Know More About Brain Tumor

Know More About Brain Tumor


Every year more than 17,000 people in the US find out they have a brain tumor. People with a brain tumor may face the following symptoms.

General symptoms include:
1. Headaches, which may be severe and may worsen with activity or in the early morning.
2. Seizures
3. Personality or memory change.
4. Nausea or vomiting
5. Vision changes, such as blurred vision

Symptoms that may be specific to the location of the tumor include:
1. Pressure or headache near the tumor
2. Loss of balance and difficulty with fine motor skills (cerebellum)
3. Changes in judgment, including loss of initiative, sluggishness, and muscle weakness or paralysis (frontal lobe of the cerebrum)
4. Partial or complete loss of vision (occipital lobe or temporal lobe of the cerebrum)
5. Changes in speech, hearing, memory, or emotional state, such as aggressiveness and problems understanding or retrieving words (frontal and temporal lobe of cerebrum)
6. Altered perception of touch or pressure, arm or leg weakness on one side of the body, or confusion with left and right sides of the body (frontal or parietal lobe of the cerebrum)
7. Inability to look upward (pineal tumor)
8. Lactation and altered menstrual periods in women, and growth in hands and feet in adults (pituitary tumor)
9. Difficulty swallowing, facial weakness or numbness, or double vision (brain stem)

Tumor location. A tumor can form in any part of the brain. Some tumor locations cause greater damage than others, and some tumors are harder to treat due to their location than others.

steps in the Brain Tumor .
1. Normal, no complaints, no evidence of disease
2. Able to carry on normal activity; minor symptoms of disease
3. Normal activity with effort; some symptoms of disease
4. Cares for self; unable to carry on normal activity or active work
5. Requires occasional assistance but is able to care for needs
6. Requires considerable assistance and frequent medical care
7. Disabled: requires special care and assistance
8. Severely disabled; hospitalization is indicated, but death not imminent
9. Very sick, hospitalization necessary; active treatment necessary
10. Moribund, fatal processes progressing rapidly
11. Dead

Treatment:

