A brain tumor is defined as an abnormal or uncontrolled growth of cells in the brain. Tumors can be benign (non-cancerous) or malignant (cancerous). Because they settle in the brain, even a benign tumor can be dangerous. The brain is surrounded by the skull. This means that as the tumor grows, it begins to put pressure on normal brain tissues. This can cause inflammation and brain swelling. Therefore, it is very important to treat both types of tumors as quickly as possible.
A tumor is called a primary brain tumor if it originated in the brain itself. Sometimes cancer can spread to the brain from other areas, such as the lungs or chest. These types of tumors are then called secondary (or metastatic) brain tumors. Compared to other cancers, brain tumors are relatively rare; however, they are considered dangerous due to their location and sometimes aggressive nature.
Possible Symptoms of Brain Tumors
Brain tumors often invade or pressurize normal brain tissue, and symptoms are caused by that pressure. Depending on the location of the brain tumor, different types of symptoms may occur in the person. However, other illnesses, including mental illnesses, also cause these symptoms. In any case, if you experience one or more of these symptoms, you should call your doctor immediately.
Headache, particularly:
– a recent pain
– a persistent pain
– a pain that gets worse on waking
Vomiting, especially in the morning if severe
Changes in personality or behavior
Decline in mental abilities:
-memory loss
-impaired ability to calculate
-impaired judgment
New onset seizures
Neurological changes:
– vision problems (double vision, decreased vision)
– loss of hearing
– decreased sensation or weakness in a body area
– speech difficulties
– decreased coordination, shakiness
• Weakness, drowsiness, decreased alertness
• Language problems, swallowing difficulties, hiccups
• Impaired sense of smell
Uncontrolled or dysfunctional movements, hand tremors
Cessation of menstrual bleeding before menopause
Facial paralysis
Eye abnormalities:
-different size pupils
-uncontrolled movement
-eyelid falling
•Drowsiness/confusion, unusual or strange behavior
•Temporary respiratory arrest
Op.Dr. Kerem Bıkmaz Laboratory Studies
Arkansas University Yaşargil Laboratory, America
Functional Geography of the Brain
Different areas of the brain control different functions. Symptoms of a brain tumor can vary depending on the area of the brain affected.
Left temporal lobe: Hearing, sight, smell, understanding, recall of seeing or hearing, recognizing words, personality, behavior, and sexual behavior.
Brainstem: Breathing, heart rate, digestion, alertness level, sleep, sweating, blood pressure, body temperature and balance.
Cerebellum: Memory for balance, posture, coordination involving limbs and reflex movements.
Right temporal lobe: Hearing, smell, organizing, concentrating on what is seen or heard, recognition of musical tones, musical sounds, and non-speech information (eg, drawings). Long-term memory, personality, behavior and sexual behavior.
Occipital lobe: Clearly interpreting what is seen and visual images. Reading and writing, finding objects, recognizing colors, recognizing words, drawing objects and understanding whether an object is moving.
Parietal lobe: Sense of sight and touch. Organizing input from different senses for understanding, sensory control of the body, writing, mathematics and language. Positioning of the body, holding objects, and auditory and non-auditory memory.
Frontal lobe: Higher mental functions such as consciousness and responses to external stimuli, personality. Swallowing, salivating, vocalizing, chewing, facial expressions and motor coordination for hands, arms, trunk, hips, legs and feet.
Characteristics of Brain Tumors
Brain tumors are grouped into two main classes: gliomas and non-gliomas. The following describes the wide variety of brain tumor types and may help clarify the information given to you about your tumor.
Gliomas
Approximately 46% of primary brain tumors and 23% of primary spinal cord tumors are gliomas; in other words, they grow from glial cells. Within the brain, gliomas usually occur in the hemispheres of the cerebrum, but they also affect other areas, particularly the optic nerve, brain stem, and the cerebellum, especially in children. Because glial cells are of different types, gliomas are also divided into several groups.
Astrocytomas
•The most common type of glioma, accounting for 17% of all primary brain tumors.
•Can occur anywhere in the central nervous system. Treatment usually includes surgery and radiation therapy, and sometimes chemotherapy.
•Low-grade astrocytomas grow relatively slowly and surgery can completely remove the tumor.
•High-grade asrocytomas grow faster than low-grade ones and are usually treated with a combination of surgery, radiation, and chemotherapy.
Multi-Shaped Glioblastomas
Another name for high-grade astrocytomas is glioblastomas. They rapidly attack nearby tissues and contain very aggressive cells.
They are one of the most common primary brain tumors affecting adults and sometimes also affect children.
They are typically treated with radiation therapy followed by surgery, alone or in combination with chemotherapy.
Brainstem Gliomas
• These tumors located in the brainstem constitute 20% of childhood tumors and approximately 5% of adult tumors.
• It most commonly affects children aged 3-10 years and ranges from very low grade astrocytomas to more rapidly growing polymorphous glioblastomas.
