If the tumor is malignant (cancerous), waiting may result in further progression of the tumor and perhaps make it untreatable at a later stage
Brain tumors are common tumors in children and less common in adults and they could be benign (ordinary tumors or non-cancerous) or malignant (cancerous). They usually are silent till they grow in size to produce increased pressure symptoms with complaints of headache and vomiting which is most likely during early morning hours, and with progressive worsening in severity, along with visual blurring, with vomiting eventually help in relieving the headaches.
Some tumors next to important nerves can cause weakness of the action of the particular nerve and result in diminished function of a particular part of the body — like eye movement, visual impairment, face muscle movement, hearing loss, swallowing difficulty, weakness of hands or legs, difficulty in walking or seizures.
Due to the pandemic, the patients with brain tumors too are suffering due to lack of timely intervention. The fear of contracting COVID infection and the logistics for patients to reach multispecialty hospitals equipped with the best of facilities which is ideally needed to treat such cases are some of the causes for delay in seeking attention. If and when these patients develop the COVID infection, it may be harmful to operate during the period of infection as the complication of COVID could increase and be fatal too (especially if the surgery needed is through the nose as in some cases of tumors like pituitary tumors).
Since brain tumor surgeries are sometimes very critical and may need postoperative ICU care with ventilation for a longer period of time, there may be hesitancy on the part of doctors to undertake major surgeries during this period due to lack of ICU beds and ventilators (which are already in great demand for COVID patients). So, in more ways than one, the brain tumor patients are not getting timely care as needed. If the tumor is benign (non-cancerous) there is no harm in waiting for a few months till the situation is suitable and safe for such hospital admissions and surgeries.
If the tumor is malignant (cancerous), waiting may result in further progression of the tumor and perhaps make it untreatable at a later stage. Some benign tumors pressing on nerves (vision nerves by pituitary tumor) or spinal cord and causing loss of function too may need to be attended to early to preserve important function. One needs to weigh the pros and cons of immediate surgery in the given circumstances with attendant risks involved versus delayed surgery after a few weeks to even months risking growth of the tumor. The decision needs to be taken with due diligence and in discussion with the patients and their relatives.
If surgery is likely to be delayed due to the pandemic situation, some cases may be amenable to direct treatment with radiation as possible and such options need to be discussed and availed as possible for example the Stereotactic Radiosurgery in a vestibular schwannoma which is a benign tumor that arises from the neurilemma sheath of the auditory vestibular nerve, also known as the eighth cranial nerve which transmits sound and equilibrium (balance) information from the inner ear to our brain.
Post-operative treatments like radiation and chemotherapy that are needed also become difficult to administer in the current scenario where patients may have to stay in different cities closer to a hospital for prolonged treatment for over six to eight weeks. Where the treatment can be postponed, it can be considered suitably, or referred to a centre near their home. Giving chemotherapy also lowers the immunity of these patients and makes them susceptible to infections. These considerations too need to be kept in mind and extra precautions need to be observed by the patient.
The writer is Dr Anandh Balasubramaniam , Consultant Neurosurgeon at Yashoda Hospitals, Hyderabad
