Brain Tumor

A brain tumor is a collection or mass of abnormal cells in your brain or close to your brain. Brain is enclosed within your skull that is a rigid enclosure. The tumor that grows inside such a restricted space causes problems. Several types of brain tumors exist, out of which, some are noncancerous (benign) and some may turn into cancerous masses (malignant).

Brain tumors are further categorized into primary or secondary tumors. A primary brain tumor begins in your brain itself. Most primary brain tumors are benign. A secondary brain tumor, also called a metastatic brain tumor, begins in other parts of your body such as your lung or breast, and later spreads to your brain.

The rate of tumor growth and the location of a brain tumor determines its effect on the function of your nervous system. Whether benign or malignant, brain tumors when they grow, increase the pressure inside your skull. This causes damage to the brain, which can prove to be fatal. The treatment of brain tumor depends on the type of brain tumor you have, its size, and location.

The signs and symptoms of a brain tumor vary greatly and depend on the size, location, and its rate of growth. Brain tumors can cause direct damage by invading into the brain tissues and increasing the pressure within the skull. Noticeable symptoms occur when an expanding tumor exerts pressure on your brain tissues.

Headache is a common symptom of brain tumor. You may experience a new onset or change in the pattern of headaches that gradually become more severe and frequent. Headahes often:

• Occur while you are sleeping
• Are worse in the morning while you wake up
• Become worse while coughing, sneezing, or exercise

General signs and symptoms caused by brain tumors include the following:

• Unexplained nausea or vomiting
• Vision disturbances, such as:
  • Blurred vision
  • Double vision or
  • Loss of peripheral vision
• Muscle weakness and gradual loss of sensation and movement in the face, arm, or leg
• Balance problems, dizziness or vertigo
• Trouble in speaking or understanding what others are saying
• Loss of memory
• Difficulty in writing and reading
• Changes in the ability to hear, taste, or smell
• Difficulty in swallowing
• Confusion in everyday matters
• Decreased alertness, drowsiness and loss of consciousness
• Personality or behavior changes
• Seizures, especially in adults who do not have a history of seizures
• Uncontrollable movements
• Hand tremors
• Tingling or numbness on one side of the body
• Difficulty in walking
• Loss of bladder or bowel control

When to see a doctor?

Make an appointment with your doctor if you have persistent signs and symptoms that make you anxious.

The cause of brain tumor is unclear in most people with primary brain tumors. 

Brain tumors that form in the brain (Primary brain tumors)

Primary brain tumors begin to develop in the brain itself or in the tissues close to it, such as the covering membranes of the brain (meninges), cranial nerves, pituitary gland or pineal gland.

These tumors begin to form when the normal cells acquire errors or mutations in their DNA. These mutations cause cells to grow and divide at an increased rate and to continue to live without shedding. As a result of this uncontrollable growth, a mass of abnormal cells accumulates to form a tumor.

Primary brain tumors occur rarely compared to secondary brain tumors, in which cancer begins elsewhere and later spreads to the brain.

There are different types of primary brain tumors. Each tumor derives its name from the type of cells involved. For example:

• Gliomas: These tumors develop in the brain or spinal cord, and include:
  • Ependymomas
  • Glioblastomas
  • Oligoastrocytomas and
  • Oligodendrogliomas.
• Meningiomas: These tumors arises from the membranes that surround your brain and spinal cord (meninges). These are noncancerous lesions.
• Acoustic neuromas (schwannomas): These are benign tumors, which affect the nerves that pass from your inner ear to brain, and control balance as well as hearing.
• Pituitary adenomas: These are benign tumors that form in the pituitary gland at the base of the brain. These tumors can affect the secretion of pituitary hormones with has its effects throughout the body.
• Medulloblastomas: These are common cancerous brain tumors occurring in children. A medulloblastoma begins in the lower back part of the brain and tends to spread through the spinal fluid. Though these tumors are rare in adults, they do occur.
• Primitive neuroectodermal tumors (PNETs): These are rare, cancerous tumors that begin to develop in embryonic (fetal) cells in the brain. These can occur at any portion of the brain.
• Craniopharyngiomas: These are rare, benign tumors that develop near the pituitary gland, which secretes hormones to control many body functions. As the craniopharyngioma grows gradually, it can affect the pituitary gland as well as the other structures near the brain.

Cancer that begins elsewhere and spreads to the brain

Secondary (metastatic) brain tumors result from cancer that starts in other parts of your body and then spreads (metastasizes) to your brain. These type of tumors most often occur in people with a past history of cancer. Rarely, a metastatic brain tumor may be the first sign of cancer that started elsewhere in your body. Any cancer may spread to the brain, but the most common types include:

• Breast cancer
• Colon cancer
• Kidney cancer
• Lung cancer
• Melanoma

Make an appointment with your primary care doctor to make a diagnosis of brain tumor if you believe that you have signs or symptoms of it. After initial evaluation, if you have been diagnosed with a brain tumor, you may be referred to specialists such as:

• Doctors who specialize in brain disorders (neurologists)
• Doctors who treat cancer (oncologists)
• Doctors who use radiation to treat cancer (radiation oncologists)
• Doctors who treat nervous system cancers (neuro-oncologists)
• Surgeons who operate on the brain and nervous system (neurosurgeons)
• Rehabilitation specialists

It is always a good idea to be well-prepared for your appointment. Here is some information that helps you get ready for your appointment, and what to expect from your doctor.

