Brain Tumor

Brain Tumor

A primary brain tumor refers to an abnormal cluster of cells originating in the brain. This piece delves into primary brain tumors among adults.

Origins, Prevalence, and Risk Factors

Primary brain tumors encompass any tumor originating within the brain. They may arise from brain cells, the brain's surrounding membranes (meninges), nerves, or glands. Tumors can either directly damage brain cells or induce inflammation, exerting pressure on adjacent brain areas and elevating pressure within the skull. The precise cause of primary brain tumors remains elusive, although various potential risk factors are identified.

Notably, radiation therapy to the brain, employed in treating brain cancers, elevates the risk of brain tumors even up to 20 or 30 years post-treatment. Conversely, factors such as workplace radiation exposure, contact with power lines, head trauma, smoking, and hormone replacement therapy lack conclusive evidence as risk factors. The debate surrounding the risk associated with cell phone usage persists; however, recent studies predominantly suggest that cell phones, cordless phones, and wireless devices do not heighten the risk. Certain hereditary conditions elevate susceptibility to brain tumors, including neurofibromatosis, Von Hippel-Lindau syndrome, Li-Fraumeni syndrome, and Turcot syndrome. Additionally, lymphomas originating within the brain, particularly in individuals with compromised immune systems, are occasionally linked to the Epstein-Barr virus.

Distinct Tumor Types

Classification of brain tumors hinges on their location, tissue type involved, and whether they are benign or malignant. Notably, tumors initially deemed less aggressive can progress to a more malignant state. Tumor incidence varies across age groups, with gliomas and meningiomas predominating among adults. Gliomas emanate from glial cells such as astrocytes, oligodendrocytes, and ependymal cells, categorized into three types: Astrocytic tumors encompass astrocytomas (potentially noncancerous), anaplastic astrocytomas, and glioblastomas. Oligodendroglial tumors may comprise a blend of astrocytic and oligodendrocytic elements, termed mixed gliomas. Glioblastomas represent the most aggressive form of primary brain tumors.

Meningiomas and schwannomas constitute other prevalent types, frequently occurring between ages 40 and 70. While generally noncancerous, these tumors may engender severe complications or mortality due to their size or location. Meningiomas exhibit a predilection for women, while schwannomas affect both genders equally. Additional primary brain tumors among adults are infrequent and encompass ependymomas, craniopharyngiomas, pituitary tumors, primary central nervous system lymphoma, primary brain lymphoma, pineal gland tumors, and primary germ cell tumors of the brain.

Symptoms

Some tumors remain asymptomatic until reaching considerable size, precipitating rapid deterioration in health. Conversely, certain tumors manifest gradually. Symptomatology hinges on factors including tumor size, location, extent of spread, and presence of swelling. Predominant symptoms encompass alterations in mental acuity, headaches, seizures (particularly in older adults), and unilateral weakness. Headache patterns associated with brain tumors may exacerbate upon waking in the morning, subside within hours, manifest during sleep, or coincide with vomiting, confusion, diplopia, weakness, or paresthesia. Additional manifestations encompass changes in consciousness, hearing, taste or smell perception, tactile sensation, coordination, speech, vision, gait, and bowel or bladder control. Pituitary tumors may elicit unique symptoms such as abnormal nipple discharge, amenorrhea, gynecomastia, acromegaly, hypertrichosis, facial changes, hypotension, obesity, or thermoregulatory disturbances.

Diagnostic Procedures

Most brain tumors induce intracranial pressure and compress brain parenchyma due to their mass effect. Diagnostic modalities include:

- CT scan of the head
- EEG
- Histopathological examination of tumor tissue obtained during surgery or CT-guided biopsy
- Cerebrospinal fluid analysis
- MRI of the head

Treatment

Treatment strategies encompass surgical excision, radiation therapy, and chemotherapy, typically overseen by a multidisciplinary team comprising neuro-oncologists, neurosurgeons, oncologists, and radiation oncologists. Early intervention enhances prognostic outcomes, with treatment objectives encompassing tumor eradication, symptom alleviation, and enhancement of brain function or comfort.

Surgery represents a cornerstone in managing most primary brain tumors, aiming for complete resection or debulking in deeply situated or infiltrative lesions. Radiation therapy may be indicated for select tumors, while chemotherapy may be employed adjunctively. Pharmacological adjuncts encompass corticosteroids for reducing brain edema, anticonvulsants for seizure control, and analgesics or gastroprotective agents for symptom management. Supportive measures encompass rehabilitation, psychological support, and palliative care interventions to optimize quality of life.