Inoperable Brain Tumor

What is an Inoperable Brain Tumor?

Inoperable Brain Tumor is a tumor that is located in a surgically inaccessible place in the brain, or one’s that are composed of multiple tumors and can’t be all removed. Accessibility of the tumor is decided by the surgeon, depending on many factors, such as the possibility to access the tumor without damaging critical brain areas.

It might also be a tumor that is too entangled with blood vessels and operating it would be a risk for patient’s life. Or there are concerns about the patient´s ability to survive the operation, in case of other concomitant diseases ^[1]. All tumors can be classified into two big groups- benign and malignant.

Benign tumors do not invade nearby tissue and do not spread to other organs, but their location may cause some brain function impairment. Malignant tumors are dived in two subgroups- primary and secondary. Secondary tumors are metastasis from cancer located in any other organ. Primary tumors arise from the tissue in the brain ^[2].

Symptoms

Since inoperable brain tumor can be any kind of tumor, the symptoms are very variable. There are a number of generalized symptoms that are caused by the pressure of the tumor on brain or brain stem. These symptoms are:

• Headaches, that are worse in the morning and can increase with activity
• Seizures
  • Muscle twitches, spasms- so called Myclonic seizures
  • Tonic-Clonic seizures- loss of consciousness and bodily functions that is followed by twitching and relaxing of the muscles.
  • Sensory seizures, when any of senses are changed without loss of consciousness.
  • Complex seizures that can cause partial loss of consciousness or awareness.
• Personality changes
• