Brain Cancer

As the brain is such a complex organ with many components, there are a large diversity of tumours that can arise in the brain. Tumours in the brain are masses of abnormal cells that grow uncontrollably and proliferate. Tumours can be classified as benign or malignant. Benign tumours do not grow into the tissues around it or spread to different areas of the body, while malignant tumours do. However, benign tumours can grow, compress and damage the brain tissue surrounding it. This can be dangerous as it can impede the body’s function to a fatal degree.

Cancer can also spread to the brain from other sites of origin in the body. These are called secondary (metastatic) brain tumours, or brain metastases. They most often occur in people who have had cancer before. In adults, secondary brain tumours are more common that primary brain tumours.

The prevalence of the different types of brain tumours and cancers also differs between adults and children. Infants have also been diagnosed with brain cancers. Primary brain and spinal cord cancers are the second leading cause of cancer-related deaths in children.

There are over 120 types of brain tumours. Brain tumours and cancers are named after the cells and tissues they originate from. Some examples include:

Gliomas (arising from the supportive cells of the brain), including:

• Astrocytomas
• Oligodendrogliomas
• Ependymomas
• Glioblastoma multiforme
• Meningiomas
• Medulloblastomas
• Pituitary adenomas
• Germ cell tumours
• Central Nervous System Lymphomas

Different types of brain tumours have different outlooks and prognoses, and the treatment plan for each type varies as well. Some can be fast growing (high grade) or slow growing (low grade). The grades of brain tumours range from 1 to 4, grade 4 tumours being the fastest growing.

Brain cancer is uncommon in Singapore. However, the most common are astrocytomas and glioblastoma multiforme.

Brain tumours are often associated with symptoms that are specific to the region of the brain that they develop in. However, the symptoms can also be caused by other diseases of the brain in that specific location.

Some symptoms include:

• Fits or seizures
• Persistent headaches that are worse in the morning
• Vomiting
• Nausea
• Balance problems
• Coordination problems
• Difficulty walking
• Lapses in memory
• Double vision
• Abnormal eye movements
• Problems with speech and understanding speech
• Muscle twitching or jerking
• Personality or behaviour changes
• Drowsiness
• Numbness or tingling in the limbs
• Weakness of one side of the body, similar to stroke

The skull is a bony structure that cannot expand and the growth of tumours causes more space to be occupied within the skull. As a result, most of the symptoms that patients with cancer experience are associated with an increased pressure within the skull.

While headaches are a symptom of brain cancer, there are many other causes, such as stress, problems with eyesight and migraine. It is important to consult your doctor should these headaches persist, become worse, or are accompanied by other symptoms such as vomiting, double vision or other symptoms as listed above.

• Exposure to high levels of electromagnetic radiation especially during childhood
• Family history of the following genetic disorders:
• Neurofibromatosis type 1 (NF1)
• Neurofibromatosis type 2 (NF2)
• Tuberous sclerosis
• Von Hippel-Lindau disease
• Li-Fraumeni syndrome
• Having a weakened immune system

The symptoms of brain cancer may resemble other diseases involving the brain, such as headaches. It’s important to discuss with your doctor should you experience any of the symptoms.

If your doctor suspects you may be suffering from brain cancer, he/she may recommend several different tests in order to confirm and diagnose it.

Your doctor may put you through a neurological exam. These could include checking your vision, hearing, balance, coordinations, strength and reflexes. If there are any weaknesses in these, it may point to the part of the brain that could be affected by a tumour.

Magnetic resonance imaging (MRI) and computerised tomography (CT) of the brain produces accurate images of the brain. Sometimes a contrast dye may be injected as well to make the detection of abnormalities in the brain easier to see. This allows the doctor to detect any abnormal changes in the brain, as well as to find the precise location of the tumour. The scan can also be analysed to confirm if there is increased pressure within the skull. There are also other specialised MRI scan components such as functional MRI, perfusion MRI and magnetic resonance spectroscopy.

Your doctor may also conduct a biopsy. This involves using a needle to collect a sample of the abnormal tissue, or a tumour removed as part of an operation could be analysed. The sample is examined under the microscope to determine if it is cancerous or benign. Sometimes, a biopsy may not be attempted if there is a very high risk of causing damage to the surrounding important structures.

Treatment options for brain tumours depends on the type of tumour, the size and location of the tumour as well as age and general health of the individual.

The prognosis depends on the type, size and location of the tumour. While brain cancer has a With early diagnosis and appropriate treatment, the outlook may be positive. Younger patients may also survive longer than older patients.

Treatment is multidisciplinary, personalised and precise and there are a variety of treatment options available. These may include the following, and possibly in combination:

• Surgery
• Radiation therapy including:
  • External Beam Radiation Therapy
  • Stereotactic Body Radiation Therapy
  • Proton Beam Therapy
• Chemotherapy
• Targeted drug therapy

Once the diagnosis is made the consultation with an oncologist is essential in order to understand which treatment options are the most suitable.