Brain Cancer

Animation of an MRI brain scan, starting at th...
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Alternative Names:Glioma, Meningioma

Definition:
Brain cancer is a disease of the brain in which cancer cells (malignant) arise in the brain tissue. Cancer cells grow to form a mass of cancer tissue (tumor) that interferes with brain functions such as muscle control, sensation, memory, and other normal body functions.

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There are more than 100 different types of brain tumour, depending on which cells within the brain are involved. The most common (about 50 per cent of brain cancers) is called a glioma, and it is formed not from the nerve cells of the brain but from the glial cells, which support those nerves. The most aggressive form of glioma is known as a glioblastoma multiforme – these tumours form branches like a tree reaching out through the brain and may be impossible to completely remove.

Other tumours include:
*Meningiomas – account for about a quarter of brain cancers and are formed from cells in the membranes, or meninges, that cover the brain

*Pituitary adenomas – tumours of the hormone-producing pituitary gland

*Acoustic neuromas – typically slow-growing tumours of the hearing nerve often found in older people

*Craniopharyngioma and ependymomas – often found in younger people

The treatment and outlook for these different brain tumours varies hugely. Some, such as meningiomas and pituitary tumours, are usually (but not always) benign, which means they don’t spread through the brain or elsewhere in the body. However, they can still cause problems as they expand within the skull, compressing vital parts of the brain. Other types of brain cancer are malignant, spreading through the tissues and returning after treatment.

Brain tumours are also graded in terms of how aggressive, abnormal or fast-growing the cells are. Exactly where the tumour forms is also critical, as some areas of the brain are much easier to operate on than others, where important structures are packed closely together.

Causes:
The cause of brain cancer  remains a mystery, but some risk factors are known. These include:

*Age – different tumours tend to occur at different ages. About 300 children are diagnosed with brain tumours every year, and these are often a type called primitive neuroectodermal tumours (PNETs), which form from very basic cells left behind by the developing embryo. PNETs usually develop at the back of the brain in the cerebellum

*Genetics – as many as five per cent of brain tumours occur as part of an inherited condition, such as neurofibromatosis

*Exposure to ionising radiation – such as radiotherapy treatment at a young age

*Altered immunity – a weakened immunity has been linked to a type of tumour called a lymphoma, while autoimmune disease and allergy seem to slightly reduce the risk of brain tumours

*Environmental pollutants – many people worry that chemicals in the environment (such as from rubber, petrol and many manufacturing industries) can increase the risk of brain cancers, but research has so far failed to prove a link with any degree of certainty. Neither is there clear and irrefutable evidence for risk from mobile phones, electricity power lines or viral infections, although research is ongoing.

Symptoms:
The symptoms and signs of a brain tumour fall into two categories.

Those caused by damage or disruption of particular nerves or areas of the brain. Symptoms will depend on the location of the tumour and may include:

*Weakness or tremor of certain parts of the body

*Difficulty writing, drawing or walking

*Changes in vision or other senses

*Changes in mood, behaviour or mental abilities

Those caused by increased pressure within the skull – these are general to many types of tumour and may include:

*Headache (typically occurring on waking or getting up)

*Irritability

*Nausea and vomiting

*Seizures

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*Drowsiness

*Coma

*Changes in your ability to talk, hear or see

*Problems with balance or walking

*Problems with thinking or memory

*Muscle jerking or twitching

*Numbness or tingling in arms or legs

Diagnosis:
The initial test is an interview that includes a medical history and physical examination of the person by a health-care provider.If he or she  suspects a brain tumour, you should be referred to a specialist within two weeks. Tests are likely to include blood tests and the most frequently used test to detect brain cancer is a CT scan (computerized tomography). This test resembles a series of X-rays and is not painful, although sometimes a dye needs to be injected into a vein for better images of some internal brain structures.

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Another test that is gaining popularity because of its high sensitivity for detecting anatomic changes in the brain is MRI (magnetic resonance imaging). This test also resembles a series of X-rays and shows the brain structures in detail better than CT. MRI is not as widely available as CT scanning. If the tests show evidence (tumors or abnormalities in the brain tissue) of brain cancer, then other doctors such as neurosurgeons and neurologists that specialize in treating brain ailments will be consulted to help determine what should be done to treat the patient. Occasionally, a tissue sample (biopsy) may be obtained by surgery or insertion of a needle to help determine the diagnosis. Other tests (white blood cell counts, electrolytes, or examination of cerebrospinal fluid to detect abnormal cells or increased intracranial pressure) may be ordered by the health-care practitioner to help determine the patient’s state of health or to detect other health problems.

