Brain Cancer: a damn dozen answers
13 answers to difficult questions about brain tumors
Everyone who has somehow come across a diagnosis of "brain tumor" knows how scary it is. The unknown always scares the most. Meanwhile, the results of treatment of patients are improving every year. In particular, thanks to the improvement of diagnostic methods, surgical treatment, radiation therapy and chemotherapy, as well as innovative methods such as immunotherapy and gene therapy. The main thing is to know what and how to treat. Independent information portal Oncobrain.ru – the project of the Konstantin Khabensky Charitable Foundation – specially for the project "Social Navigator" has prepared a material that contains answers to the most important questions about brain tumors.
Experts of the Konstantin Khabensky Foundation participated in the preparation of the article: Andrey Levashov, a researcher at the Hemablastosis Chemotherapy Department with the neurooncology group of the Blokhin Russian Cancer Research Center and Endzhe Valiakhmetova, pediatric oncologist at the National Scientific and Practical Center of Neurosurgery named after academician N.N.Burdenko.
1) Brain tumors are not cancer
There are two types of diseases among malignant neoplasms: cancer and sarcoma. Cancer is a tumor formed from epithelial tissue cells. Sarcoma is a tumor formed from connective tissue cells. Most primary brain tumors are a complex structure formed mainly of glial cells, rarely neurons. Therefore, the vast majority of primary brain tumors are incorrectly called cancer.
2) The causes of tumors of the central nervous system are unknown
Rare gene defects and mutations (hereditary and acquired) increase the risk of cancer, but they are not hereditary. Some external influences can lead to the spontaneous appearance of mutations – for example, ultraviolet rays or X-rays, chemicals, infections, etc. At the moment, there is no evidence in science that any behavior or lifestyle of a child or teenager leads to the appearance of a tumor. The disease does not appear because you have done something or, conversely, missed it. Popular assumptions that tumors arise due to psychological causes (conflicts, experiences of loss, etc.) are false from the point of view of science.
3) Among all oncological diseases in children, brain tumors occupy the second place in prevalence
In the first place are acute leukemias, which account for about 30% of all tumors in children and adolescents. The detection rate of tumors of the central nervous system in children is about 15-17%.
According to the Intercontinental Cancer Registry, which combines data from 86 cancer registries on five continents, the incidence of primary brain tumors (including meningiomas) is 6-19 cases per 100,000 male and 4-18 cases per 100,000 female population. This world statistics is collected by the International Agency for Research on Cancer (International Agency for Research on cancer) with the participation of the World Health Organization. Official statistics in In the Russian Federation, the incidence of primary tumors of the central nervous system averaged 4.8 cases per 100 thousand population in 2015. According to the state medical statistics provided by the Russian Center for Information Technology and Epidemiological Research in the Field of Oncology of the P.A.Herzen Moscow Research Oncological Institute "Malignant neoplasms in Russia in 2015", the absolute number of diagnoses of malignant neoplasms of the brain and other parts of the central nervous system for the first time in life in 2015 amounted to 4,377 people. The total incidence in the Russian Federation in 2015 for this localization in 2015 amounted to 8896 cases, including 655 children under the age of 17.
4) Benign tumors of the central nervous system are no less dangerous than malignant
Even a benign, slow-growing tumor can be life-threatening if it puts pressure on the brain structures that regulate vital body functions (breathing or blood circulation). In neuro-oncology, there are benign tumors that can also spread metastases. Therefore, magnetic resonance imaging (MRI) of all parts of the central nervous system is included in the complex of primary examination of all patients, including those with benign tumors.
In addition, even benign tumors can not always be effectively cured, and in some cases they can eventually degenerate into malignant.
5) Brain tumors have no stages, there are degrees of malignancy
In patients with brain tumors, the stage of the disease is not determined, as, for example, in cancer or some types of sarcomas. Currently, the WHO classification of tumors of the central nervous system has been developed, which is morphological and determines the degree of malignancy. The approach to the treatment of CNS tumors in most cases depends on the degree of malignancy of the tumor: thus, tumors of low malignancy (grade I, grade I) are usually subject only to surgical treatment; with an intermediate degree of malignancy (grade II, grade II), surgical removal of the tumor is performed, in some cases, treatment is supplemented with radiation therapy or drug antitumor therapy (chemotherapy), and with a high degree of malignancy (grade III-IV), treatment necessarily includes tumor removal, radiation therapy and drug antitumor therapy. In many cases, it is not the size, but the localization of the tumor that determines the severity and prognosis of the disease. Some metastatic brain tumors have a more benign course than non-metastatic or rarely metastatic tumors.
