Brain tumour

A brain tumour is a growth of abnormal cells within the brain or the surrounding structures. Tumours can be classified as benign (non-cancerous) or malignant (cancerous). Benign tumours typically grow slowly and have well-defined borders, while malignant tumours are aggressive, often spreading to nearby tissues.

Brain tumours can affect anyone, regardless of age, gender, or ethnicity. They can cause a wide range of symptoms depending on their size, type, and location within the brain. Early detection and treatment are crucial for improving outcomes and quality of life.

A brain tumour is a mass or growth of abnormal cells in the brain. The brain and spinal cord are part of the central nervous system, and any abnormal growth in these areas is termed a central nervous system (CNS) tumour. Brain tumours can be primary, originating in the brain, or secondary (metastatic), spreading from other parts of the body.

Worldwide

Globally, the incidence of primary brain tumours varies by region. A systematic review and meta-analysis found the overall incidence rate to be approximately 10.82 per 100,000 person-years. However, this rate can vary significantly depending on geographical location, age, and other factors.

India

In India, the occurrence of brain tumours is estimated to be between 5 to 10 per 100,000 population, with an increasing trend. The International Association of Cancer Registries (IARC) reports that over 28,000 cases of brain tumours are diagnosed annually in India, with more than 24,000 deaths attributed to the disease each year. Notably, approximately 20% of these cases involve children.

Brain tumours are classified based on the type of cell they originate from and their location. Common types include:

• Gliomas: Tumours that arise from glial cells, which support and protect nerve cells. Subtypes include:
  
  • Astrocytomas
  • Oligodendrogliomas
  • Ependymomas
• Meningiomas: Tumours that develop from the meninges, the protective layers surrounding the brain and spinal cord.
• Pituitary Tumours: Tumours that occur in the pituitary gland, which regulates hormone production.
• Medulloblastomas: Malignant tumours typically found in children, originating in the cerebellum.
• Schwannomas: Tumours that develop from Schwann cells, which produce the myelin sheath covering nerves.
• Metastatic Brain Tumours: Tumours that have spread to the brain from other parts of the body.

The exact cause of most brain tumours remains unknown. However, several factors may increase the risk:

• Genetic Mutations: Changes in DNA can lead to uncontrolled cell growth. Some inherited conditions, such as neurofibromatosis, increase the risk of developing brain tumours.
• Radiation Exposure: Previous radiation therapy to the head can increase the risk of developing brain tumours later in life.
• Family History: A family history of brain tumours may increase the risk, although most brain tumours occur in individuals with no family history.
• Age and Gender: Certain types of brain tumours are more common in specific age groups and genders. For example, glioblastomas are more common in older adults, while medulloblastomas are more common in children.
• Environmental Factors: Exposure to certain chemicals or toxins may increase the risk, although evidence is limited.

Symptoms of a brain tumour can vary widely depending on the tumour's size, type, and location. Common symptoms include:

• Headaches: Often worse in the morning or with sudden movements.
• Seizures: New-onset seizures in adults or children.
• Cognitive or Personality Changes: Memory problems, confusion, or changes in behaviour.
• Nausea and Vomiting: Especially in the morning.
• Vision or Speech Problems: Blurred vision, double vision, or difficulty speaking.
• Weakness or Numbness: In limbs or other parts of the body.
• Balance or Coordination Issues: Difficulty walking or performing tasks that require fine motor skills.

Diagnosing a brain tumour involves several steps:

1. Neurological Examination: A doctor will assess vision, hearing, balance, coordination, strength, and reflexes.
2. Imaging Tests:
   
   • Magnetic Resonance Imaging (MRI): Provides detailed images of the brain and can help identify the location and size of a tumour.
   • Computed Tomography (CT) Scan: Useful for detecting bleeding or calcifications.
   • Positron Emission Tomography (PET) Scan: Can help determine the activity level of a tumours
3. Biopsy: A sample of tumours tissue is removed and examined under a microscope to determine if it is benign or malignant.
4. Lumbar Puncture (Spinal Tap): In some cases, cerebrospinal fluid is examined for cancer cells.
5. Blood Tests: To assess overall health and detect markers that may indicate the presence of cancer.

Treatment options depend on the type, size, location, and grade of the tumour, as well as the patient's overall health. Common treatments include:

• Surgery: The primary treatment for many brain tumours, aiming to remove as much of the tumour as possible without damaging surrounding healthy tissue.
• Radiation Therapy: High-energy rays are used to kill cancer cells or shrink tumours.
• Chemotherapy: Drugs are used to kill cancer cells or stop their growth. (Brand: Cycloxan 200 mg)
• Targeted Therapy: Drugs that target specific molecules involved in tumour growth.
• Immunotherapy: Treatments that stimulate the body's immune system to fight cancer.
• Steroids: To reduce swelling and pressure in the brain. (Brand: Stramipla 40mg Injection)
• Supportive Care: To manage symptoms and improve quality of life.

