Brain Tumor
- Brain Tumor
What is brain tumor?
An abnormal growth within the skull which interferes with normal brain activity.How brain tumor affects normal brain activity?
A tumor can cause damage by increasing pressure and pushing the brain or by invading the healthy brain tissue.What are complains of patient with brain tumor?
As we know, different parts of brain control different functions, so complains will vary depending on tumor’s location. Most common symptoms include:- Headache which is usually severe in morning and may be associated with nausea/vomiting.
- fit / seizure / convulsion
- difficulty in speech / vision / thinking / hearing / finding words
- weakness or paralysis of one side of the body or just one limb
- loss of balance
- confusion, disorientation, memory loss
- personality change
How is brain tumor diagnosed?
Patient’s complains and examination are obviously important as in any disease. But confirmation is done by:– Brain scan i.e., MRI or CT scan.Thus brain scan is must to diagnose that patient has brain tumor.What is the final test to confirm that patient has brain tumor and nothing else and if confirmed then what is the “type” of tumor?
In order to confirm that the growth which is seen on brain scan is tumor and nothing else, a biopsy is must.What is biopsy?
A biopsy (or histopathology) is a procedure in which tumor piece is examined by the pathologist to get the information on types of abnormal cells present in tumor. This can be done by 2 methods:-*Open biopsy – means a complete open surgical procedure where tumor is resected (completely removed) or debulked (partially removed), and this tumor is sent for pathological check up.*Closed biopsy – means where skull is not removed, but only a hole is made in skull (which is approx: 1-2 mm) and a small piece is removed and sent for pathological examination. This can be done by 2 ways depending upon the facility available in that hospital- Biopsy done by fixing frame over head, or
- Frameless biopsy (i.e.; computer navigation guidance – tumor piece is taken out by looking on computer monitor, and fixing of heavy frame for 2-3 hours is avoided).
Is a brain tumor cancer?
Some are cancers and some are not. Most common brain cancers are- Glioma (Astrocytoma) & metastatic brain tumors.Benign tumors are not considered cancers.What is difference between a benign tumor and malignant (cancerous) brain tumor?
Well, benign brain tumors are slow-growing tumors that can be removed or destroyed if in an accessible location. Malignant tumors (brain cancer) are rapidly growing tumors that invade or infiltrate and destroy normal brain tissue and thus more dangerous.Tumors are ‘graded’ to indicate how quickly they have the capacity to grow or how aggressive they are. WHO (world health organization) classify tumor into grades from the least aggressive to the most aggressive (eg grade 1 to grade 4). It indicates the rate of growth or how fast the tumor likely to grow in size and affect the patient adversely.But some benign tumors can be dangerous or bad if their location is inaccessible or difficult location (eg. brain stem) or involving important nerve or brain structure.What is the treatment for brain tumor?
The standard treatment for brain tumor is surgery, radiotherapy and / or chemotherapy. In general, radiation and chemotherapy treatments are used as secondary treatments for tumors that cannot be managed using only surgery.In most cases, treatment decisions specially with regard to surgery must be made quickly. The doctor and family must discuss a treatment plan based on type and location of a tumor. In treating brain tumors, a multi-disciplinary treatment team made up of various specialists is generally considered the preferred approach.What is the outcome of a patient with brain tumor?
Final outcome or result depends upon the ‘type’ of tumor, it’s location, form of therapy needed to treat it, and above all the condition of the patient before the start of the treatment. But, these are not the only factors to be considered as no two patients even with similar disease are identical.How do I choose the best brain doctor and hospital?
There is no “best” doctor, but there are certain issues which can help you to choose the doctor that is best for you. Good communication is the key to a good relationship with your doctor. If you ask questions from your doctor and don’t get satisfactory answers then consider changing. Also, you must check that if your doctor is experienced in brain tumor / brain surgeries. If not, then ask a referral to a specialist (neurosurgeon). You must ask whether the centre is fully equipped with neurosurgical set up i.e.; well equipped hi-tech ICU with adequate neuro patient load, in house 24 hours facility for CT scan and MRI imaging, operation theatre equipped with neuro-microscope and neuro-navigation machine (for increasing safety and precision in surgery).If a hospital has good facility but doesn’t have in-house 24 hours brain scan machine (MRI / CT scan). Is it so necessary to have in-house as it can be done outside at other places?
Well, firstly we should understand that brain scan is not just done to diagnose the tumor or bleed, but it the foremost tool to recheck the patient anytime after surgery if patient shows deterioration. As it is very obvious that no doctor can think of sending his patient outside in deteriorated condition, as it just not only risky but the scan is delayed and so is the treatment. If indoor scan facility is there the doctor can anytime ask for it even if there is slightest of the deterioration.There is no brain tumor surgery with zero percent risk, but can the risk be reduced to minimum by some machine or technique?
