Acoustic Neuroma

Acoustic neuroma, also called vestibular schwannoma, is a noncancerous tumor usually seen in middle-aged people. It develops gradually on the main nerve leading from the inner ear to the brain. This nerve controls hearing and balance. So, as the acoustic neuroma grows, it leads to hearing loss and problems with balance.

Symptoms

The symptoms of acoustic neuroma are subtle and therefore, tend to be overlooked. The most prominent symptom is loss in hearing in one ear accompanied by a ringing sensation in the ear, called tinnitus. Other symptoms include loss of balance, dizziness, facial weakness and numbness.

Causes

There are no established causes for this condition, except for a malfunctioning gene. The reason for the malfunctioning has not been found till date.

Risk Factors

The chances of acquiring this condition are high if either of the parents has neurofibromatosis (a rare genetic disorder). Yet another risk factor is child-hood exposure to low-dose radiation of the head and neck.

Diagnosis

As the symptoms develop slowly over a period of time and resemble middle ear and inner ear problems, detection of the tumor becomes difficult. Your doctor may order a hearing test (audiometry) and scans (CT or MRI) to confirm the diagnosis.

Treatment

Treatment method to be adopted depends on factors such as size and growth of the tumor, its location, patient’s age, and physical health. If the tumor is small, then the doctor may conduct only a regular checkup. He may decide to monitor the tumor by ordering regular imaging and hearing tests at intervals of 6 to 12 months.

Other treatment methods include stereotactic radiosurgery (non-invasive treatment that delivers gamma radiation at the tumor site without making an incision) and surgical removal of the tumor.

Astrocytoma

An astrocytoma is a type of malignant (cancerous, life-threatening) tumor of the brain. It develops from star-shaped cells in the brain called astrocytes.

Astrocytomas are broadly classified into low-grade and high-grade astrocytomas depending on the nature of their growth and location. Low-grade astrocytomas are non-spreading with slow growth whereas the higher grades spread very quickly owing to their faster growth.

Types

• Grade 1 astrocytoma: Slow growing, non-infiltrating tumor common in children and teens
• Grade 2 astrocytoma: Slow growing, infiltrating tumor lacking well-defined borders and seen in adults between the ages 20 and 40
• Grade 3 astrocytoma: Relatively quick growing and malignant astrocytoma occurring in adults in the 30-50 age groups.
• Grade 4 astrocytoma: Most common and aggressive form of all the grades seen in adults in the 50-80 age groups.

Symptoms

Symptoms vary depending on the location of the brain tumor and may include persistent headaches, double or blurred vision, vomiting, loss of appetite, difficulty in walking, seizures, gradual changes in mood or personality, and memory loss.

Risk Factors

A risk factor is anything that increases a person’s chance of developing a disease or condition. Surprisingly, some people who are exposed to several risk factors never develop a tumor, while others with not even a single risk factor do. Some of the risk factors for Astrocytoma include radiation to the head, heredity, and HIV infection.

Causes

The underlying cause of the condition is not known. Some of the possible causes include heredity, environmental factors and occupations involving exposure to radiation.

Diagnosis

Your doctor may conduct a thorough physical examination and review your medical history. In addition, various tests such as analysis of blood, and liver function tests may be ordered. The doctor may also require you to get a CT scan or MRI of the brain. If the scan reports indicate presence of a tumor, you would be referred to a neuro-oncologist (one who specializes in tumors of the brain). The neuro-oncologist orders a biopsy (taking out a small sample of the tumor mass) to confirm the presence of cancer.

Treatment

There are various treatment choices available such as surgery, radiation, radiosurgery, and chemotherapy. The treatment method adopted depends on the overall health of the patient and the relative spread of the tumor. The aim is to eliminate or cause maximum damage to the tumor cells without affecting the normal functioning of the brain.

Brain Metastases

Brain metastases are malignant tumors (abnormal mass of tissue) that initiate as cancer elsewhere in the body and spread (metastasize) to the brain. These tumors are a commonly feared complication of cancers of the lung, breast, skin, thyroid, colon, and kidney. Metastatic brain tumors occur much more frequently than primary brain tumors.

