A Guide on Brain Cancer and its treatment

Brain cancer is a cancerous growth of abnormal brain cells in the brain. Some brain tumours are benign/non-cancerous while some are malignant/cancerous. There are several different types of tumours that occur in the brain and the spinal cord. The brain is the central organ governing other organs and systems in the body, so all brain tumours need not to be ignored.
Benign tumours are those, that do not invade nearby tissue or spread to distant areas. While, malignant tumours grow and spread aggressively, overpowering healthy cells by taking their space, blood, and nutrients. Malignant tumours can also spread to distant parts of the body.

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Signs and Symptoms of Brain cancer

The signs of a brain tumour depend on the size of brain tumour, location and rate of tumour’s growth. Typical signs and symptoms any patient of brain tumours may experience, include:

• Change in pattern of headaches
• Frequent and severe headaches
• Nausea or vomiting
• Problems related to vision problems including blurred vision or double vision
• Loss of sensation or movement in an arm or a leg gradually
• Physical weakness
• Difficulty in speaking
• Getting confused in routine simple matters
• Changes in behaviour
• Seizures
• Difficulty in hearing
• Difficulty in normal walking or vertigo
• Problems with concentration, memory, attention, or alertness
• Changes in emotional response

Causing factors of Brain cancer

Many different types of primary brain tumours exist. Each gets its name from the type of cells involved. Examples include:

• Gliomas: These tumours begin in the brain or spinal cord and include astrocytomas, ependymomas, glioblastomas, oligoastrocytomas and oligodendrogliomas.
• Meningiomas: A meningioma is a tumour that arises from the membranes that surround patient’s brain and spinal cord (meninges). Most meningiomas are noncancerous.
• Acoustic neuromas (schwannomas): These are benign tumours that develop on the nerves that control balance and hearing leading from patient’s inner ear to patient’s brain.
• Pituitary adenomas: These are mostly benign tumours that develop in the pituitary gland at the base of the brain. These tumours can affect the pituitary hormones with effects throughout the body.
• Medulloblastomas: These are the most common cancerous brain tumours in children. A medulloblastoma starts in the lower back part of the brain and tends to spread through the spinal fluid. These tumours are less common in adults, but they do occur.
• Germ cell tumours: Germ cell tumours may develop during childhood where the testicles or ovaries will form. But sometimes germ cell tumours affect other parts of the body, such as the brain.
• Craniopharyngiomas: These rare, noncancerous tumours start near the brain's pituitary gland, which secretes hormones that control many body functions. As the craniopharyngioma slowly grows, it can affect the pituitary gland and other structures near the brain.

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Risk factors

In most patients with primary brain tumours, the cause of the tumour is not clear. But doctors have identified some factors that may increase patient’s risk of a brain tumour.

• Exposure to radiation: Patients who have been exposed to a type of radiation called ionizing radiation have an increased risk of brain tumour. Examples of ionizing radiation include radiation therapy used to treat cancer and radiation exposure caused by atomic bombs.
• Family history of brain tumours: A small portion of brain tumours occurs in patients with a family history of brain tumours.
• Age: Brain tumours are more common in children and older adults, although patients of any age can develop a brain tumour.
• Gender: In general, men are more likely than women to develop a brain tumour. However, some specific types of brain tumours, such as meningioma, are more common in women.
• Home and work exposures: Exposure to solvents, pesticides, oil products, rubber, or vinyl chloride may increase the risk of developing a brain tumour.
• Exposure to infections, viruses, and allergens
• Ionizing radiation: Previous treatment to the brain or head with ionizing radiation, including x-rays, has been shown to be a risk factor for a brain tumour.
• Head injury and seizures: Serious head trauma has long been studied for its relationship to brain tumours. A history of seizures has also been linked with brain tumours, but because a brain tumour can cause seizures, it is not known if seizures increase the risk of brain tumours, if seizures occur because of the tumour, or if anti-seizure medication increases the risk.