6) In adults, the disease is often asymptomatic
A brain tumor can grow asymptomatically, or it can be accompanied by characteristic changes in the body. In adult patients at the early stages of development, the disease is most often accompanied by the absence of clinical symptoms. In children, it disguises itself as infectious diseases, diseases of the autonomic nervous system, endocrinological and gastroenterological diseases. Symptoms can be divided into general and specific (characteristic of a certain type of neoplasm). Common symptoms occur due to the pressure exerted by the tumor on the brain or spinal cord: headache, fatigue and weakness, nausea and vomiting, memory impairment, personality changes, impaired sensitivity and organ functions (touch, vision, hearing and smell), convulsions (sudden involuntary muscle movements). Specific symptoms appear when the tumor affects the functional centers of the brain, and depend on the localization of the tumor. These can be: compression syndrome, imbalance and fine motor skills, lethargy, muscle weakness or paralysis, partial or complete loss of vision, swallowing disorder, weakness of facial muscles or numbness of the face, double vision, etc. Be sure to inform the doctor in detail about all the symptoms that you have noticed, including the appearance of new ones or the change of old ones.
7) Early diagnosis significantly increases the chances of recovery
A brain tumor is not a verdict, with different nosologies (diagnoses) and patient data, there are different forecasts for recovery. Early diagnosis of tumors of the central nervous system helps to improve the results of treatment of the disease, but in the presence of massive and metastatic lesions, in some cases, effective medical care is possible.
8) It is impossible to confirm or deny the presence of a brain tumor without an MRI
To make a diagnosis, it is mandatory to conduct: MRI examination of the brain and spinal cord with intravenous contrast, cytological examination of cerebrospinal fluid. If a tumor is detected, a comprehensive pathomorphological examination is performed (examination of tissue samples, in this case– tumors) on biopsy or postoperative material.
9) The treatment of brain tumors in children is significantly different from the treatment of the same diseases in adults
The differences relate to the localization, morphological properties of tumors, therefore, children and adults may have different nosologies, clinical manifestations and therapeutic approaches. For example, medulloblastoma in a child under 4 years old, a teenager and an adult are completely different tumors, which affects the choice of treatment methods and their sequence. The main method of treatment for most childhood brain tumors is surgery. Moreover, its effectiveness largely depends on the early recognition of the tumor and a well-planned careful technique of surgical intervention. But it is important to remember about the timely start of the subsequent stages of program treatment (radiation therapy and chemotherapy).
10) In brain tumors, metastasis most often occurs within the cranial box
Most tumors of the brain and spinal cord are characterized by the absence of metastases outside the central nervous system. Tumors prone to metastasis spread mainly through the cerebrospinal fluid spaces (cerebrospinal fluid), which is not typical for tumors of extracranial localization.
11) Rehabilitation is no less important than the treatment itself
After heavy treatment and a long stay in the hospital, it is very difficult for many patients to immediately return to their normal lifestyle. Adult patients, and especially children, need to eliminate its consequences in comprehensive medical, psychological and social care. Rehabilitation is aimed at restoring the physical, psychological and social status of people who have lost these abilities as a result of the disease. There are several types of rehabilitation: medical, physical, psychological, academic, psychological and pedagogical, social rehabilitation of the family.
Rehabilitation should be carried out starting from the moment of diagnosis of the disease and until the person's full return to society at all stages – hospital, outpatient and dispensary.
12) The brain and spinal cord have a barrier to antitumor drugs
Blood-brain barrier (BBB) – a semi-permeable barrier between the blood and the tissue of the brain and spinal cord, preventing the penetration of large or polar molecules into the brain, as well as blood cells, including the immune system. BBB is a physiological mechanism that ensures the constancy of the internal environment of the brain and spinal cord.
Therefore, many antitumor drugs do not create the necessary concentration in the tumor. Modern research and treatment methods, such as immunotherapy, are aimed at overcoming this barrier.
13) A primary brain tumor consists of several tumors
Primary brain tumors can be polyclonal, that is, consist of several types, so-called tumor clones. Treatment in this case should contain different groups of drugs, since each "clone" has its own sensitivity and resistance to one or another antitumor drug.
Portal "Eternal youth" http://vechnayamolodost.ru
25.08.2017