What is Brain Cancer?

What are the different types of Brain Cancer?

There are over 120 different types of brain cancers. The World Health Organization (WHO) developed a classification and grading system to standardize communication across health networks across the globe. The aim is to plan treatment and predict outcomes more accurately and in an organized fashion.

Based on site of origin, brain cancers are classified into two types:

• Primary brain cancers: Originate in brain tissue and tend to stay there.
• Secondary brain cancers: More common. These cancers start somewhere else in the body and travel to the brain. Lung, breast, kidney, colon, prostate and skin cancers are among the commonest primary cancers that can metastasize to the brain.

Some brain cancers contain cancer cells and others don’t:

• Benign brain cancers: Free from cancer cells. They grow slowly, can definitely be removed, and seldom spread to the surrounding brain tissue. Depending on the location of the cancer, they can be life-threatening.
• Malignant brain cancers: Contain cancer cells. The growth rates differ, but cells can invade healthy brain tissue surrounding it. These seldom spread beyond the brain or spinal cord.

Different Types of Brain Cancers

In adults, the most common types of brain cancer are:

• Astrocytomas: Usually start in the cerebrum. They cause seizures or shifts in behavior.
• Meningiomas: The commonest primary brain cancers in adults. Most likely to occur in 70s or 80s. They start in the meninges, the lining of the brain. They can be of grades 1, 2, or 3. They are benign and metastasis is rare.
• Oligodendrogliomas: Arise in the cells that make the covering that protects nerves. Usually grades 1, 2, or 3. They usually grow slowly and don’t spread to nearby tissue.

Among children, the most common cancer types are:

• Medulloblastoma: Usually arises in the cerebellum. Sometimes called a primitive neuroectodermal cancer. Grade IV.
• Grade I or II astrocytoma: In children, this low-grade cancer occurs anywhere in the brain. The most common astrocytoma among children is juvenile pilocytic astrocytoma. Grade I.
• Ependymoma: Arises from cells that line the ventricles or the central canal of the spinal cord. Most commonly found in children and young adults. Can be grade I, II, or III.
• Brainstem glioma: Occurs in the lowest part of the brain. Can be a low-grade or high-grade cancer. The most common type is diffuse intrinsic pontine glioma.

The common ones of brain cancer are:

• Gliomas
  • Astrocytoma
  • Pilocytic Astrocytoma (grade I)
  • Diffuse Astrocytoma (grade II)
  • Anaplastic Astrocytoma (grade III)
  • Glioblastoma Multiforme (grade IV)
  • Oligodendroglioma (grade II)
  • Anaplastic Oligodendroglioma (grade III)
  • Ependymoma (grade II)
  • Anaplastic Ependymoma (grade III)
• Craniopharyngioma
• Epidermoid
• Lymphoma
• Meningioma
• Schwannoma (neuroma)
• Pituitary adenoma
• Pinealoma (pineocytoma, pineoblastoma)

What are the signs and symptoms of Brain Cancer?

People with a brain cancer may experience either general or specific symptoms.

The symptoms of a Brain Cancer are:

• Seizures or paralysis
• Headaches
• Personality and memory changes
• Memory loss and confusion
• Nausea and vomiting
• Fatigue
• Difficulty in swallowing
• Changes in vision and other sensory perceptions

Other symptoms of Brain Cancer:

• Sleep issues and drowsiness
• Changes in ability to walk and conducting daily affairs
• Balance Issue
• Facial numbness
• Depression
• Trouble with coordinated movement of limbs

What are the causes of Brain Cancer?

A risk factor is that which increases the chance of getting a disease. Most brain cancers are not linked with any known cause. Research studies show a few risk factors that may raise the risk of developing brain cancers:

• Ionization Radiation: High dose of X-rays can cause cell damage, leading to brain cancer. People exposed to ionization radiation may have increased risk of brain cancers like meningioma or glioma. Yet, radiation induced cancers are still very rare.
• Other Exposure: Exposure to industrial chemicals or solvents is associated with increased risk. Higher risk for individuals who work in oil refining, rubber manufacturing, and drug manufacturing industries.
• Family History: Incidence rate is low, but inherited conditions like Von Hippel-Lindau disease, Li-Fraumeni syndrome, and Neurofibromatosis (NF1 and NF2) are linked to brain cancers.
• Gender: Meningiomas are twice as likely to develop in women; medulloblastomas more frequently reported in men.
• Age: Frequency is higher in older people, but can occur at any age depending on type and location.
• Immunity: Low immunity can increase risk of developing lymphomas in the brain. Causes include treatments for other cancers, organ transplant, AIDS, or congenital conditions.

Other inherited syndromes linked with brain and spinal cancers:

• Gorlin syndrome (basal cell nervous syndrome)
• Turcot syndrome
• Cowden syndrome

What are the stages of Brain Cancer?

Cancers are graded in accordance with how normal or abnormal the cells appear. Doctors plan treatment based on this observation. Staging also gives them an idea about how fast brain cancer is likely to spread. The following are brain cancer stages:

• Grade 1: Low grade malignant and slow-growing. Easy to confuse with identical healthy cells.
• Grade 2: Malignant and slow-grading. High chance of recurrence and likely to spread to surrounding tissues.
• Grade 3: Appear abnormal and actively metastasize into surrounding regions of the brain and are very likely to recur.
• Grade 4: Highly malignant and actively metastasize into surrounding tissues of the brain. Rarely some benign cancers can become malignant and a lower grade cancer may recur with a higher grade.

