment where high dose of radiation is focused on the tumor to kill it without damaging the surrounding brain. The recent advances in the brain tumor management are removal of these tumors by endoscopy or other minimally invasive techniques and the use of neuronavigation which precisely guides the surgeon towards the tumor.
Experimental treatment options may include new drugs, gene therapy, biologic immuno-agents that enhance the body’s overall immune system to recognise and fight cancer cells, and a combination of therapies.
