A brain tumor. What are the symptoms and what causes it?

A brain tumor, sometimes incorrectly referred to as brain cancer, is the abnormal growth of cells inside the brain. A brain tumor can be malignant (cancerous) or benign (non-cancerous) and can affect children as well as adults. Tumors can grow from the brain tissue itself, or as cancer from other parts of the body, it can spread to the brain. Treatment options vary depending on the type of tumor, size and location.

1. There are 150 types of brain tumors. It is estimated that every third is cancerous
2. The symptoms of the disease depend on where the tumor is located
3. These recurring with different types of tumors include e.g. headaches, visual and hearing disorders, confusion
4. Find out what causes brain tumors and how they are treated
5. You can find more such stories on the TvoiLokony home page

What is a brain tumor?

A brain tumor is an abnormal growth of cells in or around the brain. Together, tumors in the spine and brain tumors are called central nervous system (CNS) tumors. More than 150 different brain tumors have been documented and can be divided into malignant (cancerous) or benign (non-cancerous) tumors. Some tumors grow rapidly while others grow slowly. About a third of brain tumors are thought to be cancerous. However, whether brain tumors are cancerous or not, they can affect brain function and health if they grow large enough to compress surrounding nerves, blood vessels, and tissue.

At this point it should be noted that brain tumors can also be divided into primary and secondary (metastatic) tumors. Primary brain tumors include tumors that originate in the tissues of the brain or in the immediate vicinity of the brain. Primary tumors are classified as glial (made up of glial cells) or non-glial (developing on or in brain structures including nerves, blood vessels, and glands). Metastatic brain tumors include tumors that arise in other parts of the body (such as the breast or lungs) and migrate to the brain, usually through the bloodstream. Metastatic tumors are considered malignant tumors.

Brain tumor – types

As mentioned, researchers have identified more than 150 different brain tumors. Two groups can be mentioned among them:

Benign brain tumors

Struniak (Latin. my attic) – a benign, slow-growing brain tumor that most often occurs in people aged 50 to 60. Their most common locations are the base of the skull and the lower spine. Although these tumors are benign, they can invade adjacent bone and put pressure on nearby nerve tissue. These are rare tumors that account for only 0,2 percent. all primary brain tumors.

Skull throat (Latin. craniopharyngioma) – also known as Erdheim’s tumor, it is usually a benign but difficult to remove tumor. This is because it is located near critical structures deep in the brain. It usually comes from part of the pituitary gland (a structure that regulates many of the body’s hormones), so almost all patients will require hormone replacement therapy.

Meningioma (Latin. meningiomas) – the most common benign intracranial neoplasm, accounting for 10 to 15 percent of all brain tumors, although a very small percentage of this type of tumor is malignant. This tumor arises from the meninges, the membrane-like structures that surround the brain and spinal cord.

Pituitary adenoma (lat. adenoma hypophysis) – the most common intracranial tumor after gliomas, meningiomas and schwannomas. The vast majority of pituitary adenomas are benign and fairly slow growing. Even malignant pituitary tumors rarely spread to other parts of the body. Adenomas are by far the most common disease affecting the pituitary gland (lat. hypophysis). It often affects people in their 30s or 40s, although it is also diagnosed in children. Most of these tumors can be successfully treated.

Szyszyniak (Latin. pineocytoma) – these are generally benign changes derived from the pineal gland cells (Latin. pineal body), mainly in adults. They are most often well-defined, non-invasive, homogeneous, and slow-growing.

Schwannom (Latin. neurilemmoma) – also known as neuroblastoma, is a common benign brain tumor that occurs in adults. It is made along nerves, which are made up of cells that normally provide ‘electrical isolation’ to nerve cells. Schwannomas often displace the rest of the normal nerve rather than infiltrate it. The most common type of this tumor is the vestibulocochlear nerve schwannoma (Latin. vestibular schwannoma) originating in the eighth cranial nerve or the vestibulocochlear nerve that runs from the brain to the ear. Although these tumors are benign, they can cause serious complications and even death if they grow and put pressure on the nerves and eventually the brain. Other locations include the spine and, less commonly, along the nerves that extend to the extremities.

