There are more than 100 different types of brain tumour, depending on which cells within the brain are involved. The most common (about 50 per cent of brain cancers) is called a glioma, and it is formed not from the nerve cells of the brain but the glial cells, which support those nerves. The most aggressive form of glioma is known as a glioblastoma multiforme – these tumours form branches like a tree reaching out through the brain, and can be impossible to completely remove.

Other Tumours Include:

The treatment and outlook for these different brain tumours varies hugely. Some, such as meningiomas and pituitary tumours are usually (but not always) benign, which means they don’t spread through the brain or elsewhere in the body – however they can still cause problems as they expand within the bony box of the skull, compressing vital parts of the brain. Other types of brain cancer are malignant, spreading through the tissues and returning after treatment.

Brain tumours are also graded in terms of how aggressive, abnormal or fast growing the cells are. Exactly where the tumour forms is also critical as some areas of the brain are much easier to operate on than othes, where important structures are packed closely together.

The reason why tumours develop in the brain remains a mystery but some risk factors are known. These include:

Age – different tumours tend to occur at different ages. About 300 children are diagnosed with brain tumours every year and these are often a type called Primitive Neuroectodermal Tumours (PNETs) which have formed from very basic cells left behind by the developing embryo. PNETs usually develop at the back of the brain in the cerebellum.

Genetics – as many as five per cent of brain tumours occur as part of an inherited condition, such as neurofibromatosis.

Exposure to ionising radiation – such as radiotherapy treatment at a young age.

Altered immunity - a weakened immunity has been linked to a type of tumour called a lymphoma, while auto-immune disease and allergy seem to slightly reduce the risk of brain tumours.

Environmental pollutants – many people worry that chemicals in the environment (such as from rubber, petrol and many manufacturing industries) can increase the risk of brain cancers but research has so far failed to prove a link with any degree of certainty. Neither is there clear and irrefutable evidence for risk from mobile phones, electricity power lines or viral infections although research is ongoing to check these.

If your GP suspects a brain tumour, you should be referred to a specialist within two weeks. Tests are likely to include blood tests, a scan of the head (MRI or CT) and possibly other brain scans, x-rays or ultrasound scans.

In order to test a sample of the brain cancer cells it’s often necessary to carry out a biopsy of the brain. A small amount of tissue is removed to study in the laboratory (this may be done at the start of an operation to remove the tumour). Alternatively a lumbar puncture may be carried out.

The symptoms and signs of a brain tumour fall into two categories:

Those caused by damage or disruption of particular nerves or areas of the brain – symptoms will depend on the location of the tumour . There may be weakness or tremor of certain parts of the body, difficulty writing, drawing or walking, changes in vision or other senses, changes in mood, behaviour or mental abilities, and many other different problems.

Those caused by increased pressure within the skull – these are general to many types of tumour. They include headache (typically occurring on waking or getting up) irritability, nausea and vomiting, seizures, drowsiness or coma.

Treatment

The type of treatment offered, and the likely response depends on the type, grade and location of the tumour. Unlike many other organs, it’s very difficult to remove parts of the brain without causing massive disruption to the control of body functions, so a cancer near a vital part of the brain may be particularly difficult to remove.

The main treatments for brain tumours include:

Surgery – to remove all or part of the tumour, or reduce pressure within the skull.

Radiotherapy – some brain cancers are sensitive to radiotherapy. Newer treatments (stereotactic radiotherapy and radiosurgery) carefully target maximum doses to small areas of the tumour, avoiding healthy brain tissue.

Chemotherapy – these treatments are limited by the fact that many drugs cannot pass from the blood stream into brain tissues because of what is known as the “blood-brain barrier”, but may be useful when tumours are difficult to operate on, or have advanced or returned.

Newer “biological” therapies – for example, drugs which block the chemicals that stimulate growth of tumour cells.

Steroids – these can help to reduce swelling of the brain and decrease pressure in the skull.

Often a combination of treatments will be recommended.

While, as a general rule, brain tumours are difficult to treat and tend to have a limited response, it can be very misleading to give overall survival figures because some brain cancers are easily removed with little long term damage, while others are rapidly progressive and respond poorly to any treatment.

While only about 14 per cent of people diagnosed with a brain tumour are still alive more than five years later, this sombre statistic could be unnecessarily worrying for a person with a small benign brain tumour. What a person diagnosed with brain cancer needs to know will be the outlook for their individual situation, which only their own doctor can tell them.

Treatments do continue to improve – for example, survival rates for young children have doubled over the past few decades, and many new developments are being tested.

Author. Medical Advice By Vivienne Balonwu, Free Medical Advice Online.

Quality Free Medical Advice Online by Vivienne Balonwu. A variety of general health advice and news online.

