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BRAIN TUMOURS - GROWTH OF THE BRAIN

What are Brain Tumours ?

Growths of the brain (brain tumours) arise from the substance of the brain (gliomas), the membranes lining the brain (meningiomas), or nerves coming from the brain (neuromas). They are either benign (non-cancerous) or malignant (cancerous). Compared to lung or breast cancers, brain tumours are rare. They can occur at any age but most commonly develop in childhood or old age. Benign tumours, if they can be safely removed, are curable but gliomas may spread widely throughout the brain, although not throughout the rest of the body. They are difficult to cure completely. There is no known cause of brain tumours and they do not tend to run in families. There may be a sudden development of epilepsy in a previously well person. This is because a tumour is a potent source of the abnormal electrical activity which triggers fits. Some patients have a gradually worsening headache, particularly in the morning, which gradually eases off during the day. This indicates that the tumour is large and causing raised pressure within the head. Patients may also show signs of damage due to the presence of the tumour in a particular area of the brain. The type of damage gives clues as to the location of the tumour. For example, a tumour in the left front area of the brain will cause weakness of movement on the right side of the body. A large front tumour may cause a psychological illness; a tumour of the cerebellum at the back of the head will cause loss of balance (common in childhood tumours). A neuroma of the nerve of hearing, when small, will cause deafness alone. As it gets larger it may cause weakness of face movements and unsteadiness. In the early stages many of the symptoms of brain tumours are vague and it may be difficult for a GP to make the diagnosis. An average practice may see 30 patients a week with headache, but perhaps only one patient every 5 years will have a brain tumour. When a GP suspects a tumour, a referral to a specialist neurologist is arranged. Diagnosis is then confirmed by special tests, either a computerized x-ray (CT) scan or a magnetic resonance (MRI) scan. These scans will indicate if there is a tumour in the brain, where it is, and also give an indication of what it is likely to be.

Why do Brain Tumours occur ?

Almost nothing is known of the cause of brain tumours, although there are many theories. Certain types of blood vessel tumour occasionally run in families.

Treatment Involved for Brain Tumours

In most instances, an operation will be needed to establish a diagnosis and if possible remove the tumour (craniotomy). Many benign tumours can be completely removed and the condition cured. In some cases, the tumour is in an area where removal will cause too much brain damage and cure is not possible. It may, however, be possible to reduce the size of the tumour and allow you many years of healthy life, by operations being repeated on a number of occasions. Malignant tumours are more of a problem. They usually cannot be completely removed as tumour cells have spread widely into apparently normal brain. The aim of operation is to take some tumour to identify under the microscope (a biopsy), and then remove as much tumour as is safe: the surgeon will not wish to cause damage by removing normal brain tissue nearby. When the diagnosis has been established, further treatment will be either radiotherapy, chemotherapy (drugs) or a combination of both.

After Treatment of Brain Tumours

Benign tumours, if safely and completely removed, do not usually recur: you would be cured. If there were fits at the start, there may still be a tendency to fits for the rest of your life. Anticonvulsant tablets may be needed lifelong. Occasionally, even a benign tumour may recur but usually only after many years. Gliomas are often difficult to cure. From their appearance under the microscope they are graded 1 to 4. Grade 1 tumours are mostly benign in behaviour. A combination of surgery and radiotherapy may lead to a long and healthy life. Grade 4 tumours unfortunately rarely respond either to surgery, radiotherapy or chemotherapy. In these circumstances, you may receive a short course of radiotherapy as an outpatient, perhaps with steroid (cortisone-like) drugs.

If Brain Tumours are Left Untreated

Most brain tumours never stop growing. Without treatment, there is progressive brain damage, leading to disability, coma and a fatal outcome respond either to surgery, radiotherapy or chemotherapy. In these circumstances, you may receive a short course of radiotherapy as an outpatient, perhaps with steroid (cortisone-like) drugs.

Effects on Family of Brain Tumours

Patients with brain tumours require a lot of physical and emotional support from those close to them. Friends and relatives too will need support. It is important that your needs and those of your carers are discussed fully with the doctor. There are a wide range of support services which will help in the management at home. With an advanced tumour, patients can always be admitted to hospital or a hospice for terminal care.