The occurrence of brain tumours in India is steadily rising. More and more cases of brain tumours are reported each year in our country among people of varied age groups. In 2018, brain tumours was ranked as the 10th most common kind of tumour among Indians. The International Association of Cancer Registries (IARC) reported that there are over 28,000 cases of brain tumours reported in India each year and more than 24,000 people reportedly die due to brain tumours annually. A brain tumours is a serious condition and can be fatal if not detected early and treated. In this article, we tell you all you need to know about brain tumours and brain tumour treatment.
What is Brain<br> Tumour?
Uncontrolled and abnormal cell growth in the brain is called a brain tumour. The space in our skull is restricted. Therefore, this extra growth inside our brain causes more pressure inside the skull, causing life-threatening complications, and also damaging our brain.
Tumours can be either benign or malignant. The benign ones are not cancerous and cannot spread to other parts of the brain or body. The malignant ones are cancerous, grow uncontrollably and can spread to other parts of the body.
Types of <br>Brain Tumours
There are two main brain tumour types – primary and metastatic or secondary. Primary brain tumours originate within the brain. They may be either benign, without cancerous growth or malignant, with quickly-growing cancerous cells. Secondary or metastatic brain tumours are ones that start in other parts of the body like the breasts or lungs but later spread to the brain through the blood. These are always cancerous and never benign.
Primary tumours are further categorised into glial and non-glial tumours. Glial tumours or gliomas are ones that arise in the glial cells. These cells support the nervous system by surrounding and holding neurons in place, supplying nutrients and oxygen to the nerve cells, removing dead neurons, and insulating neurons from each other. Examples of gliomas are:
- Astrocytomas: These develop in the cerebrum of the brain.
- Oligodendroglial tumours: These occur in the brain’s frontal temporal lobes.
- Glioblastomas: These are very aggressive tumours and develop in the supportive tissue of the brain.
Non-glial tumours are ones that develop in structures of the brain like blood vessels, nerves, meninges or glands. Examples include meningiomas, pituitary tumours, schwannomas, pineal gland tumours, craniopharyngiomas, etc.
Secondary or metastatic brain tumours are the most common type of brain tumours and they usually spread via the bloodstream. Cancers of the breast, lungs, kidney, and skin are the ones that most commonly spread to the brain.
What are the possible causes and risk factors of Brain Tumours?
Are you wondering what causes brain tumours? Extensive research is being done to determine the exact cause of brain tumours. However, brain tumour causes are not yet clearly known.
Tumours are caused by uncontrolled cellular multiplication. This is caused by a change or mutation in our DNA. Genes that control cell division and make cells die at the correct time are affected by this mutation, and this makes the cells to grow uncontrollably, resulting in brain tumours.
Several risk factors can increase your chances of developing a brain tumour. These include:
- Radiation: Exposure to radiation can be from ionizing radiation from radiation therapy, X-rays, and CT scans. It can also be from power lines, nuclear plants, mobile phones, and cell phone towers.
- Obesity : Being overweight or obese increases your risk of developing certain kinds of brain tumours.
- Family History :Although it is rare, some types of brain tumours can be genetically inherited. If a lot of people in your family have had brain tumours, your risk of developing the same increases.
- Past Cancers : People who have had cancers like leukaemia as a child have a higher risk of developing brain tumours as an adult. Adults who have had cancers also may have a chance of getting brain tumours, but further research is needed to confirm this finding.
- Age and Race: The risk of getting brain tumours becomes greater as your age increases. Race is also a factor – Caucasians are at a higher risk of developing brain tumours than Asians or Africans.
- Exposure to Chemicals: Exposure to certain harmful chemicals in your living or work environment can put you at risk of developing a brain tumour. Examples of known carcinogens (cancer-causing substances) include diesel exhaust, coal tar volatiles, tobacco smoke, arsenic compounds, cadmium compounds, nickel compounds, and more.
Symptoms of Brain Tumour you need to watch out for
Symptoms of a brain tumour vary based on where the tumour is located and how big it is. When a tumour is big enough to put pressure on the rest of the brain tissue, you will start to notice the symptoms.
The most common ones are:
- Blurred vision
- Weakness on a part of the face or in a limb
- Memory loss
- Mood and behavioural changes
- Unequal pupils or drooping eyelids
- Tingling on one side of your body
- Loss of bowel or bladder control
- Tremors in the hands
- Changes in hearing, taste or smell
- Drowsiness and loss of consciousness
Apart from these, there are specific brain tumour symptoms in men, like development of breast tissue. Warning signs of brain tumour symptoms in women include nipple discharge, excessive body hair, and lack of menstruation.