Diagnosis

A number of tests and procedures are recommended to rule out the diagnosis.

• A neurological exam: A neurological exam may include checking:
  1. patient’s vision,
  2. hearing,
  3. body balance,
  4. coordination,
  5. strength and reflexes.
• Magnetic resonance imaging: MRI is commonly used to help diagnose brain tumours.
• Biopsy: A biopsy can be performed as part of an operation to remove the brain tumour, or a biopsy can be performed using a needle. The biopsy sample is then viewed in a laboratory under a microscope to determine if it is cancerous or benign.
• CT scan: A CT scan takes pictures of the inside of the body using x-rays taken from different angles that shows any abnormalities also size of tumour if present. A CT scan can help find bleeding and enlargement of the fluid-filled spaces in the brain, called ventricles.
• Positron emission tomography (PET) or PET-CT scan: A PET scan is used at first to find out more about a tumour while a patient is receiving treatment. It may also be used if the tumour comes back after treatment.
• Cerebral arteriogram is also called a cerebral angiogram: A cerebral arteriogram is an x-ray, or series of x-rays, of the head that shows the arteries in the brain. X-rays are taken after a special dye called a contrast medium is injected into the main arteries of the patient’s head.
• Lumbar puncture or spinal tap: A lumbar puncture is a procedure in which a needle is used to take a sample of cerebrospinal fluid to look for tumour cells, blood, or tumour markers. Tumour markers or biomarkers are substances found in higher than normal amounts in the blood, urine, spinal fluid, plasma or other bodily fluids of patients with certain types of tumours.
• Myelogram: The doctor may recommend a myelogram to find out if the tumour has spread to the spinal fluid, other parts of the brain, or the spinal cord. This is rarely done.
• Neurocognitive assessment: This consists of a detailed assessment of all major functions of the brain including storage and retrieval of memory, expressive and receptive language abilities, calculation, dexterity, and the overall well-being of the patient. These tests are done by a licensed clinical neuropsychologist.
• Electroencephalography (EEG): An EEG is a non-invasive test in which electrodes are attached to the outside of a patient's head to measure electrical activity of the brain. It is used to monitor for possible seizures.

Treatment Options for Brain cancer available at Oncoplus Hospital, Delhi

Treatment for a brain tumour depends on the type, size and location of the tumour, as well as patient’s overall health. Treatment methods commonly used are explained below:

Surgery

If the brain tumour is located in a place that makes it accessible for an operation, patient’s surgeon will work to remove as much of the brain tumour as possible.

In some cases, tumours are small and easy to separate from surrounding brain tissue, which makes complete surgical removal possible. Whereas, in other cases, tumours cannot be separated from surrounding tissue or they are located near sensitive areas in patient’s brain, making surgery risky. In these cases, the surgeon removes as much of the tumour as is safe.

Radiation therapy

Radiation therapy destroys cancer cells using high-energy beams, such as X-rays or protons.

External beam radiation can focus just on the area of patient’s brain where the tumour is located, or it can be applied to patient’s entire brain in case where cancer has spread to the brain from some other part of the body and forms multiple tumours in the brain.

Chemotherapy

Chemotherapy involves medicines to destroy cancer cells. Chemotherapy drugs can be consumed orally by the patient in pill form or can be injected into a vein. Many chemotherapy drugs are available and may be used depending on the type of cancer.

Chemotherapy side effects depend on the type and dose of drugs patients receive. Chemotherapy can cause nausea, vomiting and hair loss.

Tests of patient’s brain tumour cells can determine whether chemotherapy will be helpful for patients. The type of brain tumour patients have also is helpful in determining whether to recommend chemotherapy.

Targeted drug therapy

Targeted drug treatments aim at destroying cancer cells by identifying and blocking specific abnormalities present within cancer cells.

Targeted therapy drugs are available for certain types of brain tumours, and many more clinical trials are ongoing.

Consult the cancer specialist at Oncoplus Hospital, Delhi.