Brain Cancer: Diagnosis & Treatment Options for Brain Tumors

The abnormal cells in the body start to divide uncontrollably which leads to cancer. Cancer and tumour are not synonyms. A tumour is a mess of tissues with different shapes and sizes.

There are two types of tumours

Benign tumour: This does not mean cancer
Malignant tumour: This means cancer.

Brain tumours have grade 1-4 depending on their behaviour like the speed of growth and how they are likely to spread. Grade 1-2 are low- grade tumours and are non- cancerous, while grade 3-4 are high-grade tumours and are cancerous.

Metastatic brain cancer

When cells reach the brain by spreading from another tumour, it is called metastatic brain tumour. It is the most common type.

Causes

The clear and exact cause for brain cancer is unknown. However, it has been associated with a genetic factor, HIV infection, radiation to the head and smoking cigarette.

Symptoms

The symptoms of brain cancer are not specific to it, they can be caused by other illness too. Due to this, brain cancer remains undetected until a CT scan or MRI scan is done. However, some symptoms are weakness, headache, seizures, clumsiness etc.
In case of any of the following symptoms, medical help should be taken immediately.

Persistent vomiting for unknown reasons.
Unexplained double vision or blurring of vision.
Lethargy
A new pattern of headache
New seizures

Diagnosing brain cancer

Medical tests and physical exam will reveal if you have a problem with brain or brain stem. CT scan or MRI scan is performed.
CT scan is like an x-ray but shows more details. Contrast dye is injected in the bloodstream to highlight the abnormalities and get better results from the scan.
In most cases, an MRI scan is used in place of a CT scan for suspecting brain cancer. MRI has more sensitivity for detecting the presence of a tumour as compared to CT scan
Brain Cancer patients have more chances of suffering from other medical problems as well, so routine lab tests are performed. These routine lab tests include analysis of blood, electrolytes and liver function tests.
If a cancerous brain tumour is found then the patient is referred to a cancer specialist i.e. an oncologist.
After this, by testing a sample of the tumour, confirmation of cancer is done. This is called a biopsy.
For obtaining a biopsy, surgery is done (generally with intention of removing the whole tumour, if possible). A small piece of the tumour is removed if it is not possible to remove the whole tumour.
Another way of obtaining a biopsy is by a technique called stereotaxis, or stereotactic biopsy.
After obtaining a biopsy, it is examined by a pathologist.

The treatments of Brain cancer

Treatment of brain cancer is complicated. You need to consult many doctors. Your health care team should include oncologists, neurosurgeons and radiation oncologists along with a physical therapist, a dietician, a social worker and other specialists such as a neurologist.
Treatment protocols vary widely depending on factors like age, health and location, size and type of tumour.
Common treatments for brain cancer include surgery, radiation therapy, and chemotherapy. Generally, more than one of these is used.

Brain Cancer surgery

The aim of the surgery is to confirm the presence of tumour and remove the tumour. If it is not possible to remove the tumour, surgeons take samples of the tumour to identify its type.
For benign tumours, it is possible to cure all the symptoms by surgical removal itself.

Before surgery, you may undergo the following treatments and procedures.
o To relieve swelling, you may be given a steroid drug.
o To prevent seizures, you may be treated with an anticonvulsant drug.
o In case you have excess cerebrospinal fluid collecting around the brain, a shunt may be placed to drain the fluid. The shunt is a thin, plastic tube which drains fluid from which the fluid can be easily eliminated.

Neurosurgery: This is a special type of surgery performed on the brain and spinal cord. It aims at removing the entire brain tumour.

In today’s scenario, there have been many advances in brain tumour surgery which include cortical mapping, enhanced imaging, and fluorescent dyes.
• Cortical mapping helps to recognize areas of brain controlling language, senses and motor skills.
• Enhanced imaging devices provide more tools for surgeons in order to plan and perform surgery. A computer-based technique like Image Guided Surgery (IGS) is an example of this. However, this specialized technology is not easily available.
• 5 aminolevulinic acid is a fluorescent dye which is given in morning through mouth prior to surgery. This dye is consumed by tumour cells which helps the surgeons to remove it more effectively.

Radiation therapy

Also called radiotherapy, radiation therapy uses high energy- rays to kill tumour cells, thus stopping from growing and multiplying further.
Radiotherapy typically affects only cells in its path, it does not harm cells elsewhere in the brain.
Radiations can be given in different ways such as the following:

External radiation: It makes the use of high- energy beam of radiation. The beam targeted at the tumour travels through skin, skull and healthy brain tissues to reach the tumour. One treatment takes only a few minutes and these treatments are usually given for five days a week for a fixed time period.
Internal/ Implant radiation: This uses a very small radioactive capsule which is placed in the tumour itself. Radiation emitted from the capsule destroys the tumour. The radioactivity of the capsule decreases with time and is carefully monitored and calculated. One is required to stay in the hospital for several days during the treatment.

Stereotactic radiosurgery

It is sometimes also called “knifeless” surgical technique. In this, an MRI or CT scan is used to find the accurate location of the tumour in the brain. The single large size of the high radiation beam is used to destroy the tumour. This kind of surgery has a shorter recovery time and fewer complications.

