Brain tumor is an abnormal growth of the brain cells. The extra growth inside the brain can exert pressure on the skull, causing life-threatening complications. However, not all brain tumors are malignant. Some can be non-cancerous, benign or harmless masses of cancerous cells that mainly target the structural tissue of the brain. It can start either in the brain, or cancer elsewhere in the body can spread to the brain.

According to WHO guidelines brain tumors are categorized into four grades based on the intensity and abnormality of the cells.

• GRADE 1: Cells look benign and grow slowly; survival of the patient is likely.
• GRADE 2: Cells look slightly abnormal. The tumor grows slowly and may spread to other tissues.
• GRADE 3: Cells look abnormal. The tumor grows aggressively and tends to recur.
• GRADE 4: The cells look abnormal and spread quickly. Tumour could be life-threatening.

Warning signs and symptoms of brain tumor

Depending on the type, location, and stage of the tumor, it can cause both physical and mental symptoms. Some of the commonly observed signs and symptoms of brain tumors are

1. Unusual headache – Headache can be a common symptom. If someone is experiencing an unusual headache, especially a new one that feels localized to a specific part of the head it could be an early indication of a brain tumor. The headache tends to be more severe in the morning. A brain tumor increases the pressure inside the skull, which can lead to inflammation and tissue damage. Hence, severe, persistent headaches can occur. If there are changes in the frequency or intensity of the headaches, one must consult a doctor.

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2. Seizures – They are one of the most common symptoms of brain tumors. The seizures occur when the brain’s normal patterns of electrical impulses are disrupted. It is reported that brain tumor-related epilepsy (BTE) is common in low- and high-grade gliomas. The risk of seizures varies between 60% and 100% among low-grade gliomas and between 40% and 60% in glioblastomas.

Also Read: Epilepsy – A neurological disorder in which brain activity becomes abnormal 

3. Memory loss, Speech difficulties and hearing loss – Brain tumors can affect the stages of creating, storing and recalling of memory. Retrograde amnesia, a state where one can’t recall memories that were formed before the event that caused the amnesia and anterograde amnesia, where one can’t form new memories after the event that caused the amnesia can occur in people with brain tumor. A brain tumor can affect the communication capabilities of a person and can cause difficulties in uttering or producing sounds, finding the correct word, and understanding what others are saying. It can also have an impact on reading and writing. Also, the pressure exerted by a tumor on surrounding nerves may cause hearing loss and imbalance.

4. Weakness in the hands and legs – Weakness or numbness in the face, arms or legs is a common occurrence in brain tumors. It is caused by brain tumors located in the frontal lobes or the brainstem. Weakness in one foot/leg or both feet/legs can cause difficulty in walking. Hence, one may experience loss of balance while walking.

5. Sudden shifts in mood or personality – Mood changes are commonly associated with brain tumors located in the frontal lobe. This part of the brain is highly involved in regulating personality and behaviour and it also helps controls a person’s behavior and emotions. Sudden mood change can be seen in persons whose pituitary gland has been affected by tumors. It can cause the gland to under-or overproduce hormones, leading to an hormonal imbalance. Getting to know about one’s diagnosis of brain tumor can greatly affect the mental and emotional state.

When to see a doctor?

The above symptoms are a clear indication that one must immediately seek medical help. Upon diagnosis and conducting a range of neurological tests, your doctor will be able to identify and tell you what’s causing the symptoms. If diagnosed with a tumor, one can identify the types and follow the doctor’s advice. Always remember that early diagnosis and treatment are important to help prevent the tumor from growing.

Dr. Ravi Gopal Varma

Lead Consultant Neurosurgery – Bangalore

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Brain tumor can affect any age group starting from paediatric to geriatric age groups. The tumors vary in their origin, clinical presentation biological behaviour and prognosis in different age groups. By and large brain tumor can arise from all the structures in the cranium that includes skull bones, cartilages, meninges, brain parenchyma blood vessels choroid plexus, pituitary, spineal gland and the cranial nerves. In addition metastatic tumor can come to brain from various systemic malignancies.

