The brain is an elaborately designed organ that has well organized tissues and nerves. It is the brain that runs the entire body, controls its vital functions and determines our personality. It is encased in by the hard skull bones and the layers (meninges), to protect it from damage. There is also a cerebrospinal fluid that flows throughout the spaces in the meninges and the spaces (also called ventricles) in the brain, as well.
The three chief parts of the brain manage diverse activities.
- The Cerebrum: The cerebrum processes the information coming in from the environment, via our senses and tells us how to respond. It regulates our cognitive skills like thinking, learning,speech, feelings and emotions. The cerebrum is separated into two, the right & left cerebral hemispheres. The right hemisphere is in control of the body’s left side and the left hemisphere is in control of the body’s right side.
- The Cerebellum: The cerebellum is that part of the brain, controlling the body’s balance for walking, standing, and other multipart actions.
- The Brain Stem: The brain stem is the part that connects the brain to the spinal cord. It controls vital body functions like breathing, body temperature and blood pressure.
What are Brain Cancers ?
Brain Cancers are basically tumours of the BRAIN.
How is a brain cancer caused ?
- Radiation Exposure : The most known external risk factor for brain tumours is exposure to radiation, mostly from therapy for other diseases.
- Family History : Most cases are sporadic. Rarely, brain and spinal cord cancers run in families and in these cases, brain tumours occur when the individuals are young. These familial syndromes are-
a) Neurofibromatosis type 1 (NF1)
b) Neurofibromatosis type 2 (NF2)
c) Von Hippel-Lindau disease
d) Li-Fraumeni syndrome - Immune System Disorders : Weakened immune systems can predispose to a higher risk of brain or spinal cord lymphomas.
- Cell Phone Use : This is highly debatable, but long term studies are needed to study their effect. Cell phones do not radiate ionizing radiation, the type that damages DNA and causes cancer.
What are the types of brain cancers ?
There are several types of cancer that can initiate in the brain.
- Gliomas : Glioma is a broad term for tumours that initiate in the glial cells. These include glioblastomas, astrocytomas, oligodendrogliomas, and ependymomas.
- Meningiomas : Meningiomas are the tumours that initiate in the meninges, the layers of tissue enclosing the brain and spinal cord.
- Medulloblastomas : Medulloblastomas arise in the neuroectodermal cells (which are nothing but primitive embryonic nerve cells) in the cerebellum.
- Gangliogliomas : Gangliogliomas are tumours containing both neurons and glial cells.
- Schwannomas (Neurilemmoma) : Schwannomas develop from Schwann cells, which insulate and protect cranial nerves and other nerves, as well. Schwannomas are mostly benign tumours which can arise in almost any nerve.
- Craniopharyngiomas : These slow-growing benign tumours start on top of the pituitary gland but below the brain itself. They may press on the pituitary gland and the hypothalamus, causing pressure effects and endocrine regulation problems.
- Other Tumours : These initiate in or near the brain. These include Chordomas, Non Hodgkin’s Lymphoma and Pituitary Adenomas.
What are the Clinical features of Brain Cancers ?
The symptoms vary based on the tumour’s location in the brain. A tumour in the brain’s cerebral hemisphere can cause seizures, difficulty in speech, changes in special senses like vision and hearing, mood swings such as depression and weakness or paralysis in certain parts of the body.
Cranial Tumours (or brain tumours) build up pressure in skull and cause intracranial pressure to increase. This is either because of increased growth of the tumour, brain swelling, or cerebrospinal fluid blockage (CSF). Increased pressure can also cause headache, nausea, vomiting, blurred vision and balance problems.
How are brain cancers diagnosed ?
- A complete physical examination of the body is mandatory.
- Imaging Tests: Important diagnostic tests include the following such as X- rays, CT Scan, MRI Scan or PET Scans. Magnetic Resonance Imaging (MRI) & Computed Tomography (CT) Scans are the imaging tests used most often for diagnosis of brain diseases. These scans can detect brain tumours, and based on location can give an idea as to what the tumour is. To determine the exact extent of disease, these tests may need to be performed so doctors can view, assess and judge the cancer and determine how far it has progressed or spread.
