Brain tumor is an extremely serious neurological disease and it is very important to know about it. There are various types of brain tumors. They cause various common and specific symptoms depending on their size, type, location, properties and histology. Some tumors destroy the brain and some increase the pressure on the brain. Tumors are one of the main reasons of raised intracranial pressure. Improvement in the surgical techniques and anesthesia, developments in stereo tactic and the micro neurological techniques, remarkable advances in radiation as well as chemotherapy have brightened the future of patients of brain tumors.
Brain tumor is a well-known disease and in a highly developed country like USA approximately 1 lakh people die per year due to it, so the plight of our country is unima-ginable. Out of these many, are cases of cancer -that originate in the brain (primary) like glioma or spread from other parts of the body to the brain. (secondary). Rest of the tumors are relatively benignlike meningioma, pituitary tumor etc. Tumors occurring due to infectious diseases like tuberculoma, abscess, cysticercosis, AIDS etc. also need to be mentioned, though they have different symptoms, diagnosis and treatments.
The symptoms of brain tumors worsen gradually, depending upon the quality, location, size, and type of tumor as well as the severity of the accompanying edema.
1. Increased Intracranial pressure: Increase in the size of the tumor increases the pressure inside the skull (a fixed vault) as well as on the brain, causing symptoms like headache on both sides, nausea-vomiting, blackouts, uneasiness and diplopia. All cases of headache do not indicate brain tumor, only in 1 % of the cases, the cause of headache is brain tumor. But if a healthy individual starts experiencing headaches of increasing intensity, it is essential to get examined by a specialist.
2. The symptoms of brain tumor depend upon the location of the tumor. Therefore there can be a gradual increase of paralysis, speech loss, memory loss or lack of body co-ordination. In some patients there is only a behavioural or a personality change, or loss of bowel or bladder control :
3. Seizures or unconsciousness can also be an important symptom especially if it is accompanied by headache or paralysis; if so immediate investigations are necessary.
4. Sometimes a je,prrjage in the tumor can create an emergency situation for the patient. Usually, only if there is more than one of the above symptoms, the possibility -of a brain tumor in the patient is high.
In most of the cases the following investigations are done to confirm diagnosis of tumor.
1. CT Scan Brain (with contrast): This is a completeinvestigation in itself, but if the tumor is small or is present at the posterior of the brain or the type of the tumor cannot be confirmed on a CT Scan, MRI is required.
2. MRI (Magnetic Resonance Imaging) can be done forconfirmation and is in fact essential in some cases. For accurate diagnosis, sometimes angiography is also needed. If a person has a pace maker or a metal implant in the body MRI cannot be done and in such cases diagnosis has to be based only on CT Scan. Some patients find it difficult to sleep in the MRI chamber for 20 to 30 minutes (claustrophobia). In this condition as well as in small children a sedative or low dose of anesthesia is given and the investigation is carried out.
3. Lumbar puncture: Lumbar puncture is done for theinvestigation of the cerebrospinal fluid. But if the edema in the brain is high this investigation can be dangerous. Therefore in the cases of brain tumor, there is very little scope for this investigation. This investigation is very useful in the diagnosis of the infectious diseases of the brain like meningitis, encephalitis etc.
As mentioned earlier, there are two types of brain tumors, cancerous and the benign (non-cancerous). The brain tumor in the upper part of the brain is called supratentorial. The tumor in the posterior or inferior part of the brain is called infratentorial. These two kinds of cancerous and benign tumors also occur in the spinal cord.
Some cancerous tumors grow very rapidly and are serious, in which the patient’s lite span is only six months to 3 years e.g. malignant glioma (Anaplastic glioma, glioblastomamultifor-me etc....), whereas some cancerous tumors spread slowly like Astrocytoma, Oligodendroglioma etc.
Apart from this there are tumors of lymphoma kind in the brain, which are found mostly in the patients suffering from AIDS. .
The main benign tumors are meningioma, schwannoma and the tumors of the pituitary glands. If these are diagnosed in early stages and operated upon by a capable surgeon the life of the patient can be saved. Not only this, the patient can lead a near normal life, apart from some minor problems and weakness At the most he may have to take drugs for prevention of seizures for the rest of his life. If the cancer spreads from any other part of the body to the brain, it is known as metastatic tumor. Sometimes it so happens, that the symptoms of brain tumor may point out the presence of cancer in some other part of the body, but it is too late by then. Locating the primary cancer and treating it may increase the life span of the patient.
The role of a neurosurgeon is more important in the treatment of a brain tumor than a neurologist. If the tumor is cancerous, the services of an oncologist and radiation physician are also very important. After surgery and other treatments the remaining symptoms like seizures, swelling, paralysis etc. can be attended to from time to time by a neurologist.
There is so much advancement in the treatment of brain tumors that some types of tumors can be stopped from growing, and eventually shrunk by the use of gamma radiation, without opening the brain. If this fails, only then the conventional surgery needs to be done. Many small and superficial tumors can be removed through stereotaxis technique, in which they can be sucked out through a special needle or in some cases, it can be dissolved or cauterized with the help of particular rays. In other cases, the surgeons remove the tumor by opening the brain and spinal cord. Sometimes, intricate surgeries can be performed with the help of a microscope, which do not affect the normal parts of the brain. Due to this the brain operations can go on for six to twelve hours. The advances in anesthesia have helped in reducing the risk of surgery. Fortunately, there are experienced surgeons, good anesthesiologist and excellent techniques available at various places in India and abroad.
After surgery, physiotherapy and necessary medicines are given to cure the symptoms and side effects. If the biopsy of the tumor shows malignancy, chemotherapy, radiation etc are used to try to cure the patient.
The brain tumor is undeniably a serious disease, but majority of non-malignant cases can be cured. For this it is necessary to recognize the early symptoms and analyze them and getting the problem diagnosed and treated by a specialist at the earliest. There is no need to be panicky, about it.