BRAIN TUMOR

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Brain tumor  occurs when abnormal cells form within the brain. There are two main types of tumors: cancerous (malignant) tumors and benign (non-cancerous) tumors. Tumors can be divided into primary tumors, which start within the brain, and secondary tumors, which have spread from elsewhere, known as metastatic brain tumors.

Types

The most common primary brain tumors are

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• Gliomas- These tumors begin in the brain or spinal cord and include astrocytomas, ependymomas, glioblastomas, oligoastrocytomas and oligodendrogliomas.

• Meningioma- A meningioma is a tumor that arises from the membranes that surround your brain and spinal cord (meninges). Most meningiomas are noncancerous.

• Pituitary adenomas -These are mostly benign tumors that develop in the pituitary gland at the base of the brain. These tumors can affect the pituitary hormones with effects throughout the body.

• Nerve sheath tumors -These are benign tumors .

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Secondary Brain Tumors- the most common types of cancers that bring about secondary tumors of the brain are lung cancer, breast cancer, malignant melanoma, kidney cancer.

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In pediatric age group common tumors are medulloblastoma, pilocytic astrocytoma, ependymoma, craniophryngioma, germinoma,

 

Causes

Family History

Radiation exposure

Genetic mutations

Idiopathic/ Sporadic

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WHO GRADE FOR BRAIN TUMORS

 

Tumor  Grade                      Characteristics                                                Tumor Types Pathology

 

WHO Grade I                      Least malignant (benign)                                Pilocytic astrocytoma    

                                             Possibly curable via surgery alone                 Ganglioglioma      

                                             Long-term survival                                         Craniopharyngioma

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WHO Grade II                     Relatively slow growing                                 Diffuse Astrocytoma

                                             Somewhat infiltrative                                      Oligodendrolglioma

                                             May recur as higher grade

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WHO Grade III                   Tend to recur as higher grade                          Anaplastic astrocytoma

                                             Malignant, infiltrative                                     Anaplastic ependymoma

                                                                                                                     Anaplastic oligodendroglioma

WHO Grade IV

                                            Most malignant                                                Glioblastoma Multiforme(GBM)

                                            Raid growth, aggressive                                   Medulloblastoma

                                            Widely infiltrative

                                            Rapid recurrence

Symptoms-

·         Headache

·         Nausea , Vomiting

·         Seizures

·         Personality changes

·         Weakness or paralysis in one part or one side of the body

·         Loss of balance or dizziness

·         Vision changes

·         Hearing change

·         Facial numbness or tingling

·         Confusion and disorientation

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In pediatric patients the sign and symptoms are seizures,vomiting, inability to feed, increased head size, failure to thrive, weakness in one side of body, loss of balance.

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Diagnosis

• Neurological examination

• Imaging tests. Magnetic resonance imaging (MRI) with contrast  is commonly used to help diagnose brain tumors.

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Treatment

Treatment for a brain tumor depends on the type, size and location of the tumor, as well as overall health of the patient.

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Surgery

The primary and most desired course of action described in medical literature is surgical removal (resection) of tumor via craniotomy. The main objective of surgery is to remove as many tumor cells as possible.

Radiation Therapy

Radiation therapy uses high-energy X-rays to kill cancer cells and abnormal brain cells and to shrink tumors.

Chemotherapy

Chemotherapy is  generally is considered to be effective for  pediatric tumors, germinomas, lymphomas and oligodendrogliomas and glioma.

 

 

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 Spine Tumors

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A spinal tumor is abnormal mass of tissue within or surrounding the spinal cord and/or spinal column. Spinal tumors can be benign (non-cancerous) or malignant (cancerous).

Spinal tumors are referred to in two ways.

1. By the region of the spine in which they occur ascervical, thoracic, lumbar and sacrum.

2. By their location within the spine.

• Intradural-extramedullary ( 40%)  – The tumor is located inside the thin covering of the spinal cord (the dura), but outside the actual spinal cord.The most common of these types of tumors are meningioma, schwannoma, neurofibroma.

• Intramedullary – These tumors grow inside the spinal cord. They typically derive from glial or ependymal cells. Frequency of occurrence in this location is approximately 5%. Astrocytomas and ependymomas are the two most common types. Astrocytomas are more common in the thoracic region followed by the cervical. Ependymomas are most common in the filum  followed by the cervical region.

• Extradural (55%)– The tumor is located outside the dura, which is the thin covering surrounding the spinal cord.. These lesions are typically attributed to metastatic cancer or less commonly schwannomas derived from the cells covering the nerve roots. The bony spinal column is the most common site for bone metastasis. Common primary cancers that spread to the spine are lung, breast and prostate.

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• In pediatric patients the common tumors are artrocytoma, ependymomna in the cervical region.

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Sign and Symptoms-

Pain is the most common symptom at presentation. Incontinence and decreased sensitivity in the saddle area (buttocks) are generally considered warning signs of spinal cord compression by the tumor. Other symptoms of spinal cord compression include lower extremity weakness, sensory loss, numbness in hands and legs and rapid onset paralysis.

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Diagnosis

By clinical examination and  Contrast MRI of the spine.

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Treatment-

Surgery-

Surgery is the main modality of treatment.

Indications for surgery vary depending on the type of tumor. Primary (non-metastatic) spinal tumors may be removed through complete en bloc resection for a possible cure. In patients with metastatic tumors, treatment is primarily palliative, with the goal of restoring or preserving neurological function, stabilizing the spine and alleviating pain.

Non-Surgical Treatments

Nonsurgical treatment options include observation, chemotherapy and radiation therapy.

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