Brain Cancer Treatment

An overgrowth of the cells in the brain leading to the formation of masses known as tumors is known as brain cancer.

1. Brain tumors can be classified as benign (non-cancerous) or malignant (cancerous).

The tumors that are benign include:
a) Acoustic neuroma or vestibular schwannomas: These types of tumors occur on the vestibular nerve, which is the nerve that goes from the inner ear to the brain.
b) Meningioma: These are the commonly seen primary brain tumors. They form in the meninges, which are the layers of tissue protecting the brain and spinal cord (backbone).
c) Gangliocytoma: These types of tumors form in the nerve cells known as the neurons.
d) Pineocytoma: These types of tumors form in the pineal gland, which is present deep inside the brain and responsible for the secretion of the melatonin hormone.
e) Chondroma: These tumors usually begin at the base of the skull and the lower part of the spine.
f) Pituitary adenoma: These tumors form in the pituitary gland, which is present at the base of the brain and is responsible for making and controlling the hormones in the body.

Brain tumors that are malignant include:
1) Glioma: These tumors form in the glial cells, which are surrounding the nerve cells. The different types of gliomas are:
2) Astrocytoma: These types of tumors begin in the glial cells known as astrocytes.
3) Glioblastoma: The aggressive form of astrocytomas that grow rapidly are known as glioblastomas.
4) Oligodendroglioma: These are rare types of tumors that begin in the cells that form myelin, which is a layer of insulation around the nerves present in the brain.
5) Medulloblastoma: These tumors form at the base of the skull, and are the most common type of brain cancer in children.

2. Brain tumors can also be classified as:
a) Primary brain tumors: These are tumors that develop in the brain.
b) Secondary brain tumors: These are tumors that spread (metastasize) to the brain after forming in a different part of the body. The cancers that commonly spread to the brain include lung cancer, kidney cancer, breast cancer, bladder cancer, and melanoma (a type of skin cancer).

The exact cause of brain cancer development is not known. Brain cancer occurs when the changes (mutations) in certain genes cause the brain cells to grow rapidly, leading to tumor formation. Brain cancer can be caused due to a history of radiation therapy (a type of cancer treatment). Brain tumors are also thought to be hereditary in nature and maybe passed down from immediate family members.

The factors that increase the chances of developing brain cancer include:

• Radiation exposure
• Family history
• Increase in age
• Smoking
• Exposure to chemicals, pesticides, fertilizers, and herbicides
• Working with certain elements that can cause cancer like plastic, rubber, lead, petroleum
• Epstein-Barr virus infection (a common viral infection that spreads through saliva)

The symptoms of brain cancer are:

• Headaches, that may become more severe and frequent
• Nausea
• Vomiting
• Vision problems like double vision, blurred vision, or loss of peripheral vision
• Loss of sensation in an arm or a leg
• Speech difficulties
• Difficulties in maintaining balance
• Fatigue
• Confused state of mind
• Difficulty in making decisions
• Behavioral or personality changes
• Inability to follow simple instructions
• Hearing problems
• Seizures (temporary abnormalities in muscle movements due to uncontrolled electrical activity between the brain cells)

The following tests may be done to confirm the diagnosis of a brain tumor:

1. Physical examination: The doctor performs a general health examination of the patient. The patient’s symptoms are asked, along with the medical history and family history of the patient.
2. Neurological exam: The doctor will look for changes in the balance, reflexes, coordination, hearing, vision, and mental status of the patient to find out that part of the brain which may be affected by a tumor.
3. Blood tests: Blood tests may be recommended to check for the presence of tumor markers, which are the substances secreted by the tumors into blood, which may indicate the presence of cancer.
4. Imaging tests: Certain imaging tests like CT scans, MRI scans, PET scans help the doctor to view the internal organs of the body and locate the tumor.
5. Biopsy: The doctor uses a needle to take a small sample of the suspected tissue growth through a small hole in the skull. This sample is sent to the laboratory to check for the presence of cancer cells, the type of cancer cells that may be present, and how fast is it growing.
6. Spinal tap: A small needle is used for the removal of the fluid present around the spine. This fluid is sent to the laboratory to check for the presence of cancer cells.

The treatment of a brain tumor depends on the size, type, location, and severity of the tumor, along with the overall health status of the patient. The different types of treatments done for brain cancer include:

1. Surgery:
The doctor will surgically remove the tumor whenever possible.
The surgeon has to work with great precision to avoid any damage to the functional areas of the brain.
2. Radiation therapy:
This form of treatment includes using high-powered energy beams like x-rays and protons to kill the cancer cells.
Radiation therapy may sometimes be performed before surgery to shrink the tumor so that it can easily be removed.
3. Chemotherapy:
This form of treatment involves the use of certain drugs to kill the cancer cells.
These drugs can be given orally in the form of pills or injected into the veins (intravenously).
Chemotherapy may be done before surgery to shrink the tumor.
Chemotherapy may also be done after surgery to kill any cancer cells that may have been left behind.
4. Immunotherapy:
Certain drugs boost the body’s immune system or disease-fighting system to kill the cancer cells.
5. Targeted drug therapy:
This therapy involves the use of certain medications that attack specific characteristics in the cancer cells, without affecting the healthy cells.
6. Laser thermal ablation:
This therapy makes use of lasers to heat and destroy the cancer cells.

Brain cancer can lead to the following complications:

• Decreased alertness
• Difficulty in speaking
• Slower or faster pulse rate and breathing
• Numbness
• Inability to move a leg or arm on one side of the body
• Weakness
• Hearing, vision, and smelling problems

The side effects of brain cancer treatments based on the type of treatment done may include:
1. Surgery:
Infection
Bleeding
Damage to the functional areas of the brain
2. Radiation therapy:
Headache
Skin reactions
Fatigue
Memory loss
Hair loss
Irritation of the scalp
Weight gain
Nausea
3. Drug therapies (chemotherapy, targeted drug therapy, immunotherapy):
Nausea
Vomiting 
Hair loss
Mouth ulcers
Loss of appetite
Weight loss
Diarrhea
Easy bruising
Increased risk of infection

Although brain cancer cannot be prevented, controlling the following risk factors can decrease the probability of developing brain cancer:

• Quit smoking
• Limit alcohol consumption
• Avoid unnecessary exposure to radiation
• Avoid exposure to chemicals and pesticides

The Cost of Brain Cancer Treatment in India varies across differerent cities and hospitals.