What you can do?

• At the time you make the appointment, be sure to ask if there is anything you should do in advance, such as dietary restrictions.
• Make a list of symptoms you have, including those that may seem unrelated to the reason of your appointment.
• Note down your key personal information, including major stresses or recent life changes.
• Make a list of all your medications, vitamins or supplements that you take.
• Ask a family member or friend to accompany you. Sometimes, it can be hard to remember all the information provided by your doctor. The person who accompanies you may remember something that you might have missed or forgotten.

Write down questions to ask your doctor.

Preparing a list of questions can help as your appointments will be brief. For a brain tumor, some basic questions to ask your doctor include:

• What type of brain tumor do I have?
• Where is my brain tumor located?
• How large is my brain tumor?
• How aggressive is my brain tumor?
• Is my brain tumor cancerous?
• Will I need additional tests?
• What are my treatment options?
• Is there any treatment that can cure my brain tumor?
• What are the benefits and risks of each treatment?
• Is there a treatment you feel is best for me?
• Are there brochures or other printed material that I can take with me? What websites do you recommend?
• What factors determine whether I should plan for a follow-up visit?

What to expect from your doctor?

Your doctor may ask you a number of questions such as:

• When did you first begin experiencing symptoms?
• Do your symptoms occur continually or are they occasional?
• How severe are your symptoms?
• Is there anything that seems to improve or worsen your symptoms?

To confirm the diagnosis of brain tumor, your doctor may recommend a number of tests and procedures, such as:

• A neurological exam: A neurological examination includes evaluation of your vision, hearing, balance, coordination, strength, and reflexes. Abnormalities detected in one or more areas provide indications about the portion of your brain that could be affected by a brain tumor.
• Imaging tests
• Magnetic resonance imaging (MRI) is commonly used to diagnose brain tumors. In some cases, a special dye may be injected into a vein in your arm during your MRI study. A number of specialized MRI scan components such as functional MRI, perfusion MRI, and magnetic resonance spectroscopy help your doctor evaluate the tumor and plan treatment.
• Other imaging tests include computerized tomography (CT) scan and positron emission tomography (PET).

Tests to diagnose cancer in other parts of your body

If it is believed that your brain tumor is a result of cancer that has begun from another area of your body, your doctor may order tests and procedures to check from where the cancer has originated. For example, a CT scan of the chest may be done to look for signs of lung cancer.

Collection and analysis of a sample of abnormal tissue (biopsy): A biopsy may be performed as a part of the operation performed to remove the brain tumor, or can be performed using a needle.

A stereotactic needle biopsy is performed in case of brain tumors located in hard to reach areas or very sensitive areas within your brain that might be damaged by a more extensive operation. Your neurosurgeon will make a small hole into your skull through which a fine needle is inserted. Tissue sample is removed using this needle, which is usually guided through CT or MRI scanning.

The tissue sample is then viewed under a microscope to determine whether it is cancerous or benign. This information is crucial to confirm a diagnosis and, most importantly, to guide treatment.

The treatment plan for brain tumors is based on the type, size, and location of the tumor, as well as your general health and preferences.

Surgery.

Surgical removal is considered if the brain tumor is located at a place that is easily accessible for an operation. Your surgeon will work to remove as much of the brain tumor as possible. In case of small-sized tumors that are easy to be separated from the surrounding brain tissues, complete surgical removal is possible. In some cases, tumors cannot be separated from the surrounding tissue or they are located at sensitive areas in your brain, which makes surgery difficult and risky. In such situations, your doctor will excise as much of the tumor that is safe.

Your symptoms may get better even if a small portion of the brain tumor is removed. Surgical removal of a brain tumor carries common risks, such as infection and bleeding. Other risks may occur depending on the part of your brain where your tumor is located. For instance, surgery performed on a tumor that is near the nerves that connect to your eyes may have a risk of vision loss.

Radiation therapy.

Radiation therapy makes use of high-energy beams, such as X-rays or protons, to destroy the tumor cells. Radiation therapy can be directed from a machine outside your body (external beam radiation), or, in very rare cases, a device emitting radiation may be placed inside your body close to your brain tumor (brachytherapy).

External beam radiation is focused towards the area of your brain where the tumor is located, or it can be given to your entire brain (whole-brain radiation). Whole-brain radiation is commonly used to treat cancer that has spread to the brain from some other part of the body.

Side effects of radiation therapy depends on the type and dose of radiation you receive. Common side effects during or immediately following radiation include fatigue, headaches, and scalp irritation.