The treatment of an adult brain tumor depends on many factors, including the size, location, type, and grade of the tumor, whether it is cancerous, whether it has spread to other parts of the CNS or body, and the person’s age and overall health. People diagnosed with a CNS tumor generally need to seek treatment as soon as possible, because some tumors can grow quickly and cause severe symptoms.In many cases, a team of doctors will work with the patient to determine the best treatment plan. Successfully treating brain and spinal cord tumors can be challenging. The blood-brain barrier, which normally serves to protect the brain and spinal cord from harmful chemicals entering those structures through the bloodstream, also keeps out many types of potentially beneficial drugs. Surgery can be difficult if the tumor is near a delicate portion of the brain or spinal cord. Radiation therapy can damage healthy tissue.
o Surgery Surgery is the first treatment most commonly used for a brain tumor and is often the only treatment needed for a benign brain tumor.Surgery to the brain requires the removal of part of the skull, a procedure called a craniotomy. After the surgeon removes the tumor, the patient’s own bone will be used to cover the opening in the skull.There have been rapid advances in surgery for brain tumors, including the use of cortical mapping and enhanced imaging devices to give surgeons more tools to plan and perform the surgery. For a tumor that is near the speech center, it is increasingly common to perform the operation when the patient is awake for part of the surgery; typically, the patient is awakened once the surface of the brain is exposed, and special electrical stimulation techniques are used to locate the speech center and thereby avoid causing damage while removing the tumor.In addition to removing or reducing the size of the brain tumor, surgery can provide a tissue sample for biopsy analysis. For some tumor types, the results of the analysis can help in showing if chemotherapy or radiation therapy will be useful. In a cancerous tumor, even if the cancer cannot be cured, its removal can relieve symptoms if it is creating pressure on parts of the brain.
o Radiation therapyRadiation therapy is the use of high-energy x-rays or other particles to kill cancer cells. Doctors may use radiation therapy along with surgery to slow or stop the growth of tumors. Radiation can be directed in the following ways:
1. Conventional radiation therapy. The treatment location is determined based on anatomic landmarks and x-rays. In certain situations, such as whole brain radiation therapy for brain metastases, this technique is appropriate. For more precise targeting, different techniques are required.
2. Intensity modulated radiation therapy (IMRT). Radiation therapy is delivered with greater intensity or dose to thicker areas of the tumor and with less intensity to thinner areas of the tumor. This is accomplished by placing tiny metal leaves in the beam to reduce the intensity of the beam in order to customize the shape of the dose to the shape of the tumor.
3. Three-dimensional conformal radiation therapy. Based on CT and MRI images, a three-dimensional model of the tumor and normal tissues is created on a computer. Beam size and angles are determined that maximize tumor dose and minimize normal tissue dose.
4. Stereotactic radiosurgery. Stereotactic radiosurgery involves delivering a single, high dose of radiation directly to the tumor and not healthy tissues.
o Fractionated stereotactic radiation therapy. Radiation therapy is delivered with stereotactic precision but divided into small daily fractions over several weeks using a relocatable head frame, in contrast to the one-day radiosurgery. This technique is used for tumors located close to sensitive structures, such as the optic nerves or brain stem.
o ChemotherapyChemotherapy is the use of drugs to kill cancer cells. Systemic chemotherapy is delivered through the bloodstream, targeting cancer cells throughout the body. The goal of chemotherapy can be to destroy cancer cells remaining after surgery, slow the tumor’s growth, or reduce symptoms.Chemotherapy can be delivered orally (by mouth), intravenously (IV, by vein), or directly into the tumor cavity. IV chemotherapy is either injected directly into a vein or through a thin tube called a catheter, a tube temporarily put into a large vein to make injections easier. For a malignant brain tumor, it is expected that a combination of treatments will be required. Typically, treatment begins with surgery, followed by radiation therapy and chemotherapy.
o ImmunotherapyImmunotherapy (also called biologic therapy) is designed to boost the body’s natural defenses to fight the cancer. It uses materials either made by the body or in a laboratory to bolster, target, or restore immune system function.Different methods are being applied, such as the use of dendritic cells or the use of vaccines aimed against a specific molecule that is expressed on the surface of the tumor cells. Several studies are currently being tested throughout the country in clinical trials.
o Advanced/recurrent brain tumors if, in spite of initial treatment, the brain tumor does not go into remission (the temporary or permanent disappearance of symptoms) or if it recurs, treatment can still manage the symptoms caused by the tumor. Symptom management is always important since the symptoms of a brain tumor can interfere with quality of life.

After Treatment
After treatment for a brain tumor ends, talk with your doctor about developing a follow-up care plan. This plan may include regular physical examinations and/or medical tests to monitor your recovery for the coming months and years. Many brain tumors have a high tendency to recur, so people should be routinely monitored for new symptoms with regular MRI scans. The frequency of the follow-up visits and the scans depends on the type of the tumor and other factors, therefore, your oncologist or neuro-oncologist will determine your schedule.People recovering from a brain tumor are encouraged to follow established guidelines for good health, such as maintaining a healthy weight, not smoking, eating a balanced diet, and having recommended cancer screening tests. Talk with your doctor to develop a plan that is best for your needs. Moderate physical activity can help rebuild your strength and energy level. Your doctor can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about Healthy Living After Cancer

Brain tumor

Unraveling Brain Tumors
Molecular Biologists Devise Strategy To Starve Brain Tumors

September 1, 2007 — Brain tumor researchers have found that brain tumors arise from cancer stem cells living within tiny protective areas formed by blood vessels in the brain. Killing those cells is a promising strategy to eliminate tumors and prevents them from re-growing. The researchers have found that drugs that block new blood vessel formation can destroy the protected areas and stop cancer from developing.



Brain tumors are often deadly. Figuring out a way to wipe them out has been a mystery for scientists. But now, a new discovery may offer clues and hope for those with even the most hard-to-treat tumors.

In the last two months, Will Pappas has had three surgeries, chemo and radiation.

