World Brain Tumour Day: Difference Between Cancerous And Non-Cancerous Tumours

Diagnosis of a brain tumour is not the end of life as many of them can be treated and give the patient an excellent long-term life.

A brain tumour is a word that terrifies most people but not necessarily all brain tumours are harmful. Most tumours typically present with either symptom of raised pressure in the brain (headache and vomiting) or epileptic fits. So any headache which is persistent and associated with vomits, seizures or any weakness in one part of the body should not be ignored and investigated further. In addition, some tumours may present with either weakness in the limbs or vision loss or hearing loss, depending on their location. A contrast MRI of the Brain is the mainstay of the diagnosis. However, some patients may need additional tests like a PET scan or an angiogram. Brain tumours are malignant (cancerous) and benign (non-cancerous). Let's understand the difference between them by Dr Sandeep Vaishya, HOD & Executive Director, Neurosurgery, Fortis Memorial Research Institute, Gurugram.

Cancerous (Malignant) Tumour

Malignant tumours are perhaps more common than benign. For example, glioblastoma multiforme (grade IV tumour) is the most typical brain tumour and one of the most malignant tumours in the body, with average survival being 1-2 years.

1. Grade I malignant tumours are almost curable, while Grade II also have a very long life expectancy.
2. Grade III and IV are considered high-grade tumours with poorer long term outcomes.
3. Nearly all will require surgery followed by radiotherapy and chemotherapy.

Suppose a person has any abnormal symptoms as mentioned above. In that case, he should consult a neurosurgeon to rule out a tumour because if the tumours can be picked early, they can be treated better and have a better prognosis.

Non-Cancerous (Benign) Tumour

Benign tumours almost always arise outside the brain and only compress on the brain tissue. If obliterated, benign tumours don't come back but still require a long term follow-up to rule out a recurrence. But if any tumour is left, it needs a close follow-up, and many of them will require Stereotactic Radiosurgery to control the tumour. And suppose benign tumours are harvested early when they are still small. Then, many of them can avoid surgery and be treated by stereotactic radiosurgery, a single-day treatment. Examples of common benign tumours are pituitary, meningioma, acoustic, and craniopharyngiomas.

1. Pituitary tumours usually present with a diminution of vision and hormonal changes in some patients and are removed by an endoscopic approach through the nose. A specific variety of pituitary tumours is a prolactinoma which presents with loss of menstruation. They mostly can be treated with medicines and don't need surgery. Another variety is Growth hormone producing tumours, leading to a significant increase in height if the tumour occurs before puberty.
2. Meningiomas arise from the brain's covering and can be located anywhere inside the skull and usually require surgery. Deep seated skull base meningiomas can sometimes be challenging to remove. Some are very vascular and may require preoperative embolisation (where the blood supply to the tumour is blocked, thus making it safer to operate).
3. Acoustic tumours have a fixed location and arise from the 8th nerve, which helps in hearing. Most tumours can be easily removed by surgery. In contrast, stereotactic radiosurgery can treat small meningiomas and acoustic tumours. During this single-day treatment, a high dose and highly focussed radiation are given to the tumour while sparing the normal brain tissue.
4. Craniopharyngiomas are more often seen in young children and present with vision loss and hormonal changes. They have more complicated management, and apart from microsurgery, many may require postoperative radiotherapy and hormonal replacement therapy.