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Brain tumor – what are the symptoms and how to treat this disease? At the turn of October and November, we celebrated the International Brain Cancer Awareness Week. At that time, various initiatives were undertaken all over the world to disseminate knowledge about these diseases and the situation of patients. Attention was drawn to the need for social education in the field of imaging diagnostics and currently available treatment methods.
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According to the statistics of the International Agency for Research on Cancer, Poland ranks 4th in terms of the incidence of brain tumors and this is, unfortunately, a growing tendency. Every year, nearly 3000 people in our country learn about a malignant tumor developing in their brain. Over 9 out of 100 people are diagnosed with benign tumors annually. Brain tumors are a very important problem of pediatric oncology in Poland – it is the second most common (after leukemia) childhood malignant neoplasm, accounting for approximately 20 percent of childhood cases. Against the background of these meaningful numbers, education in the knowledge of the symptoms of brain tumors seems to be extremely important. Their awareness will allow you to seek medical help early, make a quick diagnosis and take advantage of modern methods of treatment.
Brain tumor – Disturbing signals
Every brain tumor, regardless of the degree of malignancy, is dangerous because of its location. A developing tumor puts pressure on important centers in the brain that control the body’s functions. Clinical manifestations of brain tumors may vary. Sometimes they are secretive, lasting for years, and sometimes they intensify rapidly after disclosure, even within a few weeks. All brain tumors have two kinds of symptoms: general and local.
Brain tumor – General symptoms result from the location of the tumor in the cavity of the skull, which is a bony, inextensible flask surrounding the brain. This means that the increase in even a small additional volume inside it leads to an increase in intracranial pressure and the appearance of cerebral edema. This process results in headaches. Initially, due to the widespread occurrence of headaches, they are usually underestimated. The patient takes a painkiller and experiences relief. Also, the doctor at the present stage of the disease may not suspect the presence of a tumor in the patient. One thinks more about exhaustion or migraine. However, as time goes on, the symptoms get worse. The pains are becoming more frequent and intense, there is also another symptom – nausea. At first, the patient suspects that he has made a nutritional error or that something has just hurt him. However, the intensity of nausea increases, and vomiting may also occur, which is already a very serious symptom of increased intracranial pressure. Nausea and vomiting usually appear in the morning after waking up while the patient is still in bed. The increasing tightness in the cranial cavity caused by the presence of a tumor over time leads to sleepiness. The sick person stays in bed longer and longer. Another symptom is onset disturbance of consciousness. Initially, they are a kind of confusion, a distortion of orientation as to time, place and the surrounding people. Then the disturbance of consciousness passes into disorders consciousness, and in the end stage of the disease – v coma.
At some stage of the disease, they join the general symptoms local symptoms (focal length). Their scope and type depends on the place where the tumor grows, and more precisely on which part of the brain is oppressed by the tumor and what functions of the organism it is responsible for. These can be very different neurological symptoms, with varying degrees of severity.
For example, tumors located in the vicinity of the cerebral cortex, by irritating it, can lead to epileptic seizures ranging from tremors or numbness of a finger or hand to general convulsions of the entire body. Tumors located in the vicinity of the motor cortex cause paresis, usually limited to the upper or lower limb (paresis is the inability to perform the intended movement). Tumors in a different position can cause speech disorders, reduced visual field, double vision or drooping eyelid, pain in the half of the face, sounds and noise in the ear.
In turn, tumors located near the brainstem can lead to facial asymmetry, choking, or even swallowing disorders, due to the paralysis of the nerves responsible for the functioning of the muscles in this area of the body.
Brain tumors developing in the hypothalamic-pituitary axis interfere with the secretion of hormones that stimulate the reproductive system. Tumors of the pituitary gland in women can lead to amenorrhea, infertility due to disturbed ovulation cycle and leakage of milk-like secretions from the breasts. In other cases, regardless of gender, they lead to gigantism, i.e. unrestrained growth of the patient, or to its arrest. Tumors oppressing the circulation of the cerebrospinal fluid cause hydrocephalus, while tumors that develop in the posterior cavity of the skull are manifested by imbalance, difficulties in maintaining a standing position and inability to perform precise movements, e.g. holding a pen and writing efficiently.
Brain tumor neurology is an extremely broad field and as complex as the anatomy and physiology of the brain itself. Therefore, each of the above symptoms should make the patient seek medical help and undergo diagnostic tests.
Imaging tests to detect brain tumors
Any cancer detected early is easier to treat. Early diagnosis is also very important in the case of brain tumors. Imaging tests are used to detect them: computed tomography (CT) and magnetic resonance imaging (MR). The introduction of computed tomography and magnetic resonance imaging to clinical practice significantly increased the possibilities of early, non-invasive detection of brain tumors. The sensitivity of diagnostic methods, resulting mainly from the higher and higher resolution of imaging – both linear and contrast – allows to notice smaller and smaller changes in the brain. The most accurate examination of the brain is considered to be magnetic resonance imaging, which not only helps in planning the extent of brain tumor resection, but also, thanks to the appropriate software, enables the performance of a biopsy or surgery under the control of resonance imaging.