"You hold out hope that well, it's just something little, and they can get it all. And then it wasn't. Then you think, well, at least it's not cancerous, and then it is," Cayce Pappas, Will's mom, says.

"It" is a brain tumor -- the stubborn kind that's hard to treat. In fact, doctors gave this seven-year-old only a 20 percent chance of surviving. Stories like Will's have molecular biologists determined to find a way to destroy brain tumors.

"It's what makes us all come to work in the morning," Richard Gilbertson, a molecular biologist from St. Jude Children's Hospital, says.

For years, researchers thought all cells inside a tumor were the same. But recently, they've discovered something different -- a small group of cancer stem cells.

"They give rise to all the cells that make up the cancer," Dr. Gilbertson explains.

Dr. Gilbertson's research shows those cancer stem cells live close to blood vessels, which fuel them. In lab experiments, he's proven drugs that target the blood vessels also destroy the cancer stem cells and can ultimately wipe out the tumor.

"So, if you can target those cells, you can have a devastating effect on the disease," Dr. Gilbertson says. Drugs like Avastin and Tarceva are now being tested in humans to see if they can target the cancer stem cells. "It's this tangible way of actually getting at the heart of the disease," Dr. Gilbertson says.

Will is taking the drug Tarceva. His mom is hoping it will work a miracle.

"That would be amazing. We would jump at the opportunity to increase our odds. He's still got a lot left to do," Cayce says.

Dr. Gilbertson says other cancers, like those of the blood, breast and colon, also contain cancer stem cells and may be treated in a similar way in the future.

BACKGROUND: Researchers at St. Jude Children's Hospital have found that brain tumors appear to arise from cancer stem cells that live inside tiny protective 'niches' formed by blood vessels in the brain. Breaking down these niches is a promising strategy for eliminating the tumors and preventing them from regrowing.

ABOUT CANCER STEM CELLS: Scientists previously believed that tumors are lumps of cancerous tissue that must be completely removed or destroyed to cure a patient. But over the last five years, cancer researchers have learned that not all cancer cells are created equal. In the same way that normal tissue in the body is generated from stem cells, so is cancer. CSCs are the ultimate source of the tumor, consistently supplying it with new cells. Researchers have identified the CSCs for acute myeloma leukemia, four types of brain cancer, and breast cancer. So it is possible that we need not kill all cancer cells to rid a patient of the disease. Targeting the CSCs specifically might be much more efficient.

CANCER'S ACHILLES HEEL: To find a weakness for CSCs, neurobiologists at St. Jude compared them to noncancerous neural stem cells. These neural tissue generators are concentrated in regions rich in blood vessels. The vessels are lined with endothelial cells, which secrete chemical signals that help stem cells survive. CSCs, they discovered, required similar conditions to flourish: in over 70 human brain tumors, the CSCs were frequently located close to tiny vessels called capillaries. When the researchers injected mice with a mix of stem and endothelial cells from human brain tumors, those animals sprouted larger tumors than the mice that received stem cells alone.

NEW DRUG THERAPY: The new findings from St. Jude indicates that it is possible to kill the cancer by disrupting the shielded compartments in the small capillaries of the brain where CSCs reside. Anti-angiogenic drugs, such as Avastin, block the formation of new blood vessels. In tests with mice, those same drugs cause a significant drop in cancer stem cells and slow tumor growth. Human clinical trials are currently in progress at St. Jude to determine the effectiveness of Avastin and another anti-angiogenic drug in eliminating tumors and preventing their recurrence in children with brain cancers.

Brain tumor

Stereotactic surgery

Stereotactic surgery or stereotaxy (not to be confused with the virtuality concept of stereotaxy) is a minimally-invasive form of surgical intervention which makes use of a three-dimensional coordinates system to locate small targets inside the body and to perform on them some action such as ablation (removal), biopsy, lesion, injection, stimulation, implantation, radiosurgery (SRS) etc. "Stereotactic" in Greek (another accepted spelling is "stereotaxic") means "solid ordering".

