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BRAIN ATTACK:

Know About the Treatment Options for Brain Tumor

By Dr. Anil Kumar Kansal in Neurosurgery , Neurosciences

Dec 13 , 2023 | 9 min read

A brain tumour is a serious medical condition that arises from the abnormal growth of cells within the brain. Imagine the skull as a tight enclosure for this vital organ; any growth inside such a confined space can lead to complications. These tumours can be either cancerous (malignant) or noncancerous (benign). As they grow, they can raise the pressure within the skull, causing potential brain damage that could be life-threatening.

Despite the challenges of brain tumours, advances in medicine have opened up diverse treatment options. However, the right treatment varies for each person based on factors like tumour type, stage, health, and more. Let's explore these factors before discussing treatment options.

Factors Influencing Brain Tumour Treatment

The key factors that play a crucial role in determining brain tumour treatment include:

Type of Tumour

There are many different types of brain tumours, each with its own unique characteristics. Some tumours are more aggressive than others, and some are more likely to respond to treatment. Broadly, brain tumours can be either benign or malignant. Benign tumours do not spread to other parts of the body but can still cause problems if they grow large enough. Malignant tumours are cancerous and can spread to other parts of the body.

Location of Tumour

Tumours that are located in critical areas of the brain may not be surgically removable, or they may require a more delicate surgery that carries a higher risk of complications. For example, tumours that are located near the brain stem or the optic nerves are more difficult to remove surgically. Tumours can be categorised into the following two types based on their location.

  • Operable Tumour: A tumour which can be surgically removed with minimal risk of brain damage is known as an operable tumour.
  • Inoperable Tumour: If a tumour is located in a place near a vital area or structure and is inaccessible by the surgeon, then this tumour is termed inoperable. Tumours located in the brainstem and thalamus are two such examples. But we do a stereotactic biopsy in thalamic tumours.

Patient's Age and Overall Health

Younger patients may be able to tolerate more aggressive treatment, while older patients or patients with other health conditions may need to be treated more conservatively. For example, older patients or patients with heart disease may not be able to tolerate the high doses of radiation therapy that are sometimes used to treat brain tumours. In such cases, the heart doctor of the patient decides the best way forward based on the dynamics of their case.

It is important to talk to a doctor about treatment options. Doctors can help patients understand the different options available and make the best decision for their health.

What are the Treatment Options for Brain Tumour?

When it comes to treating brain tumours, several approaches are available, each tailored to the unique characteristics of the tumour and the patient. These options include:

Brain Tumour Surgery

Surgery is often the first line of treatment for brain tumours. The goal of brain tumour surgery is to remove as much of the tumour as possible without causing too much damage to surrounding tissue. Surgery can be used to cure some brain tumours, but it is often used to relieve early signs and symptoms and prolong life. For example, surgery may be used to remove a tumour that is causing seizures or to relieve pressure on the brain.

There are situations when brain tumour surgery cannot be performed due to the tumour's location being hard to reach or too close to vital structures.

Craniotomy

A craniotomy is one of the most common types of surgery for a brain tumour. The procedure involves shaving a portion of the head, making an incision in the scalp, and then using an operating drill to remove a portion of the skull where a tumour is located. This enables the surgeon to remove as much tumour as possible. Once the tumour is removed, the portion of the skull which was removed is replaced, fixed with titanium plates and screws and then the scalp is stitched back.

Awake Craniotomy

In some cases, if a patient is undergoing awake craniotomy, they will be awake to allow the neurosurgeon to map where the functions of the brain are located. It is a fairly painless procedure as the brain tissue itself cannot feel pain, but the patient might be able to feel the pulling of the tumour. The neurosurgeon will remove as much tumour as possible without any brain damage. When an entire tumour is removed, it is known as ‘total resection. When only a part is removed, it is known as ‘debulking’. The bone flap that is removed is replaced, and the wound is closed using stitches.

More Surgical Options

  • Craniotomy & microsurgical with neuronavigation (half robotic) through the nose to remove the pituitary tumour/base of the skull tumour.
  • Endoscopic brain surgery.
  • Stereotactic brain surgery for deep-seated tumours.

Radiation Therapy

Radiation therapy uses high-energy beams to kill cancer cells. Radiation therapy can be used alone or in combination with surgery or chemotherapy. Radiation therapy can be delivered externally (from a machine outside the body) or internally (using implants placed directly in the brain). For example, radiation therapy may be used to kill cancer cells that remain after surgery or to shrink a tumour before surgery.

After receiving radiation therapy, individuals might experience short-term side effects, such as tiredness, mild skin reactions, temporary hair loss, upset stomach, and potential neurologic symptoms like memory issues. These effects usually subside shortly after the treatment ends. Additionally, radiation therapy is generally not suggested for children under the age of 5 due to the potential harm it could cause to their developing brains. The lasting effects of radiation therapy hinge on the extent of radiation exposure to healthy tissue. These long-term effects may involve challenges with memory, hormonal balance, and cognitive functions, leading to difficulties in comprehending and performing intricate tasks.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells. Chemotherapy can be used alone or in combination with surgery or radiation therapy. Chemotherapy can be given orally, intravenously, or directly into the brain. For example, chemotherapy may be used to kill cancer cells that have spread to other parts of the body or to prevent a tumour from coming back after treatment.

