A persistent headache that refuses to go away. A sudden seizure can occur in someone who has never experienced one before. Unexplained weakness in an arm or leg. While these symptoms often link to stress, migraines, fatigue, or other common conditions, they can occasionally point to something more serious — a brain tumour.
On World Brain Tumour Day, observed on June 8, it is important to raise awareness of the early signs of brain tumours, the remarkable advances in treatment, and the growing hope available to patients and families.
Brain tumours are relatively common neurosurgical conditions. However, they are not as common as tumours that may occur in other parts of the body. In recent years, more brain tumours are diagnosed due to the wider availability of CT & MRI.
The most common signs are a headache that is constant and doesn’t go away, seizures or fits, or weakness of some part of the body.
A headache is a very commonly occurring problem – almost everyone suffers a headache at some point in time or other in their lives. The question is which headache needs attention from a specialist, as a majority of headaches are simple and may be related to everyday life issues like stress and anxiety, hunger, poor sleep habits, excessive TV or mobile use, or even a fever.
One needs to see a specialist when the headache does not go away despite simple medication or increases in severity, changes in character or is associated with other symptoms like blurring of vision, fits, giddiness, etc.
Generally brain tumours cause problems that either affect the function of nerves or the brain and cause weakness of a limb, difficulty in vision or hearing, etc.; they may also irritate the brain and cause fits, facial pain, etc.
Tumours in the brain may be cancerous (or malignant) or non-cancerous (or benign). There are a large number of tumours that may occur in the brain with a large variety of pathologies. Tumours, or cancers from other parts of the body, may sometimes spread to the brain – and these are called secondaries or metastases. One point to note is that cancers of the brain most often do not spread outside of the brain.
The main difference between the benign and malignant tumours is that once the benign tumour is removed completely, it will not (in all probability) recur or come back. Cancerous tumours, on the other hand, can recur depending on their aggressiveness.
While there are multiple types of brain tumours, both cancerous and non-cancerous, the main treatment method is surgery, which is done to remove the tumour. It has been clearly shown in scientific literature and evidence that removal of the tumour gives the best results, even if the tumour is a cancer.
Surgical removal of the majority of the tumour reduces the amount of tumour in the body and makes it easier for the other methods of management to work, e.g., radiation therapy or chemotherapy.
For benign brain tumours, surgery is the only way to treat them, as radiation therapy will not make the tumour disappear.
Having said this, with modern pathology that depends largely on immunohistochemistry and molecular biology, there are many tumours that we thought cancerous which actually behave like a benign tumour. Many brain tumours benefit from surgery, although treatment decisions are to be tailored based on tumour type, location, patient factors and multidisciplinary assessment.
Cancerous brain tumours are most often treated by surgery and followed up with radiation therapy and chemotherapy. A small number of tumours respond very well to radiation and chemotherapy. In the majority, radiation is the mainstay of what is called adjuvant therapy, which tries to attack the cancer cells left behind in the brain after surgery. The results of radiation therapy are always better when the amount of tumour is minimal, and therefore maximal removal of a tumour is the mainstay. Chemotherapy plays a very small role in the majority of brain tumours.
Currently the risk involved in brain tumour surgery is about 3-4% for most tumours. This changes with the type of tumour and its location as well as the surgeon’s experience and expertise with operating on these tumours.
The reasons for the reduction in the risks and complications associated with brain tumour surgery are the advances in technology related to imaging or scans before surgery to intraoperative technology. In the operating room, anaesthesia techniques, medications and monitoring have improved in a major way, making it easy for the surgeon. What has also improved are the various technological tools at the disposal of the surgeon that help him/her to improve the results of surgery and ensure patient safety. These include equipment like neuro-navigation (which works like a GPS and tells the surgeon how to reach the lesion without disturbing the normal nerves of the brain), neuro-monitoring (that continually monitors the working of the different major nerve fibres of the brain, ensuring that the patient does not suffer any postoperative problems) and intraoperative imaging (like intraoperative ultrasound and MRI).