Embryonic hemangioma (lat. haemangioblastoma) – a slowly growing tumor, usually located in the cerebellum (lat. cerebrum). It comes from blood vessels, can be large, and is often accompanied by a cyst. This tumor is most common in people between the ages of 40 and 60 and is more common in men than in women.

Malignant brain tumors

The most common type of brain tumor are gliomas (Latin. glioma) and account for almost 80 percent. malignant brain tumors. They are formed from glial cells. These cells can be divided into astrocytes, ependymal cells and oligodendrocytes.

Glial tumors include:

Astrocytomas (Latin. astrocytomata) – the most common of all, they account for about half of all primary brain and spinal cord tumors. Astrocytomas develop from stellate glial cells called astrocytes. They can occur in many parts of the brain, but most often appear in the forebrain (Latin telencephalon). People of all ages can develop astrocytomas, but they are more common in adults, especially middle-aged men. Astrocytomas at the base of the brain are more common in children or younger people and are responsible for most brain tumors in children. In children, most of these tumors are considered low-grade tumors, while in adults most of them are high-grade.

Ependymoma (Latin. ependymoma) – is formed as a result of the tumor transformation of cells in the lining of the ventricular system (Latin systema ventricularis) and accounts for two to three percent of all brain tumors. Most of the ependymomas are well defined.

Glioblastoma multiforme (lat. glioblastoma multiforme) – the most invasive type of glial tumor. These tumors tend to grow rapidly, spread to other tissues, and have a poor prognosis. They can be made up of several different types of cells, such as astrocytes and oligodendrocytes. Glioblastoma is more common in people between the ages of 50 and 70 and is more common in men than in women.

Medulloblastoma (lat. medulloblastoma) – usually arises in the cerebellum, most often in children. They are high-grade tumors but usually respond to radiation and chemotherapy.

Skapodrzewiak (Latin. oligodendroglioma) – is derived from cells that produce the myelin sheath, which ensures mechanical protection and is an electrical insulator of the axon.

Malignant rhabdoid tumor (lat. malignant rhabdoid tumor) – a rare, very aggressive tumor that tends to spread throughout the central nervous system. It often appears in many places in the body, especially in the kidneys. It is more common in young children but can also occur in adults.

The causes of the formation of a brain tumor

Brain tumors are thought to arise when certain genes on a cell’s chromosomes are damaged and no longer function properly. These genes normally regulate the rate at which a cell divides (if it divides at all) and repair genes that in turn repair defects in other genes, as well as genes that should cause the cell to self-destruct if the damage is beyond repair. In some cases, a person may be born with partial defects in one or more of these genes. Environmental factors can then lead to further damage. In other cases, environmental damage to genes may be the only cause. It is not known why some people develop brain tumors and others do not.

When a cell divides rapidly and its internal growth controls are damaged, the cell can eventually develop into a tumor. Another line of defense could be the body’s immune system, which would optimally detect the abnormal cell and destroy it. However, tumors can produce substances that block the immune system from recognizing the abnormal cancer cells and eventually overpower all internal and external factors that stop them growing.

A rapidly growing tumor may require more oxygen and nutrients than the local blood supply intended for normal tissue can provide. Tumors can produce substances called angiogenesis factors that promote the growth of blood vessels. New vessels as they grow increase the nutrient delivery to the tumor and eventually the tumor becomes dependent on these new vessels. Research is being done in this area, but more extensive research is needed to translate this knowledge into potential therapies.

See also: «I struggled with a brain tumor because I wanted to live to see my son born. Today I want to help patients with glioblastoma “

Brain tumor – symptoms

Symptoms vary depending on the location of the brain tumor. Among those that can accompany various types of brain tumors are:

1. headache which may increase in the morning or wake you up at night;
2. seizures or convulsions;
3. difficulty thinking, speaking, or articulating words;
4. personality changes;
5. weakness or paralysis of one part or one side of the body;
6. loss of balance or dizziness;
7. blurred vision;
8. hearing impairment;
9. numbness or tingling of the face;
10. nausea and vomiting, and difficulty swallowing;
11. confusion.

Depending on the location of the brain tumor, different symptoms can be listed.