Symptoms of brain metastases depend on the size and location of the tumors. In some people the symptoms develop over time, and therefore, may not be evident in the initial stages of the disease. The majority of symptoms are related to the nervous system and include headache, nausea, cognitive (relating to intellectual activities such as thinking, understanding or remembering) and motor (relating to movement) dysfunctions, and seizures.

Diagnosis involves physical examination and review of past medical records. If your doctor suspects metastases, they may order imaging tests to obtain a clear picture of the brain for diagnosis. In rare cases, a biopsy (removal of a small sample of the tumor for microscopic examination) may also be recommended.

Treatment strategy for metastatic brain tumors is determined based on factors such as size and location of the tumor, the overall health of the patient, and the initial location of the tumor. The aim of the treatment is two-fold:

• Limit further metastases
• Bring respite from the symptoms

Treatment approaches include drugs, surgery, and radiation. Some of the common side effects associated with drugs and radiation therapy include fatigue, nausea, vomiting, and hair loss. Surgery is associated with potential side effects such as swelling or bleeding of tissues at the site of surgery.

Brain Tumors

A brain tumor is the growth of abnormal cells in the brain. When most normal cells grow oldor get damaged, they die, and new cells take their place. Sometimes, this process goeswrong. New cells form when the body doesn’t need them, and old or damaged cells don’tdie as they should. The buildup of extra cells often forms a mass of tissue called a growth ortumor.

Types of Tumor

Brain tumors are alsoclassified as either primary or metastatic.When a brain tumor originates in thebrain it is referred to as a primary braintumor. Primary brain tumors are named according to the type of cells or the part of the brain in which they begin. Some of the common types of primary brain tumors include:

• Astrocytoma: tumor arises from star-shaped glial cells called astocytes
• Meningioma: tumor arises in the meninges (membrane covering brain and spinal cord)
• Ependymoma: tumor arises from cells that line the ventricles or the central canal of the spinal cord
• Brain stem glioma: tumor occurs in the lowest part of the brain

Metastatic brain tumors begin ascancer elsewhere in the body and thenspread to the brain.

Brain tumors are classified as eitherbenign (non-cancerous) or malignant (cancerous).

• Benign brain tumors do not contain cancer cells, they can be removed and seldom grow back. They don’t spread to other parts of the body but may become malignant.
• Malignant brain tumors contain cancer cells and are generally more serious and often are a threat to life. They are likely to grow rapidly and crowd or invade the nearby healthy brain tissue, and may break away from malignant brain tumors, spreading to other parts of thebrain or to the spinal cord. They rarely spread to other parts of the body.

Grades of Tumor

Doctors group brain tumors by grade. The grade of a tumor refers to the way the cells look under a microscope, and include

• Grade I: tissue is benign. Cells look nearly like normal brain cells, and they grow slowly.
• Grade II: tissue is malignant. Cells look less like normal cells than do the cells in a Grade I tumor.
• Grade III: malignant tissue has cells that look very different from normal cells. The abnormal cells are actively growing (anaplastic).
• Grade IV: malignant tissue has cells that look most abnormal and tend to grow quickly.

Risk Factors

The exact causes of brain tumors are not clear, but there are certain risk factors that could lead to brain tumors:

• Ionizing radiation from sources such as high dose x-rays (such as radiation therapy from a large machine aimed at the head) can cause cell damage that leads to atumor.
• Family history, although rare. Only a very small number of families have several members with brain tumors.

Symptoms

The symptoms of a brain tumor depend on tumor size, type, and location. The most commonsymptoms include:

• Problems with memory
• Problems balancing orwalking
• Headaches
• Muscle jerking ortwitching (seizures orconvulsions)
• Nausea and vomiting
• Changes in speech,vision, or hearing
• Numbness or tingling inthe arms or legs
• Changes in mood,personality or ability toconcentrate

Diagnosis

If you have symptoms that suggest a brain tumor, your doctor will conduct a physical examand ask you about your personal and family health history.You may have one or more of the following tests:

