Written By Kshiti Kulkarni
A brain tumor is an abnormal growth or collection of cells in the brain. Tumors can be cancerous or non-cancerous. It can be benign or malignant. It meddles with a person’s decision-making, concentration, reflexes, and learning ability. What makes it so destructive is that the accumulation of cells can exert pressure on various parts of the brain, which interferes with the regular function of said part and blocks the flow of fluids into the brain altogether. This exertion of pressure is what causes most of the symptoms including headaches, seizures, and behavior changes. Dealing with brain tumors also impacts the patient’s emotional health, as mood disorders like anxiety often accompany brain tumors. In 2020, approximately 308,102 people were diagnosed with brain or spinal cord tumors, making it the 10th leading cause of death worldwide. The purpose of this article is to provide a comprehensive overview of the types of tumors, risk factors, diagnosis, treatments, and coping strategies associated with brain tumors. There are two types of brain tumors: Primary Brain Tumors and Metastatic Brain Tumors.
Primary Brain Tumors originate in the brain. Each year, around 79,000 people in the US are diagnosed with it. Some of the common Primary Brain tumors include gliomas and meningiomas. Around 33% of all brain tumors are gliomas. A glioma is a type of tumor in the glial cells, which are responsible for providing support and protection to the neurons. Three main types of gliomas that occur in adults are astrocytoma, oligodendroglioma, and ependymomas. Astrocytomas are tumors that develop in the astrocytes - a type of neuroglia that supports the neurons by connecting them to blood vessels and exchanging nutrients and growth factors. Oligodendrogliomas are tumors that develop from the oligodendrocytes - a type of supportive brain cell that's responsible for producing the myelin sheath that covers and protects the axons of the central nervous system. Ependymomas occur in ependymal cells, which play an important role in brain metabolism and cerebrospinal fluid homeostasis. Symptoms of gliomas include speech problems, personality changes, seizures, headaches, and numbness. Meningiomas are the most common type of brain tumor, accounting for about more than 30% of all brain tumors. Meningiomas occur in the meninges, which is the membrane that surrounds the brain on the inside of the skull. Symptoms of meningiomas include vision loss, memory loss, loss of smell, loss of hearing, weakness in limbs, and confusion.
Metastatic Brain tumors originate in other parts of the body and then travel to the brain. They are formed because cancerous cells from other parts of the body enter the blood vessels and eventually make their way to the brain. Common sources of origin of this type of tumor are the lungs, breast, and colon. The most common type of brain metastasis is lung-brain metastasis. Around 25% of lung cancers lead to brain metastasis. Some common symptoms of this are slurred speech, memory problems, unsteadiness, and personality changes. Breast cancers can directly metastasize in the brain, or metastasize in another body part (bones, liver, lungs) before making its way to the brain. Common symptoms include impaired judgment, balance problems, nausea, vomiting, and hemiparesis.
The causes and risk factors are not fully understood yet. However, certain factors can be associated with the growth of brain tumors. One of these factors is genetics and family history. A patient is at a higher risk of a brain tumor if a relative has been diagnosed with it. Additionally, hereditary conditions such as Turcot Syndrome and neurofibromatosis are known to increase the chances of brain tumors and are associated with the development of about 5% of all brain tumors. Another factor is radiation. This includes radiation therapy and nuclear fallout, which is capable of mutating a patient’s DNA. Another factor is the environment. This includes exposure to solvents, pesticides, infections, allergens, and viruses such as Epstein-Barr and HIV. Other factors include severe head trauma, excess cell phone use, and smoking and drinking. Age and sex are also considered risk factors, as brain tumors are more common in children and males. Furthermore, occupations such as construction and farming are associated with an increased risk of brain tumors due to exposure to hazardous carcinogenic chemicals. Ongoing research is trying to identify more risk factors to help take preventative measures.
