Brain tumour

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Types
Stages
Symptoms
Causes And Risk Factors
Prevention
Diagnosis
Treatment
Lifestyle/management
Prognosis And Complications
Alternative Treatments
References

A brain tumour, known as a central nervous system tumour or an intracranial tumour, is an abnormal mass of cells that grows from either the brain or surrounding tissue. There are >150 types of brain tumour: some are cancerous (malignant) while some are non-cancerous (benign). They may grow slowly or quickly. Regardless of the type of tumour, the tumour can become large and compress the nearby nerves and blood vessels and hinder the brain’s functioning.

More men are affected by brain tumours than women, and it is more common in older people.

Brain tumours can be either primary or secondary. The tumour is primary if it has developed from the cells of the brain or its surrounding tissues; however, a tumour is metastatic or secondary if it originated from another organ and has migrated to the brain via the blood. Primary tumours may be benign or malignant, while metastatic tumours are always malignant.

Types

Benign brain tumours are of the following types:

Meningioma: These are the most common brain tumours that are formed in the meninges (the protective layer surrounding the spine and brain). They grow extremely slowly.

Craniopharyngioma: These are located deep in the brain and generally develop on a part of the pituitary gland that regulates the body’s hormones. These are difficult to surgically remove, and most people require certain hormone replacement therapy.

Pituitary adenoma: These are relatively slow-growing, small tumours that develop on the pituitary gland. These are among the more common brain tumours and can be successfully treated.

Schwannoma: These tumours develop on cells that provide “electrical insulation” to the nerve. These tumours can cause serious complications if not treated. They can develop in the spine and, in rare cases, on the nerves in the limbs.

Pineocytoma: These are slow-growing tumour cells formed on the pineal gland, which is responsible for releasing melatonin. Generally, these are seen in adults.

Chordoma: These are rare, slow-growing tumours generally seen in people when they are 50-60 in age. They are located either at the base of the skull or the base of the spine.

Glomus jugulare: These are rare tumours that arise at the base of the skull.

Gangliocytoma: These are relatively rare, occurring in young adults. These tumours form on the nerve cells.

The malignant brain tumours are of the following types:

Gliomas: The tumour forms in glial cells, which are cells that are present around nerve cells and help in their functioning. These are the most common type of malignant brain tumours. Some types of gliomas include:

Astrocytoma: These tumours are of astrocytes, which are a type of glial cells.

Glioblastoma: These are astrocytoma that grow faster and more aggressively.

Oligodendroglioma: These tumours form in cells that form myelin (a protective covering around the nerves). These are relatively rare.

Medulloblastomas: These are common in children; they form at the base of the skull and are fast-growing tumours.

Stages

Rather than stages, brain cancer is assigned a grade depending on how it is under a microscope. These grades are listed below:

· Grade I: Cells look almost similar to normal cells, and the tumour is very slow-growing and non-cancerous

· Grade II: The tumour is cancerous and slowly growing, and the cells look somewhat different under a microscope

· Grade III: These are faster growing than earlier stages and have significant abnormalities when viewed under a microscope. These cells may spread to other parts of the brain.

· Grade IV: These tumours have fast-growing cells with abnormalities that can be viewed under a microscope. These cells can spread to other parts of the brain and may develop their own blood vessels to facilitate their growth.

Symptoms

Some symptoms of brain tumour include the following:

· Headache

· Nausea and vomiting

· Seizure

· Altered mental state, including forgetfulness, change in personality, irritability, reduced response, lack of enthusiasm and confusion

· Change in gait

· Difficulty in physical coordination

· Blindspot in normal vision

· Language disorder that causes difficulty in communication

Causes And Risk Factors

Causes

Doctors are unaware of what causes most brain tumours, and research is currently on going to determine causes and how to treat them.

Risk Factors

Some factors that increase the risk of developing brain tumours include:

· Radiation therapy treatment

· Genetic mutation of certain chromosomes

· Family history

· Electromagnetic field exposure, e.g., cell phones

Prevention

Brain tumours cannot be prevented; however, certain factors that increase the risk, such as exposure to radiation or environmental factors, such as smoking, can be avoided.

Diagnosis

Based on the following tests, the diagnosis for a brain tumour can be made:

· Physical exam

· Visual field examination

· Hearing test

· A lumbar puncture to remove cerebrospinal fluid to test the presence of tumour cells

· Magnetic resonance imaging (MRI) with contrast

· Computed tomography (CT) with contrast

· Positron emission tomography (PET)

· Biopsy

· Blood test to check for tumour markers (substances secreted by tumour cells)

· Magnetic resonance spectroscopy to verify the chemical nature of the tumour observed on the MRI

Treatment

The treatment for brain tumours depends on the type of tumour, location, age, and overall physical condition. The treatment for a brain tumour can be performed in the following manner:

· Surgery: The best option to treat brain tumours is to safely remove maximum tumour cells by surgery. This may be followed by radiation and chemotherapy. The benefit of the surgery depends on its location, age and overall health. The benefits of the surgery include a reduction in pressure because of the tumour, improvements in the symptoms and survival.

· Chemotherapy: When given along with radiation therapy, the survival rates improved in people with oligodendrogliomas and glioblastomas.

· Radiation therapy: This may be used alone or along with surgery. Note that there is improvement in people that have gliomas.

