Brain Tumors

Symptoms of Brain Tumor:

The signs and symptoms of a brain tumor vary greatly and depend on the size, location, and growth rate of the brain tumor.

General signs and symptoms caused by brain tumors may include:

New start or change in headache pattern
Headaches that become more frequent and severe
Unexplained nausea or vomiting
Vision problems such as blurred vision, double vision, or loss of peripheral vision
Gradual loss of feeling or movement in an arm or leg
Imbalance
speech difficulties
feeling very tired
Confusion
difficulty making decisions
Inability to follow simple commands
personality or behavior changes
Seizures, especially in people without a history of seizures
hearing problems

Causes of Brain Tumors

Primary Brain Tumors

Primary brain tumors originate in the brain itself or from tissues close to it, such as the membranes that cover the brain (brains), cranial nerves, pituitary gland, or pineal gland.

Primary brain tumors begin when normal cells develop changes (mutations) in their DNA. A cell’s DNA contains instructions that tell the cell what to do. Mutations tell cells to grow rapidly, divide, and continue living while healthy cells die. As a result, a tumor-forming mass of abnormal cells develops.

In adults, primary brain tumors are much less common than secondary brain tumors, where the cancer starts elsewhere and spreads to the brain.

There are many different types of primary brain tumors. Each gets its name from the type of cells involved. We can list them as follows:

Gliomas: These tumors begin in the brain or spinal cord and include astrocytomas, ependymomas, glioblastomas, oligoastrocytomas, and oligodendrogliomas.

Meningiomas:

A meningioma is a tumor that arises from the membranes (meninges) that surround your brain and spinal cord. Most meningiomas are not cancerous.

Acoustic Neuromas (Schwannomas): These are benign tumors that develop in the nerves that control balance and hearing from your inner ear to your brain.

Pituitary Adenomas: These are tumors that develop in the pituitary gland at the base of the brain. These tumors can affect pituitary hormones through their effects on the body.

Medulloblastomas: Although they can occur at any age, they are most common in children. A medulloblastoma starts in the lower back of the brain and tends to spread through the spinal fluid.

Germ Cell Tumors: Germ cell tumors can develop during childhood, when the testicles or ovaries will form. But sometimes germ cell tumors affect other parts of the body, such as the brain.

Craniopharyngiomas: These rare tumors begin near the pituitary gland of the brain, which secretes hormones that control many body functions. As the craniopharyngioma grows slowly, it can affect the pituitary gland and other structures near the brain.

Cancers that Start Elsewhere and Spread to the Brain

Secondary (metastatic) brain tumors are tumors that arise from cancer that starts elsewhere in your body and then spreads (metastasizes) to your brain.

Secondary brain tumors occur most often in people with a history of cancer. Rarely, a metastatic brain tumor may be the first sign of cancer starting anywhere in your body. In adults, secondary brain tumors are much more common than primary brain tumors.

Any cancer can spread to the brain, but common types include:

• breast cancer
  Colon cancer
  kidney cancer
  Lung cancer
  Melanoma

Risk factors

In most people with a primary brain tumor, the cause of the tumor is not clear. However, there are some factors that can increase your risk of a brain tumor. Risk factors include:

• Radiation exposure: People who are exposed to a type of radiation called ionizing radiation have an increased risk of brain tumors. Examples of ionizing radiation include radiation therapy used to treat cancer and radiation exposure caused by atomic bombs.
  Family history of brain tumors: A small proportion of brain tumors occur in people with a family history of brain tumors or a family history of genetic syndromes that increase the risk of brain tumors.
  If you suspect you have a brain tumor, your doctor may recommend a number of tests and procedures, including:

Diagnosis

• Neurological exam: A neurological exam may include checking your vision, hearing, balance, coordination, strength, and reflexes. Difficulty in one or more areas can provide clues about the part of your brain that may be affected by a brain tumor.
• Imaging tests: Magnetic resonance imaging (MRI) is commonly used to help diagnose brain tumors. A number of specialized MRI scanning components, including functional MRI, perfusion MRI, and magnetic resonance spectroscopy, can assist in tumor evaluation and treatment planning. Sometimes other imaging tests are recommended in certain situations, including computed tomography (CT) and positron emission tomography (PET).

