World Brain Tumor awareness day: Why early detection is important?

Did you know that a recurrent headache, vomiting, new onset of epilepsy, weakness or numbness of any part of the body, and difficulty with memory or concentration can be a sign of a brain tumor?  Well, brain tumors can also lead to difficulty in walking, controlling urine and stool. Basically, it can severely impact a persons quality of life.

According to published data from India, Central nervous system tumors occur with a frequency of 5-10 per 100,000 population and account for 2% of all malignancies occurring in our population. In regular clinical practice, it is common to come across patients coming with complaints arising from a tumor inside the skull and they can occur in all age groups. Our brain is central to our existence- both for the physical functioning of our body and to determine our mental state. The presence of a tumor can impact our health by directly affecting the body by producing a variety of weakness or numbness, difficulty with walking, and difficulty with dexterity. It can also impact our quality of life by causing primary mental changes- forgetfulness, speech defects, depression and by loss of bladder or bowel control.

Early detection and timely intervention are therefore key to save lives. But it is also important to note that not all brain tumors are cancerous. Hence, education and awareness on the different kinds of brain tumors are also crucial. Lets begin with understanding what a brain tumor is all about and how it impacts a persons health and quality of life.

What is a brain tumor?

A brain tumor is a mass of abnormal cells within the skull and may arise in any part of the skull and the brain itself- the membranes that surround the brain (ie. the meninges), the bones that surround the brain, and the blood vessels of the brain. Tumors that originate outside the brain but spread to the brain from other sites like the lung, breast, kidney, skin, etc., may also be categorized as brain tumors. 

What are the different types of brain tumors?

Tumors that arise from the brain tissue or its covering are called primary brain tumors. These tumors are named according to the cell type from which they originate. Among the primary brain tumors, the commonest are astrocytoma, meningioma, oligodendroglioma, pituitary adenoma, schwannoma, chondrosarcoma, chordoma (arising from astrocytes, meningeal cells, pituitary gland, cranial nerves, cartilaginous elements within the bone, primitive developmental elements within mature bone respectively).

The larger group of brain tumors is constituted by tumors that originate elsewhere but spread to the brain alongside its blood supply. These are called secondary brain tumors or metastatic tumors.

 Another way of grouping brain tumors is into malignant (cancerous) and benign (non-cancerous) tumors.

Which of the most common benign tumors of the brain?

Among the most common benign tumors are meningiomas, schwannomas, and pituitary adenomas. Unfortunately, malignant tumors of the brain are more common. The common malignant tumors are metastases followed by gliomas.

What are the symptoms of brain tumors?

Symptoms of brain tumors depend on the tumor and its location. Different areas of the brain serve different functions and the location of the tumor determines the symptoms.

Tumors in the brain often produce no symptoms in the early stages. As they enlarge, they can present with symptoms due to their physical mass resulting in raised pressure inside the skull. The most common symptom is a headache that does not respond to analgesics and worsens in the evening or early morning. Vomiting, visual problems, change in the level of consciousness and even coma are other symptoms of rising pressure within the brain.

Tumors that arise from eloquent areas of the brain may have more dramatic symptoms like loss or impairment of speech/language functions, weakness of one side of the body, disturbance of gait and balance (drunken gait), loss or impairment of vision, changes in behavior and personality, different types of epileptic fits, milk discharge from the breast, change of voice, difficulty in swallowing, deafness, etc.

How is the diagnosis of a brain tumor made?

The first guide to the presence of a brain tumor is the detailed history and clinical examination of the individual. This is followed by investigations, mainly imaging studies including CT scan and MRI along with a battery of blood tests as indicated.

What is the treatment of brain tumors?

Treatment usually depends on the kind of brain tumor. The mainstay of treatment is the microsurgical removal of the tumor. Surgery for brain tumors is complex. Safety and outcome of brain surgery is improved using several technological advances in this field like Neuro-Navigation, Intraoperative Neuro Monitoring, Ultrasonic aspirator and endoscopic surgery. Micro neurosurgery involves using an operating microscope for the surgery. Endoscopic surgery and minimally invasive brain surgery techniques are also available. How the surgery is performed will depend on the training and expertise of the surgeon and the type, location and extent of the tumor.

Surgery may need to be followed by adjuvant radiotherapy and chemotherapy if required, based on the biopsy report. In some varieties of tumors like prolactinoma arising from the pituitary gland treatment goals may be attained with only medicines.

Why is early detection crucial?

As a brain tumor enlarges, it affects the normal functioning of that part of the brain. Early detection and early treatment of a brain tumor can safeguard the normal surrounding brain. It may also increase the treatment options. For example, some tumors can be treated by radiosurgery. As tumors enlarge, they may invade parts of the brain and skull that may make curative treatment difficult. Larger tumors often have a higher risk from surgery. Also, remember that benign tumors of the brain are by and large curable by surgical removal. Unfortunately, the long term outcome of the common malignant brain tumors is not that good, with limited survival despite optimal treatment with surgery, radiotherapy and chemotherapy. Therefore early detection that can lead to timely intervention becomes crucial.