Well, every neurosurgeon wants to remove the tumor without damaging the brain, but where exactly to open on the skin and skull is by experience of the operating surgeon and this can vary from surgeon to surgeon. It is expected that after opening the diseased part should fall in the center of the opening, but unfortunately it is not true all the time i.e.; surgeons are also human beings and human error can always happen. So instead of imagination and relying on the ability of the experience of the surgeon, there is a machine called ’navigation’ which helps in locating the brain tumor or bleed, without giving any tension to surgeon to plan the site of opening. Also once the opening is done, it helps surgeon to plan correct pathway (because the exact depth and direction can be known).The biggest problem is where exactly is the problem located? Different surgeons may mark differently over the skin and thus open at different sites which may obviously go wrong or not totally correct. Also once tumor or bleed is deeply placed (this includes bleed from the blood vessel due to raised blood pressure) then biggest headache of an operating surgeon is to plan correct entry point so that the problem is reached in single attempt.THE BIGGEST SURPRISE FOR THE READERS OF THIS WEBSITE IS- THAT NO SURGEON CAN BE 100% SURE THAT HE IS ENTERING THE BRAIN THROUGH CORRECT CORRIDOR (THUS SOMETIMES MULTIPLE ATTEMPTS ARE REQUIRED TO LOCATE THE PROBLEM). EVEN IF PROBLEM IS REACHED, ONE CANNOT BE SURE THAT THIS IS THE SHORTEST ROUTE TO LOCATE THE PROBLEM (IT MAY BE TUMOR OR BLEED OR ANY OTHER THING). THUS THE FUTURE COMPLICATIONS WHICH PATIENT IS UNFORTUNATELY GOING TO FACE ARE THE RESULT OF THE BAD LUCK OF THE SURGEON WHO HAD TO PUT MULTIPLE HOLES IN THE BRAIN, BECAUSE HIS EXPERIENCE ACTUALLY DID NOT SUPPORTED ON THAT PARTICULAR DAY IN THAT PARTICULAR PATIENT.You must be wondering that as each part of brain controls some important function of the body; just little bad luck can lead to major problems like paralysis / speech problems / poor intelligence / and what not. Yes, you are right this is very much correct (where navigation machine is not used).Really job of a neurosurgeon is very difficult and very risky. BUT THIS RISK CAN BE REDUCED TO THE MINIMUM BY USING NAVIGATION MACHINE SYSTEM. THE PROBLEM CAN BE LOCATED BY CONTINOUSLY LOOKING ON A COMPUTOR MONITOR; THUS THE DANGEROUS EXTRA SEARCH FOR LOCATING THE PROBLEM WHICH MOSTLY IS CAUSE OF COMPLICATIONS CAN BE AVOIDED. THUS IT JUST NOT SAVE THE TIME OF SURGERY BUT ALSO SAVE LIFE AND AVOIDABLE DANGEROUS COMPLICATIONS. ALSO THE OPENING IS SMALL THUS LESS STITCHES AND PAIN IS WHAT PATIENT GETS (BECAUSE SURGEON OPENS EXACTLY OVER THE PROBLEM AND NOT BY FULL BIG INCISION). It has been accepted by top world neuro doctors that without navigation machine one should not do complicated neurosurgery. But alas! the machine or facility is not available in many of the big hospitals also.WE FEEL THAT EVERY HUMAN LIFE IS IMPORTANT AND ALL PATIENTS SHOULD BE TREATED AS RELATIVES. WITHOUT NAVIGATION MACHINE WE CAN’T GIVE 100 PERCENT JUSTICE TO OUR PATIENTS”.If navigation machine is so helpful in brain surgery then what is the reason that it is not available in every big hospital?
Well, this question should be actually answered by hospitals who don’t have this. But may be the machine cost is too much and many hospitals don’t find it cost effective as they are already performing the surgeries for years in old traditional ways. BUT IT SHOULD BE WELL UNDERSTOOD THAT THE LIFE OF ANY PATIENT IS AS IMPORTANT AS OF ANY DOCTOR OR ANY VIP. And most importantly patient who comes to a doctor to perform surgery is completely because of one word ‘faith’. And we believe that proper justice is not done to our patients if navigation machine is not used in difficult brain surgeries.What are different brain tumors treated / operated at your hospital?
The most common brain tumor is Astrocytoma and second most is meningioma.Alpabetically,Acoustic neuromaAstrocytoma :Grade 1 – Pilocytic astrocytoma,Grade 2 – Low grade astrocytoma,Grade 3 – Anaplastic astrocytoma,Grade 4 – Glioblastoma ( GBM )ChordomaChoroid plexus papillomaCraniopharyngiomaColloid cystDermoid tumorEpidemoid tumorGerminomaGlomus jugulare tumorJuvenile pilocytic astroctomaLymphomaMedulloblastomaMeningiomaMetastatic brain tumorsOther Gliomas : brain stem glioma, ependymoma, mixed glioma, optic nerve glioma, subependymoma, GangliogliomaOligodendrogliomaPineal tumorPituitary adenoma ( pituitary tumor)Primary neuroectodermal tumor ( PNET )Rathke’s cleft cyst & arachnoid cystVestibular schwannoma
