About Brain Tumours
The mere thought of someone close harbouring a brain tumour is devastating. Besides most brain tumour victims are children or adults in their prime of life. This not only makes it more poignant but also creates a need to look after such victims who can often, with the medical resources available, be restored to near normalcy. This, however, needs a multi-disciplinary approach, which is expensive and rarely available under one roof. Even after the completion of the hospital treatment (surgery, radiotherapy or chemotherapy), many patients require intensive rehabilitation at their homes and sometimes in special institutions.
Here is an introduction to brain tumours:
The Brain and the
The Brain and the Spinal Cord
What, then, is a
What, then, is a brain tumour?
Benign tumours grow slowly and never spread to other parts. But as they slowly increase in size they can cause pressure on the normal brain and interfere with mental and bodily functions. Some of the benign tumours known are: meningiomas, pituitary adenoma, craniopharyngioma, epidermoid cysts, neurocytoma, haemangioma, pilocytic astrocytoma, etc.
Malignant tumours or cancers are aggressive tumours that grow fast and infiltrate the surrounding brain and sometimes spread to the other parts of the brain or spine. There are various types of malignant brain tumours like High Grade Astrocytoma/Glioma, ependymoma, PNET, medulloblastoma, lymphoma, Germ cell tumours. With aggressive and timely treatment some of these can be cured.
Some Common Symptoms:
Methods of detecting a brain
Methods of detecting a brain tumour:
Most of the symptoms described above are non-specific and can be caused by many other diseases. A detailed history and medical examination is first done by the doctor and if a brain tumour is suspected then further tests like CT or MRI scan, angiogram, CSF test, hormonal blood test or EEG may be done.
Treatment depends upon the tumour type, patient's age and general condition
The various Neurosurgical approaches
• Craniotomy - This is the commonest approach which allows
maximum tumour removal. To reach the tumour, a window is created by
cutting the skull bone and after the operation this bone is replaced.
Radiotherapy plays a very important role in all malignant tumours and even in some benign brain tumours. Following surgery, radiation therapy targets the remaining tumour cells to prevent or delay its recurrence. Depending upon the sensitivity of different tumour types to radiation and the biological dose of radiation used, these tumours are either completely eradicated (cured) or they shrink or stabilise thus relieving symptoms.
The dose, duration and technique of radiotherapy depends upon the type, size, site of the tumour and the patient's age and general condition. For most tumours, only the affected part of the brain with some margins is irradiated. However for some tumours like medulloblastoma, lymphoma and germ cell tumours that have a higher risk of spread to the spine, the entire brain and spine is irradiated.
Treatment Planning using head masks of thermoplastic material (ORFIT), simulator machines and planning computers help in more accurate positioning of the radiation beam for adequate coverage of the tumour while minimising the dose to the normal brain. After studying the CT / MRI scans, surgical and pathology reports, the area to be treated is decided. The path of the radiation beam is then carefully marked on the Thermoplastic mask using the simulator machines.
Stereotactic radiosurgery (SRS) and radiotherapy (SRT) are special techniques of radiotherapy which have the potential to reduce the dose of radiation to normal brain and critical structures as compared to conventional radiotherapy. These techniques require a lot of manpower and high technology and are indicated in special types of tumours or conditions. We are also conducting some trials in this regard.
Chemotherapy is the treatment of certain types of brain tumours with cytotoxic drugs. Chemotherapy is useful for a variety of brain tumours including lymphomas, medulloblastomas, germ cell tumours, PNET and some gliomas. Commonly used drugs used for brain tumours are CCNU, BCNU, vincristine, Cisplatin, Temozolomide etc. Generally these drugs are given in combination every 4 to 6 weeks to a maximum of 6 cycles. Sometimes, if one combination of drug regimen stops working for the tumour, another drug or a combination (2nd line) may be tried. Most of the chemotherapy treatment may be administered on an OPD basis although some may require admission. Blood tests for haemoglobin, white blood count and platelets and sometimes, liver and kidney function tests are done before each cycle of chemotherapy.
In children brain tumours are the second most common cancer or tumour after leukaemia. The common childhood brain tumours include medulloblastoma, gliomas, astrocytoma, ependymoma, PNET and germ cell tumours. In most children the cause of the brain tumour is not known but in some tumours like the Optic glioma it may be due to a hereditary disease called neurofibromatosis. The effect of the tumour and its treatment on the brain function, mental and physical growth is more pronounced in children with developing brain. There is, therefore, a need for timely diagnoses, treatment and rehabilitation of these children. Fortunately, a majority of childhood brain tumours are curable with modern treatment, and with the medical resources available, these children can be restored to near normalcy. This, however, needs a multidisciplinary approach, which is expensive and rarely available under one roof. Even after completion of the hospital treatment many children require intensive rehabilitation at their homes and sometimes at special institutions.
The World Health Organization had dedicated the last decade to the brain. With remarkable strides in the management of brain tumour there is a need for a foundation to provide the highest level of care to such patients and perform research into various aspects of brain tumours. Brain tumours are the commonest solid tumours in children and in our country affect thousands of young adults each year. We plan to reach out to all patients suffering from brain tumour to help them and their families through this devastating period.