Brain Cancer

More than 150 types of brain tumours have been identified. Primary brain tumours are categorised as glial or non-glial and malignant or benign. Some brain tumour can also develop in your spinal cord.

Benign brain tumours

Following are the brain tumours that are usually benign:

• Chordomas
  These are slow-growing tumours originating from the bottom part of the spine and the base of the skull. They are usually benign.
• Craniopharyngiomas
  These are brain tumours that generally arise from a part of the pituitary gland. These tumours are quite challenging to remove as they are located near vital structures deep in the brain.
• Gangliomas, gangliocytomas, and anaplastic gangliogliomas
  These tumours are relatively rare and arise from the nerve cells or neurons.
• Glomus jugulare
  These are benign tumours that arise at the top of your jugular vein under the base of the skull. They are the commonest types of glomus tumour.
• Meningiomas
  These are the commonest form of primary brain tumours that grow relatively slowly. They arise from the meninges - the layers of tissue protecting your spinal cord and brain. A meningioma can be malignant in rare cases.
• Pineocytomas
  These are slow-growing tumours that develop in the pineal gland that lies deep inside the brain and produces melatonin hormone.
• Pituitary adenomas
  These types of tumours develop in the pituitary gland that lies at the base of the brain. This gland produces and regulates hormones in the body. Pituitary adenomas may produce excess pituitary hormones and they are usually slow growing.
• Schwannomas
  These are benign brain tumours that are commonly found in adults. They arise from the Schwann cells occurring in the cranial nerves or the peripheral nervous system. These cells facilitate the conduction of nerve impulses. The most common types of schwannomas are acoustic neuromas that occur on the vestibular nerve.

Malignant brain tumours

Around 78% of malignant primary brain tumours are gliomas. They arise from the glial cells that support nerve cells. Following are the types of gliomas:

• Astrocytoma
  These are the commonest types of gliomas that develop in the star-shaped glial cells known as astrocytes. Although they can form in any part of the brain, they are most commonly seen in the cerebrum.
• Ependymomas
  Ependymomas commonly occur near the ventricles of the brain. They develop from the radial glial cells or the ependymal cells.
• Glioblastoma (GBM)
  These are the tumours that form in the glial cells known as astrocytes. These are the fastest-growing astrocytomas.
• Oligodendroglioma
  These are relatively rare tumours that arise in the myelin-forming cells. Another type of malignant brain tumour is medulloblastoma, which is a fast-growing tumour that forms at the skull base. They are the commonest malignant brain tumours in children.

Brain tumours can occur at any age and affect both children and adults. They are more commonly seen in males than in females. Meningioma, a benign tumour is the only brain tumour that is more common in females. Glioblastoma, one of the most serious types of brain tumour, is more common in elderly people.

Tumours that originate in the brain itself are called primary brain tumours. These are relatively rare brain tumours.

Brain tumours can result in serious complications, whether they are benign or malignant. This is because the skull has a rigid structure that prevents the tumour from expanding. Apart from that, if the tumour is located in parts of the brain that regulate important functions, the following symptoms may occur:

• Difficulty in walking
• Weakness
• Complete or partial vision loss
• Balance problems
• Difficulty using or understanding language
• Memory problems

Following are some of the ways by which brain tumours cause problems:

• Putting pressure on the surrounding tissues.
• Directly destroying the healthy brain tissue by invading it.
• Increasing the pressure inside the skull.
• Blocking the normal CSF flow through spaces within the brain, causing them to enlarge.
• Causing accumulation of fluid within the brain.
• Causing some parts of the brain to bleed.

Even though brain tumours may give rise to the above-mentioned complications, some patients with brain tumours don’t have any symptoms as their tumours don’t enlarge enough to press on the surrounding structures.

Some patients with brain tumours don’t experience symptoms, especially if the size of the tumour is too small. The signs and symptoms vary depending on the size, type, and location of the tumour. Following are some commonly seen symptoms of brain tumours:

• Seizures
• Headaches that are more severe at night or in the morning
• Personality changes
• Difficulty speaking or understanding a language
• Paralysis or weakness in one side or one part of your body
• Vision problems
• Balance problems or dizziness
• Facial numbness or tingling
• Hearing issues
• Confusion and disorientation
• Nausea or vomiting

It is known that brain tumours form when certain genes on the chromosomes are damaged and cease to function optimally, but it is not clear why this occurs. The DNA located on the chromosomes directs the cells all over the body into performing their functions. For example, it tells them when to multiply or divide or when to grow or die.

