Anatomy of Tumour

Anatomy of Tumour

Early symptoms of brain tumour can be subtle or obvious, depending on the type, size, and location of the tumour.It’s important to confront the challenges with prescribed treatments
By Dr Ramandeep S Dang/Dr Prakash Khatri

If you have persistent signs and symptoms like headaches that gradually become more frequent and severe, unexplained nausea or vomiting, vision problems like blurred vision, double vision or loss of peripheral vision, gradual loss of sensation or movement in an arm or a leg, difficulty with balance, speech difficulties and confusion in everyday matters, consult your doctors because you might have brain tumour.
Early symptoms can be subtle or obvious, depending on the type, size, and location of the tumour. However, just because a person has these problems, doesn’t mean he or she has a brain tumour.
No one knows what causes brain tumours; there are only a few known risk factors that have been established by research. Children who receive radiation to the head have a higher risk of developing a brain tumour as adults, as do people who have certain rare genetic conditions such as neurofibromatosis or Li-Fraumeni syndrome. But those cases represent a fraction of the approximately 35,000 new primary brain tumours diagnosed each year. Age is also a risk factor – people over the age of 65 are diagnosed with brain cancer at a rate four times higher than younger people.
A brain tumour is a mass or growth of abnormal cells in your brain or close to your brain. Brain tumours can begin in the brain (primary brain tumours), or cancer can begin in other parts of the body and spread to the brain (secondary, or metastatic, brain tumours). Many different types of brain tumours exist. Some brain tumours are noncancerous (which are called benign), and some brain tumours are cancerous (which are called malignant).
Malignant tumours can grow and spread aggressively, overpowering healthy cells by taking their space, blood, and nutrients. They can also spread to distant parts of the body.
These day, neuronavigation systems enable surgeons to visualize the anatomy of a patient’s brain during surgery and precisely track the location of their surgical instruments in relation to the anatomy – even accommodating for the brain shift that occurs during surgery. Using Stealth Station technologies during procedures like tumour resections, surgeons can navigate more precisely, perform less-invasive procedures, and help improve clinical outcomes
If a brain tumour is diagnosed, relieving symptoms remain an important part of your care and treatment. Today, most tumours can be removed safely with microsurgical techniques in a manner that maximizes tumour removal and minimizes harm to the patients. How quickly a brain tumour grows can vary greatly. The growth rate as well as location of a brain tumour determines how it will affect the function of your nervous system. Brain tumour treatment options depend on the type of brain tumour the patient has, as well as its size and location.
Signs and Symptoms
The signs and symptoms of a brain tumour vary greatly and depend on the brain tumour’s size, location and rate of growth. General signs and symptoms caused by brain tumours may include new onset or change in pattern of headaches, headaches that gradually become more frequent and more severe, unexplained nausea or vomiting, vision problems, such as blurred vision, double vision or loss of peripheral vision, gradual loss of sensation or movement in an arm or a leg, difficulty with balance, speech difficulties, confusion in everyday matters, personality or behaviour changes, seizures, especially in someone who doesn’t have a history of seizures and hearing problems.
In most people with primary brain tumours, the cause of the tumour is not clear. But doctors have identified some factors that may increase your risk of brain tumour. The risk of a brain tumour increases as one ages. Brain tumours are most common in older adults. However, a brain tumour can occur at any age. And certain types of brain tumours occur almost exclusively in children. People who have been exposed to a type of radiation called ionizing radiation have an increased risk of brain tumour. Examples of ionizing radiation include radiation therapy used to treat cancer and radiation exposure caused by atomic bombs.
A small portion of brain tumours occur in people with a family history of brain tumours or a family history of genetic syndromes that increase the risk of brain tumours.If it is suspected that the patient can have a brain tumour, the doctor may recommend a number of tests and procedures. Magnetic resonance imaging (MRI) is commonly used to help diagnose brain tumours. In some cases, a dye may be injected through a vein in the arm during the MRI study called MRI brain with contrast. Other imaging tests may include computerised tomography (CT) scan and positron emission tomography (PET).
It is suspected that the brain tumour may be a result of cancer that has spread from another area of the body, the doctor may recommend tests and procedures to determine where the cancer originated. One example might be a CT scan of the chest to look for signs of lung cancer.A biopsy can be performed as part of an operation to remove the brain tumour, or a biopsy can be performed using a needle. The biopsy sample is then viewed under a microscope to determine if it is cancerous or benign. This information is critical to establish a diagnosis and prognosis and, most importantly, in guiding treatment.
Treatment
Treatment for a brain tumour depends on the type, size and location of the tumour. If the brain tumour is located in a place that makes it accessible for an operation, the neuro-surgeon will work to remove as much of the brain tumour as possible. In some cases, tumours are small and easy to separate from surrounding brain tissue, which makes complete surgical removal possible. In other cases, tumours can’t be separated from surrounding tissue or they’re located near sensitive areas in your brain, making surgery risky. In these situations only the part of the tumour is removed which is safe.
Removing a portion of the brain tumour may help reduce your signs and symptoms. Surgery to remove a brain tumour carries risks such as infection and bleeding. Other risks may depend on the part of the brain where your tumour is located. For instance, surgery on a tumour near nerves that connect to your eyes may carry a risk of vision loss.
Radiation therapy
Radiation therapy uses high-energy beams, such as X-rays or protons to kill tumour cells. Radiation therapy can come from a machine outside your body (external beam radiation), or, in very rare cases, radiation can be placed inside your body close to your brain tumour (brachytherapy).
External beam radiation can focus just on the area of your brain where the tumour is located, or it can be applied to your entire brain (whole-brain radiation). Whole-brain radiation is most often used to treat cancerthat has spread to the brain from some other part of the body. Side effects of radiation therapy depend on the type and dose of radiation you receive. Common side effects during or immediately following radiation include fatigue, headaches and scalp irritation.
Radio surgery
In Stereotactic radio surgery, multiple beams of radiation is to give a highly focused form of radiation treatment to kill the tumour cells in a very small area. Each beam of radiation isn’t particularly powerful, but the point where all the beams meet — at the brain tumour — receives a very large dose of radiation to kill the tumour cells.
There are different types of technology used in radiosurgery to deliver radiation to treat brain tumours, such as a Gamma Knife which is available in cancer institutions. Radio surgery is typically done in one treatment, and in most cases you can go home the same day.
Chemotherapy
Chemotherapy uses drugs to kill tumour cells. Chemotherapy drugs can be taken orally in a pill form or injected into a vein (intravenously). Chemotherapy side effects depend on the type and dose of drugs you receive. Chemotherapy can cause nausea, vomiting and hair loss.
Targeted drug therapy
Targeted drug treatments focus on specific abnormalities present within cancer cells. By blocking these abnormalities, targeted drug treatments can cause
Rehabilitation after treatment
Since brain tumours can develop in parts of the brain that control motor skills, speech, vision and thinking, rehabilitation may be a necessary part of recovery. Your doctor may refer you to services that can help Physical therapy can help you regain lost motor skills or muscle strength. Occupational therapy can help you get back to your normal daily activities, including work, after a brain tumour or other illness.Speech therapy with specialists in speech difficulties (speech pathologists) can help if you have difficulty in speaking.

(The author are Endoscopic Brain and Spine Surgeon/Sr Consultant Neurosurgery, Sri Balaji Action Medical Institute, New Delhi)