Treatment of brain tumors
Treatment of brain tumors is combination therapy. Depending on the needs, surgery, radiotherapy or chemotherapy are used. All of the above-mentioned forms of treatment are very often used or some of them are combined. The therapy is selected individually, taking into account the general health of the patient and the degree of malignancy of the neoplasm. For benign tumors where complete tumor removal is possible, surgery alone may suffice. Often, however, surgery is complemented by radiation therapy. Napromienianie it is intended to prevent a tumor from growing back as well as kill any cancer cells that have not been removed. Irradiation is even a must in the case of malignant tumors. Here, surgical treatment is usually non-radical, as it is impossible to remove all the malignant cells that make up the tumor from the brain without damaging the brain tissue. Therefore, the procedure is performed in a way that spares the tumor surroundings as much as possible. Some neoplasms, e.g. located in close proximity to nerves, do not qualify for surgery at all.
Radiotherapy is a very important element of treatment and can take various forms. Most often, it is fractionated radiation therapy aimed at the area of the brain tumor, which lasts for several weeks. In other cases, especially with multiple metastatic tumors, whole brain irradiation is used. The most advanced technology in this area is spatial, three-dimensional irradiation, i.e. radiosurgery.
Also brachytherapy is used, i.e. a form of intracerebral radiation. This method involves implanting radioactive isotopes into the tumor that irradiate the tumor from the inside. Depending on the isotope used, it acts on the tumor for a longer or shorter time, after which its radioactivity disappears.
Despite the involvement of highly advanced technologies in the treatment process, malignant tumors often resist treatment and grow back. For this reason, the third form of therapy is also used as it is chemotherapy. Despite modern technologies, involved in both the treatment process and diagnostics, the race with cancer is often lost, which is why new, more and more effective therapies in the fight against brain tumors are still being sought.
Neuroradiosurgery and gamma knife
More than 40 years ago, Professor Lars Leksell developed a revolutionary new non-invasive treatment for brain tumors called Gamma Knife® (from Eng. “gamma knife”). Today, more than 50 patients worldwide are treated each year with this safe and precise method. From this year on, this method of treatment is also available in Poland.
Gamma Knife® it is not a knife in the literal sense of the word because the surgeon does not make any cuts in the skull bone or in the operated brain. Instead of an invasive procedure that requires opening the skull, 192 beams of cobalt radiation are directed to a selected area of the brain (the so-called shield). Single beams of gamma rays carry little energy and do not damage the tissue they pass through, and by focusing in one place, their energy is added up, destroying cancer cells. Gamma Knife technology® largely replaces classical neurosurgery and allows operations to be carried out close to sensitive anatomical structures. Many types of tumors, vascular lesions and functional brain diseases can be treated in this way. The limitation of the method is the size of the tumor – usually up to 4 cm in diameter. Illumination is generally from 20 minutes to 2 hours. The patient does not feel anything during the procedure and can usually return home and daily activities on the same day. With Gamma Knife® there is no need for recovery, which is necessary after classic surgery.
In Poland, only in one center – Allenort Radiosurgery Center in Warsaw – there is a possibility of treatment with this neurosurgical technique. The first treatments with Gamma Knife®, still on a commercial basis, were performed in March 2011. Since August 5, 2011, treatment has been financed by the National Health Fund. Until the beginning of October 2011, 94 treatment procedures were carried out, which were used by patients from 15 provinces. The youngest patient was 16 years old and the oldest patient was 83 years old. Until now, the most frequently recognized and treated lesions were meningiomas tumors (54 cases) and neuroblastomas (11 cases). Also, 7 treatments of irradiation of multiple brain tumors were performed. Currently, over 200 patients who have been qualified for the Gamma Knife procedure are waiting for treatment®. The Allenort Radiosurgery Center in Warsaw is able to perform approximately 1 procedures per year.
According to reviews Professor Mirosław Ząbek, an outstanding neurosurgeon, director of the Allenort Radiosurgery Center in Warsaw, Gamma Knife offers amazing therapeutic possibilities. Before starting the procedure, surgeons first plan everything on the computer and explain every detail. Only then do they begin the operation – bloodless, painless and extremely precise. 192 beams of cobalt rays replace the scalpel. The tumor necrosis after irradiation. The patient may return home on the same day and then report only for a check-up. Depending on the size of the tumor, the necrosis process takes several months or longer. Some tumors disappear completely, others shrink. The Gamma Knife invention allows you to avoid all the inconveniences of traditional surgery: the skull is not opened, no anesthesia is administered, and postoperative pain is avoided. Infectious complications and a long stay in the hospital are also avoided. The treatment of brain tumors with the Gamma Knife device is carried out as part of one-day surgery.
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