January 19, 2020

Brain Tumor

The Central Nervous System consists of the brain and the spinal cord. It is through this that we see, feel, hear, taste, act, fight, love, yearn, win, loose and remain aware about our environment.

A tumor that affects a part of this system therefore can lead to more damage than a tumor elsewhere in the body. Tumors that affect the brain, the spine or peripheral nerves may originate from the structures themselves or from surrounding tissues. Nature protects the nervous system by placing it inside an air conditioned, air tight, humidity controlled, unbending safe vault- the skull and the spinal column. Any tumor arising from the walls or its linings will also press on the inside contents.

Diagnosing and treating these tumors that affect the most intricate organ of our body obviously needs highly trained and skilled doctors and advanced facilities. This task can be done only by a team of specialists from departments of Neurosurgery, Neurology, Neuro-radiology, Neuro-oncology, and Neuropathology.

What is a brain tumor?

Any new growth (neoplasm) inside the head is called brain tumor. It may arise from the brain itself, or from its cavities(ventricles), or from its coverings (meninges) or the skull bone or its blood vessels.

What are the different types of brain tumor?

Brain tumors are classified according to the cell of their origin. About half of them are malignant (cancerous) and the remaining are benign (non-cancerous).

Are brain tumors treatable?

Yes, mostly they are treatable using one or more available modalities. Often, more than one modality is needed to effectively treat them. The location, size and type of the tumor along with age and condition of the patient, determine the risk versus benefits of treatment.

Are brain tumors curable?

The benign tumors are mostly curable if treated adequately. The cancers of the brain can only be controlled for variable lengths of time depending upon their nature and response to treatment.

How does a brain tumor present/ what are the symptoms?

The presentation of a brain tumor is mainly dependent on its location. Usual symptoms are:

  1. Headache: usually worst in the morning, often associated with vomiting. The intensity varies, usually becoming worse as time passes.
  2. Fits/Seizure: Uncontrolled and unprovoked shaking of a part or all of the body with or without loss of consciousness. It is more significant if it occurs for the first time in adult life; or the fits continue despite adequate medical treatment or they change their nature.
  3. Weakness: in one arm or a leg or on one side of face. It may gradually worsen over a period of time.
  4. Loss / diminution of vision in one or both eyes
  5. Loss/diminution of hearing in one or both ears
  6. Loss of appetite and weight
  7. Drowsiness or loss of consciousness
  8. Hormonal imbalance

What are the treatment options?

             Surgery is the mainstay of treatment of brain tumors as most of them present with features of raised intracranial pressure like headache, vomiting and limb weakness. Biopsy is mandatory to know the type of tumor and plan further management. Other modalities like radiotherapy or chemotherapy work as adjuncts and act best after the bulk of the tumor has been surgically removed.

Is surgery for brain tumor useful and safe?

             Surgery is the very safe at a well-equipped center. For benign tumors, no further treatment is required after surgery. For malignant tumors, surgery combined with radiotherapy provides the best results. Safety of surgery is dependent on the tumor location and the condition of the patient at the time of surgery. Elective brain surgery is safer than driving on Delhi-NCR roads.

How do you make brain tumor surgery safe?

  1. Use of different specialized sequences of MRI to diagnose and define tumor accurately like MRS, Tractography.
  2. Use of high-end operative microscope.
  3. Use of Neuro navigation technique – computer associated localization of lesion.
  4. Use of high speed drills, CUSA, high-end bipolar cautery and graduated suction.
  5. Minimal access surgery for brain using endoscope.
  6. Modern anesthesia techniques (awake anesthesia, BIS monitoring etc.)
  7. Neurophysiological monitoring during surgery.

After surgery will I be able to work and live normally?

           Yes, but you will need a period of rest after surgery. Body takes time to heal from surgical insult. The return to normalcy is dependent on the nature and location of the tumor and your condition before surgery was done. Normally, the better you were at the time of surgery, the faster the recovery.

When should surgery be done?

           As soon as possible after the detection of the tumor to maximize the chances of recovery.

What is radiotherapy?

          Radiotherapy is the use of high doses of radiation to destroy tumor cells to shrink the tumor and possibly halt /slow its progression. Tumor cells in brain spread far from the edges of the tumor as seen on MRI. Surgery can only remove the visible tumor. Modern techniques are Gamma knife, Cyberknife and Stereotactic Radiosurgery.

How effective and safe is drug treatment for brain tumors?

            Used as an adjunctive therapy along with surgery and radiotherapy. Some agents notably there are no proven cases where any brain tumor has been successfully treated by those systems.

What did Temozolamide, do help in increasing the diseases free survival in many malignant brain tumors.

Will I have to take drugs for epilepsy all my life?

            The chances of tumor leading to seizures are highest in first year. Therefore, drug therapy to control/ prevent seizures is usually advised for one year, but it may need to be taken for the rest of life under certain specific conditions.

Are there any proven alternative therapies for Brain tumors?

           Despite claims by many practitioners of alternative systems (i.e. other than Allopathy)

I do wrong that I got this tumor in my head?

           Modern science still does not know for sure as to what causes most of the brain tumors and thus it is not possible at this time to say if there is anything you might have done differently to prevent a brain tumor.

About Author

Dr Rahul Gupta, M.B.M.S., MCh (PGIMER, Chandigarh)
Senior Brain, Spine and Endovascular Surgeon,Director and Head of Department, Department of Neurosurgery, 
Fortis hospital, Sector 62, NOIDA and Escorts, Okhla Delhi

Sugita Scholar, Nagoya Univ. School of Medicine, Japan – 2011
Assistant Professor,PGIMER,Chandigarh;
Associate Professor,  G B Pant Hospital,
MAMC, University of Delhi, New Delhi, India.
Ph – 91-9971700389, 

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