BRAIN CANCER(TUMORS)

Jinu Janet VargheseGroup: 4Year: 5

Tbilisi State Medical University

Definition• Brain cancer is a disease of the brain in which cancer cells

(malignant) arise in the brain tissue. Cancer cells grow to form a mass of cancer tissue (tumour) that interferes with brain functions such as muscle control, sensation, memory, and other normal body functions.

Types of brain tumors

• Benign: The least aggressive type of brain tumor is often called a benign brain tumor. They originate from cells within or surrounding the brain, do not contain cancer cells, grow slowly, and typically have clear borders that do not spread into other tissue.

• Malignant: Malignant brain tumors contain cancer cells and often do not have clear borders. They are considered to be life threatening because they grow rapidly and invade surrounding brain tissue.

• Primary: Tumors that start in cells of the brain are called primary brain tumors. Primary brain tumors may spread to other parts of the brain or to the spine, but rarely to other organs.

• Metastatic: Metastatic or secondary brain tumors begin in another part of the body and then spread to the brain. These tumors are more common than primary brain tumorsand are named by the location in which they begin.

The most common primary brain tumors are:

• Gliomas (50.4%)

• Meningiomas (20.8%)

• Pituitary adenomas (15%)

• Nerve sheath tumors (8%)

Benign tumours can be divided into the following:

• Chordomas: starting in embryonic cells in the spine or base of the skull nerve

• Hemangioblastomas: starting in the blood vessels

• Meningiomas: starting in the membrane covering the brain

• Osteomas: in the skull bones

• Pinealomas: in the pineal gland

• Pituitary adenomas: in the pituitary gland

• Schwannomas: in the cells that wrap around nerves

Gliomas

• Most tumours develop from the supporting cells of the brain known as the glial cells. They may be named after the type of cell that they are made up of, or after the part of the brain where they are found; such as a brain stem glioma. More than half of all primary brain tumours are gliomas.

Types of glioma• Astrocytic tumours• Oligodendroglial tumours• Mixed glioma• Ependymal tumours

Medulloblastoma

• Medulloblastomas are one of the most common malignant brain tumours in children, but rare in adults. They usually develop in the cerebellum at the back of the brain but may spread to other parts of the brain. Very occasionally, these tumours spread outside the brain to the lymph nodes or lungs.

• Medulloblastoma is a type of primitive neuroectodermaltumour (PNET). PNETs develop from cells that are left over from the earliest stages of a baby’s development in the womb.

Meningioma

• Meningiomas arise from the meninges, which are the membranes that cover the brain. They can occur in any part of the meninges over the brain or spinal cord and usually grow very slowly. There are three subtypes of meningioma:

• Benign meningioma - a slow-growing, grade 1 tumour• Atypical, clear cell or chordoid meningiomas - are grade 2

tumours• Rhabdoid, papillary or anaplastic (malignant)

meningiomas - are faster growing, grade 3 tumours.

Pineal region tumours

• The pineal gland is just below the area where the two cerebral hemispheres join together. Tumours in this part of the brain are extremely rare. They can be made up of different types of cells. Some may be slow-growing, while others may grow more quickly.

• The most common tumours found in the pineal gland are germinomas; others include teratomas, pineocytomas and pineoblastomas.

Acoustic neuroma• Acoustic neuromas (also called vestibular schwannoma or

neurilemmoma), are benign tumours that develop in the acoustic or auditory nerve, which controls hearing and balance. The nerve is covered by cells called Schwann cells. The tumour starts from these cells, so it’s also known as a schwannoma.

• Acoustic neuromas are usually only found in adults and are more common in people who have a genetic condition called neurofibromatosis type 2 (NF2).

Haemangioblastoma

• This is a rare type of tumour that develops from the cells that line the blood vessels. Haemangioblastomas are benign and grow slowly. It may take several years for symptoms to appear.

