Brain Cancer

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Overview

Brain cancer is a condition where malignant tumours are formed in the brain. Brain cancers happen when the cells start dividing uncontrollably and form abnormal masses. Brain tumor is one of the less common cancers in India.

Types

Based on their origin and their tendency to spread, brain cancers are classified into primary brain tumours and secondary brain tumours. Tumours that originate in the brain are called primary brain tumours. These are further classified into benign and malignant types based on their tendency to spread to nearby and distant organs.

1. Primary Brain Tumours: Brain tumours that originate in the brain are called primary brain tumours. Those tumours that remain localised and do not spread to other areas are called benign tumours. The tumours that spread to other organs, on the other hand, are called malignant tumours. Malignant tumours tend to affect brain functions, such as sensation, memory, muscle control and other normal body functions.

Depending on the region of origin, primary brain tumours are further classified into gliomas, meningiomas, vestibular schwannomas, pituitary adenomas and primitive neuroectodermal tumours (medulloblastoma). Gliomas, which are one of the fast-growing tumours, are further classified into glioblastoma, astrocytoma, oligodendroglioma and ependymoma.

2. Metastatic or Secondary Brain Tumours: Tumours that spread to the brain from other body sites are called metastatic or secondary brain tumours.

Benign brain tumours are less serious than malignant tumours; however, the former can still cause brain problems by pressing on nearby tissues. Hence, benign tumours need to be regularly monitored or managed as per the specialist’s recommendation.

Symptoms

Brain cancer symptoms develop gradually and the type of symptoms that are witnessed depend on the exact location and size of the tumour in the brain. Following are the symptoms associated with brain cancer:

Behavioural and emotional changes
Impaired speech and judgment
Impaired sense of smell
Lack of recognition
Reduced mental capacity
Inflammation of the optic nerve
Memory loss
Paralysis on one side of the body
Inability to write
Seizures
Spatial disorders
Difficulty in speaking and swallowing
Muscle weakness on one side of the face
Uncoordinated gait
Headache, especially in the morning
Loss of hearing
Vomiting
Prolonged drowsiness (somnolence)
Loss of vision

Courses

Although the exact causes for primary and secondary brain tumours are not known, researchers have identified a few factors that may increase one’s risk of developing brain cancer.

Age: The risk of developing brain cancer increases with age. A few brain tumours are more common among children than adults.
Exposure to Harmful Chemicals: Individuals working in oil refineries, handlers of jet fuel or chemicals like benzene, chemists, embalmers & rubber industry workers show a higher risk of developing brain cancer.
Family History: Family history of certain disorders increases the risk of developing certain brain tumours:
- Neurofibromatosis type 1 and type 2
- Tuberous sclerosis
- Von Hippel-Lindau disease
- Li-Fraumeni syndrome
History of Radiation Therapy to Brain: Prior radiation exposure to the brain, often as a treatment for another cancer, increases brain cancer risk.

Other risk factors such as smoking, radiation exposure and viral infections like HIV have been suggested but not proven to cause brain cancer.

Diagnosis

Initially, a medical interview and a physical examination are conducted to assess the condition of the patient. To be more particular, it will be a neurological exam, where various factors such as vision, coordination, hearing, balance, strength and reflexes are examined.

If tumour growth is suspected in the brain, then additional tests are recommended.

a. Imaging Tests:

CT Scan: CT scan is a commonly recommended test if brain cancer is suspected. It is a painless imaging method that shows detailed brain structures along with abnormalities if any. In a few cases, a dye may be injected for better clarity.
MRI Scan: MRI scan is another sensitive imaging method that is used for brain cancer diagnosis. This test also provides detailed structures of the brain and helps specialists achieve accurate diagnosis.
PET Scan: A PET scan can help specialists in understanding the functioning of the brain. During the procedure, radioactive tracers along with carbohydrates like glucose are injected into the bloodstream. Tumour cells will need more energy for multiplication and growth, and therefore, they absorb these radioactive tracers in larger quantities. During a PET scan, those regions that absorb more glucose appear as bright spots in the PET images, and this data helps the specialists to detect any abnormal growths.

b. Biopsy: Occasionally, a biopsy may be conducted where a small sample of tissue is excised and examined under the microscope for the presence of cancer cells. The tissue for biopsy can be taken during the surgical removal of the tumour or through needle insertion.

Other tests may include blood tests, electrolytes and liver function as brain cancer patients often present themselves with other health problems.

Treatment

Brain cancer treatments work best when they are customised as per the patient’s needs. The treatment planning for brain cancers is made based on multiple factors, such as the type of tumour, its location and size, the patient’s age and their overall condition.

The main treatment options for brain cancers include surgery, radiation therapy and chemotherapy. The personalised treatment plans often include either one or a combination of these treatment options.

a. Surgery: As a treatment method, surgery removes the tumour entirely along with a small portion of surrounding healthy tissues without affecting the normal brain functions. If the tumours are located in hard-to-reach regions, surgery may be performed to remove that portion of the tumour that is easily operable. Surgery is also performed to ease the symptoms of brain cancer.

Surgery is often combined with other treatment methods namely radiation therapy and chemotherapy to enhance the overall effectiveness of the treatment.

b. Radiation Therapy: Radiation therapy is a non-invasive, localised treatment approach for brain cancers. This method uses high-energy radiation beams to destroy the tumour cells.

Radiosurgery is an advanced form of radiation therapy where radiation beams are delivered to the tumour with surgical precision. This method uses highly focussed proton beams or x-ray beams to destroy the tumour cells. Through its high-grade accuracy, this method reduces damage to the surrounding healthy tissues and thereby has few treatment-related complications.

CyberKnife is a high-end radiosurgery platform that targets the tumour present in the brain with sub-millimetre precision and protects healthy brain tissues, while also reducing the risk of common cognitive side effects of whole-brain radiation.

c. Chemotherapy: Chemotherapy is a systemic therapy that uses potent drugs to destroy tumour cells by affecting their growth and multiplication. Chemotherapy can be administered intrathecally, intravenously or through biodegradable chemically impregnated polymers.

Other less prominent treatment options include hyperthermia (heat treatments), immunotherapy (immune cells directed to kill certain cancer cell types) or steroids to reduce inflammation and brain swelling.

Frequently Asked Questions

1. Is brain cancer rare in India?

According to the latest stats, brain cancer is the 14th most common cancer in India. In other words, the incidence of brain cancer is relatively rare as compared to the incidence of other cancers such as breast cancers, head and neck cancers, lung cancers or colorectal cancers.

2. Can I fully recover from a brain tumour?

Yes, you can recover completely from a brain tumour if it is detected early and treated appropriately. It takes a few weeks to regain normal functioning and get back to routine activities.

3. What is awake brain surgery?

Awake brain surgery or awake craniotomy is a surgery performed on the brain while you are fully awake. Awake brain surgery is used to treat some brain (neurological) conditions, including a few brain tumours or epileptic seizures. This is a painless procedure.

This surgery helps surgeons assess in the real-time impact of how the removal of tissue will affect your speech, vision and movement.

4. For how long do I need to stay in the hospital after the treatment?

This depends on the stage of the tumour treated and the overall condition of the patient. Usually, it takes 3-7 days for patients to be ready for discharge from the hospital.

5. What can I do to avoid brain tumours?

Having a healthy lifestyle plays a pivotal role in reducing the risk of developing various cancers. Nevertheless, few brain tumours develop spontaneously; therefore, you must keep an eye on the abnormal signs and symptoms, and if something seems concerning, please get in touch with your doctor.