1. Frontal lobe (pour. frontal lobe): behavioral and emotional changes; impaired judgment or motivation; changes in the sense of smell or loss of vision; paralysis on one side of the body; decreased mental abilities and memory loss.
2. The parietal lobe (pour. parietal lobe): speech disorders; writing, drawing, or naming problems; problems with recognizing the environment; spatial disorders and eye-hand coordination.
3. Occipital lobe (pour. occipital lobe): loss of sight in one or both eyes, narrowed field of view; blurred vision, hallucinations.
4. The temporal lobe (pour. temporal lobe): difficulties in speaking and understanding the language; problems with short-term and long-term memory; increased aggressive behavior.
5. The brain stem (lat. brain stem): behavioral and emotional changes, difficulty speaking and swallowing, drowsiness, hearing loss, muscle weakness on one side of the face (e.g. tilting the head, crooked smile), muscle weakness on one side of the body, uncoordinated gait, drooping eyelid or double vision and vomiting.
6. The pituitary gland: increased secretion of hormones (Cushing’s syndrome, acromegaly), menstrual arrest, abnormal milk production, decreased libido.

Brain tumor – diagnosis

Advanced imaging techniques can pinpoint brain tumors. Diagnostic tools include standardized computed tomography (CT) or computerized axial tomography (CAT) and magnetic resonance imaging (MRI). Other MRI sequences may help the surgeon plan a tumor resection based on the location of normal nerve pathways in the brain. Intraoperative MRI is also used during surgery to biopsy the tissue and remove the tumor.

Magnetic resonance spectroscopy (MRS) examines the chemical profile of the tumor and determines the nature of the lesions seen on MRI. Positron emission tomography (PET scan) can help detect recurring brain tumors.

Sometimes the only way to make a definitive diagnosis of a brain tumor is through a biopsy. The neurosurgeon performs a biopsy and the pathologist makes a final diagnosis by determining if the tumor appears benign or malignant and assessing it accordingly. In the diagnosis of a brain tumor, a lumbar puncture is also performed, in which the doctor uses a small needle to remove the cerebrospinal fluid from the area of ​​the spine. The fluid is then tested in the laboratory to find cancer cells. Healthcare professionals use this procedure when they suspect that a tumor has attacked the layers of tissue that cover the brain.

See also: A woman lives without a piece of the brain. “Doctors were annoyed with how I functioned”

Brain tumor – treatment

Brain tumors (whether primary or metastatic, benign or malignant) are usually treated with surgery, radiation therapy, and / or chemotherapy, either alone or in a variety of combinations. While it is true that radiotherapy and chemotherapy are used more frequently for malignant, residual or recurrent tumors, decisions about which treatment to use are made on a case-by-case basis and depend on many factors. There are risks and side effects associated with any type of therapy.

Brain tumor and surgical treatment

It is generally accepted that complete or nearly complete surgical removal of the brain tumor is beneficial to the patient. However, it is important to know that neurosurgeons face the challenge of removing as much of the tumor as possible without damaging the brain tissue important to the patient’s neurological functions (such as the ability to speak, walk, etc.). Normally, the doctor opens the skull through craniotomy to access the tumor and remove as much of it as possible. An external ventricular drain (EVD) may remain in the fluid cavities of the brain during surgery to drain normal cerebral fluid while the brain recovers from surgery.

Another frequently performed procedure before craniotomy is a stereotaxic biopsy. This procedure allows doctors to extract the tissue for an accurate diagnosis. Usually, a special stereotaxic frame is attached to the patient’s head, followed by an MRI or CT scan with a contrast agent to determine the location of the lesion. In the next step, the doctor drills a hole in the patient’s skull to allow access to the abnormal area.

Brain tumor and radiation therapy

Radiation therapy uses high-energy ionizing radiation to kill cancer cells and abnormal brain cells, and to shrink tumors. Radiotherapy can be a treatment option if the tumor cannot be successfully treated with surgery. When it comes to radiotherapy, the following can be mentioned:

Proton Beam Treatment, which uses a specific type of radiation where protons are directed specifically at the tumor. The advantage of this method is that less tissue surrounding the tumor is damaged.

External beam radiotherapy (EBRT) in turn uses a variety of radiation beams to obtain conformal coverage of the tumor while limiting the dose to the surrounding normal structures. It is worth adding that with the use of modern methods, the risk of long-term radiation injuries is very low.

Stereotactic Radiosurgery is a technique that focuses radiation using many different beams on a target tissue. This method causes less damage to the tissues adjacent to the tumor.