Pituitary tumours

• Pituitary tumours are benign and are also called pituitary adenomas. Symptoms often appear as disturbances in vision or hormone levels.

Grading

• Grade I: The tissue is benign. The cells look nearly like normal brain cells, and they grow slowly.

• Grade II: The tissue is malignant. The cells look less like normal cells than do the cells in a grade I tumor.

• Grade III: The malignant tissue has cells that look very different from normal cells. The abnormal cells are actively growing and have a distinctly abnormal appearance (anaplastic).

• Grade IV: The malignant tissue has cells that look most abnormal and tend to grow quickly.

Staging

• Brain cancers are staged (stage describes the extent of the cancer) according to their cell type and grade because they seldom spread to other organs, while other cancers, such as breast or lung cancer, are staged according to so-called TMN staging which is based on the location and spread of cancer cells. In general, these cancer stages range from 0 to 4, with stage 4 indicating the cancer has spread to another organ (highest stage).

Causes

• The exact cause of brain tumours is unknown. But there are several risk factors. These include:

• Age: The risk of getting a brain tumour increases with age. But certain types of brain tumours are common in young adults and children.

Tissue of Origin Children Adults

Astrocytes Pilocytic Astrocytoma (PCA) Glioblastoma Multiforme (GBM)

Oligodendrocytes Oligodendroglioma

Ependyma Ependymoma

Neurons Medulloblastoma

Meninges Meningioma

• Genetic conditions: Brain tumours are usually not inherited. But there are certain genetic conditions that have been linked to brain tumours. These include neurofibromatosis type 1 and type 2, tuberous sclerosis, Li-Fraumeni syndrome, von Hippel-Lindau syndrome, Turcotsyndrome and Gorlin syndrome.

• Previous radiation: If there has been a exposure to radiation in the past, for example, radiotherapy, there is a slightly higher risk of developing a brain tumour.

• Research is ongoing into other possible causes of brain tumours. This includes viruses, power lines and mobile phones. At present, there is no scientific evidence to prove there is a link between these and brain tumours.

Signs and Symptoms• Brain cancer causes symptoms when it pushes on the brain

or destroys brain tissue. Symptoms depend on the size and location of the tumour as well as how quickly it grows.

• Although headaches are often a symptom of brain cancer, it is important to remember that most headaches are due to less serious conditions such as migraine or tension, not cancer. Headaches caused by a brain tumour are often severe, associated with nausea and vomiting and are usually worse in the morning. They can last for extended periods of time or may "come and go."

• Brain tumors can cause many symptoms. Some of the most common are

• Headaches, usually worse in the morning• Nausea and vomiting• Changes in your ability to talk, hear, or see• Problems with balance or walking• Problems with thinking or memory• Muscle jerking or twitching• Numbness or tingling in arms or legs

Diagnosis• The initial test is an interview that includes a medical

history and physical examination of the person.

• The most frequently used test to detect brain cancer is a CT scan. A dye needs to be injected into a vein for better images of some internal brain structures.

• MRI has high sensitivity & detects anatomic changes in the brain.

• A tissue sample (biopsy) may be obtained by surgery or insertion of a needle to help determine the diagnosis.

• Other tests (white blood cell counts, electrolytes, or examination of cerebrospinal fluid to detect abnormal cells or increased intracranial pressure) may help determine the patient's state of health or to detect other health problems.

Special tests

• PET scan

• EEG: The test records the electrical activity in your brain. It is often done if there are seizures.

• Angiogram: This test looks at the blood vessels in the head. It is done if the tumour is close to a blood vessel

Treatments

• The main treatments used for brain tumours are surgery, chemotherapy, radiotherapy and medication to control symptoms such as seizures. The treatment or combination of treatments is advised in each case depending on various factors.

Surgery

• Surgery is often the main treatment for benign brain tumours and primary malignant tumours. The aim of surgery is to remove the tumour (or even some of the tumour) whilst doing as little damage as possible to the normal brain tissue.

