Tumors, cancer of the brain: signs, symptoms, treatment
The problem of malignant brain tumors continues to be quite relevant and challenging, despite advances in the diagnosis and treatment of tumors in General.
According to statistics, the incidence of brain tumors (neoplasia) is about 1.5%, often they are registered in children. In adults, the predominant age of onset is 20-50 years, more often in males. In children tumors of the Central nervous system by frequency ranked second, second only to leukemias (cancers of blood-forming tissue), and the most common variety of glioma and congenital variants of neoplasia, while in adults, in addition to gliomas, the formation of vascular tumors, meningiomas and are often found secondary, metastatic, nodes.
Like other malignant tumors, brain tumor characterized by rapid growth, lack of clear boundaries with the surrounding tissue, the ability to grow into the substance of the brain, damaging it and also metastasis.
Certain types of cancer reach a considerable size in a few months, and the growth process is compounded by the fact that they are in the confined space of the skull, so the complications and the symptoms are always severe. As a rule, outside the cranial cavity, they do not go and metastasize in liquornik paths within the head.
In the brain there are also benign tumors grow slowly and do not give metastases. However, the concept of malignancy against tumors of the Central nervous system is highly relative, which is associated with an increase in a small volume of the cranial cavity. In addition, many benign tumors do not have clear boundaries with the surrounding healthy tissue, and this complicates their removal without subsequent neurological disorders. Any brain tumor, even benign way or another causes compression of the nervous tissue, damage to vital nerve centers and a significant increase in intracranial pressure, therefore, is accompanied by pronounced symptomatology and had adverse consequences. In this regard, even the benign tumors often have a malignant course.
It should be noted that the term «brain cancer» is not applicable to tumors of the nervous tissue since cancer, in terms of histogenesis (origin) is a tumor of epithelial cells. In the brain the source of development of neoplasms of neuroglia are the main supporting «skeleton» of neurons, which performs the trophic function (glioma, glioblastoma), derived mesenchyme, blood vessels, sheaths of nerves, etc.
Causes of brain tumors
The exact causes of malignant brain tumors to date not been established. Does not exclude the possibility of environmental influence, genetic abnormalities, changes in hormonal levels and metabolism, ionizing radiation, the possible role of viral infections and injuries.
In children, the following factors have a value of violations in the course of embryogenesis, i.e. during the period of fetal development in the formation of nervous tissue. When you change the normal movement of tissue primordia, stored fields of embryonic, immature cells, there are preconditions for the development of congenital dizontogeneticheskie tumors. As a rule, they are manifested at a very early age of the child.
Genetic anomalies are the basis of family history (hereditary) tumours of the nervous system, such as Recklinghausen’s disease, diffuse glioblastomas etc.
The cause of secondary, or metastatic, brain tumors are the tumors of other localizations. Most often metastatic cancer of the lung, breast, intestines. These tumors are not independent, so considered within the context of neoplasia, which was their source.
Many are interested in the question: does the use of mobile phones to the possibility of developing cancer or brain tumors? To date, convincing data to prove this assumption, no, but research is ongoing.
Types and characteristics of classification of brain tumors
Brain tumor – a rather large group of tumors that include both benign and malignant variants, which differ in origin, location, clinical course and prognosis.
A single classification is still there, is because of the diversity of tumors, the difficulties of their diagnosis and different opinions of researchers concerning specific types of neoplasias.
Histogenetic classification based on the selection of variants with specific histological structure and degree of differentiation, become more complete and accurate thanks to the capabilities of modern diagnostic techniques such as immunohistochemical, cytogenetic and molecular genetic. Using these techniques it is possible to more reliably determine the source of origin of specific neoplasms by finding specific genetic features and markers (proteins), typical of those or other cells of the nervous tissue.
Based on the degree of maturity of the release:
Localization of the tumor are:
- Intermediate group (teratoma, embryonal tumors);
- A separate group (metastatic nodes, cysts, tumors of unclear origin, etc.).
Depending on the histogenesis decided to allocate the following the most common types of brain tumors:
Among benign brain tumors are most often diagnosed with a meningioma, which is formed of the vessels of the meninges and approximately 20% of all tumors growing within the cranium. Usually found a meningioma in adults, and is an isolated node, located at the basal (adjacent to the base of the skull) or convexital (outer) surface of the brain, rarely in the ventricles of the brain. With timely detection and treatment the prognosis is favorable, however, when localization in the region of the brain stem, the consequences can be unfavorable, since even at small sizes meningioma is able to compress nerve tissue and cause serious disorders.
