A brain tumor is a localized intracranial lesion or is a collection or mass of abnormal cells in your brain. A tumor usually grows as a spherical mass but, it can also grow diffusely and infiltrate tissue. Tumors are of two kinds: benign ( non-cancerous) and malignant (cancerous). The malignant tumors are more dangerous since it can metastasize (spread to other body parts) than benign tumors.
An estimated 21,810 new cases of malignant brain and other nervous system tumors are projected for the year 2008 (Jemal, seigal, ward, et. Al., 2008). The neoplastic lesions in the brain ultimately cause death by impairing vital function such as respiration and increased intracranial pressure. In between 1990 and 2004, the death rates for brain and other nervous system declined in both men and women due to various medical and surgical approach to treatment.
Classifications of Brain Tumor
The brain tumors are classified into two types:
- Primary brain tumor: It originates in your brain and develops from brain cells and tissue, the outer membranes of the brain called meninges, nerve cells, and glands.
Some primary brain tumor is:
- Gliomas: gliomas covers about 30% of all brain and central nervous system tumors and 80% of all malignant brain tumors. It arises from glial cells in the brain or spine.
- Meningiomas: They arise from the arachnoid “cap” cells of the arachnoid villi in the meninges. Manifestation depends on the area involved and is the result of compression rather than an invasion of brain tissue. They are usually benign however, a small percentage are cancerous.
- Acoustic neuroma (Schwannoma): It is a rare non-cancerous tumor of eight cranial nerve, which is responsible for hearing and balance. The patient usually experiences loss of hearing, tinnitus, vertigo and staggering gait. As the tumor grows painful sensation of the face may occur on the same side.
- Pituitary adenomas: It occurs in the Pituitary gland which represents 10-15% of all brain tumors and causes symptoms as a result, of pressure on adjacent structures or hormonal changes such as hypo or hyperfunction of the pituitary.
- Angiomas: It is a mass composed largely of abnormal blood vessel found either in or on the surface of the brain.
- Secondary brain tumors
They develop from structures outside the brain and occur in 10-20% of the patient with cancer. The following can metastasize to the brain:
- Breast cancer
- Lung cancer
- Gastrointestinal tract cancer
- Pancreas cancer
- Kidney cancer
- Skin cancer (melanomas)
- Secondary brain tumors are always malignant (cancerous).
The exact causes of brain tumor are still unknown however, several risk factors have been identified.
- Genetic disorder: It is one of the risk factors for brain tumor only about 5-10% of cancers are genetically inherited. Consult your doctor if anyone of your family members has been diagnosed with brain tumor.
- Age: The risk of getting brain tumor increases with age, the highest incidence occurs in the fifth, sixth and seventh decades. However, the children are also diagnosed with a congenital brain tumor
- Chemical exposure: Being exposed to certain chemicals can increase the risk for brain tumors (for instance working in a chemical factory).
- Radiation: Those who have been exposed to ionizing radiation through high radiation cancer therapies, imaging diagnostic centers. It is the strongest risk factor for a latency period of 10-20years after exposure.
Sign and symptoms
- A headache ( worse in the morning, any strenuous activities, are exaggerated by coughing, sneezing)
- Nausea/ projectile vomiting
- Double vision (Diplopia)/ visual disturbances and vertigo
- Disorientation and confusion
- Weakness in the limbs, face or one side of your body
- Lack of coordination and balance
- Numbness and pain in the face
- Speech dysfunction
- Mood swing, changes in personality
- Sensory impairment
- Hydrocephalus may develop later.
The progression of the sign and symptoms is important because it indicates tumor growth and expansion.
- Past medical history with physical and neurologic assessment
- Intracranial pressure
- CT-scan of the head enhanced by contrast agent can give specific information about tumor
- MRI of the head is a most helpful diagnostic tool for detecting tumor
- EEG can detect abnormal brain wave in a region occupied by tumor
- Cytologic test of CSF (cerebrospinal fluid can be tested for cancer cells)
- Biopsy of the tumor tissue can be examined to identify the tumor type.
Treatment of Brain Tumor
The treatment of brain tumor depends on your age, tumor size, tumor type and other health factors.
Brain tumors are treated with a combination of the various approach to management:
- Medical management: The medical management includes a therapeutic approach to chemotherapy and external-beam radiation therapy with or without surgical procedures. Radiation therapy decreases the incidence of reoccurrence of incompletely resected tumors. Intravenous (through vein iv) autologous bone marrow transplantation is used in some cases receiving chemo or radiation therapy. Thus, it can save a patient from the bone marrow toxicity linked with high doses of chemo and radiation. The patient receives a large dose of chemotherapy and radiation to destroy maximum numbers of cancer (malignant ) cells. As for the chemo and radiation therapy, certain side effects are seen due to the high dose, for which the patient and family have to be prepared for.
- Surgical management: The objective of surgical approach is to remove or destroy the entire tumor without increasing the neurologic deficit to relieve symptoms by removal or to minimize the possible complication related to the growth and metastasis of a tumor. A different type of surgery is carried out depending on the type of tumor, its location, and its accessibility. To name some of the surgical operations are craniotomy and excision of tumor or mass, transsphenoidal microsurgical removal. In cancerous tumor cases, surgery is done along with the chemo and radiation therapy whereas, in non-cancerous cases surgery alone is carried out alone followed by pharmacological treatment and long-term follow up.
- Nursing management: The patient with the neurological disease and brain tumor may be at risk for both Sensory and motor dysfunction. Pre-operative management, intra-operative management, Post-operative management, intensive care and rehabilitation has to be supervised and cared for nurses. Nurses play a vital role along with doctors and surgeon in treating the patient equally.
- Pharmacology therapy: Analgesics such as codeine phosphate are given orally for mild to a moderate headache. Corticosteroids such as dexamethasone and prednisolone reduce inflammation and oedema around a tumor. Osmotic diuretics (e.g. Mannitol) to decrease the fluid content in the brain causing a decrease in intracranial pressure. Anti-seizure agents (phenytoin, sodium valproic acid) are used to prevent Seizures whereas high doses of antibiotics( vancomycin) are given intra-operatively and post-operatively to prevent infections.
Primary prevention can be done through early detection and screening. It prevents a complication that can occur as a tumor grows and puts pressure and brain tissue.
Consult your neurologist if you have any queries, or experiencing any of these symptoms.