How do I know if I have Brain Cancer?

When the patient presents with suggestive symptoms of brain cancer, the physician will do a thorough medical history and physical examination. Then a plan for screening tests and procedure is drawn out for diagnosis of brain cancer.

Your doctor may decide to do some of the following tests:

• Physical exam
• Mental assessment
• Eye exam or eye test
• Hearing tests
• Testing your facial muscles
• Testing your swallowing or gag reflex
• Checking the strength in your limbs
• Checking your balance or coordination
• Checking the sensation on your skin

Imaging for Brain Cancer can be done by the following ways:

• Computed tomography (CT) scan
• CT angiography (CTA)
• Magnetic Resonance Imaging (MRI)
• Magnetic resonance angiography (MRA) and venography (MRV)
• Magnetic resonance spectroscopy
• Magnetic resonance perfusion
• Functional MRI (fMRI)
• Biopsy (stereotactic, surgical/open)
• Positron emission tomography (PET) scan
• Chest X-ray
• Electroencephalography (EEG)
• Evoked potentials
• Lumbar puncture or spinal tap
• Myelogram

How is Brain Cancer Treated?

Treatment depends on the type and grade of the cancer, where it is located, its size, and the patient’s age and health. The plan for treatment may involve different types of treatment called a multidisciplinary approach to treatment.

Treatment options and recommendations depend on several factors:

• The size, type, and grade of the cancer
• Whether the cancer puts pressure on vital parts of the brain
• If the cancer has spread to other parts of the CNS or body
• Side effects
• The patient’s preferences and overall health

Treatment options include:

• Surgery: Usually the first segment of treatment. For grade 1 cancers, a surgery may suffice as it is possible to remove the cancer. Otherwise, it is also possible to reduce the size of the cancer and ease symptoms.
• Radiation therapy: Follows surgery to kill any cancer cells that remain in the area. If surgery isn’t an option, radiation therapy alone can also be given.
• Chemotherapy: Used to kill brain cancer cells. It is given orally, via IV, or, less often, in wafers a surgeon places in the brain.
• Targeted therapy: Used to treat only certain types of brain cancers. These drugs attack specific parts of cancer cells and help stop cancers from growing and spreading.
• Immunotherapy: Some types have shown promise in treating brain metastases from lung cancer and melanoma.
• Combined therapies: Combined therapies are also an option.

Brain Cancer Treatment Follow-up

Care for individuals with brain cancer doesn’t end when treatment ends. Follow-up care helps physicians keep on checking to ensure the cancer has not returned, or to deal with any symptoms, and screen the general health of patients.

Watching out for recurrence

One objective of follow-up care is to check for a recurrence. A cancer may recur since small portions of cancer cells may stay undetected in the body. After some time, these cells may divide in number until the point they appear on test outcomes or indicate a relapse.

Alternatives for rehabilitative treatment include:

• Language instruction
• Word related treatment
• Counselling
• Medication to reduce fatigue and upgrade memory

Treatment For Recurrent Brain Cancer

Some brain cancers are totally cured with the first round of treatment. Others will return eventually after they were first treated. The doctor will be able to monitor the development for some time and help to control the indications of the cancer.

Treatment for recurrent Brain Cancer:

• Surgery
• Radiotherapy
• Chemotherapy
• Clinical trials
• Support

Implants Used in Brain Cancer Treatment

There are more than one type of implants used in the treatment of brain cancer. Some are surgical while the other is a part of radiation therapy.

Surgical Implants

• Shunt: A thin tube (shunt) is placed into a ventricle of the brain, through a small hole in the skull. This device moves excess fluid from the brain to another part of the body, such as the abdominal cavity, where it’s absorbed into the bloodstream. A filter catches stray cancer cells that may be in the cerebral spinal fluid (CSF). This procedure can help relieve pressure in the skull.
• Ommaya Reservoir: A small reservoir attached to a tube under the scalp is implanted. The tubing leads into a ventricle of the brain where the CSF circulates, allowing delivery of chemotherapy to the brain and CSF, or to remove fluid for biopsy.

Radiation Implants

Brachytherapy is a kind of treatment for cancers, it puts a radiation appropriately close to the disease tissue. Little radioactive inserts are put into or close to the cerebrum cancer amid surgery. They are otherwise known as seeds or pellets. This type of treatment is additionally called interstitial radiation. Brachytherapy is not utilized as regularly as outside radiation to treat cerebrum cancers.

Dangers of Brachytherapy

• Contamination
• Seizures
• Cerebral pain
• Death of close-by tissue (corruption)
• Brain swelling

The patient may be awake during this procedure. Provided that this is true, nearby anesthesia may numb the area on the head. Or a general anesthesia may be given. Thin cylinders (catheters) might be set into little gaps in your skull. The radioactive seeds are sent through the catheters into the cancer. The catheters might be removed immediately or left set up until the seeds are removed.

A few kinds of low-dose seeds are left set up a few months or permanently. These seeds may need to be set during open brain surgery (craniotomy).