Radiotherapy• Radiotherapy is a treatment which uses high-energy

beams of radiation which are focused on cancerous tissue. This kills cancer cells or stops cancer cells from multiplying.

Radiotherapy is sometimes used instead of surgery when an operation is not possible for a malignant brain tumour. Sometimes it is used in addition to surgery if it is not possible to remove all the tumour with surgery or to kill cancerous cells which may be left behind following surgery.

Chemotherapy• Chemotherapy is a treatment which uses anti-cancer medicines to

kill cancer cells, or to stop them from multiplying. It may be used in addition to other treatments such as surgery or radiotherapy; again, depending on various factors such as the type of tumour.

Medication to control symptoms• If the patient has seizures caused by the tumour then

anticonvulsant medication will usually control the seizures. Painkillers may be needed to ease any headaches. Steroid medication is also commonly used to reduce inflammation around a brain tumour. This reduces the pressure inside the skull, which helps to ease headaches and other pressure symptoms.

Human fat can help treat brain cancer???

• Research was conducted by Alfredo Quinones-Hinojosa, from Johns Hopkins University School of Medicine.

• Stem cells taken from a patient's own body fat could soon be used to treat deadly brain cancer. Scientists have successfully used stem cells derived from human body fat to deliver biological treatments directly to the brains of mice with the most common and aggressive form of brain tumour, significantly extending their lives.

• The experiments advance the possibility that the technique could work in people after surgical removal of brain cancers called glioblastomasto find and destroy any remaining cancer cells in difficult-to-reach areas of the brain, researchers said.

• Glioblastoma cells are particularly nimble; they are able to migrate across the entire brain, hide out and establish new tumours. Cure rates for the tumour are notoriously low as a result, researchers said. In the mouse experiments, researchers used mesenchymal stem cells (MSCs) - which have an unexplained ability to seek out cancer and other damaged cells - that they harvested from human fat tissue.

• They modified the MSCs to secrete bone morphogeneticprotein 4 (BMP4), a small protein involved in regulating embryonic development and known to have some tumour suppression function.

• The researchers, who had already given a group of mice glioblastoma cells several weeks earlier, injected stem cells armed with BMP4 into their brains. Researchers said the mice treated this way had less tumour growth and spread, and their cancers were overall less aggressive and had fewer migratory cancer cells compared to mice that didn't get the treatment.

• Meanwhile, the mice that received stem cells with BMP4 survived significantly longer, living an average of 76 days, as compared to 52 days in the untreated mice study.

• Standard treatments for glioblastoma include chemotherapy, radiation and surgery, but even a combination of all three rarely leads to more than 18 months of survival after diagnosis.

Case History• This is a 21 year old male. MRI scan was done to see

the extent of tumor growth outside his brain. He had surgery once 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, diagnosis following surgery was Malignant glioma.

• The patient was operated and the entire tumor growing outside his skull was removed. 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.

References

• http://www.webmd.com/cancer/brain-cancer/• http://www.medicinenet.com/brain_cancer/page5.htm• http://ibnlive.in.com/news/human-fat-can-help-treat-brain-cancer/469494-

17.html• http://www.nlm.nih.gov/medlineplus/braincancer.html• http://www.cancer.gov/cancertopics/types/brain• http://www.macmillan.org.uk/Cancerinformation/Cancertypes/Brain/Aboutbraint

umours/Types.aspx• http://www.braintumor.org/brain-tumor-information/understanding-brain-

tumors/• http://chealth.canoe.ca/channel_condition_info_details.asp?disease_id=22&chan

nel_id=12&relation_id=1619• http://www.patient.co.uk/health/cancer-of-the-brain-and-brain-tumours• http://www.cancer.ie/cancer-information/brain-cancer/symptoms-and-diagnosis• http://www.mangalorean.com/browsearticles.php?arttype=Health&articleid=272