Treatment:
The type of treatment offered and the likely response depends on the type, grade and location of the tumour. Unlike many other organs, it’s very difficult to remove parts of the brain without causing massive disruption to the control of body functions, so a cancer near a vital part of the brain may be particularly difficult to remove.

The main treatments for brain tumours include:

*Surgery – to remove all or part of the tumour, or to reduce pressure within the skull

*Radiotherapy – some brain cancers are sensitive to radiotherapy. Newer treatments (stereotactic radiotherapy and radiosurgery) carefully target maximum doses to small areas of the tumour, avoiding healthy brain tissue.

*Chemotherapy – these treatments are limited by the fact that many drugs cannot pass from the bloodstream into brain tissue because of the ‘blood-brain barrier’, but may be useful when tumours are difficult to operate on, or have advanced or returned.

*Biological’ therapies – for example, drugs that block the chemicals that stimulate growth of tumour cells

*Steroids – can help to reduce swelling of the brain and decrease pressure in the skull
Often a combination of treatments will be recommended.

While, as a general rule, brain tumours are difficult to treat and tend to have a limited response, it can be very misleading to give overall survival figures because some brain cancers are easily removed with little long term damage, while others are rapidly progressive and respond poorly to any treatment.

While only about 14 per cent of people diagnosed with a brain tumour are still alive more than five years later, this sombre statistic could be unnecessarily worrying for a person with a small benign brain tumour. What a person diagnosed with brain cancer needs to know will be the outlook for their individual situation, which only their own doctor can tell them.

Treatments do continue to improve – for example, survival rates for young children have doubled over the past few decades, and many new developments are being tested.

Other treatments may include hyperthermia (heat treatments), immunotherapy (immune cells directed to kill certain cancer cell types), or steroids to reduce inflammation and brain swelling. These may be added on to other treatment plans.

Clinical trials (treatment plans designed by scientists to try new chemicals or treatment methods on patients) can be another way for patients to obtain treatment specifically for their cancer cell type. Clinical trials are part of the research efforts to produce better treatments for all disease types. The best treatment for brain cancer is designed by the team of cancer specialists in conjunction with the wishes of the patient.

Prognosis:
Survival of treated brain cancer varies with the cancer type, location, and overall age and general health of the patient. In general, most treatment plans seldom result in a cure. Reports of survival greater that five years (which is considered to be long-term survival), vary from less than 10% to a high of 32%, no matter what treatment plan is used.

So, why use any treatment plan? Without treatment, brain cancers are usually aggressive and result in death within a short time span. Treatment plans can prolong survival and can improve the patient’s quality of life for some time. Again, the patient and caregivers should discuss the prognosis when deciding on treatment plans.

Living with Brain Cancer:
Discuss your concerns openly with your doctors and family members. It is common for brain cancer patients to be concerned about how they can continue to lead their lives as normally as possible; it is also common for them to become anxious, depressed, and angry. Most people cope better when they discuss their concerns and feelings. Although some patients can do this with friends and relatives, others find solace in support groups (people who have brain cancer and are willing to discuss their experiences with other patients) composed of people who have experienced similar situations and feelings. The patient’s treatment team of doctors should be able to connect patients with support groups. In addition, information about local support groups is available from the American Cancer Society at http://www.cancer.org/docroot/home/index.asp.

Prevention:
Although there is no way to prevent brain cancers, early diagnosis and treatment of tumors that tend to metastasize to the brain may reduce the risk of metastatic brain tumors. The following factors have been suggested as possible risk factors for primary brain tumors: radiation to the head, HIV infection, and environmental toxins. However, no one knows the exact causes that initiate brain cancer, especially primary brain cancer, so specific preventive measures are not known. Although Web sites and popular press articles suggest that macrobiotic diets, not using cell phones, and other methods will help prevent brain cancer, there is no reliable data to support these claims.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

 

Resources:
http://www.medicinenet.com/brain_cancer/page5.htm
http://www.nlm.nih.gov/medlineplus/braincancer.html
http://commons.wikimedia.org/wiki/File:MRI_head_side.jpg

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