BRAIN CANCER(TUMORS)
Jinu Janet Varghese
Group: 4
Year: 5
Tbilisi State Medical University

Definition
• Brain cancer is a disease of the brain in which cancer cells
(malignant) arise in the brain tissue. Cancer cells grow to
form a mass of cancer tissue (tumour) that interferes with
brain functions such as muscle control, sensation, memory,
and other normal body functions.

Types of brain tumors
• Benign: The least aggressive type of brain tumor is often
called a benign brain tumor. They originate from cells
within or surrounding the brain, do not contain cancer cells,
grow slowly, and typically have clear borders that do not
spread into other tissue.
• Malignant: Malignant brain tumors contain cancer cells and
often do not have clear borders. They are considered to be
life threatening because they grow rapidly and invade
surrounding brain tissue.

• Primary: Tumors that start in cells of the brain are called
primary brain tumors. Primary brain tumors may spread to
other parts of the brain or to the spine, but rarely to other
organs.
• Metastatic: Metastatic or secondary brain tumors begin in
another part of the body and then spread to the brain.
These tumors are more common than primary brain tumors
and are named by the location in which they begin.

The most common primary brain tumors are:
• Gliomas (50.4%)
• Meningiomas (20.8%)
• Pituitary adenomas (15%)
• Nerve sheath tumors (8%)

Benign tumours can be divided into the following:
• Chordomas: starting in embryonic cells in the spine or
base of the skull nerve
• Hemangioblastomas: starting in the blood vessels
• Meningiomas: starting in the membrane covering the
brain
• Osteomas: in the skull bones
• Pinealomas: in the pineal gland
• Pituitary adenomas: in the pituitary gland
• Schwannomas: in the cells that wrap around nerves

Gliomas
• Most tumours develop from the supporting cells of the
brain known as the glial cells. They may be named after the
type of cell that they are made up of, or after the part of
the brain where they are found; such as a brain stem
glioma. More than half of all primary brain tumours are
gliomas.
Types of glioma
• Astrocytic tumours
• Oligodendroglial tumours
• Mixed glioma
• Ependymal tumours

Medulloblastoma
• Medulloblastomas are one of the most common malignant
brain tumours in children, but rare in adults. They usually
develop in the cerebellum at the back of the brain but may
spread to other parts of the brain. Very occasionally, these
tumours spread outside the brain to the lymph nodes or
lungs.
• Medulloblastoma is a type of primitive neuroectodermal
tumour (PNET). PNETs develop from cells that are left over
from the earliest stages of a baby’s development in the
womb.

Meningioma
• Meningiomas arise from the meninges, which are the
membranes that cover the brain. They can occur in any part
of the meninges over the brain or spinal cord and usually
grow very slowly. There are three subtypes of meningioma:
• Benign meningioma - a slow-growing, grade 1 tumour
• Atypical, clear cell or chordoid meningiomas - are grade 2
tumours
• Rhabdoid, papillary or anaplastic (malignant)
meningiomas - are faster growing, grade 3 tumours.

Pineal region tumours
• The pineal gland is just below the area where the two
cerebral hemispheres join together. Tumours in this part of
the brain are extremely rare. They can be made up of
different types of cells. Some may be slow-growing, while
others may grow more quickly.
• The most common tumours found in the pineal gland are
germinomas; others include teratomas, pineocytomas and
pineoblastomas.

Acoustic neuroma
• Acoustic neuromas (also called vestibular schwannoma or
neurilemmoma), are benign tumours that develop in the
acoustic or auditory nerve, which controls hearing and
balance. The nerve is covered by cells called Schwann cells.
The tumour starts from these cells, so it’s also known as a
schwannoma.
• Acoustic neuromas are usually only found in adults and are
more common in people who have a genetic condition
called neurofibromatosis type 2 (NF2).

Haemangioblastoma
• This is a rare type of tumour that develops from the cells
that line the blood vessels. Haemangioblastomas are
benign and grow slowly. It may take several years for
symptoms to appear.

Pituitary tumours
• Pituitary tumours are benign and are also called pituitary
adenomas. Symptoms often appear as disturbances in
vision or hormone levels.

