Brain tumor Totally Explained

Everything about Brain Cancer totally explained

A brain tumor is any intracranial tumor created by abnormal and uncontrolled cell division, normally either in the brain itself (neurons, glial cells (astrocytes, oligodendrocytes, ependymal cells), lymphatic tissue, blood vessels), in the cranial nerves (myelin-producing Schwann cells), in the brain envelopes (meninges), skull, pituitary and pineal gland, or spread from cancers primarily located in other organs (metastatic tumors). Primary (true) brain tumors are commonly located in the posterior cranial fossa in children and in the anterior two-thirds of the cerebral hemispheres in adults, although they can affect any part of the brain. In the United States in the year 2005, it was estimated that there were 43,800 new cases of brain tumors (Central Brain Tumor Registry of the United States, Primary Brain Tumors in the United States, Statistical Report, 2005 - 2006), which accounted for 1.4 percent of all cancers, 2.4 percent of all cancer deaths, and 20–25 percent of pediatric cancers. Ultimately, it's estimated that there are 13,000 deaths/year as a result of brain tumors. is a frequent reason for seeking medical attention in brain tumor cases.
   Large tumors or tumors with extensive perifocal swelling edema inevitably lead to elevated intracranial pressure (intracranial hypertension), which translates clinically into headaches, vomiting (sometimes without nausea), altered state of consciousness (somnolence, coma), dilatation of the pupil on the side of the lesion (anisocoria), papilledema (prominent optic disc at the funduscopic examination). However, even small tumors obstructing the passage of cerebrospinal fluid (CSF) may cause early signs of increased intracranial pressure. Increased intracranial pressure may result in herniation (for example displacement) of certain parts of the brain, such as the cerebellar tonsils or the temporal uncus, resulting in lethal brainstem compression. In young children, elevated intracranial pressure may cause an increase in the diameter of the skull and bulging of the fontanelles.
   Depending on the tumor location and the damage it may have caused to surrounding brain structures, either through compression or infiltration, any type of focal neurologic symptoms may occur, such as cognitive and behavioral impairment, changes, hemiparesis, (hemi) hypesthesia, aphasia, ataxia, visual field impairment, facial paralysis, double vision, tremor etc. These symptoms are not specific for brain tumors - they may be caused by a large variety of neurologic conditions (for example stroke, traumatic brain injury). What counts, however, is the location of the lesion and the functional systems (for example motor, sensory, visual, etc.) it affects.
   A bilateral temporal visual field defect (bitemporal hemianopia—due to compression of the optic chiasm), often associated with endocrine disfunction—either hypopituitarism or hyperproduction of pituitary hormones and hyperprolactinemia is suggestive of a pituitary tumor.

WHO Classification of Tumors of the Central Nervous System

The website http://www.brainlife.org describes the various WHO (World Health Organization) classifications of brain tumors, from 1979 to 2007. The most recent WHO classification of brain tumors is on page http://www.brainlife.org/who/2007_classification.htm.

Brain tumors in infants and children

In 2000 approximately 2.76 children per 100,000 were affected by a CNS tumor in the United States. This rate has been increasing and by 2005 was 3.0 children per 100,000. This is approximately 2,500-3,000 pediatric brain tumors occurring each year in the US. The tumor incidence is increasing by about 2.7% per year. The CNS Cancer survival rate in children is approximately 60%. However, this rate varies with the age of onset (younger has higher mortality) and cancer type.
In children under 2, about 70% of brain tumors are medulloblastoma, ependymoma, and low-grade glioma. Less commonly, and seen usually in infants, are teratoma and atypical teratoid rhabdoid tumor.

Signs and symptoms

Severe Headaches: This was the most common symptom, with 46% of the patients reporting having headaches. They described the headaches in many different ways, with no one pattern being a sure sign of brain tumor. Many - perhaps most - people get headaches at some point in their life, so this isn't a definite sign of brain tumors. You should mention it to your doctors if the headaches are: different from those you ever had before, are accompanied by nausea / vomiting, are made worse by bending over or straining when going to the bathroom.
Seizures: This was the second most common symptom reported, with 33% of the patients reporting a seizure before the diagnosis was made. Seizures can also be caused by other things, like epilepsy, high fevers, stroke, trauma, and other disorders. This is a symptom that should never be ignored, whatever the cause. In a person who never had a seizure before, it usually indicates something serious and you must get a brain scan. A seizure is a sudden, involuntary change in behavior, muscle control, consciousness, and/or sensation. Symptoms of a seizure can range from sudden, violent shaking and total loss of consciousness to muscle twitching or slight shaking of a limb. Staring into space, altered vision, and difficulty in speaking are some of the other behaviors that a person may exhibit while having a seizure. Approximately 10% of the U.S. population will experience a single seizure in their lifetime.
Nausea and Vomiting: As with headaches, these are non-specific - which means that most people who have nausea and vomiting do NOT have a brain tumor. Twenty-two percent of the people in our survey reported that they'd nausea and/or vomiting as a symptom. Nausea and/or vomiting is more likely to point towards a brain tumor if it's accompanied by the other symptoms mentioned here.
Vision or hearing problems: Twenty-five percent reported vision problems. This one is easy - if you notice any problem with your hearing or vision, it must be checked out. The eye doctor is the first one to make the diagnosis - because when they look in your eyes, they can sometimes see signs of increased intracranial pressure.
Problems with weakness of the arms, legs or face muscles, and strange sensations in your head or hands. Twenty-five percent reported weakness of the arms and/or legs. Sixteen percent reported strange feelings in the head, and 9% reported strange feelings in the hands. This may result in an altered gait, dropping objects, falling, or an asymmetric facial expression. These could also be symptoms of a stroke. Sudden onset of these symptoms is an emergency - you should go to the emergency room. If you notice a gradual change over time, you must report it to your doctor.
Behavioral and cognitive problems: Many reported behavioral and cognitive changes, such as: problems with recent memory, inability to concentrate or finding the right words, acting out - no patience or tolerance, and loss of inhibitions - saying or doing things that are not appropriate for the situation.

