What are brain tumors and how are they treated?

Brain cancer is a tumor occurring in or around the brain. They destruct or infiltrate/replace healthy cells making it impossible for the brain to function as it should.

Brain cancer can develop separately then it is called primary. Secondary forms are caused by metastatic cells that appear from malignant cells and are brought with the blood from other organs already affected by cancer.

Short information about brain tumors

Brain cancer is distinguished by rapid growth and aggressive effects on healthy tissues, brain oncology is capable of destroying adjacent tissues, growing in them or squeezing. It can be developed from the brain’s own cells or from cells brought through the circulatory system from other organs, where a malignant tumor metastasizes.

Brain cancer is first of all classified into an operable and inoperable form. Inoperable tumors, i.e. that is impossible to remove surgically, can be either cancerous or non-cancerous. There are two reasons why doctors do not undertake remove brain tumor:

1. The tumor cannot be accessed through surgical intervention; there is a high risk of affecting other brain regions.
2. It is a late-stage cancer tumor meaning that there are multiple metastases.

Brain tumor diagnostics

Today, the main diagnostic methods for a brain tumor are MRI and CT. In some cases, a biopsy. But it is a full-fledged operation on the brain with its own risks.

When classifying tumors, including pituitary adenomas, the following factors are taken into account:

- Localization;
- Origin;
- Nature – cancerous or non-cancerous tumor.

The obligatory examination of tumor cells, which is mandatory when brain cancer is detected, allows doctors to understand the severity of pathological changes.

Thanks to the data obtained, it is possible to establish the stage of the neoplasm. The stage is determined by the following factors:

- The speed of growth;
- The blood flow to the tumor;
- The presence or lack of zone of tumor necrosis;
- The degree of similarity of cancer cells to healthy ones;
- Limited or widespread pathological focus within healthy tissues.

Tumors of the pituitary gland, for instance, are more often noncancerous and are caused by heredity.

The causes of brain cancer occurrence are still not known exactly. They can arise under the influence of genetic and certain external factors. In rare cases, brain cancer develops from radiation exposure during childhood, usually for therapeutic purposes.

Brain tumor signs

Severe headache is a frequent symptom for both noncancerous and cancerous neoplasms. It can be also accompanied by nausea and vomiting. Symptoms such as impotence in men or menstrual irregularities and uterine bleeding in women can indicate a pituitary gland tumor.

It is worth knowing that any signs of brain dysfunction may indicate a brain tumor. Thus, it is important not to neglect these signs and undergo a thorough examination in case of:

- Headaches;
- Disorders of consciousness;
- Mental disorders developed spontaneously;
- Impairment of speech, vision or hearing;
- Problems with motor functions (paralysis, muscle spasms and cramps);
- Lack of concentration of attention;
- A strong decrease in thought processes (memory, computing ability, etc.).

It is possible that the above signs will turn out to be a symptom of another disease, but even in this case, it is highly important not to delay the visit to the doctor.

Methods of brain tumor therapies

The choice of the optimal therapy for brain tumors is contingent on the growth speed, type, and size of the neoplasm, and the general health condition of the person. There are various therapeutic methods and these data determine the tolerability and possibility of different methods use.

The treatment methods include:

- Conventional surgery or radiosurgery;
- Radiation therapy;
- Chemotherapy;
- Biological preparations of targeted therapy;
- Combined techniques.

Surgical removal of the pathological focus is often performed at the early stages. It is made only if it is possible to do so without damaging the adjacent tissues.

If it is impossible to excise the tumor but the operation can be considered safe for the patient, then resection (cutting off a part) is also appointed to quickly lower intracranial pressure at high rates. Relapses with a noncancerous tumor, as a rule, do not occur.

Over the past couple of decades, modern oncology has been enriched with new methods of targeted irradiation of cancer cells that allow not doing harm to the healthy cells. The use of radiotherapy is chosen only in cases where the tumor is responsive to it. It allows the diminishing of the tumor volume and the destruction of cancerous cells.

