Expert Care for Brain Cancer

Brain cancer develops when abnormal cells grow uncontrollably within the brain. A tumour may begin in the brain itself or spread to the brain from cancer elsewhere in the body.

It is important to distinguish between:

• Primary brain tumours: Begin in the brain or nearby tissues.
• Secondary or metastatic brain tumours: Spread to the brain from cancers such as lung, breast, kidney, melanoma or colorectal cancer.
• Benign brain tumours: Non-cancerous but may still cause serious problems by pressing on important parts of the brain.
• Malignant brain tumours: Cancerous tumours that can grow rapidly and invade nearby brain tissue.

At AIROC Hospitals, Kondapur, Hyderabad, patients with suspected or confirmed brain tumours receive coordinated evaluation, personalised treatment planning and supportive care from a multidisciplinary cancer-care team.

Overview and Types

Gliomas

Gliomas develop from glial cells, which support and protect nerve cells. They include several tumour types and grades.

Common gliomas include:

• Astrocytoma
• Oligodendroglioma
• Ependymoma
• Glioblastoma

Glioblastoma

Glioblastoma is an aggressive primary brain cancer that usually develops in adults. Treatment often involves surgery followed by radiation therapy and chemotherapy, depending on the patient’s condition.

Astrocytoma

Astrocytomas begin in astrocytes, a type of glial cell. They can range from slow-growing tumours to aggressive cancers. Molecular testing helps doctors classify the tumour and plan treatment.

Oligodendroglioma

Oligodendroglioma develops from oligodendroglial cells. Diagnosis involves tissue examination and molecular testing for specific genetic changes.

Ependymoma

Ependymoma develops from cells lining the brain’s fluid-filled spaces or the spinal cord. It can occur in both children and adults.

Medulloblastoma

Medulloblastoma is a malignant brain tumour that most commonly affects children, although it can also occur in adults. It usually develops in the cerebellum, which helps control movement and balance.

Primary Central Nervous System Lymphoma

This lymphoma begins in the brain, spinal cord, eyes or surrounding tissues. Treatment differs from that used for most other primary brain tumours.

Other Brain Tumours

Other tumours that may affect the brain include:

• Meningioma
• Pituitary tumours
• Schwannoma
• Craniopharyngioma
• Germ-cell tumours

Not all of these tumours are cancerous, but they may still require treatment based on their size, location, growth and symptoms.

Symptoms and Causes

Symptoms depend on the tumour’s location, size and growth rate. They may develop gradually or appear suddenly.

Possible symptoms include:

• New or worsening headaches
• Headaches that are more severe in the morning
• Unexplained nausea or vomiting
• Seizures
• Blurred or double vision
• Difficulty speaking or understanding words
• Weakness or numbness on one side of the body
• Problems with balance or walking
• Hearing changes
• Memory or concentration difficulties
• Personality, mood or behavioural changes
• Confusion or unusual drowsiness
• Hormonal changes
• Loss of bladder or bowel control in selected cases

These symptoms can also be caused by non-cancerous neurological conditions. New seizures, sudden weakness, speech difficulty, loss of consciousness or a severe sudden headache require urgent medical attention.

What Causes Brain Cancer?

Brain cancer develops when genetic changes cause cells in the brain or central nervous system to grow abnormally. In most patients, the exact cause is unknown.

Brain cancer:

• Is not contagious
• Is not generally caused by routine mobile-phone use
• Cannot be diagnosed from symptoms alone
• May occur without an identifiable risk factor

Diagnosis and Treatment

Diagnostic Evaluation

Brain-tumour evaluation may include:

• Neurological examination
• Vision and hearing assessment
• MRI of the brain with contrast
• CT scan
• Functional or advanced MRI in selected cases
• PET imaging when clinically appropriate
• Examination of other body areas when metastasis is suspected
• Surgical or stereotactic biopsy
• Histopathology
• Immunohistochemistry
• Molecular and genetic tumour testing
• Lumbar puncture for selected tumour types only

A biopsy or surgically removed tissue sample is generally required to identify the exact tumour type and grade. In selected cases, imaging location or surgical risk may influence how the diagnosis is established.

Treatment Options

Treatment depends on the tumour’s type, grade, molecular profile, size, location and whether it has spread. The patient’s age, symptoms, general health and personal preferences are also considered.

Surgery

Surgery aims to remove as much of the tumour as safely possible while protecting essential brain functions.

Options may include:

• Craniotomy
• Image-guided neurosurgery
• Awake brain surgery in selected patients
• Stereotactic biopsy
• Procedures to relieve pressure or fluid accumulation

Complete removal may not be safe when a tumour is close to areas controlling speech, movement, vision or other critical functions.

Radiation Therapy

Radiation therapy uses precisely directed radiation to destroy cancer cells or slow tumour growth. Approaches may include:

• External-beam radiation therapy
• Intensity-modulated radiation therapy
• Image-guided radiation therapy
• Stereotactic radiosurgery or radiotherapy
• Whole-brain radiation therapy for selected metastatic cancers

Chemotherapy

Chemotherapy may be used alone or with radiation therapy. The choice of medicine depends on the tumour type, molecular findings and previous treatment.

Targeted Therapy

Targeted medicines may be considered when testing identifies a specific genetic alteration, protein or biological pathway involved in tumour growth.

Tumour-Treating Fields

Tumour-treating fields use alternating electrical fields and may be considered for selected patients with glioblastoma where clinically appropriate and available.

Supportive Care and Rehabilitation

Supportive treatment may include:

• Medicines to reduce brain swelling
• Anti-seizure medication
• Pain and symptom management
• Physiotherapy
• Speech and swallowing therapy
• Occupational therapy
• Neuropsychological support
• Nutritional guidance
• Psychological counselling
• Palliative care

Prevention and Risk Factors

Most primary brain cancers cannot currently be prevented because their causes are usually unknown. Having a risk factor does not mean that a person will develop brain cancer.

Possible risk factors include:

• Previous exposure to ionising radiation involving the head
• Certain inherited genetic syndromes
• A weakened immune system
• Increasing age for some tumour types
• Certain childhood or young-adult age groups for other tumour types
• A history of cancer elsewhere in the body, which increases the possibility of brain metastasis

Inherited conditions associated with certain brain tumours may include:

• Neurofibromatosis
• Li-Fraumeni syndrome
• Tuberous sclerosis
• Von Hippel–Lindau disease
• Turcot syndrome

Risk Awareness

There is no routine brain-cancer screening programme for people at average risk. Helpful measures include:

• Attending follow-up after previous cancer treatment
• Following surveillance advice for inherited tumour syndromes
• Discussing a strong family history with a genetic counsellor
• Seeking medical assessment for persistent neurological symptoms
• Obtaining urgent care for a first seizure or sudden neurological changes