Diagnosis

Although there's no specific clinical symptom or sign for brain tumors, slowly progressive focal neurologic signs and signs of elevated intracranial pressure, as well as epilepsy in a patient with a negative history for epilepsy should raise red flags. However, a sudden onset of symptoms, such as an epileptic seizure in a patient with no prior history of epilepsy, sudden intracranial hypertension (this may be due to bleeding within the tumour, brain swelling or obstruction of cerebrospinal fluid's passage) is also possible.
   Symptoms include phantom odors and tastes. Often, in the case of metastatic tumors, the smell of vulcanized rubber is prevalent.
Imaging plays a central role in the diagnosis of brain tumors. Early imaging methods—invasive and sometimes dangerous—such as pneumoencephalography and cerebral angiography, have been abandoned in recent times in favor of non-invasive, high-resolution modalities, such as computed tomography (CT) and especially magnetic resonance imaging (MRI). Benign brain tumors often show up as hypodense (darker than brain tissue) mass lesions on cranial CT-scans. On MRI, they appear either hypo- (darker than brain tissue) or isointense (same intensity as brain tissue) on T1-weighted scans, or hyperintense (brighter than brain tissue) on T2-weighted MRI. Perifocal edema also appears hyperintense on T2-weighted MRI. Contrast agent uptake, sometimes in characteristic patterns, can be demonstrated on either CT or MRI-scans in most malignant primary and metastatic brain tumors. This is due to the fact that these tumors disrupt the normal functioning of the blood-brain barrier and lead to an increase in its permeability.
   Electrophysiological exams, such as electroencephalography (EEG) play a marginal role in the diagnosis of brain tumors.
   The definitive diagnosis of brain tumor can only be confirmed by histological examination of tumor tissue samples obtained either by means of brain biopsy or open surgery. The histologic examination is essential for determining the appropriate treatment and the correct prognosis. This examination, performed by a pathologist, typically has three stages: interoperative examination of fresh tissue, preliminary microscopic examination of prepared tissues, and followup examination of prepared tissues after immunohistochemical staining or genetic analysis.

Treatment and prognosis

Many meningiomas, with the exception of some tumors located at the skull base, can be successfully removed surgically. In more difficult cases, stereotactic radiosurgery, such as Gamma Knife radiosurgery, remains a viable option.
   Most pituitary adenomas can be removed surgically, often using a minimally invasive approach through the nasal cavity and skull base (trans-nasal, trans-sphenoidal approach). Large pituitary adenomas require a craniotomy (opening of the skull) for their removal. Radiotherapy, including stereotactic approaches, is reserved for the inoperable cases.
   Although there's no generally accepted therapeutic management for primary brain tumors, a surgical attempt at tumor removal or at least cytoreduction (that is, removal of as much tumor as possible, in order to reduce the number of tumor cells available for proliferation) is considered in most cases. However, due to the infiltrative nature of these lesions, tumor recurrence, even following an apparently complete surgical removal, isn't uncommon. Postoperative radiotherapy and chemotherapy are integral parts of the therapeutic standard for malignant tumors. Radiotherapy may also be administered in cases of "low-grade" gliomas, when a significant tumor burden reduction couldn't be achieved surgically.
   Survival rates in primary brain tumors depend on the type of tumor, age, functional status of the patient, the extent of surgical tumor removal, to mention just a few factors.
   Patients with benign gliomas may survive for many years, while survival in most cases of glioblastoma multiforme is limited to a few months after diagnosis if treatment is ignored.
   The main treatment option for single metastatic tumors is surgical removal, followed by radiotherapy and/or chemotherapy. Multiple metastatic tumors are generally treated with radiotherapy and chemotherapy. Stereotactic radiosurgery, such as Gamma Knife radiosurgery, remains a viable option. However, the prognosis in such cases is determined by the primary tumor, and it's generally poor.
   A shunt operation is used not as a cure but to relieve the symptoms.(External Link

) The hydrocephalus caused by the blocking drainage of the cerebrospinal fluid can be removed with this operation.

Research to treatment with the Vesicular stomatitis virus

In 2008, Researchers of the Yale University, led by Dr. Anthony van den Pol, have discovered that the Vesicular stomatitis virus, or VSV, can infect and kill brain tumors, without affecting the other brain cells. The oncolytic properties of the virus, which normally applies to cancer cells, have shown to apply to brain tumors as well.
In the research, a human brain tumor was implanted into mice brains. The VSV was injected via their tails and within 3 days all tumor cells were either killed or dying. On the 10,000 infected tumor cells, only one healthy brain cell was affected "on accident."
Research on virus treatment like this has been conducted for some years, but no other viruses have been shown to be as efficient or specific as the VSV. Future research will focus on the risks of this treatment, before it can be applied to humans.

Further Information

Get more info on 'Brain Cancer'.

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