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Neuro Oncology in India

Neuro-Oncology

Neuro-oncology is the study of brain and spinal cord neoplasms, many of which are (at least eventually) very dangerous and life-threatening (astrocytoma, glioma, glioblastoma multiforme, ependymoma, pontine glioma, and brain stem tumors are among the many examples of these). Following are several objectives of neuro-oncology –

  • To know the prognostic factors that are influencing glioma outcome.
  • To treat primary peripheral and central nervous system tumors
  • Careful study of typical radiological appearance, prognosis and treatment options for the neurological complications of cancer such as epidural spinal cord compression and brain metastases.
  • Careful study of signs and symptoms of brain tumors in children and adults
  • Neurological complications associated with systemic cancer
  • Careful study of typical radiological appearance, prognosis and treatment options for primary brain tumors such as brain stem glioma, lowgrade glioma, medulloblastoma and glioblastoma.

Brain Cancer

Brain tumors are abnormal growths of cells in the brain.

  • Although such growths are popularly called brain tumors, not all brain tumors are cancer. Cancer is a term reserved for malignant tumors.
  • Malignant tumors can grow and spread aggressively, overpowering healthy cells by taking their space, blood, and nutrients. They can also spread to distant parts of the body. Like all cells of the body, tumor cells need blood and nutrients to survive.
  • Tumors that do not invade nearby tissue or spread to distant areas are called benign.
  • In general, a benign tumor is less serious than a malignant tumor. But a benign tumor can still cause many problems in the brain by pressing on nearby tissue.

Symptoms of Brain Cancer

The following symptoms are most common:

Other nonspecific symptoms and signs include the following:

  • Altered mental status — changes in concentration, memory, attention, or alertness
  • Nausea, vomiting
  • Abnormalities in vision
  • Difficulty with speech
  • Gradual changes in intellectual capacity or emotional response

Symptoms that may be specific to the location of the tumor include:

  • Pressure or headache near the tumor
  • Loss of balance and difficulty with fine motor skills is linked with a tumor in the cerebellum.
  • Changes in judgment, including loss of initiative, sluggishness, and muscle weakness or paralysis is associated with a tumor in the frontal lobe of the cerebrum.
  • Partial or complete loss of vision is caused by a tumor in the occipital lobe or temporal lobe of the cerebrum.
  • Changes in speech, hearing, memory, or emotional state, such as aggressiveness and problems understanding or retrieving words can develop from a tumor in the frontal and temporal lobe of the cerebrum.
  • 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 are linked to a tumor in the frontal or parietal lobe of the cerebrum.
  • Inability to look upward can be caused by a pineal gland tumor.
  • Lactation, which is the secretion of breast milk and altered menstrual periods in women, and growth in hands and feet in adults are associated with a pituitary tumor.
  • Difficulty swallowing, facial weakness or numbness, or double vision is a symptom of a tumor in the brain stem.
  • Vision changes, including loss of part of the vision or double vision can be from a tumor in the temporal lobe, occipital lobe, or brain stem.

Brain tumor symptoms when the tumor is in the front of the brain (cerebrum)

  • Seizures
  • Visual changes
  • Slurred speech
  • Paralysis or weakness on half of the body or face
  • Increased intracranial pressure
  • Drowsiness and/or confusion
  • Personality changes

Symptoms of a brain tumor in the brainstem (middle of brain) may include:

  • Seizures
  • Endocrine problems (diabetes and/or hormone regulation)
  • Visual changes or double vision
  • Headaches
  • Paralysis of nerves/muscles of the face or half of the body
  • Respiratory changes
  • Increased intracranial pressure

Symptoms of a brain tumor in the cerebellum (back of brain) may include:

  • Increased intracranial pressure
  • Vomiting (usually occurs in the morning without nausea)
  • Headache
  • Uncoordinated muscle movements
  • Problems walking (ataxia)

Brain Tumor Causes
Primary brain tumor causes are largely unknown. Researchers believe most brain tumors are caused by a combination of events. Current areas of investigation focus on:

  • Genetic cell mutations
  • Defects
  • Viruses
  • Injury
  • Chemicals
  • Hormones
  • Environmental factors
  • Occupational factors