Another frequent type of benign brain tumors (gliomas) is the so-called astrocytoma – a slowly growing tumor, detectable in all parts of the brain and most often affects young people. Astrocytoma, despite its goodness, often has no clear boundaries with the surrounding nervous tissue, and can grow diffuse (no isolated node), which creates significant challenges in its surgical treatment. Other types of benign tumors are much rarer.
Among malignant tumors the most frequent are glioblastomas and medulloblastomas.
Medulloblastoma is one of the most malignant of brain tumors, because it comes from the least Mature cells medulloblastoma. As a rule, the reason of it are diskineticeski changes, it is a violation of the displacement of embryonic primordia in utero, preserving in brain tissue fields immature embryonic cells. In this regard, medulloblastoma most often found in children, accounting for a fifth of all intracranial tumors in childhood. The preferential localization of the tumor, the worm of the cerebellum.
Glioblastoma is the second incidence after astrocytomas and affects persons aged 40-60 years, mostly men. This tumor is able to grow rapidly, often has no clear boundaries with the surrounding tissues prone to the development of secondary changes – necrosis (necrosis of tissue), hemorrhage, cysts, and therefore has a mottled appearance when cut. Outside of brain metastasis never found, but the rapid rise and defeat the different parts of the brain can lead to death of the patient within 2-3 months.
In addition to these, in the brain may cause other, much more rare tumors (sarcoma of the brain, pigmentation of the tumor, etc.).
High malignant neoplasia often are characterized by low sensitivity to treatment (chemotherapy and radiation therapy, surgical removal), so the prognosis in such cases is always bad.
A special place is secondary, metastatic tumors. Most often metastasize breast cancer, lung, kidney. The individual cells or clusters from the bloodstream to the brain and, settling in the microvasculature, give rise to the growth of the new node. As a rule, the histological structure of such metastases is similar to the structure of the primary tumor, i.e. it is a cancer that is formed by epithelial cells originating from another body. To define their relationship is not particularly difficult. Metastases can quite easily be removed surgically, because around them, a zone of softening of the nervous tissue, but this does not prevent the possibility of their growth in the future.
Symptoms of brain tumor are multiple. There is no specific clinical signs indicating the presence of a «cancer» or other neoplasms, and the manifestations due not only to defeat specific portions of the brain, but also increase intracranial pressure (ICP) and the displacement of its structures.
All of the symptoms associated with tumor development can be divided into several groups:
- Focal neurological symptoms;
- Dislocation syndrome.
General cerebral signs
Cerebral symptoms associated with increased intracranial pressure due to extra volume of tissue in the cranial cavity, and irritation of the nerve endings of the brain, its membranes, with involvement in the pathological process of blood vessels. In most cases there is a violation of the circulation of cerebrospinal fluid, which leads to the stretching of the ventricles of the brain, its swelling and, as a consequence, increased intracranial pressure.
The main and most frequent cerebral symptom is headache. It is permanent, bursting character, may worsen at night or in the morning, also when coughing, physical exertion. Over time, the growth of the tumor and increase the pressure inside the skull, its intensity increases. In addition to this diffuse intense pain, you may experience patchy, drilling or throbbing.
Other common signs of tumors of the brain are vomiting, appearing with the greatest severe headaches, dizziness and blurred vision. Vomiting may be the result not only of intracranial hypertension, but a direct irritation of the vomiting center with the growth of neoplasia in the medulla oblongata, the cerebellum and region of the fourth ventricle. In such cases, it will be one of the early symptoms of the disease. Frequent vomiting does not bring relief and gives the patient considerable suffering.
Dizziness is very typical for the lesion of the brain stem, frontal and temporal lobes.
With increasing intracranial pressure results in compression of the Central retinal vein, carrying the venous blood from the eye that is manifested by blurring of the vision, reduction in visual acuity. Over time, the development of atrophy of disks of optic nerves.
Among cerebral symptoms there are also seizures caused by irritation of nervous tissue, and mental disorders. Mental disorders can be expressed in the propensity to depression or, conversely, apareciste, the absence of criticism to his condition, memory loss, reduced intelligence, of slovenliness. Patients are able to make unwarranted and inappropriate behavior, look inward with the failure of communication, food, etc. is Very bright mental disorders are manifested in lesions of the frontal lobes of the cerebral hemispheres (the so-called «frontal psyche»).