· Laser thermal ablation: This is a newer technique that may be useful for smaller tumours in locations that are deep inside. The doctor will insert a small catheter and use laser to destroy tumour cells.

· Immunotherapy: This is known as biological therapy. The immune system is stimulated to act on cancer cells and destroy them.

· Targeted therapy: This treatment targets cancer cells and is used when side effects of cancer therapy cannot be tolerated.

· Active surveillance: The doctor may determine that the best course of action is just to wait and observe the tumour with regular tests.

· Physical therapy: In certain people, the tumour can cause paralysis. Physical therapy exercises can be helpful to restore the functioning of muscles and nerves.

Lifestyle/management

Some necessary precautions include the following:

· Coordination and movement: It may get difficult to coordinate actions between hands, legs and eyes. The different types of therapy may help improve coordination and perform daily tasks.

· Seizure control: Driving and using heavy machinery may be impossible for at least a few months after the last seizure as prevention.

· Counselling and emotional support: Talking to friends, family or trained professionals in case of feeling overwhelmed helps for emotional stability.

· Thinking and behavioural changes: Talking to people about the brain tumour to people that are close helps prevents any problem that may be associated with memory and behavioural changes.

Prognosis And Complications

Prognosis

The prognosis varies depending on different factors such as the location of the tumour, its size, its type, your age and if the tumour was successfully removed. Certain people can live normal, active lives with the tumour because it does not cause any symptoms; however, in some, it may be successfully treated. In certain cases, the tumour may reoccur after being treated. For brain tumours, regular follow-ups are necessary.

Complications

Some complications associated with the brain tumour include:

· Stroke

· Epilepsy

· Diabetes insipidus (decreased antidiuretic hormone leading to increased thirst and urination)

· Syndrome of the inappropriate secretion of the antidiuretic hormone (decreased sodium content in the blood)

· Behavioural symptoms such as depression, irritability, anxiety and insomnia

· Venous thromboembolism (blood clot in the vein)

Some complications associated with brain tumour treatment include:

· Nausea and vomiting

· Hypertension

· Stroke

· Constipation

· Cerebral abscess (infection in the brain with pus collection)

· Posterior reversible encephalopathy syndrome (a condition associated with seizures, headaches, visual disturbances and altered mental state)

· Decrease in the production of red blood cells, white blood cells and platelets

· Dermatitis

· Fatigue

· Memory loss

· Cataract

· Hearing loss

· Diabetes mellitus

· Cushing’s syndrome (excess production of cortisol or “stress” hormone)

· Infections

· Tremor

· Mood disorder

· Myopathy (a neuromuscular disorder leading to muscle weakness)

· Irritability

· Sedation

· Hyponatremia (decreased sodium in the blood)

Alternative Treatments

There are no known alternative treatments of brain tumour.

References

1. Cleveland Clinic. Brain cancer (brain tumour) Available at: https://my.clevelandclinic.org/health/diseases/6149-brain-cancer-brain-tumor#:~:text=You%20cannot%20prevent%20a%20brain,and%20excessive%20exposure%20to%20radiation. Accessed on May 18, 2021. (https://my.clevelandclinic.org/health/diseases/6149-brain-cancer-brain-tumor#:~:text=You%20cannot%20prevent%20a%20brain,and%20excessive%20exposure%20to%20radiation)

2. American Association of Neurological Surgeons. Brain tumours [Internet]. Available at: https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Brain-Tumors. (https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Brain-Tumors)

3. Mofitt Cancer Center. Brain cancer grades [Internet]. Available at: https://moffitt.org/cancers/brain-cancer/diagnosis/stages/. (https://moffitt.org/cancers/brain-cancer/diagnosis/stages/)

4. Alentorn A, et al. Handb Clin Neurol. 2016;134:19-26.

5. Butowski NA. Continuum (Minneap Minn). 2015;21:301-13.

6. Perkins A, et al. Am Fam Physician. 2016;93:211-217B.

7. Beth Israel Lahey Health Winchester Hospital. Lifestyle changes to manage brain tumors [Internet]. Available at: https://www.winchesterhospital.org/health-library/article?id=19158. (https://www.winchesterhospital.org/health-library/article?id=19158)

8. Mohile NA. Continuum (Minneap Minn). 2017;23:1635-1652.

9. Miranda HA, et al. J Neurosci Rural Pract. 2013; 4: S67–S81.

10. Hobson EV, et al. Perit Dial Int. 2012; 32: 590–594.

11. National Institute of Diabetes and Digestive and Kidney Diseases. Cushing’s syndrome [Internet] Available at: https://www.niddk.nih.gov/health-information/endocrine-diseases/cushings-syndrome#:~:text=Cushing's%20syndrome%20is%20a%20disorder,glucose%2C%20also%20called%20blood%20sugar. (https://www.niddk.nih.gov/health-information/endocrine-diseases/cushings-syndrome#:~:text=Cushing's%20syndrome%20is%20a%20disorder,glucose%2C%20also%20called%20blood%20sugar)

12. National Institute of Neurological Diseases and Stroke. Myopathy information page [Internet]. Available at: https://www.ninds.nih.gov/Disorders/All-Disorders/Myopathy-Information-Page. (https://www.ninds.nih.gov/Disorders/All-Disorders/Myopathy-Information-Page)