Brain Tumor

This is the name given to a number of tumours that can affect the brain, where a group of cells grow out of control too quickly and too irregularly. This is the basis for all cancers, and there are different types affecting the brain. These are named depending on the area and cells affected, and there may be more than one name for one type of tumour, which can be confusing. Tumours that originate solely in the brain are called primary tumours whereas other body tumours that have spread to the brain are called secondary tumours.

What causes Brain Tumour?

The cause of brain tumours remains unclear and although many possible causes have been suggested, there is little good scientific evidence for any of them.

What Are The Signs And Symptoms Of Brain Tumor?

Most brain tumours cause headaches, nausea and vomiting in their early stages due to the increasing pressure developing within the head as the tumour grows. The type of headache is often characteristic in that it is usually worse in the morning (sometimes bad enough to wake you up) and on coughing, sneezing or bending forward – i.e. any activity that increases the pressure in the head temporarily.

Another sign may be an epileptic fit, or seizure that can occur out of the blue and which may be very frightening. Blurred or double vision is relatively common also, as is early morning sickness often linked to the headache.

It is often the case that any other symptoms experienced are linked to where in the brain the tumour is located. Thus, tumours at the front of the brain can cause mood swings, personality disorders and weakness of one side of the body whereas ones at the side of the brain can cause strange smells, blackouts or feelings of deja vu.

Will I Have Any Tests Or Investigations?

Your doctor will refer you to a neurologist or a neurosurgeon – consultants who specialize in diseases of the brain and nervous system. They will do quite a number of tests, starting with a very detailed physical examination. This will include;

• An examination of the back of the eye using a special type of torch (an ophthalmoscope) – this can see whether the optic disc at the back of the eye is swollen, a sign of raised pressure within the brain (raised intracranial pressure).
• Hearing tests.
• Examination of the tongue, facial muscles and reflexes.
• Testing for power and sensation in the arms and legs.

Other investigations are then usually performed to confirm the presence or otherwise of any brain tumours including special brain scans. A CAT (computerised axial tomography) scan is a special X-ray that takes a series of pictures of the head and so builds up a cross-sectional image of the brain. A dye is injected into your arm to help the detail of the pictures here.

A similar scan, but one that uses magnetism instead of X-rays is an MRI (magnetic resonance imaging) scan, and involves slowly passing through a long cylindrical tube whilst lying completely still as the scan is taken. Dye is used as in the CT scan, and both types of scan are painless.

A newer type of scan, and one which is not always readily available, is a PET (positron emission tomography) scan where radioactive sugar solution is injected, and can show whether a tumour is benign or malignant, or whether it is active at present. The dose of radiation is no greater than that used in an ordinary X-ray, and there are no harmful side effects from it.

A chest X-ray is taken as standard, as is a skull X-ray which can occasionally show up tumours on them. An EEG (electrencephalogram) records the electrical activity within the brain, with wires being painlessly attached to the head using a special gel that washes out easily afterwards. This gives a tracing of the brain nerve impulses in the same way that an ECG test records the activity of the heart.

To find out exactly what type of tumour is being dealt with, a biopsy is the only definitive test. Under anaesthetic, a small piece of the tumour is removed and examined under a microscope, allowing exact diagnosis of the tumour to occur.

What Treatment Will I Need?

This depends on whether the tumour is a primary or secondary tumour, and the type of primary tumour involved if it is this type. With primary tumours, the best treatment is to remove them surgically, often followed by radiotherapy (X-ray) treatment to ensure any tumour cells that may have been left behind are killed. If such surgery is not possible, chemotherapy (anti-cancer drugs) are used as the main treatment in courses usually lasting several weeks. Other treatment may also be needed at the same time, such as medication to prevent any fits or to reduce the pressure inside the brain due to swelling.

Secondary tumour treatment depends on where these have arisen from (e.g. breast or bowel cancer). The usual treatment is radiotherapy to shrink down these secondary cancers as well as treating the primary tumour according to its type and location. With secondary tumours, the whole aim of treatment is to reduce any symptoms and improve the quality of life in general.

What Course Will The Illness Follow?

This is individual for each person, and your specialist will be able to give you very good advice as to what symptoms you may expect, and how readily your tumour should respond to treatment. It should be remembered that many people have brain tumours and are treated in many different ways, so the fact you are having a different treatment to another patient does not necessarily mean yours is a more serious type.

Can I Do Anything To Help Myself?

A positive mental attitude is important at this time, and there are many self-help groups that are able to give practical and pragmatic advice to help you through your treatment. If you are unsure about any aspect of your treatment – ask. Your doctor or specialist should be only too happy to try to answer your questions and reduce any unnecessary anxiety.

Tell Your Doctor

1. Have you been woken up at night by a headache?
2. Have you been sick?
3. Do you have any problems with your eyesight?
4. Have you been falling over or more clumsy recently?
5. Do you feel generally unwell?

Ask Your Doctor

1. How risky is brain surgery?
2. Will I lose my hair with treatment, and what are any other side effects?
3. Do I have to stop driving?
4. Will I need to stay on anti-epileptic drugs for life?
5. How soon can I return to work after treatment?

