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The growth that’s not good for brain

Brain tumours are among the most diverse types known to modern medicine. These can occur anywhere in the brain arising from the different types of cells present.

The growth that’s  not good for brain


Dr Abhishek Puri

Brain tumours are among the most diverse types known to modern medicine. These can occur anywhere in the brain arising from the different types of cells present. Sometimes, these may remain undetected for years together and discovered incidentally or may have a sudden onset of symptoms that are related to the area of the brain affected. The tumours affect children and adults alike but despite the similarities, presentation is usually different in the way the pathways that lead to its development. Due to the critical nature of the brain, these tumours remain difficult to diagnose and require specialised interdisciplinary care. 

Primary brain tumours usually manifest when cells have errors while dividing that allows them to grow abnormally and hence forms a tumour. Sometimes, cancer begins elsewhere but spreads to the brain (called as a secondary brain tumour). It usually happens in a variety of cancers like those arising in the lung, breast, kidney, colon, skin etc. The risk factors are not apparent but may involve exposure to radiation or those who have a positive family history of cancer. There is no direct association with the use of cell phones, but it should be minimised. 

Diagnosis

The diagnosis of brain tumours requires a comprehensive neurological examination that checks for vision, hearing, balance, coordination and muscle strength. It is usually followed by a computed tomography (CT) or a magnetic resonance imaging (MRI) that gives clues about the size or nature of the lesion. Many specific MRI components include spectroscopy, perfusion and functional studies that help to refine treatment options. Sometimes, additional tests are required to eliminate the possibility of cancer elsewhere. 

Treatment

Once the lesion is identified with clues to its probability, a neurosurgeon may plan open surgery or a targeted (stereotactic) biopsy. These techniques have become incredibly refined and safe in the past few decades due to tremendous innovations in the medical field. This biopsy sample is then studied under a microscope which may require additional molecular testing. These sophisticated laboratory tests can help for more profound insights into your treatment options.

Molecular testing involves detection of 1p/19q, IDH1&2, MGMT, MIB-1 index and/or p53. These tests, in combination, give a clue about the origin and likely clinical progression. 

Not all types of brain tumours are uniformly lethal. The treatment involves radiation and chemotherapy. Radiation therapy is delivered by state-of-the-art delivery techniques like intensity modulation or volumetric arc therapies that reduce the dose to normal tissues and helps to minimise long-term damage. 

Proton therapy also holds a lot of promise, but so far it hasn’t proven itself to be better than conventional treatments. Radio-surgery utilises multiple beams of radiation to kill tumours in a small area given to a high dose. It was initially delivered by Gamma Knife but is now supplanted by linear accelerators which rival its concerning accuracy and superior dose deliv-ery. 

Chemotherapy uses drugs to kill tumour cells and enhance the effect of radiation. It is given orally (through the mouth) or veins. Targeted drugs focus on specific abnormal pathways within the cancer cells. A medical oncologist decides on their feasibility. 

Rehabilitation

It is the most critical component of treatment of brain tumours as most families usually skip physiotherapy. Neurological disorders require a constant motivation to persist with physiotherapy and occupational therapy to give a sense of well being to affected patients and families. Depression is a major unaddressed issue with patients as most families feel social stigma to speak to professional psychologists and psychiatrists. However, these professionals help to bridge the patients’ emotional and psychological needs with a faster recovery. 

In conclusion, brain tumours can be effectively managed. Remember to stay positive throughout your journey. 

Online support

There are a few resources for patients for online support. On Twitter, search for specific hashtags like #btsm. International Brain Tumour Alliance (IBTA), Brain Tumour Foundation of India and many other non-governmental organisations also offer support groups and therapies. Affected patients and their caregivers hold monthly group discussions on specific issues on Twitter. There are support groups on Facebook as well. However, it is also important to exercise due diligence before joining these groups because some of these may not have physician vetted information.  

Symptoms

n Patients may experience variable symptoms depending on the site of the disease. These usually rely on the size and location within the brain. It is important to consult a neurologist if you experience the following:

  • New onset or worsening of the intensity of recurrent headaches.
  • Unexplained nausea or vomiting.
  • Blurring or doubling of vision. 
  • Loss of sensation or movement in an arm or a leg.
  • Difficulty in walking, balance, speech. 
  • Subtle personality or behavioural changes in your family members. 
  • Sudden onset of seizures, especially if there is no prior history.
  • Progressive hearing problems.

— The writer is radiation oncologist, Fortis Hospital, Mohali

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