Does Age Play A Role In Brain Tumour Diagnosis And Prevention?

The cause of a brain tumour is not known most of the time. Following are some factors that may raise a person's risk of developing a brain tumor.

How Wonderful is man: He sees with fat, talks with a piece of flesh, hears with a bone and breathes through a hole. This 1400-year-old quote by Hazrat Ali AS is astonishing and leads us to the thought that Man is indeed a wonderful creation. The human brain and mind, the seat of all senses, memory, control, action and hence intelligence makes it indeed enigmatic and pursuit of its understanding & functions a challenging and complex task. Hence, the study of its aberrations and malfunctions becomes even more intriguing.

Malignant and non-malignant brain and other central nervous system (CNS) tumours comprise a diverse constellation of over 100 histologically distinct subtypes with varying descriptive epidemiology, clinical characteristics, treatments, and outcomes. According to Globocan 2020, worldwide incidence of Brain tumours account for 3.9 per cent of all malignancies in males, whilst being 3 per cent in females, with the Asian population contributing more than half of these cases. Brain and other nervous system cancer is the 12th leading cause of death for men and women. Although relatively rare, the associated morbidity and mortality and the significant proportion of affected young and middle-aged individuals has a major bearing on the death-adjusted life years compared to other malignancies. (Miller et al & Dasgupta, Gupta & Jalali). According to American Cancer society, Cancer facts and figures 2022, age is a factor in general survival rates after a cancerous brain or CNS tumor is diagnosed. The 5-year survival rate for people younger than age 15 is about 75 per cent. For people aged 15 to 39, the 5-year survival rate nears 72 per cent. The 5-year survival rate for people aged 40 and over is 21 per cent. However, survival rates vary widely and depend on several factors, including the type of brain or spinal cord tumor.

Causes and risk factors of brain tumour

Most of the time, the cause of a brain tumour is unknown, but the following factors may raise a person's risk of developing a brain tumor viz

Family history (Li-Fraumeni syndrome, neurofibromatosis, tuberous sclerosis, Turcot syndrome, and von Hippel-Lindau disease), Head injury and seizures, Exposure to infections, viruses, chemical compounds, Electromagnetic fields & Ionizing radiation.

Although people of any age can develop a brain tumour, they are more common in children and older adults and as the age increases, so does the risk. Although one cannot prevent a brain tumor, one can reduce the risk of developing a brain tumour by avoiding environmental hazards such as smoking and excessive exposure to radiation.

Patients with brain tumours may present with general symptoms like headache and seizures, loss of sensory control, disturbances in vision, behaviour and personality changes, numbness, tingling, temporary loss of consciousness etc. and many others.

Diagnose and treatment of brain tumour

To diagnose a brain tumour, a multimodality approach is necessary which includes clinical exam by a neurologist or neurosurgeon, utilising various radiology modalities like Magnetic Resonance Imaging (MRI) scan, Computed Tomography (CT) scan, Positron Emission Tomography (PET CT) followed commonly by a stereotactic biopsy and subsequent histologic examination, which is of paramount importance.

Based on the correlation of the age, location, and appearance of tumour on radiology, the histopathologist arrives at a Morphologic diagnosis and refining them with the use of relevant ancillary Immunohistochemical and Molecular markers (Morphology to Molecular approach).

Many histological subtypes exist and careful identification of these are carried out.

Brian tumours are usually divided into Glial tumours (Gliomas) and non-glial tumours. The commonest Gliomas include Astrocytomas, Oligodendrogliomas, Ependymomas and Glioblastomas. Non glioma tumours include Meningioma, Embryonal or Neuronal tumours (like Medulloblastoma, CNS PNET etc), Lymphoma, Nerve sheath tumours, pituitary, and pineal gland tumours. In the pediatric age group, brain tumours are the 2nd most common tumours with gliomas and embryonal tumours forming the largest chunk.

In the current era it is important to perform Molecular markers to decide on the treatment plan basis the prognosis the tumour carries. For e.g., its necessary to do IDH 1 and IDH2 mutation, 1p/19q co deletion and MGMT studies for the common types of Gliomas or brain tumours.

Once the diagnosis is established the treatment options of Surgery, Radiotherapy, Chemotherapy or Targeted therapy are used for optimal patient management.

In conclusion, yes age does play a role in the diagnosis of a brain tumour as in certain age groups some tumours are commoner than others, but it's not the only factor and diagnosis is a multi-modality approach.

The author of this article is Dr. Shaikhali M Barodawala, Scientific and Business Head Integrated Oncopathology, Consultant and Head Anatomic Pathology, Global Reference Laboratory, Metropolis Healthcare Ltd.