Contributed by Dr. Manish Chomal, Medical Director & HOD – Radiation Oncology, HCG Cancer Centre – Jaipur
A brain tumor is a cluster of abnormal cells in the brain. Tumor diagnosis can sound like a life-threatening condition, and it is normal to feel scared, insecure, or angry about the diagnosis. But while the symptoms of most brain tumors are the same, not all tumors are malignant.
They are the commonest solid tumors found in children, and in adults the incidence is highest in 5th & 6th decade of life. Tumors in brain could be classified as primary tumors that is when the tumor develops in neural tissues within brain or secondary tumors, where tumor of some other organs spread into the brain (metastasis). Majority of brain lesion are secondary tumors. Out of primary brain tumors low grade or benign tumor lesion accounts for almost 70%. Approximately 30% primary brain tumors are malignant & aggressive. The two main groups of brain tumours are termed primary and metastatic.
Primary brain tumors instigate from the tissues of the brain or the brain’s immediate surroundings. Primary tumors are categorized as benign or malignant.
Metastatic brain tumors arise elsewhere in the body (such as the breast or lungs) and migrate to the brain.
Sign & symptoms
The sign & symptoms of any brain tumor is primarily dependent on its type and location in the brain. There are times a person may have no symptoms when their brain tumor is discovered. The common symptoms are headache with vomiting, seizures, weakness, or paralysis in any part of body, loss of hearing or vision, changes in personality, imbalance, or gait disorders etc.
Diagnosis & treatment
MRI of brain is the most important diagnostic investigation which can pick even small lesions. Once a diagnosis is established, the treatment can be planned according to it. In almost all cases the treatment begins with a surgery where the aim is for maximally safe resection. New neurosurgical techniques like neuro-navigation, use of intra operative ultrasound are very safe & effective. The detailed analysis of excised tumor helps in planning of further treatment. In low grade or benign tumors surgery alone is sufficient.
But, in high grade & malignant tumors radiotherapy is often used after the surgery.
Radiotherapy is a very important modality in brain tumor management. It can be used in place of surgery in some low grade tumors like meningioma or acaustic neuroma. It is almost always used in aggressive or high grade tumors to kill the remaining cancer cells or to reduce the chances of re-occurrences. Radiotherapy is also used in recurrent cases of low grade tumors. The new techniques of radiotherapy like Stereotactic radiosurgery (SRS) or stereotactic radiotherapy (SRT) are used in some selective benign brain lesions, small recurrent tumors, or when limited number of brain metastasis is there. In appropriately selected patients the results of stereotactic radiation are equal to surgery.
Chemotherapy is used in some selective low grade tumors & majority of high grade tumors.
Addition of chemotherapy has been proved to improve the results of surgery & radiotherapy. It can be either orally taken form or IV form. Chemotherapy & some biological agents are used in recurrent cases where tumor is arising repeatedly or where the surgery & radiotherapy has failed.
The treatment outcome of low grade tumors is very good; there are more than 90% chances of long-term survival & cure. But in high grade tumors & brain metastasis the outcome is inferior. Though with addition of new surgical & radiation techniques, new chemotherapy agents, the survival in this group is also improving. The earlier the brain tumor is detected and operated upon, the better are the chances of survival.
Nevertheless, the best thing to do if you are diagnosed with a tumor is to get the facts, stay informed and work with the most experienced doctor and care team you can find. A person should see their doctor if they experience any of the symptoms listed. With the advancement in treatment modalities, it is possible to treat inoperable brain tumors. The thought that all brain tumors are fatal proves to be wrong in today’s period, and the chances of survival looks more positive with advanced treatment modalities.