How to diagnose a Brain Tumour?
If your doctor suspects that you may have a brain tumour, then she may recommend diagnostic tests to confirm this, such as:
- Neurological examination: This will include checking your hearing, balance, vision, coordination, reflexes, and strength. Difficulties in these areas are indicators that a specific part of your brain may be affected by a brain tumour.
- Imaging: Imaging tests like Magnetic Resonance Imaging (MRI), Computerised Tomography (CT) scan, and Positron Emission Tomography (PET) scan are used to diagnose brain tumours.
- Biopsy: A tiny piece of the tumour is removed through a minimally invasive surgery and then examined to determine whether it is benign or malignant.
- Analysis of CSF: Cerebrospinal fluid is a colourless fluid present inside the spinal cord and brain. This fluid is tested to diagnose conditions like brain tumours.
- Skull X-Ray: Brain tumours can cause skull fractures, and an X-Ray can show us this. X-rays can also find calcium deposits that are found inside some brain tumours.
- Angiography: In this procedure, a fluorescent dye is injected into your bloodstream. The dye travels to the brain and lets the doctors see details about the blood supply to the tumour. This will be helpful during surgical removal of the tumour.
Types of Treatments available
There are various options available for treating brain tumours:
- Surgery: This is the most common treatment for malignant brain tumours. The surgeon removes as much of the cancerous cells as possible without damaging healthy brain tissue. Bleeding and infection are 2 possible side-effects of surgery. Benign brain tumours can also be removed through surgery.
- Minimally Invasive Surgery: Neurosurgeons use minimally invasive techniques for this brain tumour surgery to remove the cancerous cells. This technique reduces your hospital stay duration, decreases your recovery time, and lowers the mortality rate.
- Radiation Therapy: In this type of brain tumour treatment, radiation like X-rays or protons beams are used to kill tumour cells. This can be done by external beam radiation, where you sit in front of a machine and wear a protective covering, leaving only the tumour area exposed. This therapy can also be done via brachytherapy - a device is placed inside your body near the brain tumour that gives out radiation to kill the tumour cells. Side-effects of this therapy include fatigue, memory loss, headaches, and scalp irritation.
- Chemotherapy: Drugs are injected or taken orally and they target and kill the tumour cells. Chemotherapy causes side effects like hair loss, vomiting, nausea, and tiredness.
- Targeted Drug Therapy: Certain types of brain tumours are treated with drugs that target specific abnormalities that are present in the tumour cells by blocking them. This causes cancerous cells to die.
- Radiosurgery: Unlike surgery in the traditional sense of the word, this treatment method is where many beams of radiation are focused onto the brain tumour to kill the tumour cells. Various technologies like linear accelerator and gamma knife are used to treat the brain tumour with radiation.
Understanding risks associated with Brain Tumour surgery
Brain surgery is a complicated and serious process. It is the main treatment option for brain tumours. Advanced medical technology these days allows surgeons to operate using minimally invasive methods. However, brain surgery is a critical medical procedure and carries some extra risk. Complications during and after are rare, but they may occur. Here are the risks associated with brain tumour surgery:
- Infection at the incision site or in the brain
- Blood clots
- Allergic response to anaesthesia
- Memory loss
However, surgeons take utmost care to ensure that they are thorough and attentive so that the surgery is successful and no complications arise.
Understanding the Brain Tumour surgery procedure
A brain tumour surgery requires a lot of preparation. Your doctor will give you advice to prepare for this. You will have a team of neurosurgeons performing the procedure. Depending on the type of surgery, the preparation and procedure can vary. There are various methods of brain tumour surgery such as microsurgery, ultrasonic aspiration, etc.
For a minimally invasive surgery, a small keyhole incision is made and with the help of brain imaging specialists, the surgeon removes part of or the entire tumour.
In case of a craniotomy, the surgeon cuts out an area of your skull to create an opening to access the brain. Using imaging systems, the surgeon will remove the tumour. After this, the small area of bone is put back into the skull. A craniotomy can be done under general anaesthesia or using local anaesthesia while keeping the patient awake. The latter method is used if your tumour is close to a part of your brain which controls an important function like speech, hearing, movement or sight. Keeping you awake during the surgery will help the surgeon check the functions of different parts of the brain. He does this by asking you to speak or move a specific part of your body. This way, the surgeon can make sure such functions are not harmed when removing the tumour.