•Surgical not usually used for brain stem gliomas; because the brain stem is very sensitive. Radiation therapy can sometimes help reduce symptoms and prolong the patient’s life by slowing tumor growth.
•Brainstem gliomas are equally dangerous; however, low-grade tumors may have very long periods of reduction/remission.
Oligodendrogliomas
•They are relatively rare; They represent 5% of all gliomas and occur most frequently in the cerebral hemispheres of the brain in young adults.
•Low grade tumors are treated with surgery. High-grade tumors are treated with radiation after surgery; Sometimes chemotherapy is added to this. They are moderately sensitive to radiation therapy.
Ependymomas
• They constitute approximately 5% of adult intracranial gliomas and 10% of childhood tumors in the central nervous system.
Occurrence rates are highest at 5 years old and 34 years old.
• 85% does not cause cancer; most are circumscribed, slow-growing low-grade tumors.
•Usually only radiation therapy is applied; Radiation therapy is applied to those that cannot be completely removed, although some need to be surgically removed completely.
•
Non-Gliomas
Medulloblastomas or Primitive Neuroectodermal Tumors
•Represent more than 25% of all childhood brain tumors. They occur more frequently in children than in adults.
•They start in the lower part of the brain (cerebellum) and spread to the spine or other parts of the body.
•They are usually cleared by surgery and radiation therapy.
• They are fast growing tumors; however, they are very sensitive to radiation therapy and chemotherapy.
Meningiomas
• 27% of all primary brain tumors and tends to affect women more than men.
•Compresses neighboring brain tissues as it grows; It is usually benign but can be life threatening.
•Some grow slowly; however, some also grow faster or have sudden growth spurts.
•Recurrence cannot be predicted, regular follow-up and scans are important.
Schwannomas
•They are usually benign and surgically removed if possible.
•A common type (known as vestibular schwannoma or acoustic neuroma) affects the eighth cranial nerve. This nerve contains nerve cells important for balance and hearing. This type can grow on one or both sides of the brain.
Metastatic Brain Tumors
Cancer cells from other parts of the body, such as the lungs or chest, can reach the brain through the blood and begin to form a secondary or metastatic tumor. Metastatic brain tumors are actually more common than primary brain tumors. Surgery and/or radiation therapy are generally used for treatment.
Diagnosing Brain Tumors
If you have symptoms of a brain tumor, the doctor will want to do some tests. There are several advanced diagnostic procedures used to detect the type and location of abnormalities within the brain.
Predicted Factors Affecting Central Nervous System Tumors
Histology (cell type)
Patient’s age
Tumor location
Functional neurological status
Less important factors:
Metastatic spread
Size of tumor resection (in surgical patients)
Neurological Evaluation
evaluations are usually done by a neurologist or neurosurgeon.
The rater will look for signs of decreased mental function (eg, inability to concentrate, poor memory, inability to perform arithmetic or simple tasks), weakness, numbness, poor muscle tone, changes in reflexes, and changes in vision.
Imaging
•Patients will undergo magnetic resonance imaging (MRI) or computed tomography (CT) to examine the anatomy of the brain.
•Additional scans such as magnetic resonance spectrometry (MRS) and positron emission tomography (PET) can be performed to better understand the characteristics of the tumor (Is it growing fast? Is it stable? Has it invaded normal tissue? etc.).
•These scans are then used to determine the most appropriate treatment for each patient.
Biopsy
If a clear diagnosis cannot be made from the scans, a biopsy may be done to pinpoint the type of tumor.
After local anesthesia is administered, a long needle is inserted through a small hole in the skull to remove a small piece of the tumor.
The tumor sample is evaluated to determine the type of tumor and how aggressive it may be.
Information from the biopsy is then used to determine what treatment is most appropriate for the patient.
Two main factors are considered in the grading of brain tumors: the types of cells that make up the tumor and the growth rate of the tumor. Also, the age of the patient is important; The younger the patient, the better the course of the disease. To a lesser extent, the amount of tissue removed is also a factor, although it is not as important as the type of cancerous cell, the rate of growth, or the age of the patient.
When considering surgery, tumor location is important; because some areas have a major impact on quality of life, life expectancy and type of treatment. Good general health and physical condition play a large role in predicting outcomes; younger patients have a better prognosis.
Treatment of Brain Tumors
If the brain tumor is malignant, treatment is required. Here are some treatment options. Also, many clinical trials allow patients to access new experimental treatments.
Surgery
•The most direct way to remove the tumor mass is surgical removal of the primary tumor.
•The surgeon will usually perform a craniotomy. In this operation, the skull cavity is entered by removing a piece of skull bone to reach the brain. The removed bone is reattached at the end of the surgical procedure.
Radiation Therapy
•Radiation therapy plays a leading role in most cancerous brain tumors.
•Benign tumors may also require radiation to control their growth.
Post-surgical beam
• Although the entire tumor appears to have been surgically removed, microscopic tumor cells remain in the surrounding brain tissue and may spread elsewhere or form a new brain tumor.