Chemotherapy involves a specific plan or schedule with a set number of cycles delivered over a certain period. A patient might receive one drug at a time or a mix of different drugs simultaneously. Chemotherapy aims to achieve different goals, such as eradicating any remaining tumour cells post-surgery, slowing tumour growth, or alleviating symptoms.

The side effects of chemotherapy vary based on the person and the dosage, but they can include tiredness, susceptibility to infections, nausea and vomiting, hair loss, reduced appetite, and diarrhoea. These effects generally fade once treatment concludes. In rare instances, certain drugs might lead to slight hearing impairment. Others might impact kidney function, in which case patients could receive extra fluids intravenously to safeguard their kidneys.

Targeted Therapy

Targeted therapy uses drugs to target specific molecules in cancer cells. Targeted therapy can be used alone or in combination with surgery, radiation therapy, or chemotherapy. For example, targeted therapy may be used to treat brain tumours that are caused by specific genetic mutations.

Types of Targeted Therapies

  • Bevacizumab (Avastin, Mvasi)
  • Larotrectinib (Vitrakvi)
  • Dabrafenib (Tafinlar)

Brain Tumour Symptoms

Brain tumour symptoms can vary widely depending on the size, location, and type of the tumour. Some common symptoms of brain tumours include:

  • Headaches: Persistent or worsening headaches that may be more intense in the morning or accompanied by nausea and vomiting.
  • Seizures: New-onset seizures, especially in adults, can be a sign of a brain tumour. Seizures can take various forms, from generalised convulsions to focal seizures affecting specific parts of the body.
  • Cognitive and Behavioral Changes: Brain tumours can cause changes in cognition, memory, concentration, and mood. Patients might experience confusion, memory problems, personality changes, irritability, or mood swings.
  • Vision Problems: Tumours that affect the optic nerve or other parts of the visual pathway can lead to visual disturbances, such as blurred or double vision, loss of peripheral vision, or flashes of light.
  • Motor Coordination Issues: Tumours can affect motor skills, leading to issues like weakness, numbness, or clumsiness in limbs. Patients may have difficulty walking, maintaining balance, or performing fine motor tasks.
  • Speech and Language Problems: Brain tumours located in areas responsible for language function can cause difficulties in speech production, comprehension, and expression.
  • Sensory Changes: Tumours can affect sensory perception, leading to changes in sensation, such as tingling, numbness, or altered perception of touch.
  • Nausea and Vomiting: Increased pressure within the skull due to a tumour can cause nausea and vomiting, particularly in the morning.
  • Hearing Problems: Tumours in the auditory pathway can result in hearing loss, tinnitus (ringing in the ears), or other auditory disturbances.
  • Fatigue: Persistent fatigue or drowsiness can be a symptom, often resulting from increased pressure within the brain.
  • Changes in Appetite or Weight: Some brain tumour patients experience changes in appetite, weight loss, or weight gain without apparent cause.
  • Difficulty Swallowing: Tumours located in the brainstem or near the base of the skull can affect swallowing and lead to choking or difficulty eating.

It's important to note that these early signs and symptoms can also be indicative of various other medical conditions. If you or someone you know is experiencing persistent or worsening symptoms, especially those that are sudden or severe, it's essential to seek medical attention promptly for proper diagnosis and treatment.

Read more - Understanding Brain Tumors and Nurturing Well-Being

Diagnosing Brain Tumour

Doctors use different tests to find and identify brain tumours. They also check if the tumour has spread to other parts of the body. This is rare but important to know. These tests help doctors decide on the best treatments.

For most types of tumours, the only sure way to know if there is a tumour is to take a small piece of it for testing. This is called a biopsy. Sometimes, doctors need to remove part or all of the tumour with surgery. If they can't do a biopsy, they might suggest other tests to help with the diagnosis.

Biopsy (Open or Needle Biopsy / Stereotactic Biopsy)

A biopsy is a surgical procedure that involves taking a sample in case of a non-definite diagnosis and inoperable states of the tumour tissue. It is used to determine the exact type of tumour for further treatment. The sample tissue diagnosis can further be used to determine if radiation therapy / chemotherapy / Radiosurgery will be useful.

What Happens During a Biopsy?

A biopsy is carried out in the following steps:

  • Patients with a brain tumour will undergo an MRI or CT Scan to determine the exact location of the tumour.
  • A dose of general anaesthesia is given to the patient.
  • A small ‘burr hole’ is drilled into the skull by the neurosurgeon.
  • The surgeon then passes a needle through the hole to take a sample of the tumour.
  • The hole is closed using stitches, and the patient is given steroids to help with swelling.

Read more - Does Brain Tumor Mean That I Am Suffering from Cancer?

Word of Advice

If you are considering brain surgery in India, take your time to explore treatment options. Also, ask questions if anything's unclear and have a detailed discussion with your doctor about what each treatment aims to achieve and what you can expect during the process. Most importantly, given that brain tumour treatment cost is an important factor, it's crucial to discuss the cost of brain tumour surgery and other treatment options with your doctor.