Some other ways of delivering external beam radiation therapy are under study. They are:

Intensity modulated radiation therapy: In this, computers are used to target brain tumour with more accuracy and reducing damage to healthy tissues.
Proton beam radiation therapy: Here protons are used as a source of radiation instead of x-rays. Its dose is less than that of the x-ray beam. The proton beam is aimed at the tumour.

Side effects of Brain Cancer surgery

Generally, there are fewer or no side effects of radiotherapy. In rare cases, people may have nausea after radiation therapy.
After each radiation treatment, you may feel tired. Doctors advise staying as active as possible in such condition.

Radiation therapy can cause hair loss or reddening of scalp and ears. Headache or pressure may also be felt. Medication helps to provide relief for this.
For children, radiation can harm some healthy areas of the brain like a pituitary gland. This can lead to learning problems and slow down growth and development.

Chemotherapy

It involves the use of drugs to kill tumour cells. It targets those cells which grow and divide i.e. cancer cells. Generally, a combination of drugs may be used. While radiation and surgery are performed on the targeted tumour, chemotherapy affects the whole body. Which means that it can also affect healthy growing cells, that is why chemotherapy can cause side effects.
Drug intake can be done orally or through an IV line. Some of them are given through shunt.

Effectiveness of chemotherapy

This is largely depended on the kind of cancer the patient is suffering from.
Sometimes, chemotherapy can destroy all harmful cells and they never grow again. But this is not always the case.
It can prove effective in preventing the spread of cancer to other body parts.
In other cases, it simply shrinks the tumours that cause pain or pressure.

Uses of Chemotherapy

In some cases, chemotherapy is able to treat cancer by itself, but most of the time, it is used in combination with:

Surgery
Radiation therapy

Biological therapy: In this, living materials are used to kill cancer cells. These living materials include bacteria, vaccines, or antibiotics.

Time period

Chemotherapy is generally given in cycles. A short period of intensive medication and then a period of rest and recovery constitutes a cycle. The tenure of one cycle is usually a few weeks.
After 2 to 4 cycles, the treatment is halted for a break and the progress is observed.

Ways of giving Chemotherapy

Oral: The patient swallow the pills or liquid containing drugs.
Topical: Drugs are applied to the skin in the form of a cream.
Intravenous(IV): The drugs go directly into a vein. This can be done with needle, catheter, port or pump.
Intraperitoneal(IP)
Injection
Intra-arterial: The chemotherapy goes directly into the artery.

Side effects

There are also side effects treating brain cancer through chemotherapy such as nausea, vomiting, loss of appetite, mouth sores, hair fall etc. While some of these side effects may be relieved through medication, they can be very difficult for some to tolerate.

Latest Researches on Brain Cancer Treatment

Latest Research on brain cancer treatment

Brain Tumor treatment, Latest Research

Latest treatments for Brain cancer treatment

With the evolving technology and researches taking place every day, new ways for treatment of brain cancer are being discovered. New therapies for treating cancer are studied in labs. Then they are tested in clinical trials with people suffering from brain cancer
Through these clinical trials, the effectiveness of new therapies is tested and then they are further developed. Some patients may be reluctant to try these new therapies as they do not want any experiment to be done on their body.

Clinical trials are nowadays available for almost every kind of cancer.
They offer new therapies which can prove to be more effective than the existing ones.
There are also some risks associated with these new therapies. They are proved less effective and, in some cases, fatal for the patient as they are in their testing stage only.
People suffering from cancer are eligible to volunteer for such clinical trials.
You can consult your oncologist if you want to get treatment through these clinical trials.

Follow Up

When a brain tumour is diagnosed, one has to be cautious. You should take regular appointments with your consultants. There is a potential risk of recurrence of cancer. Also, people with brain cancer are at higher risk of other problems also.

The survival rate in brain cancer

The survival rate is again influenced by age, treatment, location and type of cancer.
Generally, younger patients have better survival chances.
The most common types of brain cancer are metastasized. So the prognosis depends on original cancer.
Today, treatments for most of the brain cancer types are available and provides better chances of survival.

Home care for brain cancer

Along with medical treatment, proper care of the patient should be taken at home also.
Following points can be taken into consideration :

Supportive measures in accordance with the patient's need should be taken, for example, a patient having difficulty in walking should be provided with walkers.
The service of a speech therapist can be taken if the patient has problems regarding speaking or swallowing.
If the progress of the patient is poor, it is appropriate to discuss things like hospice care, provision for a living will and advance directive to doctors.
Advance directives refer to some legal documents. They provide means to express the choice of treatment you want and selecting the person who would make decisions on your behalf if you are not in a condition to do the same.

Support groups and counselling

Will power and desire to live are the most important requirements for any treatment to be successful.
People suffering from brain cancer should have a positive outlook on life. You should share your emotions with your friends and family. If you don’t want to burden your loved ones with your problems, you can talk with your oncologist and social workers who are ready to help the cancer patients. Don’t feel stressed or depressed in your life. Talk with other cancer patients who have been through a similar experience. Always find reasons to smile and laugh.
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