In theory, any organ system inside the body can be subjected to stereotactic surgery. Difficulties in setting up a reliable frame of reference (such as bone landmarks which bear a constant spatial relation to soft tissues), however, mean that its applications have been limited to brain surgery. Besides the brain, biopsy and surgery of the breast are done routinely to locate, sample (biopsy) and remove tissue. Plain X-ray images (radiographic mammography) and computed tomography can be used to guide the procedure.

Brain tumor

List of brain tumor patients
This article provides a list of notable people who had a primary or metastatic brain tumor (either benign or malignant) at some point in their lives, as confirmed by public information. Tumor type and survival duration are listed where the information is known. Blank spaces in these columns appear where precise information has not been released to the public. Medicine does not designate most long term survivors as cured.

To put survival periods in context, a Norwegian hospital reviewed 1,218 patient records from 1960–1994 and reported median survival times for several tumor types over this 35 year period as listed in the table below.[1]

According to the United States National Cancer Institute, an estimated 18,500 new cases and 12,760 deaths occurred nationwide in 2005. These high overall mortality rates are due to the prevalence of aggressive types such as glioblastoma multiforme. Nearly 14% of new brain tumor diagnoses occur in persons under 20 years of age.

Tumor type	Median survival
Glioblastoma multiforme	12 months (1.0 years)
Anaplastic astrocytoma	25 months (2.1 years)
Astrocytoma (low grade)	95 months (7.9 years)
Oligodendroglioma	74 months (6.2 years)
Mixed glioma	65 months (5.4 years)
Medulloblastoma	109 months (9.1 years)
Brain stem tumors	9 months (0.8 years)
Pineal region tumors	60 months (5.0 years)

Brain tumor

Research to treatment with the vesicular stomatitis virut

in 2000, researchers at the University of Ottawa, led by John Bell PhD., have discovered that the vesicular stomatitis virus, or VSV, can infect and kill cancer cells, without affecting healthy cells if coadministered with interferon.

The initial discovery of the virus' oncolytic properties were limited to only a few types of cancer. Several independent studies have indentified many more types susceptible to the virus, including glioblastoma multiforme cancer cells, which account for the majority of brain tumors.

In 2008, researchers artificially engineered strains of VSV that were less cytotoxic to normal cells. This advance allows administration of the virus without coadministration with interferon. Consequently administration of the virus can be given intravenously or through the olfactory nerve. In the research, a human brain tumor was implanted into mice brains. The VSV was injected via their tails and within 3 days all tumor cells were either dead or dying.

Research on virus treatment like this has been conducted for some years, but no other viruses have been shown to be as efficient or specific as the VSV mutant strains. Future research will focus on the risks of this treatment, before it can be applied to humans.

Brain tumor

Treatment and prognosis
Many meningiomas, with the exception of some tumors located at the skull base, can be successfully removed surgically. In more difficult cases, stereotactic radiosurgery, such as Gamma knife, Cyberknife or Novalis Tx radiosurgery, remains a viable option.[7]

Most pituitary adenomas can be removed surgically, often using a minimally invasive approach through the nasal cavity and skull base (trans-nasal, trans-sphenoidal approach). Large pituitary adenomas require a craniotomy (opening of the skull) for their removal. Radiotherapy, including stereotactic approaches, is reserved for the inoperable cases.

Although there is no generally accepted therapeutic management for primary brain tumors, a surgical attempt at tumor removal or at least cytoreduction (that is, removal of as much tumor as possible, in order to reduce the number of tumor cells available for proliferation) is considered in most cases.[8] However, due to the infiltrative nature of these lesions, tumor recurrence, even following an apparently complete surgical removal, is not uncommon. Several current research studies aim to improve the surgical removal of brain tumors by labeling tumor cells with a chemical (5-aminolevulinic acid) that causes them to fluoresce [9]. Postoperative radiotherapy and chemotherapy are integral parts of the therapeutic standard for malignant tumors. Radiotherapy may also be administered in cases of "low-grade" gliomas, when a significant tumor burden reduction could not be achieved surgically.