Over the years several phenomenal advances have taken place in the comprehensive management of brain tumor improving the safety, efficacy, longevity as well as the overall functional outcome of these tumors. The technology and innovations have improved the visibility, accessibility, receptibility and overall ability to treat. Brain tumor outcomes are no longer dismal. However, there are few malignant brain tumors which need definitive answers. The improvements are in several spheres.

1. Diagnosis – MRI has revolutionized the diagnosis of brain tumors. Even the smallest tumors can be diagnosed with Gadolinium contrast. MR Spectroscopy can reasonably predict the nature of the tumor. Diffusion Tensor Imaging of the brain can give valuable information about the displacement of important structure in the brain by the tumor. Similarly in eloquent areas including the brain stem, PET CT or MRI will be very useful in accurately determining the size of the tumor, particularly in metastatic brain tumor.

2. Surgery – Microsurgery has provided magnification depth illumination and visibility making the tumor accessible to the surgery regardless of the location. Intra-operative ultrasound can accurately locate the deep seated tumors and guide the surgeons to reach all the shortest trajectory. Intra operative MRI can help the surgeons to get real time information about the extent of removal thereby facilitating gross total resection of these tumors.

Radio frequency bipolar and laser systems can make the total removal as well as supramaximal resection in selective intra-parenchymal tumors. Ultra-sonic surgical aspirator will help the surgeons to break the hard tumors into pieces and remove step by step without disturbing the surrounding parenchyma. Neuro-navigation systems provides real time imaging guidance all through the surgery keeping the three dimensional orientation to the surgeon and helps to prevent transgressing into normal brain tissues.

The intra operative fluorescence will highlight the tumor with a different colour under the fluorescent microscope. One should be able to resect the tumor hidden as islands between the normal tissues thus achieving complete removal. Complete removal of brain tumor  has been proven to offer better longevity and lesser chances of recurrence beyond doubt. Finally, neuroleptanalgesia will facilitate awake brain surgery in all eloquent areas making sure of brain function throughout the surgery .A variety of  haemostats are now available to control the bleeding and to achieve haemostasis quickly. Advances in neuro-anaesthesia have made all these techniques including the intra operative brain function monitoring possible.

3. Molecular Diagnosis – Brain tumor diagnosis has gone much beyond the simple histological cell based diagnosis. In the present day battery of tests provides information on gene modification, mutation, deletion, proliferative index, molecular markers, enzymes, factors that up regulate or down regulate the molecular pathways and immuno histological data that helps in deciding upon the type of treatment as well as prediction of outcomes (prognosis as well as chances of recurrence). This research has identified several abnormal genes that facilitates the formation of tumors as well as influences the recurrence.

This has the future implications and will enable successful gene editing that can alter the profile and course of the tumor. Significant research is on the way to make this as a notable therapy. The molecular mechanisms and its understanding are paving the way for the introduction of targeted therapy for the tumors. Several such molecules and the nucleotides are already in the market and several others are under clinical research and trials.

It is the hope that this will be the future gold standard of therapy for many tumors. Immunological modulation is another method of combating the brain tumor growth. This is also in the experimental phase. Enzyme intervention and blocking the metabolic pathways of the tumors to prevent them from growing is another notable method to fight these tumors.

4. Tumor Stem Cell Concepts – Tumor Stem cell concepts that nurtures and propagates the tumors as well as responsible for recurrence is another target for the future treatment of brain tumor. The tumor cells escape the natural immunological surveillance within the body thereby surviving in the safe hideouts to cause recurrence as well as to metastasize. Targeting these cells will technically provide the eradication and elimination of the tumorogenic process within the system. Brain tumor vaccine is customized and tailor made to each individual, is another method that is being tried in some of the management of brain tumors.

 5. Adjuvent Therapy – Many malignant tumors require adjuvant therapy to enhance the progress and reduce the chances and recurrence.

6. Radiotherapy – Several advances have taken place in the delivery of radiation to the brain tumor. The image guidance, stereotactic system has improvised precise delivery of high dose radiation purely to the tumor protecting the surrounding brain tissues from the effects of radiation. Thus stereotactic radio therapy delivers high dose radiation to the tumor as a single fraction or divided as small fraction.