•The purpose of the beam applied after surgical scraping is to reduce the size of the remaining tumor, stop its growth, or both.
•If the entire tumor cannot be safely removed, irradiation is often recommended after surgery.
Radiation when surgery is not appropriate
•Radiation can be used instead of surgery for tumors that cannot be reached by surgery or that are thought to be particularly responsive to radiation.
Brachytherapy
• It is a method of selectively giving high dose radiation to tumors.
• Independent radioactive sources, often in the form of metal grains or rods, are placed in or near the tumor or tumor pit.
• Placing the radioactive source exactly, mostly with the help of computer, ensures that the healthy tissue is less exposed to the radiation and the dose of the radiation received by the tumor is at the highest level.
•Can be used in combination with brachytherapy, surgery and/or chemotherapy.
Radiation and Chemotherapy
•Using chemotherapy in conjunction with radiation therapy is beneficial for some patients with high-grade tumors.
Chemotherapy may include one or more drugs and is given cyclically (for example, once a day for 3 weeks, followed by a 1-week rest period to make new cells).
• Chemotherapy can be administered orally, intravenously, by another infusion method, or as a layer placed directly into the brain.
Gamma Knife (Sterotactic radiation therapy)
•Gamma blades are actually highly focused, narrow-width cobalt gamma-ray beams.
•An alternative to surgery, this treatment directly destroys brain abnormalities without the need for an incision.
•It is used to treat benign and malignant tumors, metastatic tumors and other vascular disorders.
•Patients have fewer side effects and a shorter recovery time compared to conventional surgery.
•Surgery typically takes between 30 minutes and 3 hours, and most patients can return home the same day.
Side Effects of Treatment
Brain tumor treatment can have side effects. Sometimes side effects are sudden or can develop within a few days. The severity of side effects may be related to the dose of the drug or the length of treatment.
Chemotherapy
Chemotherapy drugs are made to kill fast-growing cells. However, because these drugs circulate throughout the body, they can also affect normal, healthy cells. Damage to healthy tissue causes side effects.
It is unclear whether elderly patients may tolerate chemotherapy less well. Some conditions, such as many medications used by elderly patients and other medical problems, can make cancer treatment more difficult. However, according to one study, elderly cancer patients without medical complications may experience the same level of toxicity and benefit as younger patients.
• Because chemotherapy targets fast growing cells, fast dividing normal cells such as hair follicles, bone marrow and stomach cells are also affected. As side effects, baldness, nausea, vomiting and diarrhea occur.
•Chemotherapy also causes weakness, fever and infection due to anemia; because the immune system is weakened by drugs.
Radiation Therapy
The side effects of radiation therapy for a brain tumor are caused by the effect of radiation on the normal brain tissue surrounding the tumor.
• Patients may experience headache, nausea, vomiting, drowsiness, fever, and tumor-related neurological symptoms may worsen shortly after the initial application of radiation therapy. These symptoms should become progressively milder as treatment progresses.
•Symptoms may worsen within a few weeks to months of starting radiation therapy. These symptoms may indicate that the tumor is progressing. It is necessary to observe these symptoms over a period of time to determine whether the cause is tumor or treatment.
•Depending on the nature of the radiation therapy, late-term radiation effects may develop months or years after the therapy. It is good to keep a record or a diary of any symptoms you experience; so you can discuss the symptoms with the doctor.
Surgery and Other Treatments
•Surgery and radiation can cause edema (swelling) of the brain around the tumor.
• Swelling puts pressure on the surrounding brain tissues and creates headaches, insomnia and other serious problems.
•Your doctor may prescribe steroids to prevent these problems.
• These steroids, also known as corticosteroids, are hormones that occur naturally in the body and are different from the “anabolic steroids” used by bodybuilders.
Steroids do little to kill cells of most tumor types; however, it can relieve some symptoms, such as headaches, and prevent further swelling that can occur with surgery or radiation therapy.
What Can Be Done Against Side Effects
Side Effect
Supportive Care
Anemia
Agents that form red blood cells
Baldness (permanent or temporary)
Wigs, turbans, headdresses, hats
Blood clots
Blood thinners
Constipation
Dense fiber foods, increasing fluid intake, laxatives, stool softeners
Diarrhea
Low fiber foods, high protein foods, increasing fluid intake, avoiding spicy or irritating foods, antidiarrheal medications
Dry mouth
Sugar-free gum, ice chips
Fatigue
Conserving energy, delegating work, giving frequent short breaks, prioritizing activities, good nutrition, adequate calorie take (Average 15 calories per 450g each day. If you’re losing weight, add 500 more), drinking at least 8 glasses of water a day, additional vitamins may be necessary.
Fever/infection
Acetaminophen or ibuprofen for fever; antibiotics for infection.
Loss of appetite
Smaller meals, dietary supplements, appetite enhancers
Mouth sores
From alcohol (including alcoholic mouthwashes), tobacco, salt Avoiding sugary, very hot and very cold foods
Nausea or vomiting
Antiemetics
