Knowing Brain Tumor

Brain tumor can be classified into primary brain tumors or metastatic/secondary brain tumors. Common benign, primary brain tumors are meningioma and pituitary tumors, and are confined within the brain. Glioma is the most common type of malignant primary brain tumor. Among various types of glioma, glioblastoma is highly aggressive. Patients are typically diagnosed in the prime of their lives .Secondary brain tumors originate from cancer cells arising from other organs, such as the lung, breast and colon etc., and are malignant in nature. Over 75% of such brain tumors are diagnosed in the age of 40 or above. Although compared to other types of cancer, the incidence of brain tumors is relativelylow, but can cause significant disability Annually brain tumor incidence in Hong Kong is around 1000 cases.

Therapies

Dr Michael Kam, Clinical Oncologist

Surgeries

Dr Leung Kar Ming, Neurologist

Metastatic Brain Tumors

Dr Lee Kin Chung, Clinical Oncologist

Brain Tumor Radiotherapy

Dr Ken KM Cheung, Neuro-oncologist

Awake Craniotomy

Dr. Jason Ho, Neurosurgeon

Structure and Function of the Brain

The brain can be divided into the Cerebrum, the Cerebellum, and the Brainstem The cerebrum consists of two oval hemispheres. On the cerebrum surface, gyri and sulci further form the cerebrum into the frontal lobe at the front of the brain, the temporal lobe on the sides, the parietal lobe at the top, and the occipital lobe at the back.

Symptoms

Different parts of the brain are responsible for functions, thus the symptoms a brain tumor patient experiences largely depend on its location, nature or size. Some patients may remain symptom-free, and are incidentally diagnosed during regular body checkups. Brain cancer patients can have the following symptoms:

Seizure (Focal/Generalized)
Headache
Vomiting
Cognitive impairment, change in personality, memory loss
Impairment of mobility and sensation of limbs
Dizziness, tinnitus
Facial paralysis, pain or problems with swallowing
Vision loss, diplopia, visual impairment
Endocrine disorders
Dysphasia or aphasia
Urinary and fecal incontinence

Diagnosis

Computed Tomography

Since computed tomography can be performed quickly and is available in most acute hospitals, it is usually used for rapid preliminary diagnosis for common brain diseases e.g. brain trauma, stroke or brain tumors. The disadvantage is radiation.

Magnetic Resonance Imaging

This modality does not involve radiation. It can better illustrate the nature and size of the tumor, the relationship of the tumor with different brain structures and diagnose other diseases e.g. brain abscess or brain inflammation. Moreover, it definitely helps in neurosurgical planning.

Positron Emission Tomography (PET)

This method is usually used in differentiate brain metastases from primary brain tumor. It helps in locating the primary tumor for brain metastases. PET, however is relatively costly comparing to computed tomography and magnetic resonance imaging.

Treatment

Your doctor will decide the suitable treatment plana depending on the characteristics nature and location of the brain tumor, pastyour medical history and fitnessoverall the . Treatment options fors brain tumors following include:

Surgery
Radiotherapy
Chemotherapy
Targeted Therapy
Other therapies

Surgery

The aim of surgery is to obtain tissue biopsy, resect thebrain tumor and any surrounding brain tissues Ideally, the tumor should be removed completely However,brain tumors may have invaded attachedto important brain tissue. It is not easy to remove the tumor completely. As ensuring patient free from new deficit is also important, the tumor will be first removed as much as possible and subsequently treated with adjuvant radiotherapy or chemotherapy to enhance the tumor control.

Radiotherapy (IncludingGamma Ray, Cyberknife and Stereotactic Body Radiation Therapy)

Radiotherapy works by emitting ionizing radiation beams to destroy cancer cells. Advanced radiation technology, such as radiosurgery can be utilized to eradicate tumors with a high level of precision in selected circumstances. Although radiation therapy does not require a surgical incision, certain adverse effects can occur. The most common being brain swelling “cerebral edema”, alopecia and headache. Radiotherapy is one of the cornerstones of treatment for glioblastoma and other malignant central nervous system tumors

Chemotherapy and Targeted Therapy

Chemotherapy works by using a drug to destroy cancer cells. The most commonly used chemotherapy drug for glioblastoma is Temozolomide. Glioblastoma can also be treated by using anti-VEGF targeted therapy, a drug that inhibits the growth of tumor blood vessels thereby reducing its blood supply.

Other medical treatment

Other treatments include drugs targeting brain tumor complications e.g. antiepileptic drugs and steroid, which can be used to reduce cerebral edema. Tumor-treating field is also helpful in treating GBM.

Complications and Long-term effects

Brain is a crucial organ in the human body, complications and long term effects of the brain tumor or treatments=will have profound influence on patients.

Brain tumor or treatment complications and long-term effect include:

Impairment of cerebral function, for instance cognitive function, reasoning and memory impairments
Damaging cranial nerve will cause visual, auditory, olfactory, speech and swallowing impairment
Coma
Stroke, incoordinaton, limb weakness/paralysis
Endocrine disorders, cerebrospinal fluid rhinorrhea
Seizure
Meningitis
Bacterial infection
Urinary or fecal incontinence
Deep vein thrombosis of the lower limbs
Pneumonia

The support of family and friends is essential for good rehabilitation.

In addition to practical support, family accompaniment may also increase patients’ confidence in life and treatment, which can help them deal with the tumors more positively. Do follow HKACS to learn more about brain tumors and show your support!