Brain Tumor

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Case History


 This is a 21 year old patient who was transferred on April 1st, to be seen by me and for further management. MRI scan was done (fig 1)to see the extent of tumor in his brain. You can see the tumor growing out of his brain.  He had surgery once in Pune about a year ago and the Neurosurgeon encountered problem during surgery and decided not to replace the bone flap that was removed for surgery. The tumor kept growing (fig 2 and 3), diagnosis following surgery was Malignant glioma. I decided to operate on this patient and surgery was done on April 7th and the entire tumor growing outside his skull was removed (fig 4) and reconstructed his skull (fig 5). Patient is doing very well, awake, talking, moving all his extremities and drinking full  liquids. He was weak on the left side before surgery and that remains unchanged at the moment.


Overall I am quite pleased with outcome and more than likely he will be discharged for further treatment on April 11th.


What is a brain tumor?


Brain tumors are tumors that grow in the brain. A tumor is a mass of abnormal tissue growth of which exceeds and persists in excessive manner even after cessation of the stimuli that provoked the cause. When doctors describe tumors in parts of the body other than the brain, they use the words benign (meaning harmless) or malignant (meaning cancerous). These meanings change, however, when referring to tumors in the brain.


Benign brain tumors:


A benign brain tumor consists of benign (harmless) cells and has clear margins. Surgery alone may be sufficient to cure this type of tumor.


Malignant brain tumors:


A malignant brain tumor is life-threatening. It may be malignant because it consists of cancer cells, or it may be called malignant depending on where it is located. In other words, a brain tumor composed of benign cells–but located in a vital area is still considered “malignant”. Malignant brain tumors hardly ever spread outside the brain and spinal cord.


TYPES


Tumors that start within the brain are known as  primary brain tumors.


Metastatic brain tumors are tumors formed by cancer cells that start elsewhere in the body like breast, lung, kidney etc and spread to the brain.



Who gets brain tumors?


Primary brain tumors can occur in people of all ages. Metastatic brain tumors are much more common in adults.


Primary malignant brain tumors are the second most common cause of cancer death in children up to 15 years old. They are the second most common cause of cancer death in people ages 15 to 34. They are the third most common cause of cancer death in males ages 35 to 54.


WHAT CAUSES A BRAIN TUMOR?


The cause of primary brain tumors is unknown. Environmental agents, familial tendencies, viral causes, and other possibilities are under investigation. Brain tumors are not contagious.


The various types of brain tumors occur with different frequency in children and in adults.


The most common childhood tumors are:


1. Astrocytoma
2. Medulloblastoma
3. Ependymoma


The most common adult tumors are:


1. Metastatic brain tumors from lung, breast, melanoma, and other cancers
2. Glioblastoma Multiforme
3. Anaplastic (Malignant) Astrocytoma
4. Meningioma


What are the symptoms of brain tumors?


Brain tumors are often difficult to diagnose because their symptoms, which serve as clues for the medical specialist, can be hard to pin down.


In general, the symptoms depend on the size of the tumor and the part of the brain affected. But as a tumor grows, it can affect other parts of the brain, producing new symptoms. The tumor may grow into other areas of the brain, or the “mass effect” may cause the additional symptoms. Additionally, the symptoms produced by a brain tumor often mimic the symptoms of other diseases–and vice versa.


Because symptoms may appear gradually, and because they are often not clear-cut, it may be a long time between the beginning of symptoms and the actual diagnosis.


Some of the common signs and symptoms are—Headache usually just after waking and lessening as the day goes on, Vomiting usually just after waking, with or without nausea, Mental changes, often sluggishness or drowsiness, uncoordinated, clumsy movements, Seizures.


Then ofcourse rest depends location of the tumor, like double vision, trouble with speech etc



How are brain tumors diagnosed?


The diagnosis of a brain tumor begins in the doctor’s office. The doctor begins by asking the patient a number of questions to get a complete history of the symptoms. Then he or she will do a basic neurological examination.


NEUROLOGICAL EXAMINATION


A basic neurological examination includes the following:


Eye movement, pupil reaction, and eye reflex tests 
Hearing tests using a ticking watch or tuning fork 
Reflex tests using a rubber hammer 
Balance and coordination tests. Heel-to-toe walking. Heel-to-shin movements. Balance with feet together and eyes closed. Rapid alternating movements such as touching the finger to the nose with eyes closed.
Sense of touch tests using a pin point and cotton ball
Sense of smell tests using various odors
Facial muscle tests–smiling, grimacing
Tongue movement, gag reflex tests Mental status tests. Asking for the current time and date. Asking who is President.
Abstract thinking test. Asking for the meaning of “a stitch in time saves nine.”
Memory tests. Asking to have a list of objects repeated. Asking for a description of the food eaten at breakfast yesterday. Asking for a description of the events of last X-Mas etc


If the doctor suspects brain tumor then he may order CT scan or an MRI scan of the brain.  There are other tests he may order depending on his suspicion.


Treatment of Brain tumor


Biopsy, Formal surgery, if the tumor is malignant, in addition to surgery doctor may suggest radiation and or chemotherapy. There are quite a few new treatment modalities that are available but I feel these are best discussed with the treating doctor.

Author: Dr. K.B. Mallya


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