Brain Tumors


A brain tumor is an abnormal growth of cells within the brain, which can be cancerous or non-cancerous (benign).

It is defined as any intracranial tumor created by abnormal and uncontrolled cell division, normally either in the brain itself (neurons, glial cells (astrocytes, oligodendrocytes, ependymal cells), lymphatic [ifd, blood vessels), in the cranial nerves (myelin-producing Schwann cells), in the brain envelopes (meninges), skull, pituitary and pineal gland, or spread from cancers primarily located in other organs (metastatic tumors).

Primary (true) brain tumors are commonly located in the posterior cranial fossa in children and in the anterior two-thirds of the cerebral hemispheres in adults, although they can affect any part of the brain

Symptoms of brain tumors may depend on two factors: tumor size (volume) and tumor location. The time point of symptom onset in the course of the disease correlates in many cases with the nature of the tumor (“benign”, i.e. slow-growing/late symptom onset, or malignant, fast-growing/early symptom onset) is a frequent reason for seeking medical attention in brain tumor cases.

Large tumors or tumors with extensive perifocal swelling edema inevitably lead to elevated intracranial pressure (intracranial hypertension), which translates clinically into headaches, vomiting (sometimes without nausea), altered state of consciousness (somnolence, coma), dilatation of the pupil on the side of the lesion (anisocoria), papilledema (prominent optic disc at the funduscopic examination). However, even small tumors obstructing the passage of cerebrospinal fluid (CSF) may cause early signs of increased intracranial pressure. Increased intracranial pressure may result in herniation (i.e. displacement) of certain parts of the brain, such as the cerebellar tonsils or the temporal uncus, resulting in lethal brainstem compression. In young children, elevated intracranial pressure may cause an increase in the diameter of the skull and bulging of the fontanelles.

Brain Tumor Symptoms

Unfortunately, it is very common for brain tumor patients to experience symptoms associated with their tumor(s) and/or treatment(s).

People with brain tumors often suffer from:

  • Headaches
  • Seizures
  • Sensory (touch) and motor (movement control) loss
  • Deep venous thrombosis (DVT, or blood clot)
  • Hearing loss
  • Vision loss
  • Fatigue
  • Depression
  • Behavioral and cognitive (thinking) changes
  • Endocrine dysfunction (hormone/gland changes)

These symptoms may be associated with the type, size, and/or location of the tumor, as well as the treatments used to manage it. Surgery, radiation, chemotherapy, and other treatments all have the potential to generate new symptoms as they work to reduce the impact of the tumor.

Brain Tumor Diagnosis

In cases where a brain tumor is suspected, a number of tests may be done to help the doctor tell if a tumor is indeed present. These tests may also be able to help the doctor determine what kind of tumor it is.

Some of the tests performed to first diagnose the tumor are later used to monitor progress — to see if the tumor has disappeared, is shrinking, remains the same, or has changed in some way. Like many other medical conditions, follow-up care for a brain tumor might go on for years or even a lifetime.

Brain Metastases

Brain metastases are the most common type of brain tumor, with the total number diagnosed annually outnumbering all other intracranial tumors combined. As the incidence of brain metastases rises due to improved cancer therapy for systemic disease, it is imperative that improved intracranial therapy be developed as well. The most common source of brain metastases in males is lung cancer and in females is breast cancer. The mechanisms by which primary tumors produce brain metastases are thought to be hematogenous spread from primary or secondary sites in the lung. The cerebrum is involved in 80 to 85% of all brain metastases, the cerebellum in 10 to 15%, and the brainstem in 3 to 5%. Different types of primary tumors have different relative frequencies of single versus multiple metastases. Melanoma has the highest tendency to produce multiple lesions, followed by lung and breast cancers.

Metastatic brain tumors present with the usual signs and symptoms of any expanding intracranial mass lesion. These include increased intracranial pressure and focal neurological deficits with focal irritations. Such symptoms include headaches, focal weakness, mental status changes, seizures, ataxia [inability to coordinate voluntary muscular movements], and sensory and visual changes. Whole brain radiation therapy (WBRT) is the most widely used method of treating brain metastasis, despite the fact that patients treated this way have an expected survival of only three to four months. Significant neurotoxicity has been reported with the use of WBRT. Acute effects include hair loss (alopecia), nausea, vomiting, lethargy, otitis media and severe cerebral edema. Though some of these effects can be transient, dermatitis, alopecia, and otitis media can persist for months after irradiation. Chronic effects are even more serious, and these include atrophy, leukoencephalopathy, radiation necrosis, neurological deterioration and dementia. Surgical removal of solitary and occasionally multiple lesions has been reported to enhance survival, with several reports indicating improvement of neurological function. Radiosurgery is a technique that allows the delivery of a single high dose of radiation in a highly accurate manner. The Gamma Knife (a dedicated neuro-surgical instrument ) allows numerous beams of radiation to converge on a target site, resulting in a high dose of radiation delivered to the target site with a sharp dose gradient at the target edge. Median survival with Radiosurgery alone improved in many series. Gamma Knife Radiosurgery yields added advantages: outpatient treatment, lower morbidity, greater flexibility in terms of local and number of tumors treated, and the ability to treat the patient over multiple periods of time for the development of new lesions.



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