Brain cancer
What’s that?
A brain tumor is a mass that forms inside the skull. It can affect both the brain tissue itself and the surrounding structures, such as vessels, nerves, and brain membranes. The manifestations depend on the location and size of the tumor. Depending on the situation, the patient may require surgical or conservative treatment.
About the disease
Brain tumors occur in 10 to 15 people out of every 100,000. They can develop at any age, from infancy to advanced old age. The main feature of the disease is the development of a voluminous structure in a limited space, which leads to compression of the brain. Accordingly, even a benign tumor can cause serious complications in the patient.
Types
There are several options for classifying brain tumors. Depending on the structure, malignant and benign neoplasms are distinguished. Localization of the pathological focus allows the following types to be distinguished:
Extracerebral: develops from the brain’s membranes or the vessels that feed them.
Intracerebral:
- subtentorial;
- supratentorial;
- hemispheric;
- tumors of the medial structures;
- tumors at the base of the brain.
Primary and secondary (metastatic) neoplasms are distinguished depending on their origin. In turn, primary tumors are divided into groups depending on their source cells (astrocytic, neuronal, embryonic, vascular, etc.).
Cancerous lesions are typically staged, which determines the treatment options, prognosis, and typical signs and symptoms. There are four stages, ranging from the mildest to the most severe.
- The first stage—in this case, one of the parts of the brain is affected by a small neoplasm or nodule. There is no penetration into neighboring tissues, and pressure is applied to the surrounding areas of the brain;
- Stage two – tumor growth is slow, but there is penetration into neighboring areas;
- The third stage – the tumor changes its structure, the cells divide faster, sprouting neighboring sections and tissues;
- Stage four – the tumor is large and grows into neighboring brain structures; distant metastases are possible.
Symptoms
Focal symptoms are often among the first to appear. They arise due to the tumor’s pressure on the surrounding tissues and chemical reactions to foreign cells, hemorrhages, vessel blockage by tumor embolus, and compression of tissues and nerves. As the formation grows, symptomatology from neighboring areas joins, and then—general brain symptoms. If the structure is large, the so-called mass effect may occur (the main structures of the brain are displaced, and the cerebellar region is wedged into the skull opening).
One of the earliest signs is a headache. It usually occurs due to irritation of blood vessels, nerves, and brain membranes. The sensation may be attack-like or tumescent, and the intensity also varies. Diffuse pain over the whole head is characteristic of the brain membrane lesion.
Another sign is vomiting, which is not associated with food intake. It may occur at the peak of the headache. Vertigo occurs in the form of slumping or spinning of the body or objects around.
Muscle weakness or hypertonicity, differing on one and the other side of the body, and changes in tendon reflexes may occur. Muscle and joint paresthesia — sensations during movements, pressure, and vibration—may also be affected.
Seizure syndrome is typical of many tumors – sometimes, it is the first sign of brain damage. There may be absences or tonic seizures, Jacksonian seizures. Some people may also have an aura before the seizures. When the tumor grows, there may be partial seizures or decreased activity of foci.
Some people may have mental disorders. Sluggishness, lack of initiative, aggression, euphoria, unreasonable cheerfulness, and apathy can also be signs of brain damage. Tumor growth increases the severity of symptoms. Visual hallucinations, severe memory disorders, attention deficit disorder, and thinking problems may occur.
Possible vision problems include congestion in the optic nerve area—these are flies in front of the eyes—blurred vision, pallor, and deterioration of vision. The visual fields may drop out.
Additionally possible:
- hearing loss;
- aphasia;
- ataxia;
- eye movement disorders;
- hallucinations (auditory, gustatory);
- autonomic dysfunction.
If the hypothalamic-pituitary region is affected, hormone metabolism suffers.
Causes of brain tumor development
Scientists have not yet determined the exact cause of tumors, but there are assumptions about the connection of their growth with the action of radioactive radiation, toxins penetrating the body, and environmental pollution. Children may develop congenital neoplasms – one of the reasons is considered to be disorders of intrauterine development.