Some patients explore complementary therapies to manage symptoms and improve well-being. These may include:

• Acupuncture: May help alleviate pain and nausea.
• Herbal Supplements: Some herbs are believed to support immune function, though evidence is limited.
• Mind-Body Techniques: Practices like meditation, yoga, and massage therapy to reduce stress and improve quality of life.

It's essential to discuss any alternative therapies with a healthcare provider to ensure they do not interfere with conventional treatments.

• Radiation Exposure: Individuals who have received ionising radiation to the head, such as through previous cancer treatments, are at greater risk.
• Chemical Exposure: Prolonged exposure to industrial chemicals and solvents may elevate risk, though evidence is still under investigation.
• Weakened Immune System: People with compromised immune systems, such as those with HIV/AIDS or organ transplant recipients, may be more prone to certain types of brain tumours like primary central nervous system lymphoma.

Brain tumours, whether benign or malignant, can lead to various complications depending on their size, location, and growth rate:

• Neurological Deficits: These may include paralysis, difficulty speaking, memory loss, or vision problems.
• Seizures: Brain tumours are a common cause of new-onset seizures in adults.
• Cognitive Impairment: Patients may experience difficulty concentrating, learning, or making decisions.
• Hydrocephalus: A build-up of fluid in the brain can result from tumours blocking cerebrospinal fluid flow, leading to increased intracranial pressure.
• Emotional and Behavioural Changes: Mood swings, depression, or personality changes may occur.
• Recurrence: Some tumours, especially malignant ones, can return after treatment.

Living with a brain tumour is challenging, but certain lifestyle adaptations and support systems can make the journey more manageable:

• Follow a Structured Routine: This helps manage memory issues or fatigue.
• Take Medications as Prescribed: Especially steroids, anticonvulsants, or painkillers to manage symptoms effectively.
• Stay Physically Active: Light exercise improves mood and may boost cognitive function.
• Eat Nutritiously: A brain-healthy diet rich in omega-3s, antioxidants, and whole foods supports healing and well-being.
• Engage in Cognitive Activities: Reading, puzzles, or learning new skills may help maintain mental function.
• Access Support Groups: Connecting with others in similar situations can reduce feelings of isolation.
• Focus on Mental Health: Therapy or counselling is vital for coping with emotional distress.

Understanding the truth behind brain tumours helps patients and caregivers make informed decisions:

• “All brain tumours are cancerous.”
  False. Many brain tumours are benign and do not spread, although they may still cause symptoms due to pressure on brain structures.
• “Mobile phones cause brain tumours.”
  Current scientific evidence does not conclusively link mobile phone use to brain tumours.
• “Brain tumours always require surgery.”
  Not necessarily. Some tumours may be monitored if they’re small and not causing symptoms, or treated with radiation or chemotherapy.
• “Recovery is impossible.”
  Many patients recover well, particularly those with benign tumours or low-grade cancers detected early.
• “Brain tumours are always fatal.”
  This is not true. Prognosis depends on tumour type, location, and early intervention.

Seek medical attention if you or a loved one experience:

• Persistent or worsening headaches
• Unexplained seizures
• Sudden changes in personality, memory, or behaviour
• Loss of balance or coordination
• Difficulty speaking, seeing, or hearing
• Nausea or vomiting, especially in the morning
• Weakness or numbness in limbs or face

Early diagnosis significantly improves the chance of successful treatment and management.

If diagnosed with a brain tumour or experiencing symptoms, consider asking your healthcare provider:

1. What type of brain tumour do I have?
2. Is it benign or malignant?
3. What treatment options are available?
4. What are the side effects of each treatment?
5. Will I need surgery, chemotherapy, or radiotherapy?
6. What are the risks of recurrence?
7. Are there clinical trials I can join?
8. How will this tumour affect my daily life?

Being a caregiver or friend to someone with a brain tumour requires compassion, patience, and practical support:

• Be Present: Listening and simply being there means more than trying to fix the problem.
• Help with Tasks: Offer assistance with chores, errands, or transportation to medical appointments.
• Encourage Positivity: Uplift the patient’s spirit through kind words, humour, and enjoyable activities.
• Educate Yourself: Understanding the illness helps you provide better care and advocacy.
• Support Mental Health: Encourage professional counselling or therapy when needed.
• Communicate Clearly: Brain tumours can affect speech and cognition—speak simply and listen attentively.

Brain tumours are complex and potentially life-altering conditions that require a multidisciplinary approach to diagnosis, treatment, and long-term management. While the journey can be challenging, advances in medical technology, early detection, and supportive care have significantly improved outcomes for many patients.

Whether benign or malignant, a brain tumour’s impact on an individual's life is profound. Education, awareness, emotional resilience, and a strong support network are essential to navigating this diagnosis. With the right care, many people with brain tumours go on to lead meaningful and fulfilling lives.