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Brain cancer represents the consequence of abnormal cells that grow or multiply in the brain or skull, ultimately forming a mass or tumor. The brain tumor can be benign (noncancerous and unlikely to spread) or malignant (cancerous and sometime deadly). Regardless of the type, the skull has a limited amount of space meaning that such a mass can affect the function of the brain, which practically controls the entire body. Generally, brain tumors destroy healthy brain cells, increase inflammation and elevate intracranial pressure. A brain tumor that starts within the brain tissue is called primary brain tumor while a tumor that starts in other parts of the body and migrates to the brain is known as secondary (metastatic) brain tumor.
There are several types of brain cancer.
The brain consists of several types of cells. If one type of cell changes its normal characteristics, it eventually leads to a form of brain cancer. More exactly, the cells experience mutations in their DNA, which makes them grow and multiply abnormally while healthy cells die. The result of the growth is a mass or tumor that originates within brain tissue including pineal and pituitary gland, cranial nerves and meninges, hence the name: primary brain cancer. There are different types of primary brain cancer, whose names were given after the part of the brain affected by the cancer. The most common are: gliomas, meningiomas, pituitary adenomas, vestibular schwannomas and medullobrastomas.
Secondary or metastatic brain tumors differ from primary brain tumors by the fact that instead of originating in the brain, the abnormal cells spread from other parts of the body, such as lungs, kidney and breasts through the bloodstream until they reach the brain tissue. The process of cells traveling to the brain is known as metastasis. However, similar to primary brain cancer, the tumors receive their name according to the type of tissue from where cancerous cells originated (metastatic breast cancer for example). This type of cancer is the most common among individuals.
A difference must be made between tumors that contain cancerous cells and tumors that do not present signs of cancer.
Unfortunately, specialists have not found the exact cause of brain cancer. However, they linked various factors including environmental toxins, HIV infection, radiation, smoking and genetics that might explain the abnormal change in brain cells. Even though the cause is not clear, specialists managed to identify factors that could increase the risk of brain cancer.
Even though researchers continue to study all the risk factors that may lead to brain cancer, they have not found yet a successful way to prevent it. For secondary brain tumors, there is hope and we have a strong example. Quitting smoking, which is a vicious habit, minimizes the chances of lung cancer, thus decreasing the risk of cancerous cells in the lungs spreading to the brain tissue.
In terms of symptoms, various factors like the type, location and extent of the tumor, age and health history of the patient intervene. Tumors can react by destroying or compressing normal tissue or increasing the pressure within the skull. The symptoms develop gradually and for this reason, individuals wait too long before consulting a doctor and receiving a diagnosis. That being said, general signs and symptoms include:
The symptoms mentioned above do not necessarily indicate the presence of a brain tumor in comparison to other specific symptoms including:
Any individual that pays attention and recognizes the symptoms listed above must head to the doctor who will perform various tests and procedures in order to establish an accurate diagnosis for brain cancer. First, the individual must give a detailed report containing the personal and family medical history, followed by a physical and a neurological examination, which helps the doctor analyze cranial nerve function, motor coordination, reflexes and balance, mental status and memory skills. Other tests include a lumbar puncture for examining the cerebrospinal fluid, an endocrine evaluation for detecting abnormal levels of hormones, audiometry also knows as a hearing test for identifying possible tumors around the auditory nerve or vestibular schawannoma and a visual field test for detecting vision loss. Considering the various types of brain tumors, different doctors including a neurosurgeon, radiologist and oncologist may take part in the diagnosis or treatment process.
If doctors cannot reach to an accurate diagnosis just by using the scans, they perform a biopsy with the purpose to determine the specific type of tumor. This procedure consists of taking a small amount of tumor or a sample of abnormal tissue for further testing. A pathologist analyzes the tissue under a microscope. The doctor can perform the biopsy using a needle that he must insert into a hole drilled into the patient’s skull, which represents a separate diagnostic procedure or while removing the brain tumor, then becoming a part of the open surgical procedure. Stereotactic biopsies are more complex than needle biopsies and doctors use them for tumors located in critical parts of the brain.
The treatment for brain cancer depends on several factors, which refer to the characteristics of the tumor, more exactly, type, location, size, extent and the patient’s age. Depending on the stage of cancer, the treatment may have the goal to relieve the symptoms or cure the patient. Doctors may choose to combine treatments for more efficiency. The main goal, however, is the removal of the tumor in its entirety or at least, as much as possible with the help of surgery in order to eliminate the possibility of recurrence. If doctors cannot remove the entire tumor using surgery, they resort to other treatment methods including chemotherapy and radiation therapy. In addition, they recommend medications meant to control side effects caused by the brain tumor like anticonvulsant medications against seizures, Furosemide against intracranial pressure and corticosteroid medications against inflammation.
Surgery: Doctors choose surgery as a treatment only when they are certain that they have the ability to reach the tumor without affecting or injuring vital parts of the brain. If they succeed to remove a large part of the tumor, this will release the intracranial pressure. Next, they will use radiation and chemotherapy for the remaining cancerous cells.
Radiation: Radiation therapy treats the tumor using high-energy rays, which impede cancerous cells to divide and reproduce. Doctors use this procedure with the purpose to protect healthy normal cells. The patient does not feel the effects of radiation immediately, but in time. Apparently, aggressive brain tumors have a quicker response to radiation. Doctors have two options: use a machine that targets the tumor with high-energy rays from outside the patient’s body or place radioactive material inside the tumor cavity after removing the tumor.
Chemotherapy: The patient must take drugs like Temozolomide, Carmustine and Lomustine in order to interrupt cell division. The main downside of this method is that both cancerous and healthy cells are affected. Side effects usually include hair loss, vomiting and nausea. For this reason, patients must take breaks during the period of medical administration so the body can rebuild healthy cells.
Before leaving the hospital, the doctor must discuss with the patient and his family about home care needs while keeping in mind his symptoms. For instance, if the patient has troubles walking, a cane, a walker or even a wheelchair represents a great help. On the other hand, if the patient presents changes in mental status, then a plan must be developed for his special needs. Driving or other activities that require high cognitive functions will most likely be eliminated from the patient’s routine because of possible seizures. During recovery, the spiritual and emotional support of family and friends is very important for relieving the patient’s pain. Specialists like nurses, counselors and spiritual caregivers might approach the patient in order to provide their help.
Brain Cancer Rehabilitation: Because tumors affect vision, speech and control movement, rehabilitation becomes necessary for the patient. Indeed, the brain has the power to heal itself after the treatment, but this requires time. Therefore, a neuropsychologist intervenes in order to assess the negative effects caused by the brain cancer and plan every step of the rehabilitation process. During that process, he evaluates the patient’s cognitive abilities, personality and daily behavior. He might use physical, speech and occupational therapy to help the patient regain lost functions.
Brain Cancer Recurrence: The response of a tumor to the doctor’s treatment, its stagnation or recurrence at the end of the treatment varies according to the tumor type and location. Doctors consider it a recurrent tumor if continues to persist after the treatment, if grows back after being destroyed by the treatment or another tumor takes the place of the original one. If the cancer process stagnates, it means that cancerous cells cannot grow and replace healthy cells anymore. Doctors cannot predict if a specific tumor may recur or not and for this reason, they continue to use CT or MRI scans on patients one or two times a year following the treatment.