A possible factor could be brain injury, activating an existing process. There is evidence that some brain tumors may develop after radiation therapy prescribed for the treatment of other pathologies, immunosuppressive treatment, and HIV infection. There is a hereditary predisposition to some types of brain cancer. However, for many people, the cause remains unknown.
About 10-30% of brain tumors are of metastatic origin. These are cells carried by blood (less often by lymph) into brain vessels, tissues, and membranes. About 60% of such tumors are multiple.
Most often metastasizes to the brain:
- in men – lung damage, colorectal cancer, kidney damage;
- in women – breast cancer, melanoma, colorectal and lung cancer.
Intracerebral metastases occur with cancer of the uterus, digestion, or prostate.
Diagnosis
The first examination is performed by a neurologist. The doctor evaluates general complaints, conducts an examination, and examines muscle tone, reflexes, contact, emotions, and cognitive functions. An EEG and echoencephalography are also performed. A visit to an ophthalmologist is indicated to assess the condition of the eye fundus, acuity, and visual fields.
A suspicion of a tumor mass is an indication for a CT or MRI scan of the brain. Brain angiography, PET, and other complementary examinations may also be ordered. A biopsy can help determine the type of cancer in some cases, but it is not always possible.
Treatment
The scope of treatment is selected depending on the specifics of the course of the brain tumor. The most effective treatment is surgical removal of the tumor. The use of surgical microscopy and navigation allows radical removal of the tumor and minimizes trauma to healthy tissues. If the tumor cannot be removed completely, after its partial removal, the patient is treated with radiation, as well as chemotherapy, targeting (“targeted”) or immunotherapy.
Stereotactic radiosurgery (on linear gas pedals such as CyberKnife or GammaKnife) is possible for malignant tumors of small size (up to 3 cm). To remove tumor tissue, many beams of radiation are used at once, directed to one point or collected in a single beam. The beam’s direction will constantly change during the irradiation session, but it necessarily passes through the tumor tissue.
For larger tumors, and especially in cases where the tumor cannot be surgically removed, classical remote radiation therapy is used. In some cases, it is used after surgical treatment to reduce the risk of recurrence (re-growth).
Chemotherapy is carried out with cytostatic drugs, taking into account the type of tumor. Its effectiveness is significantly increased if it is combined with radiation therapy.
Targeted therapy in combination with radio- and chemotherapy improves the survival of patients with aggressive brain tumors. It is more often used in the treatment of glioblastomas.
Immunotherapy methods for malignant tumors (antitumor vaccines, immune boosters) and their integration into the existing treatment standards are currently under consideration.
All these treatment options are available in more than 890 hospitals worldwide (https://doctor.global/results/diseases/brain-cancer). For example, CyberKnife radiosurgery can be done in 2 clinics from Israel for an approximate price of $15.7 K – 26.2 K (https://doctor.global/results/asia/israel/all-cities/all-specializations/procedures/cyberknife-radiosurgery).
Prevention
Brain tumor prevention, in general, includes:
- healthy lifestyle;
- optimal physical activity (preferably outdoors);
- a good night’s rest;
- avoidance of bad habits (smokers and alcohol abusers are almost 30% more likely to develop brain tumors);
- a diet rich in fruits and vegetables;
- limiting stressful situations (or changing one’s attitude toward negative circumstances).
Rehabilitation
Rehabilitation after removal of brain tumors depends on the amount and type of intervention. General measures include prohibitions on:
- alcohol consumption;
- airplane rides;
- heat procedures (bath, sauna);
- tanning (both natural and in a tanning bed);
- active sports.
If certain functions are lost, each patient is prepared for an individual rehabilitation program (physiotherapy, psychotherapy, physical therapy, etc.). In some cases, chemotherapy or radiation therapy consolidates the result of surgical treatment. Regular check-ups with an oncologist are mandatory for timely detection of possible recurrences and/or metastases.