Local neurological disorders
Focal neurological symptoms associated with damage to tumor specific part of the brain. The characteristics associated with the functions of this area. With the growth of tumors in the frontal lobes possible mental disorders, movement disorders, speech disorder and even lack.
Dislocation syndrome is associated with an increase in tumor volume, compressing the adjacent formation, which may lead to displacement of brain structures relative to its axes. With a significant increase in ICP occurs the formation of so-called intracranial hernia, when the parts of the brain wedged under the spurs of the Dura, or the foramen Magnum. Such States are, in some cases fatal therefore require urgent neurosurgical care.
The course of the disease depends not only on the localization of specific tumors, but also on the degree of differentiation (maturity) of its constituent cells. So, poorly differentiated (high malignant) tumors are characterized by rapid growth, rapid development of a bright clinical picture and poor prognosis. Treatment is difficult due to poor sensitivity to different methods of influence. On the other hand, benign tumors, even of small size, localizes in the brain stem, can lead to death in a short time.
Some of the described symptoms, in particular headache, dizziness, decreased vision often have many of us, but their presence should not be a reason to immediately suspect the brain tumor. Do not forget that tumors of this localization is quite rare, while migraine, low back pain, cardiovascular disorders, hypertension and many other diseases is very, very common and give similar symptoms. If there are any complaints, you need to consult a specialist who will prescribe the whole range of available examinations to exclude tumors of the brain.
For brain tumors are not usually distinguished stage. Much more important from the standpoint of the clinical course, response to treatment and prognosis is the selection of degrees of malignancy. Simplistically they can be represented as follows:
- Grade I – benign tumors;
- Grade II – involves the tumor of undetermined or low-grade (vysokomehanizirovannoe neoplasms); such tumors may recur, and the degree of differentiation (maturity) may be reduced;
- III degree – a highly malignant neoplasia that require radiation therapy and chemotherapy;
- Grade IV characterizes the poorly differentiated, highly malignant tumors, difficult to treat due to poor sensitivity and has a very poor prognosis.
From survey to diagnosis
Because often the early symptoms of tumor can be very nonspecific, for the confirmation or refutation of suspicion required further examination. Modern diagnostic procedures and brain imaging methods allow us to determine the tumor even smaller size in different parts of the brain.
The main methods of diagnostics of brain tumors are:
At the onset of symptoms indicating the possibility of tumor growth, it is necessary to consult a doctor. The neurologist will examine, in detail asked about the nature of complaints will conduct a neurological examination and will prescribe the necessary examinations.
According to the law the «gold standard» diagnosis of tumors of the brain can be considered a contrast enhanced MRI to detect various tumors, to clarify their localization, size, the nature of the change of the surrounding tissues, the presence of compression of the ventricular system, etc.
In the presence of contraindications to MRI (pacemakers, metal mounted, weight of the patient, etc.), and in the absence of the possibility of such study, it is possible to diagnose using computed tomography with contrast or without.
Skull x-ray can detect the presence of foci of destruction (destruction) of bone tissue under the influence of the tumor or, on the contrary, her seal; change of vascular pattern.
With the help of pneumoencephalography (x-ray examination with the introduction of air or other gases) you can set the status of the ventricular system of the brain, to judge the violation of CSF dynamics (circulation of cerebrospinal fluid).
Electroencephalography is indicated for the detection of foci of increased activity of the brain (especially in the presence of seizures), which usually correspond to the location of tumor growth.
Can be used as the radioisotope methods with sufficient accuracy to determine not only the location of tumors, but some of its properties.
Lumbar puncture with subsequent examination of the CSF provides an opportunity to measure the level of pressure that often increases in intracranial tumors. The composition of the cerebrospinal fluid is also changed in the direction of increasing content of protein and cellular elements.
Angiography can determine the change in the vascular system of the brain, characteristics and intensity of vascularity in the tumor itself.
Ophthalmologist when brain tumors will establish the changes of visual acuity and other violations, and the study of the fundus will help to identify the presence of congestion, atrophy of the optic nerve head.
If you are experiencing difficulty in the instrumental diagnosis in complex and unclear cases it is possible that the biopsy – taking a piece of tumor for histological examination. This method allows you to set the type of the neoplasm and its degree of differentiation (tumor grade). If necessary, it can be supplemented with immunohistochemical study to detect specific proteins, typical of those or other cells of the nervous tissue (e.g., protein S 100 and NSE).