Grading
• Grade I: The tissue is benign. The cells look nearly like
normal brain cells, and they grow slowly.
• Grade II: The tissue is malignant. The cells look less like
normal cells than do the cells in a grade I tumor.
• Grade III: The malignant tissue has cells that look very
different from normal cells. The abnormal cells are actively
growing and have a distinctly abnormal appearance
(anaplastic).
• Grade IV: The malignant tissue has cells that look most
abnormal and tend to grow quickly.

Staging
• Brain cancers are staged (stage describes the extent of the
cancer) according to their cell type and grade because they
seldom spread to other organs, while other cancers, such
as breast or lung cancer, are staged according to so-called
TMN staging which is based on the location and spread of
cancer cells. In general, these cancer stages range from 0 to
4, with stage 4 indicating the cancer has spread to another
organ (highest stage).

Causes
• The exact cause of brain tumours is unknown. But there are
several risk factors. These include:
• Age: The risk of getting a brain tumour increases with age. But
certain types of brain tumours are common in young adults
and children.
Tissue of Origin Children Adults
Astrocytes Pilocytic Astrocytoma (PCA) Glioblastoma Multiforme (GBM)
Oligodendrocytes Oligodendroglioma
Ependyma Ependymoma
Neurons Medulloblastoma
Meninges Meningioma

• Genetic conditions: Brain tumours are usually not
inherited. But there are certain genetic conditions that
have been linked to brain tumours. These include
neurofibromatosis type 1 and type 2, tuberous sclerosis, Li-
Fraumeni syndrome, von Hippel-Lindau syndrome, Turcot
syndrome and Gorlin syndrome.
• Previous radiation: If there has been a exposure to
radiation in the past, for example, radiotherapy, there is a
slightly higher risk of developing a brain tumour.
• Research is ongoing into other possible causes of brain
tumours. This includes viruses, power lines and mobile
phones. At present, there is no scientific evidence to prove
there is a link between these and brain tumours.

Signs and Symptoms
• Brain cancer causes symptoms when it pushes on the brain
or destroys brain tissue. Symptoms depend on the size and
location of the tumour as well as how quickly it grows.

• Although headaches are often a symptom of brain cancer, it
is important to remember that most headaches are due to
less serious conditions such as migraine or tension, not
cancer. Headaches caused by a brain tumour are often
severe, associated with nausea and vomiting and are
usually worse in the morning. They can last for extended
periods of time or may "come and go."

• Brain tumors can cause many symptoms. Some of the most
common are
• Headaches, usually worse in the morning
• Nausea and vomiting
• Changes in your ability to talk, hear, or see
• Problems with balance or walking
• Problems with thinking or memory
• Muscle jerking or twitching
• Numbness or tingling in arms or legs

Diagnosis
• The initial test is an interview that includes a medical
history and physical examination of the person.
• The most frequently used test to detect brain cancer is a CT
scan. A dye needs to be injected into a vein for better
images of some internal brain structures.
• MRI has high sensitivity & detects anatomic changes in the
brain.
• A tissue sample (biopsy) may be obtained by surgery or
insertion of a needle to help determine the diagnosis.
• Other tests (white blood cell counts, electrolytes, or
examination of cerebrospinal fluid to detect abnormal cells
or increased intracranial pressure) may help determine the
patient's state of health or to detect other health problems.

Special tests
• PET scan
• EEG: The test records the electrical activity in your brain. It
is often done if there are seizures.
• Angiogram: This test looks at the blood vessels in the head.
It is done if the tumour is close to a blood vessel

Treatments
• The main treatments used for brain tumours are surgery,
chemotherapy, radiotherapy and medication to control
symptoms such as seizures. The treatment or combination
of treatments is advised in each case depending on various
factors.

Surgery
• Surgery is often the main treatment for benign brain
tumours and primary malignant tumours. The aim of
surgery is to remove the tumour (or even some of the
tumour) whilst doing as little damage as possible to the
normal brain tissue.

