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Introduction

Tumours arising from in and around the brain – its substance, supporting tissue or its covering within the skull are all called brain tumours in general. They are fortunately not the commonest tumours in adults, but are the commonest solid tumours in children.

What is a Brain tumour?

A brain tumour is an abnormal mass of tissue in which some cells grow and multiply uncontrollably due to loss of mechanisms that control normal cells growth. The growth of a tumour takes up space within the skull and interferes with normal brain activity. A tumour can cause damage by increasing pressure in the brain, by shifting the brain or pushing against the skull, and by invading and damaging nerves and healthy brain tissue. The location of a brain tumour influences the type of symptoms that occur. This is because different functions are controlled by different parts of the brain. Brain tumours rarely metastasise (spread) to other parts of the body outside of the Central Nervous System (CNS). The CNS includes the brain and spinal cord.

Some tumour types are more common in children than in adults. When childhood brain tumours occur in adults, they often occur in a different part of the brain than in children. Although most primary tumours attack member of both sexes with equal frequency, some, such as meningiomas, occur more frequently in women, whereas others, such as medulloblastomas, more commonly affect boys and young men.

The treatment outcomes in brain tumour patients are as individual as the patients themselves. Your doctors will help you understand the possible repercussions of your specific tumour.

What is the difference between a primary brain tumour and a metastatic (secondary) brain tumour?

Primary brain tumours originate in the brain itself. Primary brain tumours do not spread from the brain to other parts of the body except in rare cases. Pathologists classify primary brain tumours into two groups:

  • Glial tumours (gliomas)
  • Nonglial tumours

Gliomas are composed of glial cells, which include astrocytes, oligodendrocytes, ependymal cells, Schwann cells, microglia and satellite cells. Nonglial tumours develop on or in structures within the brain, such as nerves, blood vessels and glands.

Metastatic or secondary brain tumours begin as cancer in another part of the body. Some of the cancer cells may be carried to the brain by the blood or may spread from adjacent tissue. The site where the cancerous cells originated is referred to as the primary cancer. Metastatic brain tumours are often referred to as brain metastases or lesions. Metastatic brain tumours are the most common brain tumours. Because people are surviving primary cancers for longer periods of time, there has been an increase in metastatic lesions.

Is a Brain tumour cancer?

Some brain tumours are cancerous and some are not. Malignant tumours are considered cancer. Two of the most common forms of brain cancer are metastatic brain tumours (brain metastases) and Glioblastoma Multiforme (GBM).

Benign tumours are not considered cancer. Some benign tumours have malignant forms, such as malignant meningiomas. Also, some benign brain tumours later develop into cancer. The reason for this is unknown.

What is the difference between a benign Brain tumour and a malignant (cancerous) Brain tumour?

Benign brain tumours are slow-growing tumours that can be removed or destroyed if in an accessible location. Malignant tumours (brain cancer) are rapidly growing tumours that invade or infiltrate and destroy normal brain tissue. No one is certain why, but some benign brain tumours may change over time to become malignant.

Tumours are graded to indicate how quickly they are growing. Most medical institutions use the World Health Organization (WHO) classification system to identify brain tumours. The WHO classifies brain tumours by cell origin and how the cells behave, from the least aggressive (benign) to the most aggressive (malignant).Some tumour types are assigned a grade, which signifies the rate of growth. There are variations in grading systems, depending on the tumour type. The classification and grade of an individual tumour help predict its likely behaviour.

The distinction between benign and malignant can be ambiguous. Some benign tumours can be as dangerous as malignant ones if in a dangerous or inaccessible location, such as the brain stem. Conversely, some malignant tumours can be successfully treated.

Although they may fall into a particular classification or category, brain tumours are specific to each individual. Brain tumours have vastly different characteristics and patterns of growth due to the molecular makeup of the individual tumour.

What are recurrent tumours?

Recurrent tumours grow back after being removed or stabilised. Recurrence commonly occurs in the same area as the original tumour, but may develop in another part of the brain or spinal cord. Both benign and malignant brain tumours can recur after initial treatment. A brain tumour that has been treated with radiation or chemotherapy may disappear or remain in remission, a state in which the tumour cells stop multiplying. Remission can be temporary or permanent. It is not possible to predict whether or not recurrence will take place. Therefore, after receiving therapy the patient will need to have follow-up appointments indefinitely, usually with MRI imaging, even if the tumour was benign.

Risk Factors

What are the common symptoms of Brain tumors?

The most common symptoms include
  • Headaches (usually, severe in the morning)
  • Nausea or vomiting (generally, very severe in the morning)
  • Seizures or convulsions (especially in adult age group)
  • Difficulty thinking, speaking, or finding words
  • Personality changes
  • Weakness or paralysis in one part or one side of the body
  • Loss of balance
  • Vision changes
  • Confusion and disorientation
  • Memory loss

Different parts of the brain control different functions, so symptoms will vary depending on the tumor's location. While these are the most common symptoms of a brain tumor, they can also indicate other medical problems. If you are having any of these symptoms, it is important to see your doctor and get a definitive diagnosis.