Survival rates in primary brain tumors depend on the type of tumor, age, functional status of the patient, the extent of surgical tumor removal, to mention just a few factors.[10]

UCLA Neuro-Oncology publishes real-time survival data for patients with this diagnosis. They are the only institution in the United States that shows how brain tumor patients are performing on current therapies. They also show a listing of chemotherapy agents used to treat high grade glioma tumors.

Patients with benign gliomas may survive for many years,[11][12] while survival in most cases of glioblastoma multiforme is limited to a few months after diagnosis if treatment is ignored.

The main treatment option for single metastatic tumors is surgical removal, followed by radiotherapy and/or chemotherapy. Multiple metastatic tumors are generally treated with radiotherapy and chemotherapy. Stereotactic radiosurgery (SRS), such as Gamma Knife, Cyberknife or Novalis Tx, radiosurgery, remains a viable option. However, the prognosis in such cases is determined by the primary tumor, and it is generally poor.

Radiotherapy is the commonest treatment for secondary cancer brain tumours. The amount of radiotherapy depends on the size of the area of the brain affected by cancer. Conventional external beam whole brain radiotherapy treatment (WBRT) or 'whole brain irradiation' may be suggested if there is a risk that other secondary tumours will develop in the future.[13] Stereotactic radiotherapy is usually recommended in cases of under three small secondary brain tumours.

In 2008 a study published by the University of Texas M. D. Anderson Cancer Center indicated that cancer patients who receive stereotactic radiosurgery (SRS) and whole brain radiation therapy (WBRT) for the treatment of metastatic brain tumors have more than twice the risk of developing learning and memory problems than those treated with SRS alone.[14][15]

A shunt operation is used not as a cure but to relieve the symptoms.[1] The hydrocephalus caused by the blocking drainage of the cerebrospinal fluid can be removed with this operation.

Brain tumor

Diagnosis
Although there is no specific clinical symptom or sign for brain tumors, slowly progressive focal neurologic signs and signs of elevated intracranial pressure, as well as epilepsy in a patient with a negative history for epilepsy should raise red flags. However, a sudden onset of symptoms, such as an epileptic seizure in a patient with no prior history of epilepsy, sudden intracranial hypertension (this may be due to bleeding within the tumour, brain swelling or obstruction of cerebrospinal fluid's passage) is also possible.

Glioblastoma multiforme and anaplastic astrocytoma have been associated in case reports on PubMed with the genetic acute hepatic porphyrias, including positive testing associated with drug refractory seizures. Unexplained complications associated with drug treatments with these tumors should alert physicians to an undiagnosed neurological porphyria.

Imaging plays a central role in the diagnosis of brain tumors. Early imaging methods—invasive and sometimes dangerous—such as pneumoencephalography and cerebral angiography, have been abandoned in recent times in favor of non-invasive, high-resolution modalities, such as computed tomography (CT) and especially magnetic resonance imaging (MRI). Benign brain tumors often show up as hypodense (darker than brain tissue) mass lesions on cranial CT-scans. On MRI, they appear either hypo- (darker than brain tissue) or isointense (same intensity as brain tissue) on T1-weighted scans, or hyperintense (brighter than brain tissue) on T2-weighted MRI. Perifocal edema also appears hyperintense on T2-weighted MRI. Contrast agent uptake, sometimes in characteristic patterns, can be demonstrated on either CT or MRI-scans in most malignant primary and metastatic brain tumors. This is because these tumors disrupt the normal functioning of the blood-brain barrier and lead to an increase in its permeability.

Electrophysiological exams, such as electroencephalography (EEG) play a marginal role in the diagnosis of brain tumors.

The definitive diagnosis of brain tumor can only be confirmed by histological examination of tumor tissue samples obtained either by means of brain biopsy or open surgery. The histological examination is essential for determining the appropriate treatment and the correct prognosis. This examination, performed by a pathologist, typically has three stages: interoperative examination of fresh tissue, preliminary microscopic examination of prepared tissues, and followup examination of prepared tissues after immunohistochemical staining or genetic analysis.

