A tumor is a mass or growth of abnormal cells. Brain tumors are classified as primary, which start in the brain, or secondary, which start in another part of the body and spread (metastasize) to the brain. Primary brain tumors can be noncancerous (benign) or cancerous (malignant). Secondary brain tumors (metastatic brain tumors) are malignant and are more common. Either benign or malignant brain tumors may require treatment because, as they grow, they press on normal brain structures in the confined space inside the skull.
- Low blood pressure and Eye problems
- Sensitivity to heat or cold
- Changes in the person's mental function
- Headaches, Seizures, Clumsiness and Dizziness
- Weakness in one part of the body
- Change in alertness (including sleepiness, unconsciousness, and coma)
- Changes in hearing, taste or smell and ability to feel pain, pressure, different temperatures, or other stimuli
- Confusion or Memory loss
- Difficulty swallowing, writing or reading
- Lack of control over the bladder or bowels
- Loss of balance, coordination
- Numbness or tingling on one side of the body
- Personality, mood, behavior, or emotional changes
- Trouble speaking or understanding others who are speaking and walking
- Abnormal nipple discharge
- Absent menstruation (periods)
- Enlarged hands and feet, Excessive body hair and Facial changes
Tumor Board Evaluation
Each and every Brain Cancer patient is evaluated by a special team of Neurologists, Neuro-oncoloigst, surgical oncologists (Head & Neck unit), Medical oncologists, Radiation Oncologists, Onco-pathologists and Imaging Specialists. Depending on the age, general condition, type of pathology and stage of the disease, a custom made treatment plan is charted out for each and every patient.
A team approach
The team will comprise of :
- Neurologist. Patient's initial visit will likely be with a neurologist who has expertise and additional training in neuro-oncology. This doctor generally serves as the "quarterback" for your care, coordinating tests and specialist appointments, and developing a plan of care.
- Radiation oncologists. Radiation oncologists use Intensity Modulated Radiation Therapy (IMRT) to kill cancer cells. IMRT is used for tumours arising from Head and Neck, Brain, Lungs, Lymphomas and Gyneccological Cancers.
- Medical oncologists. Medical neuro-oncologists manage chemotherapy or biological therapy, as well as medical disorders arising from the tumor or treatments. The neuro-oncology team of doctors, nurses and social workers use a careful and compassionate approach.
- Neuropathologists. Identifying your type of cancer is crucial to providing appropriate treatment.
- Neuroradiologists. Neuroradiologists specialize in the imaging of brain tumors. These images are essential in guiding neurosurgery or radiation treatments, or deciding about other treatment options.
- Other services. Other services, including supportive care, counseling, neurocognitive and neuropsychiatric services, brain rehabilitation and pain management whenever needed.
If the brain tumor is located in a place that makes it accessible for an operation, your surgeon will work to remove as much of your brain tumor as possible. In some cases, tumors are small and easy to separate from surrounding brain tissue, which makes complete surgical removal possible. In other cases, tumors can't be separated from surrounding tissue or they're located near sensitive areas in your brain, making surgery risky. In these situations your doctor may try to remove as much of the tumor as is safe. Even removing a portion of the brain tumor may help reduce your signs and symptoms. In some cases only a small biopsy is taken to confirm the diagnosis.
Stereotactic radio surgery (SRS) is not a form of surgery in the traditional sense. Instead, radio surgery uses multiple beams of radiation to give a highly focused form of radiation treatment to kill the tumor cells in a very small area. Each beam of radiation isn't particularly powerful, but the point where all the beams meet — at the brain tumor — receives a very large dose of radiation to kill the tumor cells.
Radio surgery is typically done in one treatment, and in most cases you can go home the same day.
Radiation therapy uses high-energy beams, such as X-rays or protons, to kill tumor cells. Radiation therapy can come from a machine outside your body (external beam radiation), or, in very rare cases, radiation can be placed inside your body close to your brain tumor (brachytherapy).
External beam radiation can focus just on the area of your brain where the tumor is located, or it can be applied to your entire brain (whole brain radiation). Whole brain radiation is most often used to treat cancer that has spread to the brain from some other part of the body.
Chemotherapy uses drugs to kill tumor cells. Chemotherapy drugs can be taken orally in pill form or injected into a vein (intravenously). The chemotherapy drug used most often to treat brain tumors is temozolomide (Temodar), which is taken as a pill. Many other chemotherapy drugs are available and may be used depending on the type of cancer.
Another type of chemotherapy can be placed during surgery. When removing all or part of the brain tumor, your surgeon may place one or more disk-shaped wafers in the space left by the tumor. These wafers slowly release a chemotherapy drug over the next several days.
DIAGNOSTIC AND STAGING WORK UP
Neurologist usually diagnoses the brain tumor after reviewing history, doing a thorough neurological examination and reviewing imaging tests.
Imaging tests may include:
- Magnetic resonance imaging (MRI) scan. MRI is a technique that uses a magnetic field and radio waves to create detailed images of the brain. Sometimes a special dye is injected into the bloodstream to make tumors appear different from healthy tissue (MR angiography). Functional MRI scans may be done to identify critical brain areas involved in speech and motor activity.
- Computerized tomography (CT) scan. A CT scan uses a sophisticated X-ray machine linked to a computer to produce detailed, two-dimensional images of the brain. A CT scan can be very helpful in certain types of tumors, especially ones close to or involving bone.
- Other brain scans. Other tests - such as magnetic resonance spectroscopy (MRS), single-photon emission computed tomography (SPECT) or positron emission tomography (PET) scanning - help doctors gauge brain tumor activity and blood flow.
- Angiogram. A special dye is injected into the arteries that feed the brain, making the blood vessels visible on X-ray. This test helps locate blood vessels in and around a brain tumor.
A biopsy involves removing a piece of the tumor for viewing under a microscope. Oncologist needs to know the tumor type and grade to plan proper treatment.
A doctor who specializes in examining brain and nervous system tumors (neuropathologist) examines the tissue. This is critical for an accurate diagnosis.
Tumor grading relates to how tumor cells look under the microscope. Grades 1 and 2 are low grade, Grade 3 is moderate, and Grade 4 is high. Low grade means that the tumor cells resemble normal brain cells. They usually grow slowly and are not likely to spread. In high-grade tumors, the cells look very abnormal and are more likely to grow quickly and spread.