What are the common symptoms of Brain tumours in children?

Some of the general symptoms of brain tumors in children are

  • Headaches
  • Vomiting (usually in the morning and without nausea)
  • Unsteadiness or loss of balance
  • Seizures
  • Double vision or vision problems
  • Decreased coordination
  • Fatigue or sleepiness
  • Weakness on one side of the body
  • Increased size of the head
  • Uncontrolled eye movements
  • Irritability; and behavioural changes

Also, a change in behaviour of the child, a sudden change in school performance, or sudden growth failure associated with increasing thirst or increased urination may be a sign of a brain tumor

Symptoms are often vague in children, especially in very young children who are not able to fully describe their symptoms. Some of these symptoms can occur with a variety of more common childhood illnesses. The difference with brain tumors is that these symptoms persist and get worse over time. If your child is experiencing any of these symptoms, it is important to see a doctor and get a definitive diagnosis.

Diagnosis

How is a Brain Tumor identified?

A brain tumor diagnosis usually involves several steps, which can include a neurological examination, brain scan(s) and/or a biopsy. The main stay of diagnosis is currently an MRI scan followed by surgery for histological examination with a pathologist.

Treatment

How is a brain tumor treated?

The standard treatment for brain tumors includes surgery, radiation therapy, and/or chemotherapy. In general, radiation and chemotherapy treatments are used as secondary or adjuvant treatments for tumors that cannot be managed using only surgery. However, radiation and chemotherapy may be used without surgery if the tumor is inoperable.

In many cases, at the time of diagnosis, treatment decisions must be made quickly, especially with regard to surgery. When possible, the doctor and family will discuss a treatment plan based on the type and location of the tumor. In treating brain tumors, a multi-disciplinary treatment team, made up of various specialists, is generally considered the preferred approach. Neurosurgeons, neurologists, medical and paediatric oncologists, radiation oncologists, pathologists and other medical professionals may be part of the treatment team.

What will happen to a patient with a Brain tumour?

To a large extent, what happens to the patient depends on the type of tumor, its location, the area of the brain involved and the forms of therapy needed to treat it. But each patient is different, and therefore, these are not the only factors to be considered.

For patients and their families, the brain tumor experience is a journey into an unknown land filled with uncertainty. Through the diagnosis, treatments and follow-up visits, there's much to learn and cope with physically, emotionally and spiritually.

The more you and your family know and understand each aspect of the tumor and its treatment, the less uncertainty remains about what will happen. The confidence a patient places in himself/herself and the medical caretakers makes a tremendous difference. Perhaps most important of all is the outlook toward the condition and treatment, and the willingness to believe in the power of healing. Brain tumor patients have a right to remain hopeful in the fight against their illness and its aftermath. Hope is a powerful coping strategy that empowers patients to look beyond the moment and into the future.

Can one lead a normal life after Brain tumor treatment?

Most brain tumors of the brain are treatable completely and post treatment patients usually lead a normal life. Even in malignant tumor the aim of treatment is to maintain a good quality of life for as long as possible without any additional problems in the future. Depending on the type of tumor even this is extendable nowadays by a few months to few years even in some worst case scenarios. With the best of care in dedicated neurooncology centres the tumor patients can live with the hope of surviving well for longer periods.

How to choose the best doctor and medical centre?

There is no one 'best' doctor, but there are issues to consider that can help guide you in choosing the doctor that is best for you. Good communication is essential for a good relationship with your doctors. If you ask your questions and get them answered, the experience will be easier for you and your family. If you are not comfortable with your doctor, consider changing doctors.

Getting a second opinion is important if your doctor does not have experience with brain tumors or if you want to confirm your primary physician's recommendation. Ask your doctor for a referral to a specialist.

There are many important questions to ask when choosing a treatment center. Does the centre have specialists in neurosurgery, neurology, neuro-oncology, and radiation oncology? What types of imaging technology are available? How many patients does the medical centre diagnose and treat per year?

Why KDAH?

At Kokilaben Dhirubhai Ambani Hospital we have a dedicated team of neurosurgeons, medical oncologists, paediatric oncologists and radiation oncologist specialised in Neurooncolgy.

There are dedicated neuroradiologists and neurorehabilitation experts to provide valuable support. Technologically, Kokilaben Hospital is most best equipped to treat brain tumors with Intra Operative Imaging with MRI (IMRIS), which can detect residual tumors during the surgery itself, thus, assisting the surgeon to achieve maximal safe resection of all tumor. It is invaluable in surgery in Gliomas and in pituitary tumors in particular.

The specialists also use latest operative advances with navigation, awake surgery techniques, neurophysiology monitoring with MEP and SSEP. The radiation oncology setup provides the latest in radiation hardware to deliver safe and precise radiation including radiosurgey and stereotactic radiotherapy.

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