Brain tumors are not contagious. It is clear, however, that a large portion of brain tumors result from other cancers, these are called secondary brain tumors

Brain Tumor Diagnosis
In addition to a complete medical history and physical examination, following tests to diagnose a brain tumor:

  • Angiogram is a procedure in which a dye allows a close inspection of all the blood vessels in the brain to aid in detecting certain types of tumors.
  • Bone Scan detects tumors and bone abnormalities. In a bone scan, a dye is injected and then absorbed by bone tissue so that X-rays can be taken.
  • Computed Tomography Scan (CT or CAT scan) is a diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce horizontal and vertical cross-sectional images (often called slices) of the body. A CAT scan shows detailed images of any part of the body, including the bones, muscles, fat and organs. CAT scans are more detailed than general X-rays.
  • Functional Magnetic Resonance Imaging (fMRI) is used to map the functional area of a patient’s brain. This technique provides an added degree of precision in guidance and navigation during surgery and maximizes tumor resection while minimizing the possibility of weakness, blindness and speech loss.
  • Magnetic Resonance Imaging (MRI) is a diagnostic procedure that uses a combination of large magnets, radio frequencies and a computer to produce detailed images of organs and structures within the body.
  • MR SPECT is a highly effective method of scanning the brain that can detect tumors that other brain scans might miss. It is a noninvasive test that offers results in real time, decreasing the need for biopsies and other surgeries.
  • Neurological exam in which a physician tests reflexes, muscle strength, eye and mouth movement, coordination and alertness.
  • Stereotactic Biopsy is a procedure that obtains a specimen of the tumor so that a neuropathologist can analyze it. The goal of the biopsy is to confirm a diagnosis. This minimally invasive approach can be used to obtain a diagnosis either before proceeding with a craniotomy or instead of a larger procedure.

Brain Tumor Treatment Options

·         Surgery

Removing a growing brain tumour is important because as the tumour gets bigger it increases the pressure inside the head. It is this increased pressure that causes some of the symptoms of brain tumours. The surgeon is sometimes able to remove the whole tumour but often this is not possible and they can only remove part of it

Radiation therapy: X-rays and other forms of radiation can destroy tumor cells or delay tumor growth. Some of the new methods are developed for delivering radiation therapy –

Hyperfractionation: In this, small doses of radiation therapy are given 2-3 times a day instead of one.

Radiosensitizers: In this, drugs are used for making cancer cells further sensitive to radiation. When radiosensitizers and radiation are combined together then it can damage more tumor cells.

Stereotactic Radiosurgery: This type of therapy damages less healthy tissues and the radiation is delivered directly to the tumor. The exact location of the tumor is diagnosed with the help of MRI or CT scan.

  • Chemotherapy: The use of drugs to kill rapidly dividing cells. It can be taken orally or intravenously.
  • Targeted therapy: The focus on a specific element of a cell, such as molecules or pathways required for cell growth, in order to use them as a target.
  • Tumor Treating Fields: (A wearable device) locally or regionally delivered treatment that produces electric fields to disrupt the rapid cell division exhibited by cancer cells by creating alternating, “wave-like” electric fields that travel across their region of usage in different directions. Because structures within dividing cells have an electric charge, they interact with these electric fields.
  • Biological Therapy: In this therapy, the immune system of a patient is used in order to fight with cancer. The natural defenses of the body are restored to fight against cancer by using substances that are either made in the laboratory or are made by the body itself. This entire procedure is known as immunotherapy or biotherapy.
  • Hyperthermia Therapy: During this therapy, the tissue of the body is exposed to high temperatures to kill and damage cancer cells or these cancer cells can also be made more sensitive to the effects of radiation.
  • Gamma Knife Radiosurgery: Neurological diseases or disorders can be treated with the help of this surgery. In this non-invasive method, the brain is operated without using general anesthesia or by making any type of incisions.

Cost of Brain Cancer Surgery

The cost of brain cancer surgery in India is relatively lower than other developed countrie due to latest technology used in hospital and higly experienced and certified doctors for brain tumors…