There are several procedures performed to diagnose a brain tumor. The first procedure is a neurological exam. Although it is not 100% accurate, it serves as a great indicator of what might be wrong, as it helps determine problems with vision, hearing, reflexes, and balance. This helps the healthcare provider know what part of the brain is causing problems. A neurologist checks a patient’s mental status, motor function, reflexes, and coordination, and evaluates the 12 main nerves (olfactory nerve, optic nerve, oculomotor, trochlear nerve, trigeminal nerve, abducens nerve, facial nerve, acoustic nerve, glossopharyngeal nerve, vagus nerve, accessory nerve, and hypoglossal nerve) in a neurological exam. The next procedure to diagnose brain tumors is a head Computed Tomography (CT) scan. This method involves taking pictures using X-ray beams and is the go-to procedure if a patient is experiencing symptoms. During a CT scan, the patient has to lie still on a table, which is then inserted in the CT scanner. This scanner then emits X-ray beams from different angles. This procedure is painless, non-invasive, and usually takes between 10-30 minutes. The result of a head CT scan helps the healthcare provider determine the next steps. If he thinks a tumor is present, he would order a brain Magnetic Resonance Imaging (MRI). MRI uses magnets to generate real-time images of what is happening inside the body. It generates the most clear brain image as compared to the other procedures. In addition, an MRI can help determine the type of tumor, as well as its location. To further confirm the tumor diagnosis, a biopsy is performed. A biopsy is a procedure in which a sample of brain tissue is surgically removed to be examined under a microscope. Biopsies are used to determine how quickly the cells are dividing. After all of these procedures are performed a team of specialists review the results and create a treatment plan.
The most common treatment for brain tumors is the surgical removal of the tumor. There are several types of surgeries suitable for brain tumor removal, the most common being craniotomy. Craniotomy is the process in which a surgeon drills a hole in the skull to access the tumor, and then carefully removes the tumor without damaging the healthy brain tissues. Another type of surgery used is endoscopic brain surgery. This surgery involves putting a long, thin tube known as an endoscope, into the brain to get the tumor. When comparing endoscopic brain surgery to craniotomy, the former results in a faster recovery, lesser pain, and lesser scarring than the latter. Another available treatment is chemotherapy. Chemotherapy involves the use of chemicals, which can be taken in the form of pills or can be injected, to kill the tumor cells. Chemotherapy can be used to treat both benign and malignant brain tumors, although it has side effects such as hair loss, vomiting, and nausea. Another possible treatment is radiation therapy. It involves energy beams, which can be generated from x-rays, protons, or other sources, that kill the tumor cells. Radiation therapy can be done externally, which is known as external beam radiation, or internally, which is known as brachytherapy. A typical External beam radiation therapy involves having radiation treatments five days a week for 2 to 6 weeks. Furthermore, an intense form of radiation therapy known as stereotactic radiosurgery is also used as a treatment. It aims weak individual beams at the tumor, but when two or more beams interact, a strong radiation dose is created, which kills the tumor. The side effects of radiation therapy include fatigue, dry, itchy, or sensitive scalp, blisters on the skin, and permanent hair loss. Ongoing research on the latest technologies such as gene editing and nanotechnology offers hope for personalized treatments, although we are a long way before these technologies are implemented into the treatment of brain tumors.
Coping with a brain tumor causes a great deal of psychological stress on both the patient and their loved ones. It is essential to develop coping strategies, as they are just as important as getting the treatment. Some helpful strategies include incorporating stress-reducing activities into daily life, such as meditation and breathing exercises. These strategies calm the brain, which reduces the challenge to some degree. Some other strategies include seeking support and communicating with friends, family members, support groups, or healthcare providers. This not only helps the patient feel supported but also helps the healthcare provider gain more insights into the patient’s life, which can help them improve the experience. Creative expression, be it journaling or painting, helps the patient process emotions and keeps them from falling into depression. Lastly, getting professional help to process information can be beneficial, as counselors and therapists are trained to navigate the patient through their emotional journey.
In conclusion, a brain tumor is a complex medical condition that deserves more attention. As research and innovation continue to advance, we can look forward to better outcomes and a healthier and happier population.
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