This technique is proved to improve the overall outcomes as well as the progression in many tumors. This technique is particularly useful for the elderly, for those who cannot undergo surgery as well as patient with recurrence. This can be offered as a primary treatment in small benign tumors in small children. Similarly, after the surgery the tumor bed can be radiated to prevent regrowth or recurrence. Proton beam therapy is a new addition that can provide better result with lesser toxicity and are particularly useful to treat children with brain tumors.

Several molecular mechanisms are being unravelled by continuous research and this has contributed to the current understanding of various brain tumors and their histological as well as biological behaviour. It has also paved the way for the current understanding as well as newer classification of the brain tumors. The on-going research is expected to provide much more insight that will guide the clinicians to make more accurate diagnosis as well as add many therapeutic options in the years to come.

Also Read: Brain : The King and a King maker 

Dr. NK Venkataramana

Founder Chairman & Director Neurosciences

Brains Super Speciality Hospital, Bengaluru.

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In India, at least 40,000-50,000 people are diagnosed with Glioblastoma Multiforme (GBM) brain tumors, of which 20 percent are children. Brain tumors are primarily treated with surgery, Chemotherapy and Radiation. After these treatments, the average survival is not more than 14 months. This indicates that such patients are left with very little or no chances of survival. However, with SPMF Therapy, such patients have been treated successfully who have survived for more than five years on average.

 SPMF is a unique type of treatment that is non-invasive and safe, painless, affordable, scientifically proven and most effective treatment for brain tumor. A patient’s condition is evaluated using MRI and the Karnofsky Performance Score (KPS) which are the gold standards for evaluating the efficacy of a therapy. This treatment is administered through an advanced medical device called AKTIS SOMA. This therapy is conducted over a 28-day period (one hour a day).

 For the first time in Indian history, Sequentially Programmed Magnetic Field (SPMF) Therapy invented by Wg Cdr (Dr.) V. G. Vasishta, Founder & Chairman, SBF Healthcare, known to have saved and revived lives of over 500 brain tumor cancer patients has set its benchmark in medical technology and has been recently adopted by the US for Neuro-Oncology Research for treatment of malignant brain tumor cancer.

Wg Cdr (Dr.) V. G. Vasishta, says, “There is a major need for non-surgical intervention without any side effects in the treatment of cancer. SPMF Therapy provides a non-invasive and safe treatment without any side effects. It halts the progression of the disease and improves quality of life and extends the survival period. It also helps develop a patient’s emotional and psychological wellbeing. This therapy has proven to be a miracle for many patients with malignant tumors and is now set to help make progress in fields of Neuro-oncology Research through our association with two leading universities in the US. Until today, India has been relying on Western countries for advanced medical treatment and techniques. I am extremely delighted that, with SPMF Therapy, we are setting the ground for an Indian medical technology to be used by people across the globe for treating a complex disorder such as brain tumors. For the first time, an advanced medical technology developed by an Indian will be approved to be used for the treatment of brain tumors in the US.”

Memorandum of Understanding (MoUs) have also been signed between SBF Healthcare and University of California, Los Angeles (UCLA) & University of Pennsylvania for advancement in Neuro-Oncology research for treatment of malignant brain tumor cancer. According to the new bill announced by US President, Donald Trump on ‘Right to Try Law’, SPMF Therapy can be used for treatment by any US citizen without any FDA approval.

 About SBF Healthcare and Research Center (SHRC) Pvt. Ltd:

SBF Healthcare and Research Center (SHRC) Pvt. Ltd., was founded in 2006 by Wing Commander (Dr) V. G. Vasishta (Retd.) soon after his retirement from the Indian Air Force. SBF in India quickly gained popularity as one of the best healthcare centers in the country for treatment of OA and cancer, owing to unrelenting dedication to excellent medical services and pioneering research in life-saving Osteoarthritis and Cancer medical technologies. A breakthrough for osteoarthritis and cancer patients came with the advent of Sequentially Programmed Magnetic Field (SPMF®) Therapy, SHRC’s popularity increased manifold and its osteoarthritis treatment and Cancer treatment regimens won mentions in leading medical journals and publications. Till date, over 8,000 cases of OA and more than 500 cases of cancer have been treated.

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