Radiosurgery.

The different types of technologies used in radiosurgery to deliver radiation and treat brain tumors are Gamma Knife or linear accelerator (LINAC). Radiosurgery is typically performed within a single procedure, and in most cases you can return home the same day.

Stereotactic radiosurgery
Stereotactic radiosurgery uses multiple beams of radiation to deliver a highly focused form of radiation treatment to kill the tumor cells situated within a very small area. Every beam of radiation is not particularly powerful, instead the point where all the individual beams meet — at the brain tumor — receives a very large dose of radiation to destroy the tumor cells.

Chemotherapy.

Chemotherapy involves use of drugs to destroy tumor cells. Chemotherapy drugs may be given orally in the pill form or injected into a vein (intravenously). The chemotherapy drug used most often to treat brain tumors is temozolomide (Temodar), which is taken in the form of a pill. Several other chemotherapy drugs are available and may be used depending on the type of cancer. Side effects of chemotherapy depend on the type and dose of drugs you take. It can cause nausea, vomiting and hair loss.

Targeted drug therapy.

Targeted drug treatment focuses on blocking the specific abnormalities present within the cancerous cells. By doing this, targeted drug therapy causes death of cancer cells.

A targeted drug therapy used in the treatment of a type of brain cancer called glioblastoma is bevacizumab (Avastin). This drug is injected through a vein (intravenously) to stop the formation of new blood vessels, obstructing the blood supply to a tumor, and thereby killing the tumor cells.

The targeted drug, everolimus (Afinitor) is used in the treatment of a benign brain tumor that develops in people with a genetic disorder called tuberous sclerosis. Everolimus acts by blocking an enzyme in the body that plays an important role in the growth of tumor cells.

Rehabilitation after treatment.

As brain tumors can involve parts of the brain that control motor skills, speech, vision, and thinking, rehabilitation may be an essential part of recovery. Your doctor may refer you to services that can help, such as:

• Physical therapy: It can help you regain your lost motor skills or muscle strength.
• Occupational therapy: It can help you return to your normal daily activities, including work, after suffering a brain tumor or other illness.
• Speech therapy: The specialists in speech difficulties (speech pathologists) can help if you have difficulty in speaking.
• Special tutoring for school-age children: This can help kids cope with changes in their memory power or thinking after resolution of a brain tumor.

Research conducted on complementary and alternative brain tumor remedies are trivial, and there is no alternative treatment that has been proved to cure brain tumors. However, some complementary therapies may help you cope up with your brain tumor and its treatment. Discuss with your doctor about the options that suit you best.

Some complementary treatments that may help include:

• Acupuncture
• Relaxation exercises
• Meditation
• Music therapy
• Hypnosis

Lifestyle modifications are necessary in order to cope with brain tumor.

A diagnosis of a brain tumor can be very frightening and devastating. It can make you feel as if you have lost control over your health. But, you may take few steps to cope up with the shock and grief that may result with your cancer diagnosis. Consider the following tips:

• Get enough information about brain tumors to make decisions about your care: Try to know from your doctor about the specific type of your brain tumor, including the treatment options and, if you want, your prognosis. As you awareness about brain tumors improves, you may gain confidence in making proper treatment decisions.
• Maintain close relationships with your friends and family: Keeping your relationships with family members strong helps a great deal while coping with your brain tumor. Friends and family may be able to provide you the practical support such as taking care of your house when you are in the hospital. They can also serve as emotional support when you feel knocked out by cancer.
• Find someone you can share your feelings with: Get hold of a good listener who can patiently listen to you talk about your hopes and fears. This might be a friend or a family member. The concern and understanding of a counselor, medical social worker, clergy member or a cancer support group may be useful.
• Ask your doctor about support groups in your neighborhood or else check your phone book, library or a cancer organization, such as the National Cancer Institute or the American Cancer Society.

Experts have identified some factors that may increase your risk of developing a brain tumor. Risk factors include:

• Age: Your risk for most types of brain tumor increases with advancing age. Brain tumors are more common in older adults. However, a brain tumor may develop at any age. Certain type of brain tumor occurs almost exclusively in children.
• Exposure to radiation: People who have been exposed to a type of radiation called ionizing radiation have an increased risk of developing brain tumors. Exposure to ionizing radiation may occur due to high-radiation cancer therapy and nuclear fallout – exposure to atomic bombs.
• Chemical exposure: People exposed to certain chemicals, most commonly found at workplaces are at an increased risk of brain cancer.
• Family history of brain tumors: Although, brain tumor is rarely inherited, a small portion of brain tumors occur in people with heredity of brain tumors or a family history of genetic syndromes that increase the risk of brain tumors.
• Race: Caucasians are more likely to develop brain tumors and African-American people are more likely to get meningiomas.
• No history of Chicken Pox: According to the American Brain Tumor Association, people with a past history of chicken pox in their childhood have a lower risk of developing brain tumors.