• Neurologic exam tests for vision, hearing, alertness, muscle strength, coordination and reflexes. Your doctor also examines your eyes for swelling caused by a tumor pressing on the nerve that connects the eye and the brain.
• Imaging tests like MRI and CT scan to detect abnormalities such as a tumor
• Angiogram involves the injection of a dye into the blood stream, which is viewed on an X-ray. Tumor or blood vessels feeding into a tumor can be detected.
• Spinal tap involves the removal of a sample of the cerebrospinal fluid (fluid found in spaces in and around the brain and spinalcord) and testing for abnormalities
• Biopsy involves the removal of tissue and testing for abnormalities

Treatment

Depending on the type and grade of brain tumor, location, size, and your age and general health, your doctor will suggest the following:

• Surgery involves the removal of the tumor. It is done either as an open brain surgery or as a less invasive procedure using an endoscope (lighted instrument with a camera attached to it).
• Radiation therapy uses high-energy radiations like X-rays to kill the tumor cells. It usually follows surgery and is sometimes used if surgery is not recommended.
• Chemotherapy is the use of drugs to kill the cancer cells. They can be given through the mouth, IV or as wafers, which are inserted into the brain.

You may get a combination of these treatments.

Chordoma

Chordoma is a rare, slow growing malignant tumor that develops in the spine and skull bones. It is thought to form from the remnants of the notochord (a preliminary structure present in a developing baby in the womb, which eventually forms the spinal cord). The exact cause of a chordoma has not been established with certainty.

Chordomas are more common in adults than children. They can be life-threatening and difficult to treat and therefore require specialized follow-up care.

The most evident signs of a chordoma are pain and neurological changes. Symptoms typical to a skull-based chordoma include headache, issues with vision such as double vision, and pain in the neck region. Symptoms vary depending on the size of the tumor. For instance, a large chordoma may bring about changes in voice and speech, as well as changes in facial sensation or movement and swallowing function. Some other symptoms include weakness in the limbs, pain, body pain, and changes in the functioning of the bowel or the bladder.

Diagnosis involves imaging tests such as CT or MRI scans. Your doctor may recommend X-rays to determine the extent of bone damage due to the tumor.

Treatment of a chordoma involves removing the maximum possible amount of tumor tissue via surgery. Surgery is followed by an aggressive dose of radiation therapy to kill any surrounding tumor cells. Radiation therapy is usually recommended as it reduces the risk of recurrence and also prolongs survival. In cases of advanced chordoma, chemotherapy may slow down the growth of the tumor or temporarily arrest the progression of the disease. Molecularly targeted cancer drugs are also gaining popularity as a treatment approach for chordomas.

Glioma

Glioma is the medical term for a primary brain tumor that originates in the glial cells of the brain. The glial cells are specialized cells that outnumber neurons as the most common types of cells present in the brain. One of the most important functions of these cells is the formation of myelin sheaths around neurons, which helps in the faster conduction of nerve impulses.

A glioma occurs when the glial cells multiply rapidly out of control.

There are three main types of glial cells: astrocytes, oligodendrocytes, and ependymal cells. Gliomas are named after the type of glial cells from which they are derived. For example, a glioma that develops from abnormal astrocytes is an astrocytoma. Similarly, gliomas evolved from oligodendrocytes and ependymal cells are known as oligodendrogliomas and ependymomas, respectively. Of the three types of gliomas, the most commonly seen are astrocytomas.

Symptoms

Symptoms of a glioma develop gradually and are therefore, likely to go unnoticed in the initial stages of the disease. Some of the common symptoms include headache, seizures, problems with speech and language, visual disturbances, and visibly reduced cognitive and functional capabilities.

Diagnosis

Scans form the foundation of a glioma diagnosis. These include a CT scan or an MRI scan. The scans create detailed images of the brain to diagnose tumors. In cases where the scan indicates a tumor, the doctor may order a biopsy (removal of a small sample of the tumor for microscopic examination) to confirm the diagnosis.

Treatment

Treatment of a glioma involves a multi-disciplinary approach and often includes valuable inputs from neuro-surgeons, oncology specialists, pathologists, and radiation therapists. A standard treatment plan takes into account factors that include location of the tumor, general symptoms, age, overall health of the patient, and stage of the disease. Surgery (craniotomy) is the most commonly adopted treatment method. The aim of this surgery is to remove the maximum possible amount of tumor. Other treatment options include radiotherapy (destroying tumor cells using high dose radiation) and chemotherapy (use of cancer-killing drugs).