Biopsy: A biopsy may be done as part of an operation to remove a brain tumor, or a biopsy may be done using a needle. Stereotactic needle biopsy can be performed for brain tumors in hard-to-reach or very sensitive areas of your brain that can be damaged by a more extensive operation. The biopsy sample is then examined under a microscope to determine whether it is benign or malignant. Advanced laboratory tests can give your doctor clues about your prognosis and treatment options. Examining your biopsy sample and determining exactly what type of brain tumor you have is a complex process.

Treatment of Brain Tumors

Treatment of a brain tumor depends on the type, size, and location of the tumor; it also depends on your overall health and preferences.

• Operation

If the brain tumor is in an accessible location for surgery, your surgeon will work to safely remove as much of the brain tumor as possible.

Some brain tumors are small and can be easily separated from the surrounding brain tissue, making complete surgical removal possible. Other brain tumors cannot be separated from surrounding tissues or are located near sensitive areas in your brain, making surgery risky. In these cases, your doctor will remove as much of the tumor as is safe.

Even removing some of the brain tumor can help reduce its signs and symptoms.

Surgery to remove a brain tumor carries risks such as infection and bleeding. Other risks may depend on the part of your brain where your tumor is located. For example, having surgery on a tumor near the nerves connecting to your eye may carry the risk of vision loss.

• Radiotherapy

Radiotherapy uses high-energy rays such as X-rays or protons to kill tumor cells. Radiotherapy may come from a machine outside your body (external beam radiation) or, very rarely, radiation may be placed inside your body near your brain tumor (brachytherapy).

External beam radiation can be focused on the area of your brain where the tumor is located, or it can be applied to your entire brain (whole brain radiation). Whole brain radiation is often used to treat cancer that has spread to the brain from another part of the body and creates multiple tumors in the brain.

Traditionally, radiation therapy uses X-rays, but a newer form of this treatment uses proton beams. Proton beam therapy allows doctors to more precisely control radiation. It can be useful in the treatment of brain tumors in children and tumors that are very close to sensitive areas of the brain. Proton beam therapy is not as common as conventional X-ray radiation therapy.

The side effects of radiation therapy depend on the type and dose of radiation you receive. Common side effects during or immediately after radiation include fatigue, headache, memory loss, scalp irritation and hair loss.

• Radiosurgery

It is stereotactic radiosurgery that uses small gamma rays to deliver a precise dose of radiation to the target.

Gamma Knife stereotactic radiosurgery

Stereotactic radiosurgery is not a form of surgery in the traditional sense. Instead, radiosurgery uses multiple beams of radiation to kill tumor cells in a very small area, giving a highly focused form of radiation therapy. Not every beam of radiation is particularly strong, but the point where all the beams meet – in a brain tumor – takes very high doses of radiation to kill tumor cells.

There are different types of technology used in radiosurgery to deliver radiation to treat brain tumors, such as the Gamma Knife or linear accelerator.

Radiosurgery is typically done in a single treatment, and you can usually go home the same day.

• Chemotherapy

Chemotherapy uses drugs to kill tumor cells. Chemotherapy drugs can be taken orally in pill form or injected into a vein (intravenously). The most commonly used chemotherapy drug to treat brain tumors is temozolomide (Temodar). Depending on the type of cancer, other chemotherapy drugs may also be recommended.

Chemotherapy side effects depend on the type and dose of drugs you take. Chemotherapy can cause nausea, vomiting and hair loss.

Tests of your brain tumor cells can determine whether chemotherapy would be beneficial for you. The type of brain tumor you have also helps with whether or not to recommend chemotherapy.

• Targeted Drug Therapy

Targeted drug therapies focus on specific abnormalities found in cancer cells. Targeted drug treatments can block these abnormalities, causing cancer cells to die.

Targeted therapy drugs are available for certain types of brain tumors, and many more are being studied in clinical trials. Your doctor may have your tumor cells tested to see if targeted therapy will be an effective treatment for your brain tumor.

Post Treatment Rehabilitation

Rehabilitation may be a necessary part of recovery, as brain tumors can develop in parts of the brain that control motor skills, speech, vision, and thinking. Depending on your needs, your doctor may refer you to:

• Physical therapy to help you regain lost motor skills or muscle strength.
  Occupational therapy to help you return to your normal daily activities, including work, after a brain tumor or other illness.
  Speech therapy with speech therapists if you have speech difficulties.
  Special education to help school-age children cope with changes in their memory and thinking after a brain tumor.