Magnetic resonance angiography (MRA),a specialized MRI is done to analyze the blood vessels in the brain. This is extremely useful before surgery to help the surgeon plan operations. - Lumbar puncture (spinal tap) : This test looks for cancer cells in the cerebrospinal fluid (CSF), the fluid that surrounds the brain and spinal cord.
- Biopsy : Removed tissue examined under a microscope by a pathologist is the only sure-shot way to make a definitive cancer diagnosis. Brain or spinal cord tumour biopsy may be done either as a stand-alone procedure, or it may be part of the main surgery to remove tumour. It could be either a stereotactic (needle) biopsy or surgical and open biopsy (craniotomy).
How are brain cancers staged and graded ?
Grade and Stage describe the brain tumour, helping to provide guidance for the oncologist in choosing the best treatment option(s). Staging is a careful attempt to find out the exact extent and spread of the cancer. The higher the stage the further the cancer has grown away from its original site in the brain.
Doctors classify brain tumours by grade. Grade refers to what the cancer cells look like, and how much they resemble their cell of origin or differentiation. The higher the grade, the more aggressive the tumour is.
- Grade I: This kind of brain tumour is benign. The cells resemble almost normal brain cells, and they grow quite slowly.
- Grade II: This kind of brain tumour is malignant. The cells look less normal than the Grade I tumours.
- Grade III: This malignant brain tumour has abnormal, anaplastic and actively growing cells.
- Grade IV: The malignant tissue has completely abnormal cells, that have no resemblance to their parent cells and they tend to grow rapidly.
Low-grade tumours (ie., grades I and II) look more normal, are benign and generally grow slowly than High-grade tumours (ie., grades III and IV).
Eventually, a low-grade tumour may evolve into a high grade tumour. However, this happens more among adults than in children.
How are brain cancers treated ?
Brain cancers are considerably harder to treat. Treatment options depend on the type of cancer, staging of the cancer, and its location. A neurosurgeon will have to be consulted. There are four standard treatments for Brain cancer.
- Surgery : Surgical treatments for brain cancer include craniotomy (most commonly). A craniotomy is removal of the brain tumour by making a surgical hole or opening in the skull, under general anaesthesia or partial anaesthesia.
- Radiation Therapy : A cancer treatment that utilizes high-energy x-rays or basically radiation to eradicate cancer cells. Radiation can be used on select patients if surgery is not a good option. Radiation therapy can also be used post surgery to kill any remaining cancer cells.
- Chemotherapy : Another kind of cancer treatment that uses either drugs or chemical substances (hence the name chemotherapy) to kill cancer cells and prevent them from dividing.
- Targeted Therapy : Immunotherapy works by utilizing your own body’s immune system to fight cancer cells. These work differently from standard chemotherapy.
Based on the nature and size of the tumor and the risk of recurrence, in certain cases a combination of different treatments may be used. A neurosurgeon will have to be consulted, and either a single therapy or a combination of treatments will be decided for the patient by a multidisciplinary panel/team of doctors like onco-surgeons, oncologists, radiologists, radiation oncologists etc.
What is the care to be taken after the removal of a brain cancer ?
Metastatic diagnostic workup and monitoring post-treatment has to include imaging and scanning of the brain, limbs, thorax, chest, retroperitoneum, and abdomen with radiography, MRI or CT scans because of the risk of possible recurrences.
Adjuvant chemotherapy or radiotherapy may be required in cases wherein excision cannot be done completely. Hormonal replacement therapy might also be required in certain cases.
How to find and reach cancer specialists for brain cancer treatment ?
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Disclaimer: The content provided here is meant for general informational purposes only and hence SHOULD NOT be relied upon as a substitute for sound professional medical advice, care or evaluation by a qualified doctor/physician or other relevantly qualified healthcare provider.