Radiotherapy
• Radiotherapy is a treatment which uses high-energy
beams of radiation which are focused on cancerous
tissue. This kills cancer cells or stops cancer cells from
multiplying.
Radiotherapy is sometimes used instead of surgery
when an operation is not possible for a malignant brain
tumour. Sometimes it is used in addition to surgery if it
is not possible to remove all the tumour with surgery
or to kill cancerous cells which may be left behind
following surgery.

Chemotherapy
• Chemotherapy is a treatment which uses anti-cancer medicines to
kill cancer cells, or to stop them from multiplying. It may be used in
addition to other treatments such as surgery or radiotherapy; again,
depending on various factors such as the type of tumour.
Medication to control symptoms
• If the patient has seizures caused by the tumour then
anticonvulsant medication will usually control the
seizures. Painkillers may be needed to ease any headaches. Steroid
medication is also commonly used to reduce inflammation around a
brain tumour. This reduces the pressure inside the skull, which
helps to ease headaches and other pressure symptoms.

Human fat can help treat brain cancer
???
• Research was conducted by Alfredo Quinones-Hinojosa, from Johns
Hopkins University School of Medicine.
• Stem cells taken from a patient's own body fat could soon be used to
treat deadly brain cancer. Scientists have successfully used stem cells
derived from human body fat to deliver biological treatments directly
to the brains of mice with the most common and aggressive form of
brain tumour, significantly extending their lives.
• The experiments advance the possibility that the technique could work
in people after surgical removal of brain cancers called glioblastomas
to find and destroy any remaining cancer cells in difficult-to-reach
areas of the brain, researchers said.
• Glioblastoma cells are particularly nimble; they are able to migrate
across the entire brain, hide out and establish new tumours. Cure rates
for the tumour are notoriously low as a result, researchers said. In the
mouse experiments, researchers used mesenchymal stem cells (MSCs)
- which have an unexplained ability to seek out cancer and other
damaged cells - that they harvested from human fat tissue.

• They modified the MSCs to secrete bone
morphogeneticprotein 4 (BMP4), a small protein
involved in regulating embryonic development and
known to have some tumour suppression function.
• The researchers, who had already given a group of
mice glioblastoma cells several weeks earlier, injected
stem cells armed with BMP4 into their brains.
Researchers said the mice treated this way had less
tumour growth and spread, and their cancers were
overall less aggressive and had fewer migratory cancer
cells compared to mice that didn't get the treatment.

• Meanwhile, the mice that received stem cells with BMP4
survived significantly longer, living an average of 76 days, as
compared to 52 days in the untreated mice study.
• Standard treatments for glioblastoma include
chemotherapy, radiation and surgery, but even a
combination of all three rarely leads to more than 18
months of survival after diagnosis.

Case History
• This is a 21 year old male. MRI scan was done to see
the extent of tumor growth outside his brain. He had
surgery once about a year ago and the Neurosurgeon
encountered problem during surgery and decided not
to replace the bone flap that was removed for surgery

• The tumor kept growing, diagnosis following surgery was
Malignant glioma.

• The patient was operated and the entire tumor growing
outside his skull was removed. Patient is doing very well,
awake, talking, moving all his extremities and drinking
full liquids. He was weak on the left side before surgery
and that remains unchanged at the moment.

References
• http://www.webmd.com/cancer/brain-cancer/
• http://www.medicinenet.com/brain_cancer/page5.htm
• http://ibnlive.in.com/news/human-fat-can-help-treat-brain-cancer/469494-
17.html
• http://www.nlm.nih.gov/medlineplus/braincancer.html
• http://www.cancer.gov/cancertopics/types/brain
• http://www.macmillan.org.uk/Cancerinformation/Cancertypes/Brain/Aboutbraint
umours/Types.aspx
• http://www.braintumor.org/brain-tumor-information/understanding-brain-tumors/
• http://chealth.canoe.ca/channel_condition_info_details.asp?disease_id=22&chan
nel_id=12&relation_id=1619
• http://www.patient.co.uk/health/cancer-of-the-brain-and-brain-tumours
• http://www.cancer.ie/cancer-information/brain-cancer/symptoms-and-diagnosis
• http://www.mangalorean.com/browsearticles.php?arttype=Health&articleid=272