By Dr Roger Henderson, MB BS Lond., LMSSA Lond. Published by Dr Vivienne Balonwu at Free Medical Advice Online.

Useful Contacts:

Cancer Research Campaign
Address: 10 Cambridge Terrace, London, NW1 4JL
Telephone: 0171 224 1333
Website: http://www.crc.org.uk

Quality Free Medical Advice Online by Vivienne Balonwu. A variety of general health advice and news online.

Prostate Cancer

The prostate gland is not essential for life. It surrounds the outlet from the bladder and secretes a fluid into the semen that nourishes the sperms. It gradually enlarges with age and can block the passage of urine from the bladder.

Who Is At Risk Of Prostate Cancer?

The risk of prostate cancer increases with age and is doubled if a relative has the disease and is quadrupled if a father or brother has it. Latent or inactive cancer may be found in 50 per cent or more of 80-year-olds, but in them it is generally of no concern and is unlikely to require treatment.

What Are Prostate Cancer Symptoms?

It is uncommon for early cancer to produce urinary symptoms. However, symptoms may include urgent and frequent urination, getting up at night to urinate, or slowing of the urinary stream with difficulty starting or emptying. A urine infection or blood in the urine may occur. See your doctor if you experience any of these symptoms because they are more likely to be due to other problems.

How Is Prostate Cancer Diagnosed?

Sometimes prostate cancer is found incidentally after an operation for a benign (non-cancerous) enlargement of the prostate. It may be found during a routine check by your doctor, who examines the prostate gland with his/her finger in the rectum. This is called a digital rectal examination.

No blood test clearly shows whether you do or don’t have cancer. There is now a blood test which can help your doctor to manage prostate cancer. This is called PSA, as it tests for prostate specific antigens. The level of PSA in the blood can be raised by many infections and conditions, including a benign enlargement of the prostate, as well as prostate cancer. However, if a digital rectal examination is suspicious and/or the blood PSA is raised, your doctor may suggest a biopsy.

A biopsy involves taking a small piece of tissue from the prostate with a special needle so that it can be examined under a microscope by a pathologist. The needle is positioned in the prostate with the help of an ultrasound probe in the rectum.

If the biopsy is positive, the doctor may order a bone scan to ensure the disease hasn’t spread into the bones. If it has spread, different treatment may be needed to control the progress. If it hasn’t spread, you probably have an early cancer.

What Are Prostate Cancer Treatments?

For early prostate cancer, there are several options that you should discuss with your doctor.

* Watchful waiting

No immediate treatment may be needed in some men, especially those who have small, slowly growing tumours, or those with limited life expectancy. Your doctor will see you periodically to monitor your condition.

* Radiotherapy (treatment with X-rays)

This has been standard therapy for small, localised prostate cancer for many years. Radiotherapy involves daily outpatient treatment that lasts about 15-30 minutes each time, for up to seven weeks. Some patients can suffer irritation of the bowel or bladder, but this can usually be controlled by medication. Loss of erections (impotence) may be a problem.

* Radical prostatectomy

A biopsy of the lymph nodes takes place initially to see if the cancer has spread into them. If it hasn’t spread, the surgeon then removes the entire prostate gland (radical prostatectomy), preserving adjacent nerves where possible. If the cancer is confined to the prostate, the results of radical prostatectomy and radiotherapy are similar. The possible complications of this surgery include incontinence (usually mild), impotence and blockage of the urine flow.

* Hormone therapy

Hormone therapy involves eliminating the effects of the male hormone, testosterone – it is known that testosterone helps spread prostate cancer. Hormone therapy can be accomplished by removing the hormone-producing part of the testicles through a small incision in the scrotum. Alternatively, medications can be taken to stop the testicles from producing testosterone or to block the effects of the male hormone. This medication must be taken for life.
 
You should carefully discuss with your doctor the full implications of all these treatments, their side-effects and their impact on your working and family life.

Your doctor will arrange follow up blood tests, especially to determine the PSA level. A rise in PSA may mean the disease has returned. Careful monitoring means that any progress of the cancer can be treated early by hormone therapy.

What About Survival From Prostate Cancer?

If prostate cancer is diagnosed before it has spread, it may be treated with radiotherapy, hormones, radical prostatectomy or watchful waiting. Your survival depends upon the biological activity of the tumour and your general level of fitness. Men over 70 seldom benefit from radical surgery.

* If you have just been found to have prostate cancer, don’t panic.

* If you’re anxious that you may have a problem, ask your doctor to check you out.

* During treatment, try to eat well, stay active and keep track of your weight. And remember to follow your treatment program exactly as your doctor advises.

By Dr Mike Kirkby

Free medical advice is published by Vivienne Balonwu.

Quality Free Medical Advice Online by Vivienne Balonwu. A variety of general health advice and news online.