by Dr. John Rees
Dr Rees discusses brain tumours for our health series this month, and directs families and patients to available support
Brain tumours are relatively uncommon compared with other parts of the body, about 16,000 are diagnosed annually with perhaps 60,000 people living daily with a brain tumour. They can occur at any age, maximally in the 50’s to 70’s. Children rarely present with a brain tumour and these occur invariably in the back of the brain and can respond well to treatment.
They are divided into primary tumours arising within the cranial cavity and those arising from a cancer elsewhere in the body, a metastasis.
Primary brain tumours are benign or malignant. Benign tumours arise outside the brain, are surrounded by a capsule (a skin), and in distinction to malignant ones, do not invade adjacent brain tissue but cause problems due to local pressure or a rise in intracranial pressure.
Meningiomas are the commonest benign tumour and arise from the meningeal lining of the brain, they are occasionally multiple.
Malignant tumours (gliomas), arise in the brain, from the glial cells. These are the supporting structures of the brain, not the neurones (brain cells), and comprise 40% of primary brain tumours, they vary in malignancy (aggressiveness), from grade 2 > 4. They invade and destroy surrounding brain and merge into it making it difficult for the surgeon to distinguish one from the other at operation.
Metastatic brain tumours arise from a cancer elsewhere in the body, typically lung or breast but occasionally any cancer and are often multiple.
Brain tumours present themselves in a variety of ways that can be very difficult to detect early on and depend very much on exactly where the tumour is situated. An epileptic fit is common, gradual increasing one sided weakness or sensory disturbance, impairment of memory, speech or vision, drowsiness, nausea and personality change. Headache is often a symptom but not the cardinal one. If the tumour has caused a rise in pressure within the brain, then headache and drowsiness are often prominent symptoms.
Diagnosis is made by CT or MRI imaging, occasionally supplemented by outlining the blood vessels (angiography). These techniques are now very sophisticated and can usually determine the exact nature of the tumour. Taking a sample via a small operation (biopsy) is needed occasionally.
Treatment depends on the nature, the site and size of the tumour and these days is usually discussed at a Multi Disciplinary (MDT) meeting where all the specialists involved with patient’s treatment will consider all the options and advise the most suitable for that individual.
If the tumour is benign, then a watch, wait and rescan at regular intervals policy may be the treatment of choice, equally a surgical removal via an open brain operation may be the best option.
If the tumour is malignant whether primary or metastatic, then oral steroids and a maximal partial removal followed by radiotherapy may be offered. It is almost impossible to completely remove a glioma surgically but the recent approval of a dye for use during operation will help to remove as much tumour as possible. Sadly, treatment for malignant gliomas is not very effective, not least because the brain is protected by what is known as the ‘blood brain barrier’. Current promising research includes the use of immunological drugs and vaccination techniques.
All these patients and families will need much support: The Brain & Spine Foundation, Brain Tumour Research, Macmillan and Marie Curie may also be able to help.