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What is Brain Tumor?

Brain tumor is growth of abnormal cells forming a mass during regeneration of brain cells. Brain tumors can be seen at all age groups from neonatal period to advanced ages and causes pressure inside the skull. This compression and pressure hinders the brain to fulfill its functions implicitly and patients show various symptoms. One important sign of brain tumors is severe headaches of long duration which is seen in about 60% of patients.

Early diagnosis is of great importance in brain tumors. Generally brain tumors are classified as benign or malignant. Not all brain tumors are life threatening; early diagnosis and appropriate intervention make critically important difference in treatment of brain tumors. Early diagnosis and availability of new advances in medical technology results in successful management of tumors. 

How does it develop?

Just like other tumors, brain tumors originate from cellular abnormalities. Cells develop exactly like living organisms; when they die they are replaced by new ones by cell division. If there is a change in the actual structure of the cell during this regeneration process, if the cells grow out of control or if the cell death does not occur when it should, masses are formed. These masses are called tumors and exact mechanism that causes tumor growth is unknown. However, the significant role of genetic factors and exposure to radiation in tumor formation is acknowledged.

Although factors causing brain tumors are still under investigation, some factors are known to be effective in formation of tumor. These factors are:
•    Genetics,
•    Exposure to radiation and various carcinogenic chemicals,
•    Various viruses particularly HIV infection,
•    Smoking,
•    Use of mobile phones (This is one of the suspected causes, although has not been proven yet.)

What are the symptoms?

Symptoms of brain tumor show inter-patient variations depending on certain factors. Symptoms vary based on the location, size, growth rate and type of tumor. Symptoms develop based on specific reasons such as compression of tumor on nerve ends and fluid accumulation in brain due to giant tumors.
Since brain manages all body movements, the symptoms can be seen in different regions. Although brain tumor is characterized with severe headache, general symptoms are as follows:
•    Severe headache,
•    Fainting attacks similar to epilepsy seizures,
•    Nausea and vomiting,
•    Balance and gait disorders,
•    Numbness and loss of sensation in arms and legs,
•    Vision disorders like blurred vision and diplopia,
•    Speech disorders,
•    Altered mental status,
•    Personality changes,
•    Slowed movements and facial expression.

What Are The Types of Brain Tumors?

Brain tumors are classified according to their location and structure. According to 2016 World Health Organization (WHO) classification of brain tumors there are 7 main categories for 30 different types brain tumors each with different characteristics. The reason for this classification is that, not all brain tumors are associated with the nervous system; some originate from abnormal cells of  blood vessels, brain membrain, or they can be secondary (metastatic) tumors spread from cancers in other parts of the body..
Principally, there are two types of brain tumors: primary and secondary tumors. Tumors develop inside the brain tissue are called primary tumors. Primary tumors can be benign or malignant. Glioma and meningioma are the most common types of primary tumors of the brain originating from glial cells in the brain.
Cancer cells located in organs such as stomach, lungs, and intestines can reach the brain via blood vessels. When these cancerous cells reach the brain and form tumors in the brain, they are called secondary tumors. These cells can also be called metastases.

Benign Tumors

Benign brain tumors do not originate from brain cells and they do not contain cancer cells. Benign tumors generally grow slowly and have clear demarcations; therefore, they can be entirely or partially removed by surgery. Benign tumors usually do not spread to the neighboring tissues but they may cause pressure and hinder some brain functions when they grow large. It must be noted that, benign tumors can turn into malignant tumors, although this is very rare. Reccurence and metastasis risk is very low in benign tumors.
Most frequently seen benign brain tumor is meningioma, others include  dermoidal and epidermoidal tumors, colloidal cyst, pituitary adenomas, neuromas, hemangioblastoma and astrocytoma. 

