By Dr Hrishikesh Sarkar
Sarvesh, a 32-year-old software professional, maintained a healthy lifestyle and was happy with his life. As he went about his day-to-day activities, he felt limb weakness and tingling in his right leg. He ignored it, dismissing it as exhaustion, until he had a seizure at work. It left him paralysed and his life turned upside down in the blink of an eye.
Sarvesh was diagnosed with anaplastic oligodendroglioma, a rare type of brain cancer on the right side of his brain. He was in danger of losing not just his limb but also his life. Doctors operated on him while he was awake to reduce the chance of paralysis and removed approximately 95% of the tumour. Further tests revealed that his cancer was malignant, necessitating radiation and chemotherapy.
“Sarvesh was able to walk again and resume work after eight months of treatment from a diverse team. All of this was made possible by the sophisticated brain tumour treatments that are now available,” says Dr Hrishikesh Sarkar, Senior Consultant - Neurosurgery, Apollo Cancer Centre, Chennai.
According to the International Association of Cancer Registries (IACR), over 28,000 cases of brain tumours are reported in India annually. In India, the prevalence of brain-related tumours is 5-10 per 1,00,000 people.
A brain tumour is distinguished by abnormal cell proliferation in the brain. It is a dangerous condition that, if not recognised and treated promptly, can be fatal. In this article, we tell you everything you need to know about brain tumours – symptoms, treatment, the success rate of the procedure and its efficacy, and myths.
Brain tumour is termed as uncontrolled cell growth inside the brain. When a tumour forms inside the brain, it puts pressure on the skull thus affecting body functions and damaging the brain. “There are more than 120 types of brain tumours based on the brain tissue that is impacted,” points out Dr. Sarkar.
Tumours are classified as benign or malignant. While benign tumours are not carcinogenic and do not spread to other areas of the body, malignant tumors are cancerous and they invade into the adjacent normal brain tissue, destroying it and grow aggressively.
The most common type of benign tumour are Meningiomas, a slow-growing tumour that forms on the lining that surrounds the brain. Glioblastoma is an aggressive and common type of malignant tumour that is classified as grade IV tumour.
The symptoms of brain tumour differ depending on the location of the tumour, its size and type. Some of the common symptoms include: headache, blurred vision, seizures, weakness in a limb, vomiting, memory loss, behavioural changes, disorientation, and loss of balance.
Experts opine that apart from strong symptoms there are also other signs that could be trivial. “Ringing in the ears, mild withdrawal from social activities, decreased hearing, these are very subtle signs that we frequently overlook. However, in a minority of cases they are the harbinger of impending brain disease and the patient needs to get themselves checked immediately if the symptoms persist for a long time,” says Dr Sarkar.
If a doctor feels that a patient has a brain tumour based on the symptoms listed above, they may offer diagnostic testing to confirm this. Neurological examinations are performed to assess the patient’s hearing, balance, vision, and reflexes, among other things, because issues in these areas may indicate that a specific portion of the brain is impacted by a tumour. To diagnose a brain tumour, imaging procedures such as Magnetic Resonance Imaging (MRI), Computerised Tomography (CT) scan, and Positron Emission Tomography (PET) scan are performed.
Advances in science and technology have resulted in new technologies that are speeding up the diagnosis of brain tumours. Brain liquid biopsy, a less invasive approach, detects brain tumour early and accurately. In this procedure, a patient’s blood is checked for markers that can indicate the presence and severity of a tumour. Another arena is the growing technology within MRI sequences that provides accurate information on the tumour and whether it will respond to a specific type of therapy.
One of the most widespread misconceptions about brain tumours is that they are lethal. That, however, is not the case. Most tumours are benign, and surgery is a good choice for completely removing the tumour and curing the patient. It is less likely to happen again.
The World Health Organisation (WHO) divides brain tumours into four categories. Grades 1–3 are mostly curable, thanks to technological advances such as surgery and radiation. Generally, only the grade 4s and few grade 3s are fatal with very limited survival time.
The most common treatment for brain tumours is minimally invasive surgery, which is followed by radiation and chemotherapy. There have been improvements in the fields of surgery, radiation, and chemotherapy that have allowed for the most precise and safe surgical work. Doctors say the new Cyberknife technology, a non-invasive radiotherapy technique with submillimetre accuracy, represents an unprecedented approach to treating complex tumours.
“Besides CyberKnife, we offer Proton beam therapy at Apollo, which is an external beam radiation therapy that precisely delivers a beam of protons to destroy tumour cells. The proton beam targets only cancer cells and causes little harm to the healthy tissue surrounding the cancer cells,” adds Dr Sarkar.
Underlining the importance of a multidisciplinary team in treating brain tumours, Dr Sarkar asserts that it requires a significant amount of manpower, tremendous input in technology, and a process to combine these two for best outcomes in surgery and patient care. “The strength of Apollo Cancer Centre is that we have the best of the technology available in the world that provides treatment with utmost precision and safety,” he adds.
The prognosis of brain surgery is determined by the patient’s age, the form of the tumour, and the extent of physical damage caused. If the patient is not too old, the tumour is benign and has been entirely treated, the chances of recurrence are very low. On the other end of the spectrum, if a person is over 60, has neurological disease, and is bedridden, or if a tumour is malignant and cannot be removed with radiation or chemotherapy, their ability to lead a normal life is greatly decreased.
Following brain surgery, post-operative care is critical. The patient is continuously monitored to ensure there are no red flags. Diet and nutrition play a key role in recovery. A healthy, nutritious, well-balanced diet helps in faster recovery. Apart from the diet, the patient should be active, continue physiotherapy, and comply with follow-up visits. Mental health support should also be provided if necessary. Dr Sarkar attributes the newest developments in brain tumour treatment to people’s increasing awareness and confidence in adjusting to modern treatment approaches for brain tumours. “Three decades ago, problems with brain surgery were as high as 60-70%. However, that number has significantly decreased to less than 1 or 2%,” he says.
Experts recommend setting up of cancer registries in all states to better determine cancer patterns among various populations, monitor cancer trends over time to advance clinical, epidemiological, and health services.
For more details on brain tumours, please refer https://apollocancercentres.com/cancers/brain-tumors/
Dr Hrishikesh Sarkar
Senior Consultant – Neurosurgery, Apollo Cancer Centre, Chennai
This article was published in association with Apollo Cancer Centre.