After the surgery, rehabilitation is necessary for proper recovery. Your doctor may recommend therapies such as:
- Physical Therapy: This therapy would help you recover your lost muscle strength and motor skills.
- Occupational Therapy: This will help you get back to your daily routine and activities including work.
- Speech Therapy: If you have difficulty speaking post-surgery, this will help.
- Tutoring: Young children who have had brain surgery may need tutoring to help them cope with memory changes.
Road to Recovery and Aftercare (Diet and Nutrition to follow)
Post-operative care after a brain surgery is extremely important. After the operation, the patient is closely monitored to make sure that the body is functioning properly. You will also be given pain medication and may have to remain in the hospital for some time while you recover. Post-surgery, you will be kept in a raised position to prevent swelling in your brain and face. Your doctor will also give you a detailed diet and nutrition plan to make sure you recover quickly. Your doctor will also give you instructions on how to take care of the surgical wound.
Your diet and nutrition have a significant impact on your recovery after brain tumour surgery. Eating healthy, nutritious food can help you heal faster and prevent complications like high blood sugar or constipation. Here are some tips that will help:
- Have smaller and more frequent meals instead of 3 large meals a day.
- Avoid hot, spicy food.
- Avoid greasy and oily food, fried stuff, and sweets.
- Remain upright for at least an hour after you eat.
- Have water between meals to stay hydrated, but do not drink too much water while eating.
- Initially, eat soft, easily digestible, bland foods.
- Eat foods containing fibre, like fresh fruits and vegetables, and whole grains.
- Avoid constipation-inducing foods, such as processed foods, dried fruits, red meat, too much dairy, and sweets.
- Have lean protein like chicken, fish, nuts, tofu, and beans.
Brain Tumour Surgery FAQs: All your concerns addressed.
Below are the answers to some frequently asked questions about brain tumour surgery:
Q. How risky is the surgery?
A. Brain surgery is a lot more risky than other surgeries. However, neurosurgeons are experts who are very thorough and ensure that no complications arise. Make sure you choose an expert neurologist near you and the best neurology hospital to get the best care possible.
Q. How to prepare for a brain tumour surgery?
A. Your doctor will give you detailed instructions about how to prepare for the brain tumour surgery. Inform the doctor about medications that you are on, including over-the-counter medications and supplements. Let your doctor know about any allergies you have, surgeries you had in the past, and if you have been drinking alcohol.
Q. What is the outlook after a brain tumour surgery? What are my chances of survival?
A. The outlook after a brain tumour operation depends on the size, type, and location of the tumour, and your general health. It also depends on whether there were any complications during or after the surgery. The earlier the brain tumour is detected and operated upon, the better your chances of survival are. With advanced medical technology, surgical complications have become rare, and the outlook is positive.
Q. Will an awake craniotomy hurt?
A. An awake craniotomy will not hurt. You will be given a drip to make you feel relaxed and comfortable. A local anaesthetic will be administered around the site of incision. You will be able to see your team of doctors and talk to them. While removing the tumour, the surgeon will continuously test your function like speech, movement, sight, hearing, etc. If anything changes, the surgeon can stop the surgery to ensure that your vital body functions are not affected.
Q. Do I continue to take my medication before the surgery?
A. In the days before the surgery, you may have to stop taking medication. Your doctor will let you know when you should stop taking them.
Q. Can I eat and drink the night before the surgery?
A. Ideally, you should not eat or drink anything after midnight the night before the surgery. You can eat something light before midnight so that you will not feel hungry in the morning. You can have small sips of water until 2 hours before the surgery, if your surgeon permits.
Q. Who will perform the surgery and how long does it take?
A. A team of specialised neurosurgeons and anaesthetists will perform the operation. Keyhole surgery for brain tumour can take upto 3 hours, while a regular craniotomy can take 3-5 hours. An awake craniotomy can take 5-7 hours.
Q. How painful will it be after the brain tumour surgery? How will the pain be managed?
A. You will be on intravenous pain medication after the surgery, and will therefore not feel any pain. You may get headaches, and the operated area may feel tender. This can be managed with pain medication prescribed by your doctor. Once the IV medication stops, your doctor will give you pain pills to manage the pain.
Q. For how long do I need to stay in the hospital?
A. The duration of stay for brain surgery is about 3 days. Your stay may be longer if you have any post-surgical problems.