Malignant Tumors

Malignant tumors growing and spreading rapidly are the primary cause of cancer. Malignant tumors don’t have clear borders and they damage the neighboring brain tissue preventing brain to fulfill its functions. It is not preferred to entirely remove these tumors formed by cells which are responsible for fulfill the brain functions with surgical approach. Total removal of malignant tumors by surgery is not always advisable as this leads to loss of brain activities. Malignant tumors can grow again after surgery.
Glial tumors and metastatic brain cells are the most  frequent type of malignant brain tumors. Glial tumors grow in an uncontrolled manner and cause cancer. Cancerous cells affect the surrounding healthy cells around them as a result of this rapid growth. A variety of treatment methods are used in the different grades of glial tumors; grade I, grade II, grade III and grade IV.
Metastatic cells, on the other hand, develop when cancerous cells in a different body part outside of brain spread to the brain. Comprising of approximately 10% of the all brain tumors, metastases can originate from different organs such as lungs, stomach and pancreas, while the origins of those cancerous cells cannot be determined for some patients.

How is it diagnosed?

Brain tumor is diagnosed requires imaging technologies, patient’s medical history and neurologic examination. Magnetic Resonance (MRI) and Brain Tomography (CTI) are the primary imaging tools used in diagnosis of brain tumors. MRI provides information about anatomic as well as the biochemical structure of brain. Imaging studies aid diagnosis by determining the size, configuration and location of tumor. In some cases, angiography, cranial x-ray, CTI and biopsy can also be used. Definitive diagnosis of brain tumors is done by pathological examination of the tumor tissue.

What Are The Treatment Methods?

Radiation and chemotherapy are also used for treatment of brain tumors. The size, location and type of tumor, as well as health status of patient determines the type of treatment.

Surgery

Modern surgical techniques in treatment of brain tumors can achieve successful results. The aim of the operation is removal of the tumors either entirely or partially. Microsurgery is performed under guidance of biopsy and microscope. A fine needle biopsy is done at a site near the tumor to determine the type of the tumor during the operation. Microsurgery is preferred to remove the entire tumor in the brain. Microsurgery method can also be used to decrease the intracranial pressure and to eliminate the symptoms caused by the tumor.

Radiotherapy

Generally used in treatment of malignant tumors, radiotherapy applies x-rays or gamma rays at certain doses and durations to the tumor and sessions are repeated at certain intervals. Recent advances in medical technology enables radiotherapy to be performed without harming the healthy tissue around tumors while destroying or preventing the growth of cells cancer cells.

Chemotherapy

Chemotherapy prevents the growth of cancerous cells using special drugs administered at certain intervals usually intra vascularly. It is commonly used in treatment of cancerous, malignant tumors and generally prolongs the life expectancy of the cancer patients.

Frequently Asked Questions

Who are under higher risk for brain tumor?

Brain tumors can be seen at any age starting from birth. However, they are more frequently seen in individuals older than 70 years of age and children younger than 10 years of age. Age, gender and Caucasian race are risk factors. Brain tumors are more commonly seen in men compared to women. Risk of brain tumor increases if there is family history .

Is every headache a sign of a brain tumor?

No. Many other diseases can cause headache such as migraine, severe stress or hypertension. If head ache is caused by a brain tumor, it is very severe, sudden-onset and unmanageable. This severe pain may also be a sign of cerebral hemorrhage. In some cases, pain is mild but lasts for a very long time.  Patients should consult a specialist to find out about the underlying cause of headache.

Should brain tumors be entirely removed?

No. Follow-up without surgery may be sufficient for some benign or congenital tumors. It is sufficient to follow-up these tumors at certain intervals. For malignant tumors, on the other hand, suitable treatment method should be used.

What is the incidence of brain tumor?

Today, incidence of brain tumor is 5/100.000; however, specialists predict an increase in number of patients in the future years. One of the important reasons of this is rapid increase is growing number of older people and developments in imaging technologies.

 

Medicana International Samsun, 

Neurosurgeon Assoc. Prof. Enis Kuruoğlu, M.D.

 

 

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