Brain tumors are abnormal growths of cells that can develop in any part of the brain or skull, including its protective lining, the brainstem, sinuses, and nasal cavity.

In India, brain cancer is a significant public health issue, with an estimated 24,820 new cases and 18,330 deaths projected for 2025. According to the National Cancer Institute (NCI), it accounts for 1.2% of all new cancer cases and 3.0% of all cancer deaths, with a 5-year relative survival rate of 33.0%.

What are the Differences Between Brain Tumors and Cancer?

All brain cancers are tumors, but not all brain tumors are cancerous. Tumors that aren't cancerous are called benign brain tumors. There are over 40 types of brain cancers, but they are generally grouped into two categories:

• Benign brain tumors: These typically grow slowly, rarely spread, and have distinct borders. However, they can still be dangerous by damaging and compressing parts of the brain, causing severe dysfunction. Very rarely, a benign tumor can become malignant. Examples include meningioma, vestibular schwannoma, and pituitary adenoma.
• Malignant brain tumors: These are cancerous and typically grow rapidly, invading surrounding healthy brain structures. They can be life-threatening due to the changes they cause to vital brain structures. Examples include olfactory neuroblastoma, chondrosarcoma, and medulloblastoma.

Types of Brain Tumors

Brain tumors are further classified into two types based on their origin:

• Primary brain tumors: These originate in the brain. Examples include meningiomas and gliomas. Very rarely, these can spread to other parts of the brain and spinal cord. Common types are:
  • Gliomas: The most common type, including glioblastoma, astrocytoma, and oligodendroglioma.
  • Meningiomas: Arise from the meninges and are usually benign.
  • Medulloblastomas: Common in children and arise in the cerebellum.
  • Pituitary tumors: Affect hormone production.
• Metastatic brain tumors: Also known as secondary brain tumors, these are malignant tumors that originate as cancer elsewhere in the body and then spread to the brain. They are about four times more common than primary brain tumors and can grow rapidly, crowding or invading nearby brain tissue.

Brain Tumor Locations

Brain tumors can form in or near brain tissue, including nerves, the pituitary gland, the pineal gland, and the membranes covering the brain.

• In adults, the most common primary tumors are meningiomas (usually benign and slow-growing) and astrocytomas (tumors starting in brain cells). Glioblastomas are the most aggressive and have a poor prognosis.
• In children, the most common type is malignant medulloblastoma.

Specific tumors tend to form in certain regions:

• Meningiomas: Form in the meninges (protective linings of the brain).
• Pituitary tumors: Develop in the pituitary gland.
• Medulloblastoma tumors: Arise from the cerebellum or brainstem.
• Skull base tumors: Grow on the underside of the brain.

Causes and Risk Factors

The exact cause of brain cancer is unknown, but several risk factors may contribute:

• Genetic Mutations: DNA changes can cause cells to grow uncontrollably. A small proportion of brain tumors are linked to rare genetic conditions like neurofibromatosis (NF) types 1 and 2, tuberous sclerosis (TSC), Li-Fraumeni syndrome, and Von Hippel-Lindau syndrome (VHL).
• Family History: While rare, some genetic conditions increase risk.
• Radiation Exposure: High doses of radiation, such as from radiation therapy or nuclear exposure, can increase risk.
• Gender: Men are more prone to brain cancer than women.
• Age: Brain tumors are more common in older adults, but some types, like medulloblastomas, are common in children. The risk increases with age.
• Weakened Immune System: Increases the risk of certain types, such as lymphoma of the brain.

Myth: Using mobile phones, artificial sweeteners, or having head injuries are not proven to cause brain tumors.

Symptoms

Symptoms vary based on the tumor's size, location, and growth rate. In some cases, there are no symptoms.

General Symptoms

• Persistent Headaches: These are reported by over 53% of people with brain tumors and often worsen over time. However, not all headaches indicate a tumor.
• Seizures or convulsions.
• Difficulty thinking, speaking, or finding words.
• Personality or behavior changes.
• Fatigue, weakness, numbness, or paralysis in one part of the body.
• Nausea or vomiting.
• Loss of balance, dizziness, or unsteadiness.
• Vision changes.
• Memory loss.
• Hallucinations.

Location-Specific Symptoms

• Frontal lobe: Poor reasoning, personality changes, and decreased speech production.
• Temporal lobe: Poor memory and difficulty with language comprehension.
• Parietal lobe: Difficulty with speaking, writing, and spatial perception.
• Occipital lobe: Poor vision or vision loss.
• Cerebellum: Poor balance, muscle movement, and posture.
• Brain stem: Seizures, headaches, and partial paralysis.

Important: Many of these symptoms can be caused by other conditions. Prompt diagnosis by a medical professional is crucial.

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How Is a Brain Tumor Diagnosed?

If a brain tumor is suspected, a doctor may perform a physical exam to check reflexes, muscle strength, and coordination. An ophthalmoscope may be used to view the optic nerve.