Another possible diagnosis would be neurofibromatosis which can be in type one or type two.

Brain tumor

Signs and symptoms
Symptoms of brain tumors may depend on two factors: tumor size (volume) and tumor location. The time point of symptom onset in the course of disease correlates in many cases with the nature of the tumor ("benign", i.e. slow-growing/late symptom onset, or malignant, fast growing/early symptom onset) is a frequent reason for seeking medical attention in brain tumor cases.

Large tumors or tumors with extensive perifocal swelling edema inevitably lead to elevated intracranial pressure (intracranial hypertension), which translates clinically into headaches, vomiting (sometimes without nausea), altered state of consciousness (somnolence, coma), dilatation of the pupil on the side of the lesion (anisocoria), papilledema (prominent optic disc at the funduscopic examination). However, even small tumors obstructing the passage of cerebrospinal fluid (CSF) may cause early signs of increased intracranial pressure. Increased intracranial pressure may result in herniation (i.e. displacement) of certain parts of the brain, such as the cerebellar tonsils or the temporal uncus, resulting in lethal brainstem compression. In young children, elevated intracranial pressure may cause an increase in the diameter of the skull and bulging of the fontanelles.

Depending on the tumor location and the damage it may have caused to surrounding brain structures, either through compression or infiltration, any type of focal neurologic symptoms may occur, such as cognitive and behavioral impairment, personality changes, hemiparesis, hypesthesia, aphasia, ataxia, visual field impairment, facial paralysis, double vision, tremor etc. These symptoms are not specific for brain tumors - they may be caused by a large variety of neurologic conditions (e.g. stroke, traumatic brain injury). What counts, however, is the location of the lesion and the functional systems (e.g. motor, sensory, visual, etc.) it affects.

A bilateral temporal visual field defect (bitemporal hemianopia—due to compression of the optic chiasm), often associated with endocrine disfunction—either hypopituitarism or hyperproduction of pituitary hormones and hyperprolactinemia is suggestive of a pituitary tumor.

Brain tumor

Brain tumors in infants and children
In the US, approximately 2000 children and adolescents younger than 20 years of age are diagnosed with malignant brain tumors each year. Higher incidence rates were reported in 1985–94 than in 1975–84. There is some debate as to possible reasons; one theory is that the trend is the result of improved diagnosis and reporting, since the jump occurred at the same time as MRIs became available widely, and since there was no coincident jump in mortality. The CNS cancer survival rate in children is approximately 60%. The rate varies with the age of onset, with younger patients having higher mortality, and cancer type.

In children under 2, about 70% of brain tumors are medulloblastoma, ependymoma, and low-grade glioma. Less commonly, and seen usually in infants, are teratoma and atypical teratoid rhabdoid tumor. Germ cell tumors, including teratoma, make up just 3% of pediatric primary brain tumors, but the worldwide incidence varies significantly

Brain tumor

What is Brain tumor?

A brain tumor is an abnormal growth of cells within the brain or inside the skull, which can be cancerous or non-cancerous (benign).

It is defined as any intracranial tumor created by abnormal and uncontrolled cell division normally either in the brain itself (Neuron, glialcells) (astrocytes, oligodendrocytes ependymal cells), (lymphatic blood vessels), in the cranial nerves (myelin-producing Schwann cells), in the brain envelopes (meninges), skull, pituitary and pineal gland, or spread from cancers primarily located in other organs (metastatic tumors).

Primary (true) brain tumors are commonly located in the posterior cranial fossa in children and in the anterior two-thirds of the cerebral hemispheres in adults, although they can affect any part of the brain.
In the United States in the year 2005, it was estimated there were 43,800 new cases of brain tumors (Central Brain Tumor Registry of the United States, Primary Brain Tumors in the United States, Statistical Report, 2005–2006),which accounted for 1.4 percent of all cancers, 2.4 percent of all cancer deaths,[2] and 20–25 percent of pediatric cancers.Ultimately, it is estimated there are 13,000 de