Having a brain tumour is not necessarily the end of the world. Log into the official website of the US-based National Brain Tumor Society (braintumor.org), and you will read stories posted by survivors of brain tumor. As in all diseases, never ignore any signs and symptoms that may indicate that something is wrong with your brain.
In June this year, brain tumour made headline news in Singapore, when their ex-national footballer Nasir Jalil died of this disease at the age of 56 in a Terengganu hospital. It goes to show that physically active people are not immune to brain tumours. So, what is brain tumour? A brain tumour can be either benign or malignant. A benign brain tumour does not contain cancer cells; once removed, it seldom grows back. Though cells from a benign tumour do not invade tissues around them or spread to other parts of the body, they can sometimes be life-threatening. A malignant brain tumour is cancerous in nature, and often causes death. Growing rapidly, the cancer cells invade the surrounding healthy brain tissue. They may also break away and spread to the spinal cord or other parts of the body.
Doctors often group brain tumours by grade — from low grade (grade I) to high grade (grade IV). The grade of a tumour refers to the way the cells look under a microscope. Cells from high-grade tumors look more abnormal and generally grow faster than cells from low-grade tumors.
Though the exact cause of brain tumours are still uncertain, doctors have identified several risk factors. These risk factors give you an increased chance of developing brain tumour.
(a) Brain tumours are more common in men than in women
(b) Brain tumors risk is higher if you are white but it does not mean Asians won’t
have the disease.
(c) Most brain tumours occur in men over 70
(d) People with family members with a history of brain tumour are likely to have it.
(e) People exposed to radiation stand a higher risk of getting this disease.
(f) People are also at a higher risk if they work in a plastic and textile factory and are
exposed to chemicals such as formaldehyde, vinyl chloride or acrylonitrile.
(g)There have also been studies linking frequent use of cellular phones to brain
The brain is like the boss of our body as it directs our activities such as walking and talking, including the things our body does without thinking (like breathing). The brain is also in charge of our senses (sight, hearing, touch, taste, and smell), memory, emotions, and personality. When a tumour occurs in our brain, a few of these activities will be affected as initial signs and symptoms. As different parts of the brain control different functions, symptoms vary according to the location of the tumour. Among the possible symptoms to look out for are:
(a) epileptic seizures in an adult.
(b) gradual loss of movement or sensation in an arm or leg.
(c) headaches that are worse in the morning, associated with loss of sense of balance,
weakness in the limbs, or vomiting.
(d) unsteadiness or imbalance, especially if it is associated with headache.
(e) changes in vision, such as getting double vision, or dropping eyelids.
(f) hearing loss with or without dizziness.
(g) speech difficulty of gradual onset.
(h) nausea or vomiting that is most severe in the morning.
(i) memory loss and problems concentrating.
(j) change in personality
(k) abnormal cessation of menstruation
Diagnosing a brain tumour usually involves a neurological examination, brain scans, and an analysis of the brain tissue. The diagnosis will allow the doctor to classify the tumour as least aggressive (benign) to the most aggressive (malignant).
In a neurological examination, the doctor measures patient’s alertness, coordination, reflexes, muscle strength and response to pain. If responses to the exam are not normal, the doctor may refer the patient to a neurologist or neurosurgeon, who will then perform a brain scan or other diagnostic tests.
Some types of tumours deposit calcium in the skull or cause changes in the bone of the skull. A skull X-ray will indicate these conditions.
(c) A brain scan
Several types of brain scans are available. All these procedures sound frightening when first mentioned to the patient, and family members have an important role in providing moral and emotional support to him or her.
–Magnetic resonance imaging (MRI) allows doctors to look inside the brain without using X-rays. The magnetic resonance scanner uses magnetism and radio waves to produce pictures of the brain or any part of the human body. It provides pictures from various planes, which allow doctors to create a three-dimensional image of the tumor. The MRI detects signals emitted from normal and abnormal tissue, providing images of most tumours. Since MRI uses magnetic fields, patients who have metal implanted in their body in any form (such pacemaker, cardiac monitor, surgical clip), should let the doctor be aware of their condition.
–CT (Computed Tomography) uses a sophisticated X-ray machine linked to a computer. Before the scan, the patient is injected with a contrast dye so that the brain shows up clearly in the pictures, including any tumours. Swelling, bleeding, and bone and tissue calcification can also be detected. Some patients may develop allergic reactions to the contrast dyes. Gadolinium, a popular contrast dye, may cause temporary headaches but has no other side effects. Another contrast agent, iodine can cause rashes and, in some cases, difficulty breathing.
–PET scan (Positron emission tomography) uses radioactive materials or tracers to detect activity in a patient’s organs and tissues. Before the scan, the patient will be injected with a tracer (usually deoxyglucose) which will travel through the bloodstream and to the organs and tissues. Next, the patient will lie down on a surface that will move into a cylinder. Now the scary part begins: the patient will hear all kinds of loud noises in the cylinder. The scanner detects the radioactivity from the tracer and sends this information to a computer, which creates a live image. A PET scan can show scar tissue, recurring tumour cells, and necrosis (cells destroyed by radiation treatment). Some nervous patients may request to be given a sedative.
(d) A biopsy
A biopsy is a surgical procedure involving the removal of tissue to look for tumour cells. The tissue is examined under a microscope. If an exact diagnosis is not possible because more than one grade of tumour cells exists within the same tumour, the tissue may be sent to an advanced laboratory for further analysis.
There are two types of biopsy: open and needle. In an open biopsy, a piece of the skull is removed so that the doctor can get access to the brain. After the tumour is completely or partially removed, the bone is usually put back into place. Also known as a needle biopsy, a closed biopsy is performed when the tumour is in an area of the brain that is difficult to reach. In this procedure, the doctor drills a small hole in the skull, called a burr hole. He puts a needle through the hold and extracts a sample of the tissue from the brain tumor.
Shock will hit most people when told they have a brain tumour. Therefore, it is best for a family member to accompany the patient when the diagnosis results are revealed. In the discussion with the doctor on the various treatment options available, it may be wise to take notes or have it recorded on a recording device. Depending on the severity, size and location of the tumour, the assistance of other healthcare professionals may be necessary for full recovery, such as dietitian, physical therapist, speech therapist and mental health counselor.
Questions that a patient may want to ask are following:
1.What type of brain tumour do I have?
2.Is is benign or malignant?
3.What is the grade of my tumour?
4.Which treatment do you recommend? Why?
5.What are the benefits of each type of treatment?
6.What are the side effects of each type of treatment?
7.What is the comparative cost of each treatment?
8.How will treatment affect my normal activities?
Surgery is usually the first counter-attack against brain tumours. The aim is to remove as much of the tumour as possible while maintaining neurological function. After surgery, chemotherapy and radiation therapy may follow to ensure that all cancer cells are killed. There are different types of treatment such as hyperthermia therapy and biologic therapy. For children with brain tumours, steroids are sometimes used to prevent swelling in the brain. Anti-seizure medications may also be prescribed.