To determine if a tumor is cancerous, a doctor may:

• Perform a biopsy: A sample of the tumor is removed and examined under a microscope.
• Order imaging tests: CT or MRI scans, PET, and SPECT.
• Perform a spinal tap (lumbar puncture): To check cerebrospinal fluid for tumor markers.
• Order genetic tests: To check for gene abnormalities.

Prevention and Early Detection

While brain cancer can't always be prevented, you can reduce risks:

• Avoid radiation exposure: Limit unnecessary CT scans.
• Stay healthy: Exercise, maintain a balanced diet, quit smoking, and reduce alcohol intake.
• Avoid exposure to chemicals and environmental toxins.
• Protect your head: Wear helmets to prevent brain injuries.
• Regular check-ups: Early detection improves treatment success.
• Manage stress: Chronic stress can weaken the immune system.
• Enhance indoor air quality: Use proper ventilation and air purifiers.
• Mental stimulation: Keep your brain active with reading, puzzles, and learning.

Treatment for Brain Cancer

Brain tumors may be treated with surgery, radiation therapy, chemotherapy, or a combination of these. Genetic testing is also performed.

• Surgery (Craniotomy): Some tumors can be completely removed. For glioblastomas, surgery is followed by radiotherapy and chemotherapy to improve outcomes.
• Radiation Therapy: Uses focused radiation on the tumor area or the entire brain. Whole-brain radiation is often used for metastatic tumors.
  • Side effects: Fatigue, headaches, memory loss, scalp irritation, and hair loss.
• Chemotherapy: Can be used for both cancerous and benign tumors, sometimes along with radiation.
  • Side effects: Nausea, vomiting, and hair loss.
• Targeted Therapy: Uses medicines that attack specific chemicals in tumor cells, causing them to die.
• Immunotherapy: Boosts the immune system to fight cancer. It's a new field that has shown success, particularly with glioblastoma.
• Clinical Trials: Research-based treatments for advanced cases, focusing on new therapies.

Side Effects of Treatment: Fatigue, nausea, memory loss, hair loss, and speech difficulties. Supportive care is vital to manage these effects.

Seizures

Seizures are a common symptom. They can be classified as:

• Focal aware seizures: The person remains conscious but may feel spaced out, have unusual sensations (tastes, smells, tingling), or experience muscle stiffness.
• Focal impaired awareness seizures: The person has trouble understanding or answering people and may make strange or repetitive movements or sounds.
• Motor seizures: Involve a change in movement, such as muscles going stiff or jerking.
• Non-motor seizures: No change in movement, but there may be sensory effects.

What to Do During a Seizure:

• Stay calm and reassure the person.
• Protect them from injury by guiding them to a safe place and removing nearby objects.
• Turn them gently on their side to prevent choking.
• Do not restrain them or force anything into their mouth.
• Note the duration of the seizure.

What to Do After a Seizure:

• Allow the person to rest.
• Reassure and orient them.
• Check for injury.
• Call for emergency help if a seizure lasts more than 5 minutes or occurs repeatedly.

Prognosis

The prognosis depends on the type of tumor and its characteristics.

• Medulloblastoma: Good prognosis with a combination of chemotherapy, radiotherapy, and surgery.
• Glioblastoma: The most aggressive form, with a median survival of only 15 months even with aggressive treatment.
• Brainstem gliomas: Poorest prognosis, with most patients dying within one year. However, focal brainstem gliomas in children can have a good prognosis.
• Acoustic neuroma: Non-cancerous and treatable with surgery, radiation, or observation.
• Oligodendrogliomas: Incurable but slowly progressive, with a reported median survival of up to 16.7 years for some grades.

Note: Younger patients and those in good overall health tend to have a better prognosis.

FAQs

Can brain cancer come back after treatment? Yes, recurrence is possible, which is why regular follow-ups are crucial.

Are there new treatments for brain cancer? Yes, scientists are researching gene therapy, personalized medicine, and new clinical trials.

Will I lose my memory or personality? Brain tumors can cause personality changes and cognitive problems, affecting your ability to think, reason, and remember.

What are the symptoms of end-stage brain cancer? Symptoms include frequent headaches, agitation, delirium, agonal breathing, hallucinations, and loss of appetite.

Can I still work or drive with brain cancer? It depends on the tumor type and side effects. Many people continue to work, but driving may be restricted due to seizures or other cognitive and vision problems.

Is brain cancer curable? While the term "cure" is rarely used, some tumors are highly treatable, and individuals can live long, healthy lives depending on the tumor's type, grade, and location.

Can I live a normal life with brain cancer? Many individuals can live fulfilling and relatively normal lives with personalized treatment, supportive care, and a strong support system.

Are there alternative or holistic treatments? No alternative treatment can replace medical care, but many people find complementary approaches like mindfulness, nutritional support, or acupuncture helpful for coping with stress. Always discuss these with your doctor.

How do I support a loved one with brain cancer? Be present, listen without judgment, and help with practical tasks like appointments or meals. Encourage them with kindness and patience. Caregiver support groups can also be helpful.