Malignant Brain Tumours

What are malignant brain tumors?

A malignant brain tumor is a fast growing cancer that spreads to other areas of brain and spine. The growth is abnormal and uncontrolled.

What are the types of malignant brain tumors?

• Primary: these tumors arise in the brain and normally do not spread outside the brain. They arise form the supporting structures of the brain called glial cells.
• Secondary: these tumors spread to brain from outside, eg tumors from lung, breast, thyroid, kidney, stomach

Who are all at risk?

• People who are more than 50 yrs. old
• People with a family history of brain tumor
• People who are exposed to radiation
• People with certain genetic disorders
• The exact cause for these brain tumors is still not known.

Can mobile phone usage cause brain tumors?

The mobile phones emit radiofrequency energy and this is considered to cause cancers. Radiofrequency energy produces heat and this heat is supposed to damage the exposed tissue. But the amount of radiofrequency energy generated by mobile phones is less and they do not cause cancers. However extensive research is on but current evidence shows that the mobile phones are unlikely to cause cancers.

What are the symptoms?

The symptoms can be due to increased pressure in the brain

• Severe persistent headache, which are typically worse in the morning or while bending.
• Nausea and vomiting
• Drowsiness, sometimes altered sensorium
• Double vision or blurred vision
• Seizures

Or due to the position of the tumor

• Frontal lobe: personality changes, weakness on one side of the body
• Temporal lobe: forgetfulness, difficulty in speaking and seizures.
• Parietal lobe: difficulty in speaking and weakness on one side of the body.
• Occipital lobe: visual loss on one side
• Cerebellum: loss of coordination
• Brain stem: unsteadiness and difficulty in walking, facial weakness and double vision.

How can one diagnose?

• Good history and clinical examination
• CT scan and MRI with contrast enhancement
• Other newer modalities like MR spectroscopy and functional MRI to know about the relation of the tumor with important structures in the brain.

How can one treat these brain tumors?

Unfortunately there is no medical treatment. Surgery forms the main stay. In surgery the tumor should be removed as much as possible for radiotherapy and chemotherapy to act. Surgery reduces the tumor bulk and it makes radiotherapy and chemotherapy to act well. Innovations in surgery like awake craniotomy, intra operative neuromonitoring have helped us to go for a near total or total excision of the tumor. There is a chemical substance called amino levulunic acid. This picks up small pieces of residual tumor under a special microscope and aids in complete excision of the tumor. One can do intra operative imaging like MRI to confirm total excision of tumor. If there is any residual tumor it can be removed in the same sitting. Radiotherapy is given in the form of conventional, stereotactic radio surgery, and gamma knife or proton beam therapy. The newer modalities are more focused and lot safer. Chemotherapy can be used along with radiotherapy in the form of oral (temozolamide), injectable (vincristine) and as implants during surgery (carmustine wafers)

What is radiosurgery?

Also called as stereotactic radio surgery. Here multiple beams are focused to a target. It delivers a large quantity to the tumor and the treatment is done in a single session. The damage to the surrounding brain is very minimal.

When not to treat these brain tumors?

In case of advanced stage, a cure may not be possible. One has to try palliative care to control the symptoms and make the patient as comfortable as possible.

After treatment care and support:

• Regular follow up to pick up symptoms of recurrence
• Supportive care like physiotherapy. Occupational therapy and speech therapy.
• Driving is not allowed for patients with brain tumors or post treatment.
• All types of contact sports and swimming should be avoided
• It is safe to have sex but pregnancy should be avoided at least for an year post treatment.
• People can get back to work in a gradual manner
• Emotional and social support is a must

Authored By Dr. Sai Sudarsan