Brain tumor is an abnormal growth in the brain causing compression and loss of important functions. Brain tumors are divided into two main groups: primary - originating from the brain and metastatic – spreading to the brain from other places.
Primary brain tumors may have numerous cell origin and are divided into four grades according to their malignancy degree, with grade I being the most benign and IV the most malignant. Treatment of brain tumors depends on the type and grade of the tumor. Most of the tumors require surgical treatment. It is of paramount importance to remove the brain tumor as much as possible. Unfortunately, this task is not always easy since the tumor may be located in a sensitive area. Tumor removal may affect that area and lead to damage. This may cause significant consequences for the patient. Following the tumor removal, it might be necessary to provide additional treatment based on the grade of the tumor. Usually, grade I-II tumors are treated with surgery only. It is important to remember that despite the benign nature these tumors may recur if not removed completely. Grade III-IV tumors require adjuvant therapy even after full resection. Chemotherapy and radiation therapy are usually employed to control tumor growth.
Metastatic tumors are the most frequent type of brain tumors. Nowadays people live longer than ever before due to medical advances. With the population ageing, the rate of cancer is increasing worldwide. And with better treatments, cancer patients live longer lives. The brain is an extremely suitable environment for cancer cells to survive.
Brain tumors may present with a variety of symptoms depending on location, size and growth rate. Benign tumors are usually slowly growing and allow the brain to adapt to the compressive effect. They may reach very large sizes before producing any symptoms. Malignant brain tumors, on the other hand, grow aggressively and tend to cause edema in surrounding tissue. Yet even malignant tumors do not cause symptoms before reaching a particular size. They may cause headaches, weakness in arms and legs, numbness, visual disturbances, seizures, dizziness, vertigo, hearing impairment and many other symptoms. The diagnosis is made on imaging. MRI with the contrast dye is the best modality to show the tumor and relation with the surrounding brain. In some cases, laboratory tests are required for detailed diagnosis. Pathological analysis of the tissue is the most important aspect of the diagnosis. No test can be as reliable as an examination of the abnormal growth. For that reason, obtaining tissue sample and subsequent analysis is the cornerstone of brain tumor management.
Surgery is the main treatment option for brain tumors. The goals of surgery are obtaining tissue for pathological examination and relieving the brain compression. In case of benign tumor complete removal provides a cure. But even benign tumors might be very challenging if they are located in sensitive areas. Malignant tumors require chemo - and radiation therapy following the surgery. In brain tumor surgery, we employ a “maximal safe resection” strategy which means we remove as much tumor as possible and not damage the important centres in the brain.
There are several tumor types very sensitive to radiation and chemotherapy. For those cases obtaining a tissue sample without major surgery is sufficient.
Metastatic brain tumors were once considered unexceptionally lethal. Yet with modern treatment options, this is not the case anymore. Removing of brain metastasis has been shown to prolong the patient’s survival and increase the quality of life. In the vast majority of cases, chemotherapy and radiation therapy are used to control the tumor growth following surgery for brain metastasis.