Awake craniotomy is a method of brain surgery where the patient is awake and interacting with the anaesthetist, surgeons and other team members as the tumour in the brain is being removed.
The technique is used when the brain tumour is located at or near a functionally important part of the brain, e.g., the speech area or the area which controls hand or leg movement, etc. Before surgery, we can understand the relationship of these important areas to the tumour by doing what is called advanced neuroimaging, including tractography (where we can see the major nerves of the brain and their connections) and functional MRI (where we can map the functions like speech and movement). If the tumour is close to any area that may affect function, we use this technique.
We are able to do this procedure because of the unique quality of the brain in that the brain itself does not have pain sensation even if we cut it.
The technique requires that the patient co-operate with the treating team during surgery and understand that he/she will be woken up from sleep during the stage of tumour removal. It is important that the patient is not extremely anxious and the patient is capable of understanding the procedure, as it is patient-dependent.
The safety of doing this procedure in today’s scenario comes from the advances in anaesthesia and neuro-monitoring that are available, as it involves keeping the patient pain- and anxiety-free while at the same time awake enough to communicate with the treating team.
Children are not small adults, and they need to be treated accordingly and differently. There are many tumours that occur in children, including those from developmental problems (called congenital tumours), inherited problems (genetic defects inherited from parents), and sporadic tumours. The problem faced is that most often these are not diagnosed until they grow to a large size, as the symptoms can be misleading.
Tumours in children also need surgery and removal – and children tolerate these removals better than adults. As surgeons we need to ensure that the child’s development is not hampered in any way because of the tumour.
To patients with a possible cancerous brain tumour: There is hope. Compared to a decade ago, outcomes are much better, and survival rates are also improved, leading to better functional outcomes.
With a non-cancerous brain tumour: Many non-cancerous tumours can be treated successfully with excellent outcomes, allowing patients to return to their normal lives.
Dr. Krish Sridhar Group Mentor, Neurosciences & Director, Institute of Brain & Spine Kauvery Hospital – Radial Road, Chennai
Common early symptoms include persistent headaches, seizures, weakness in the arms or legs, blurred vision, dizziness, and changes in hearing or speech. If these symptoms persist or worsen, consult a specialist for evaluation.
No. Brain tumours can be benign (non-cancerous) or malignant (cancerous). Benign tumours usually do not return after complete removal, while malignant tumours may require additional treatments such as radiation therapy or chemotherapy.
Seek medical attention if your headache is persistent, becomes more severe, changes in pattern, or is accompanied by symptoms such as seizures, vision problems, weakness, or dizziness.
Brain tumours are commonly diagnosed using imaging tests such as CT scans and MRI scans. Based on the findings, additional tests and a biopsy may be performed to determine the tumour type.
Surgery is the primary treatment for most brain tumours. Depending on the tumour type, location, and pathology, radiation therapy and chemotherapy may also be recommended as part of the treatment plan.
Awake craniotomy is a specialised brain surgery performed while the patient is awake during tumour removal. It is recommended when the tumour is close to areas that control speech, movement, or other critical brain functions, helping surgeons preserve these functions.
Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai (Alwarpet, Radial Road & Vadapalani), Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and paediatric trauma care.
Chennai Alwarpet – 044 4000 6000 • Chennai Radial Road – 044 6111 6111 • Chennai Vadapalani – 044 4000 6000 • Trichy – Cantonment – 0431 4077777 • Trichy – Heartcity – 0431 4077777 • Trichy – Tennur – 0431 4022555 • Maa Kauvery Trichy – 0431 4077777 • Kauvery Cancer Institute, Trichy – 0431 4077777 • Hosur – 04344 272727 • Salem – 0427 2677777 • Tirunelveli – 0462 4006000 • Bengaluru – 080 6801 68011
