Facts/ Incidence

• Brain tumors are 10th most common cancer in India (GLOBOCAN 2018)
• Brain and central nervous system tumors are the second most common cancers in children, accounts for about 26% of childhood cancers.
• The chance that a person will develop a malignant tumor of the brain or spinal cord in his or her lifetime is less than 1%.
• Glioblastoma multiforme (GBM) is the deadliest type of brain cancer, accounting for 45% of all malignant brain tumors.

Types of brain tumors

There are different types of primary brain cancer and survival rates vary significantly depending on the type of cancer. Some types of brain cancer, such as meningioma, anaplastic ependymoma and oligodendroglioma, are highly treatable, while others are less responsive to treatment. The most common primary malignant brain tumor- Glioblastoma multiforme, the 5 years relative survival is only 6.8%.

Clinical signs and symptoms

The most common symptoms of brain tumour are:

Symptoms of tumour are associated with the position they present

Each part of our brain control particular function, so a tumour can affect a specific area of the brain, thereby affecting its normal function. Some of the symptoms, according to their position, are as follows:

Diagnostic modalities

• Neurologic exam: It includes testing of vision, hearing, alertness, muscle strength, coordination, and reflexes. Eyes are looked for swelling, caused by a tumour pressing on the nerve that connects the eye and the brain.
• Angiogram: It is an imaging technique in which dye is injected into the bloodstream. If a tumour is present, the image may show the tumour or blood vessels that are feeding into the tumour.
• Spinal tap: For diagnosis, sample of cerebrospinal fluid (the fluid that fills the spaces in and around the brain and spinal cord) is usually collected by a technique called lumbar puncture.
• MRI brain contrast is the most useful imaging technique for diagnosing brain tumor

Treatment

The treatment of brain tumour depends upon the type, grade, and position of tumour and general health of patient.
Some treatment options for brain tumours are as follows:-

• Surgery: Surgery is usually the first step in the treatment of both benign and primary malignant brain tumours. This is performed on patient to remove maximum tumour so as to maintain neurological function.
• Radiotherapy: High energy beams of radiation focus on cancerous tissue to stops them from multiplying.
• Chemotherapy: Chemotherapy is a treatment where anti-cancer drugs are used to kill cancer cells, or to stop them from multiplying.
• Steroids: Steroids are commonly used for reduction and prevention of inflammation around a brain tumour.
• Anti-seizure medication: This is recommended for patients suffering from seizures.
• Ventriculoperitoneal shunt (Also called a VP shunt): A VP shunt may be placed in the head to drain excess fluid from inside the brain thereby helping to control the pressure.
• Encourage supportive care: Encourage supportive care for the patients suffering from brain tumour such as physical therapy, spiritual care and counselling to improve the quality of life.

How does surgery affect outcomes

The surgery is the main stay of the management of brain tumors. The amount of tumor removed dictates the prognosis of the patient. The neurosurgeon attempts to remove the complete tumor or the maximum bulk whichever is possible. The localization of the tum0or may sometimes restrict the surgery of brain tumor.

Role of Radiotherapy

Even when the entire tumor appears to have been removed, almost all high-grade gliomas eventually come back. This is because tumor cells have grown into the surrounding normal brain and cannot be seen with standard MRI scans. Radiation therapy uses high-energy x-rays to kill cancer cells and is usually recommended following surgery to kill any remaining tumor cells. This treatment is called adjuvant radiation. Radiation can help to delay a recurrence of the tumor, allowing you to live longer.

Radiation is generally given as a series of once-daily treatments (called fractions) over several weeks. This approach helps to kill the greatest number of tumor cells and minimize side effects on normal brain cells. The area where the radiation is delivered (called the radiation field) is carefully calculated to include the smallest possible amount of normal brain in the radiation field as possible.

There are various state of art techniques in radiation therapy like Three dimensional conformal radiotherapy (3DCRT), Intensity modulated radiotherapy (IMRT) and image guided radiotherapy (IGRT). These techniques are focused to deliver maximum dose to the tumor and to the microscopic residual disease and at the same time minimum dose to the normal brain tissue.

Role of Chemotherapy

Temozolomide has been established as the drug of choice for high grade gliomas. This is on oral chemotherapy drug which is given along with radiation. Temozolomide is usually taken by mouth daily with radiation and then for up to six monthly cycles (five consecutive days every four weeks) after the radiation. There are several other drugs which have been studied and the Oncologist may use them as per the clinical scenario.

Rehabilitation Options :

Rehabilitation is a key part of recovery. A targeted rehabilitation program led by trained therapists can help you get back your strength, stamina, and function. The various options are:

• Physical Therapy: physical therapist can help you improve your physical strength, coordination, balance, and mobility. The therapist can help you to gradually restore large motor functions and show you helpful exercises to do at home.
• Speech Therapy: You may need help with your speech skills to make sure people can understand you easily. Speech therapists also help with the swallowing problems that are associated with certain brain tumors.
• Occupational Therapy: Occupational therapist will help you regain mastery of everyday tasks such as bathing, dressing, and feeding yourself. You can also get help with more advanced skills, such as doing housework, managing money, taking transportation, and shopping/

Follow up

Periodic brain scans are usually recommended after completing the initial brain tumor treatment. This is because brain tumors can recur – or re grow – after treatment.

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