“You could set your watch by my walking into class for the lecture,” were Biju’s first words at the consultation, ‘but the last few weeks, I have been getting confused regarding time. I reach late for my classes. Sometimes I forget my way home. But my memory is otherwise fine.”
The symptoms were not very dramatic, but the diagnosis after tests and scan was. It was a brain tumor. This is how most brain tumors start, affecting memory and the brain’s capacity to process information. Other symptoms include headaches, seizures, loss of touch and movement control, sudden vision or hearing loss, unexplained fatigue, depression and behavioural change.
The brain directs the things we choose to do like walking and talking, and the things our body does without thinking, like breathing. The brain is also in charge of our senses of sight, hearing, touch, taste and smell, memory, emotions, and personality. Cancer begins in cells, the building blocks that make up tissues which form the organs of the body. Normally, cells grow and divide to form new cells as the body needs them. When this orderly process goes wrong, cancer results and these extra cells form a mass of tissue called a growth or tumor which can be benign or malignant.
Benign brain tumors can usually be removed, and they don’t normally recur. Cells from benign tumors do not invade tissues around them or spread to other parts of the body. However, benign tumors can press on sensitive areas of the brain and cause serious health problems or even become life threatening. In rare cases, a benign brain tumor may become malignant.
Malignant brain tumors are more serious and are often life threatening. They usually grow rapidly and crowd or invade the surrounding healthy brain tissue. Sometimes, they may spread to other parts of the brain, to the spinal cord, or even to other parts of the body. On occasion, the tumor may be contained within a layer of tissue. Or the bones of the skull or another structure in the head may confine it. This kind of tumor is called encapsulated.
Tumors of the brain are not very common, with an incidence of around 12 cases per 100,000 population. But it is the eight leading cause among cancer deaths, overtaking leukemia. Due to it’s location and effects on the brain, it has a significant effect on the quality of life for the patient.
The causes of brain tumors are not very clearly known. Lymphomas that begin in the brain when the immune system is weakened have been linked to the Epstein Barr virus. The role of radiation from power lines, cell phones, wireless devices, etc. is debatable and has not been proven to be a risk factor. Some inherited conditions like neurofibromatosis and Turcot syndrome increase the risk of brain tumors.
Brain tumors can arise in any age group. But the outcome need not always be grave. Not all tumors are malignant and many of them are curable if they are detected early and treated correctly. It is to promote early detection and treatment that June 8th is celebrated as World Brain Tumor day. This day initiated by Deutsche Hirntumorhilfe, the German Brain Tumor Association, in the year 2000 with the aim of directing public attention towards this disease and promoting early detection for a better chance at treatment and survival. It is now observed in many countries around the world.
Identification of the disease at an early stage is the most critical aspect in the treatment. Warning signs like early morning headaches with vomiting and blurring of vision, late onset (after 40 yrs. of age), and seizures alert the treating physician about the possibility of an underlying brain tumor. Imaging including a CT and or an MRI brain needs to be taken to confirm the diagnosis. For any lesion in the brain, assessment will be done to see if the lesion can be removed safely without causing significant damage to normal tissue around.
The aim of treatment earlier was to attempt to preserve life of the patient as much as possible. This has now been modified to preservation of function and improving or stabilizing quality of life. The treatment involves specialists across multiple departments working together – Neurosurgery, Medical and Radiation Oncology, Physiotherapy, Critical care specialists, Clinical Psychology, Pain and palliative specialists and others.
Patient’s safety and functional preservation- which leads to a better quality of life is considered of paramount importance. In malignant lesions and in certain non-cancerous lesions where the surgeon is forced to leave behind residual tumors to preserve function, adjuvant therapy like radiotherapy or chemotherapy is given.