If you suspect metastatic brain lesions, it is necessary to establish the origin of tumors, there is a possibility of cancer growth in the breast, lung, etc. For this reveals other complaints of the patient is chest x-ray, ultrasound of abdominal organs, esophagogastroduodenoscopy, mammography, etc. depending on the presumptive diagnosis.
In addition to the instrumental methods of diagnostics, changes can be detected in the blood (increased erythrocyte sedimentation rate, leukocytosis, anemia, etc.).
Treatment and prognosis of brain tumors
After an accurate diagnosis, depending on the type of tumor, its location, size and sensitivity to specific effects, the doctor chooses the most optimal method of treatment or a combination.
Main areas of therapy:
- Surgical removal;
- Radiation therapy;
The result is largely determined by the location of tumor growth, size, nature of its influence on the surrounding nervous tissue, but to an even greater extent – the degree of differentiation (tumor grade).
The main and, usually, the initial treatment is surgical removal of the tumor tissue. This is the most radical and most often the most effective way to get rid of neoplasia. Surgery to remove tumors is carried out by neurosurgeons. Because when the manipulation is removed not only the tumor itself but also part of the periphery that surrounds us, it is important to keep functionally active neural tissue. Surgical treatment is not carried out only when the implementation of any intervention dangerous to the patient’s life due to serious condition, as well as when the tumor is located in such a way that are inaccessible to the surgeon’s knife or removing it may result in dangerous damage to nearby parts (brain stem, basal ganglia). If possible, the tumor is removed partially.
In the surgical treatment of the tumor appears the possibility of a subsequent histological study of tissue with the establishment of the degree of differentiation. It is important to target in future chemotherapy and radiotherapy.
After the operation, which is one of the stages of complex treatment of patients with brain tumors, is assigned to radiotherapy and/or chemotherapy.
Radiation therapy involves the exposure to ionizing radiation on the growth of the tumor (bed after its removal), the whole of the brain or spinal cord. In case of impossibility of operation, this method becomes Central. Irradiation also allows to remove the remnants of tumor tissue after non-radical surgical removal. This type of treatment the physician prescribes radiation oncologist.
Become increasingly popular recent application of the so-called stereotactic radiosurgery (gamma knife). Method is to the local effects of gamma-rays of high intensity that allows you to remove deep-seated tumors that are inaccessible to surgical treatment. This method is effective and in some benign tumors, such as meningiomas.
Chemotherapy means the appointment of anticancer drugs to which the sensitive this type of neoplasia. Sometimes this method becomes the primary (if inoperable tumors), but more often complements the first two. It is possible to use drugs that the bloodstream reach the zone of tumor growth, as well as the introduced directly into the tumor bed or liquorous system, thus reducing the likelihood of side effects. Because this treatment is quite aggressive, and many drugs are toxic, it is required appointment of hepatoprotectors, vitamin-mineral complexes.
At all stages of symptomatic therapy to alleviate the condition of patients. With this purpose, appointed painkillers, anti-nausea drugs, etc.
In the case of the development of dislocation syndrome, the patient requires urgent surgery to decompression – decrease in intracranial pressure. This can be a puncture of the ventricles of the brain by removing excess spinal fluid. Subsequently the patient is a routine operation to eliminate the tumor.
It is important to note that the treatment of folk remedies, untested methods, various dietary supplements with psychics or hypnosis are invalid in the case of tumors of the brain and can cause death of the patient or failure of the implementation of surgical removal due to lost time and rapid progression of the disease. In such situations, you should not rely on miracle or luck, as only traditional medicine can give a chance if not a complete cure, to prolong life and improve its quality.
The prognosis for benign brain tumors is good, and malignant, most often unfavorable. It is crucial to establish a correct diagnosis as the key to successful treatment is early at the beginning.
With the correct diagnosis of benign tumors and adequate treatment patients live after its removal many years.
To a large extent the outcome depends on the degree of differentiation of tumors. In highly malignant cases, the therapy can only prolong the time to recurrence or progression of tumor growth, so to live to the patient remains relatively short period of time. In certain types of malignancy with a life expectancy of several months even with intensive treatment.
After courses of therapy, patients are subject to constant monitoring and regular MRI monitoring of the brain. Immediately after treatment, an additional imaging to monitor the effectiveness of measures taken. With highly differentiated and benign tumors in the first year after the operation you want to perform an MRI every six months, thereafter annually. In highly malignant tumours – often every three months in the first year and then every six months.
If you experience any symptoms, you must immediately, consult a doctor. These preventive measures will allow to avoid or to diagnose a relapse of a brain tumor.