When the DNA of the brain cells changes, new instructions are received by the brain cells. The body forms abnormal brain cells that multiply and grow at an abnormally faster rate and sometimes they live longer than usual. As this occurs, the abnormal cells proliferate and accumulate in the brain, giving rise to a mass of cells called a tumour.

In certain cases, a person may have changes in some of these genes since birth. Environmental factors like previous cancer treatment or exposure to large amounts of radiation may then cause further damage. In some other cases, the only cause may be the environmental injury to the genes. There are some inherited congenital conditions associated with brain tumours including:

• Neurofibromatosis type 1 and 2
• Gorlin syndrome
• Turcot syndrome
• Li-Fraumeni syndrome

Only around 5-10% of patients with brain tumours have a family history for the same.

Establishing a diagnosis of a brain tumour is relatively complicated and involves several specialists. However, in some cases, doctors may discover brain tumours while carrying out investigations for other medical problems.

If you suspect having symptoms pointing towards a brain tumour, your doctor will perform a complete physical examination and then ask you questions about your symptoms, current and past medical conditions, family medical history, surgeries and medical treatments, and current medications. They may also carry out a neurological examination, involving looking for changes in your mental status, balance and coordination, vision, hearing, and reflexes. These changes may correlate with the part of the brain affected by the tumour.

If your doctor also suspects that you may be having a brain tumour, he will suggest a brain scan, most often an MRI.

The treatment for brain tumours depends on several factors, including:

• The number of tumours
• The size, location, and type of the tumour
• Your overall health and age

Benign brain tumours are generally successfully treated with surgery and do not recur. Doctors usually use a combination of several treatment modalities to treat a tumour. Following are some of the treatment options for brain tumours:

• Surgery
  Whenever possible, the tumour is partially or completely resected. Our neurosurgeons work very carefully to minimize damage to the functional areas of the brain during these procedures.
• Radiation therapy
  X-rays tend to damage the brain tumour cells or shrink the tumour.
• Radiosurgery
  This radiation therapy employs focused radiation beams to damage tumour cells. As no incision is involved, it is not actually a surgery.
• Brachytherapy
  This is a type of radiation therapy that involves placing radioactive capsules, seeds, or other implants near or in the cancerous cells.
• Chemotherapy
  During this therapy, anticancer drugs are used to damage cancer cells in the brain. You might be given chemotherapy in the form of a pill or you may receive it through an injection. You may also be recommended chemotherapy post-surgery to damage any cancer cells left behind or to prevent the growth of the remaining cancer cells.
• Immunotherapy
  This therapy is also referred to as biological therapy. It is a type of treatment that employs the immune system of the body to fight cancer. During the therapy, the immune system is stimulated so that it performs its function more effectively.
• Targeted therapy
  This treatment involves drugs that target certain features in the tumour cells without damaging healthy cells. Your doctor may recommend targeted therapy if you can’t tolerate the side effects of chemotherapy such as nausea and fatigue.
• Active surveillance/ watchful waiting
  If you have a very small and asymptomatic brain tumour, you doctor may recommend close monitoring of the tumour and test it at regular intervals for signs of growth.

Other treatment options to deal with symptoms of brain tumours include:

• Shunts
  If the tumour causes an increase in the pressure inside your skull, you may require a shunt that is surgically introduced inside the brain to drain excess CSF.
• Palliative care
  This is a specialised type of care that focuses on providing comfort, support, and symptomatic relief to people dealing with serious and terminal illnesses.

Getting to know that you have a brain tumour can be quite stressful and even scary. All brain tumours aren’t malignant. In fact, more than a half of those are benign. However, they can still lead to serious complications. Your healthcare team will formulate a tailored and individualised treatment plan to minimize the symptoms of the tumour and improve your life quality.

The prognosis of brain cancers greatly depends upon the stage at which they are diagnosed, and the treatment is started. Family support and the positive attitude of the patient with a will to change the course of the disease also play a role in improving the treatment outcome. Our cancer care team aims not only to cure the patient physically but provides mental support also, making Kokilaben Dhirubhai Ambani Hospital, Indore the best cancer hospital in Indore.