Q. What kind of care should I take after discharge?
A. After discharge, you will need to avoid lifting heavy objects for 4 weeks. You will also have to avoid getting constipated and pushing hard during bowel movements for 4 weeks. You also need to avoid physical exertion caused by working, running, exercising, etc.
Q. When should I call a doctor?
A. You will have to keep an eye out for symptoms such as:
- Fever higher than 101.5 degrees
- Sudden weakness or pain in legs and arms
- Bad headache
- Change in your mental status
- Redness or swelling at the site of incision
- Liquid draining from the site of incision.
If you experience any of these problems, you should call your doctor right away.
Q. What kind of questions should I ask my doctor before surgery?
A. It is best to be well-informed before your brain tumour surgery. Ask your doctor questions like:
- What kind of tumour do I have and where is it located?
- What size is it, and how aggressive is it?
- Is the tumour benign or malignant?
- How can this be treated?
- Can the treatment cure me completely?
- Do I need to see a specialist?
- How will the treatment cost and can I use insurance to cover the cost?
Q. What are the first signs of a brain tumour?
A. Cancer that has spread to the brain from another part of the body is called a metastatic brain tumour, which is much more common than primary tumours. Depending on the type, size, and exact location of the tumour in the brain, the early signs may vary. Following are some general signs and symptoms.
- Personality changes or mood swings
- Memory loss and confusion
- Gradual loss of sensation or movement in an arm or a leg
- Problems balancing or walking
- Muscle jerking or twitching
- Nausea and vomiting
- Weakness and numbness
- Seizures or convulsions
Q. How can I test myself for a brain tumour?
A. If you feel any of the above-mentioned symptoms in your day to day life, then go visit a doctor. They can guide you the best.
Q. What procedures and tests diagnose the type and grade of a brain tumour?
A. If you have signs and symptoms of brain tumour, then your doctor will do a physical exam, ask about your and your family's medical history and ask you to do one or more of the following tests.
- Neurologic exam
- CT Scan
- Spinal Tap
Q. What are the treatment options for brain tumours?
A. For a low-grade tumour, like Glioma, the doctor usually keeps the patient under observation. For a high-grade tumour, the treatment could be radiation or chemotherapy. For metastatic tumour, the patient has already known or suffered cancer somewhere else in his body, the treatment involves surgery followed by focus radiation. For Meningioma, the treatment after surgery involves observation. There are certain meningiomas that need more treatment than just surgery. They may regrow or they may have biological potential and are little more aggressive. Those might need radiations.
Q. What causes brain tumours?
A. Adult brain tumours are masses of abnormal cells that generally occur in adults and results from the uncontrolled growth of those cells within the brain. Causes of brain tumour is not fully understood in medical science but there are few well-established risk factors for the cause. When the human body cells grow, divide into new cells oncogenes help them stay alive. Tumour suppressor genes are those which help keep cell division under control or make cells die at the right time. Cancers can be caused by DNA changes that turn on oncogenes or turn off tumour suppressor genes.
Q. What should I bring to my consultation with the neurosurgeon at the Narayana Health group?
A. If you have been diagnosed with a brain tumor and are planning to consult a neurosurgeon at the Narayana Health group, you need to bring all brain images with reports. If you had surgery before, bring MRI reports along with the most recent pathology reports of the tests you went through.
Q. When can my family members visit me post-surgery?
A. After the surgery is done, you will be commuted to the PACU or Post Anesthesia Care Unit and then to Neuro ICU where your family members can meet you for an allowed time period.
Q. Do brain tumors or brain cancers run in family lines?
A. Yes, brain tumors also run in family lines & are hereditary. A significant mutations in the genes may cause a tumor to develop in the brain. People with these genetic conditions have an increased risk of developing brain tumors which run in families:
- von Hippel-Lindau disease
- Li-Fraumeni syndrome
Q. How do I find a doctor for my brain tumor surgery?
A. Brain tumor treatment requires an intensive approach by the neurosurgeon. If you are looking for experienced neurosurgeons in India, you can consult Narayana Health Group. We have state of the art techniques and equipment to make brain surgery a success.
Q. Are there any risks involved with brain tumor surgery?
A. Brain tumor treatment is a major medical event, so some risks can be expected. They may include:
- Allergic reaction to anaesthesia
- Brain swelling
- Impaired speech
- Impaired vision
- Infection in the brain
- Memory problems
- Weakness of body parts