Yet another method is brachytherapy, which involves surgically placing radioactive sources within a cancerous tumor in order to heal it.

There is currently no data to suggest that one technique is better than the other in terms of clinical outcomes, and each has its own advantages and disadvantages.

Brain tumor and chemotherapy

Chemotherapy is generally thought to be effective for certain childhood tumors, lymphomas, and some oligodendrogliomas. Unfortunately, overall survival in patients with the most malignant primary brain tumors is only about 20%. Moreover, doctors cannot readily predict which patients will benefit from treatment. As a result, some specialists decide not to use chemotherapy due to the potential side effects (scarring of the lungs, weakening of the immune system, nausea, etc.).

Chemotherapy works by causing cell damage that is better repaired by healthy tissue than by cancerous tissue. Chemotherapy resistance can include the survival of cancerous tissue that does not respond to the drug, or the inability of the drug to pass from the bloodstream to the brain. There is a special barrier called the blood-brain barrier between the bloodstream and the brain tissue. Some researchers have tried to improve the effect of chemotherapy by breaking this barrier or injecting the drug into the tumor or brain. Another class of drugs is not intended to kill cancer cells, but rather to block further tumor growth.

Brain Tumor and Other Therapies

Many types of new therapies are currently being investigated, especially for tumors for which the prognosis is generally poor with existing conventional therapies. However, it is not known if these therapies will be effective. They include:

1. immunotherapy – this is a type of treatment that uses the body’s immune system to fight cancer. Therapy is mainly about stimulating the immune system to do its job more efficiently.
2. targeted therapy – thanks to which drugs target specific characteristics of cancer cells without harming healthy cells. Your doctor may recommend targeted therapy if you have trouble tolerating the side effects of chemotherapy, such as fatigue and nausea.
3. gene therapy – which involves the introduction of foreign DNA or RNA molecules into a cancer cell or surrounding tissue to cause cell death or slow tumor growth.

Combinations of treatments may also be able to improve patient outlook while reducing unwanted side effects.

Brain tumor – rehabilitation after treatment

Since brain tumors can develop in parts of the brain that control motor skills, speech, vision, and mental functions, rehabilitation may be an essential part of recovery.

While the brain can sometimes heal itself from a healing-related injury, it does take time and patience. A neuropsychologist can help patients assess the changes caused by a brain tumor and develop a rehabilitation plan. The neuropsychological assessment assesses the patient’s emotional state, daily behavior, cognitive (mental) abilities, and personality.

Depending on your needs, your doctor may refer you after treatment for a brain tumor for:

1. physiotherapy to help regain lost motor skills or muscle strength;
2. occupational therapy to help you return to your normal daily activities, including work, a brain tumor, or other illness;
3. speech therapy with speech-language specialists (speech therapists) to help you if you have speech difficulties;
4. tutoring for school-age children to help the youngest cope with changes in memory and thinking after brain tumor treatment.

Also check: What is neuropsychology?

Brain tumor – relapse

How well a tumor responds to treatment, remains in remission, or comes back after treatment depends on the specific tumor type and location. A recurrent brain tumor can be a tumor that persists after treatment, that grows back some time after it has been destroyed by treatment techniques, or a new tumor that grows in the same place as the original one.

When a brain tumor is in remission, cancer cells stop multiplying or growing. The periods of remission vary. It is generally accepted that benign tumors recur less frequently than malignant tumors. Because it is impossible to predict if or when a particular tumor may recur, lifelong MRI or CT scan monitoring is essential for people being treated for a brain tumor, even of a benign type.

Brain Tumor and Palliative Care

Palliative care is often associated with ‘going away’ and a hospice. Although a hospice can be part of some palliative care plans, it is only one part of it. Both are designed to provide comfort, but palliative care often begins with diagnosis and can be continued throughout and beyond treatment. The goal is to improve the patient’s quality of life.

Palliative care will address the symptoms of a serious illness as well as the side effects of treatments used to treat the disease, such as nausea, pain, anxiety, insomnia, anorexia and fatigue.

Brain tumor – prevention

Currently, a brain tumor cannot be prevented. You can reduce the risk of developing a brain tumor by avoiding environmental hazards such as smoking and overexposure to radiation.