Therapy of a brain neoplasm that cannot be surgically removed

- Symptomatic treatment;
- Radiation therapy;
- Radiosurgery;
- Chemotherapy.

Can the disease be cured without surgery? It all is contingent on the type of tumor. With brain cancer, there are chances of cure by some methods, but they decrease as diseased cells create metastases. The inability to perform surgery makes all treatments less effective as the risk of relapse raises.

If cancer does not metastasize and is localized in a small area, then there is a chance for a complete cure. In this case, instead of surgery, radiation therapy and surgery are preferable.

Benign brain tumors are generally resectable and grow very slowly. In symptomatic treatment, glucocorticosteroid medications are used to relieve cerebral edema and narcotic analgesics to relieve pain.

In the case of metastasis, chemotherapy by cytostatics (agents that suppress tumor growth and promote its shrinking) such as Hydrea is used.

Radiation therapy

Rotary radiation therapy

The prevalence of rotational radiation therapy is low. Although it leverages all the advances in Intensity Modulated Radiotherapy, its benefits are not yet fully understood.

Intensity Modulated Radiotherapy (IMRT)

This is the modern method of high precision radiotherapy. It is targeted, with precisely specified doses, irradiation of the tumor or the area inside it. It allows beam of rays to ideally follow the three-dimensional contours of the tumor. It makes the dose of radiation completely fall on the focus with pathology.

Stereotactic radiosurgery

In stereotactic radiosurgery, the tumor is affected by narrow beams of radiation at different angles. It is a highly precise method and the elimination of a brain tumor during radiosurgery occurs with large doses of directed radiation, and not by the method of resection and extraction.

Stereotactic radiotherapy is similar in its principles to standard radiosurgery procedures, but the course of therapy is split into several sessions. Fractionation is prescribed for extensive neoplasms or for tumors localized within vital brain tissues, if the simultaneous use of large doses of radiation is extremely undesirable.

Three-dimensional conformal radiotherapy (TCRT)

This method allows matching the parameters of tumor contours by combining the capabilities of classical radiotherapy and the method of modifying the shape of the X-ray beam. As a result, the maximum dose of radiation enters the tumor, bypassing the adjacent healthy tissues.

Chemotherapy is often prescribed in conjunction with radiotherapy. It is can be appointed during all stages of treatment. It allows slowing the speed of growth of infected cells or destroy them completely, thus preventing tumor recurrence. It is also believed that the effectiveness of radiotherapy is increased by specific radiosensitizing drugs.

How is therapy chosen?

First of all, the course of classical radiotherapy begins with a consultation, during which doctors examine the patient and their medical history. The first step is planning. The main role at this stage is played by a radiotherapy oncologist who simulates the therapy using standard X-rays or CT (sometimes MRI is used). Using the images obtained the choice of the type and direction of the path of the beam of rays that will be used is determined.

During the simulation, the patient is placed on a special table, where they must maintain maximum immobility. The fixation mask helps to maintain a certain position of the patient's head throughout the entire stage. Radiation therapy itself is usually started one to two days after the therapeutic plan is established.

During each radiotherapy session, the patient, as in the case of simulation, must remain motionless on the treatment table. One radiation therapy session lasts, on average, a few minutes. During this time, irradiation is carried out according to the parameters prescribed by the oncologist, without any unpleasant or painful sensations for the patient.

Due to the effective treatment with modern methods, relapses in noncancerous tumors usually do not occur, but can sometimes happen. In this case, radiotherapy or reoperation to remove the remaining parts of the tumor may be prescribed.

Relapses occur much more frequently after the treatment of cancerous brain tumors, sometimes many years after treatment. In case of relapse in the case of an operable tumor, a second operation is performed, in case of an inoperable one - radiosurgery. In both cases, chemotherapy and radiation therapy may be appointed.

Post by: Samuel Wrangler, M.D., Montgomery, Alabama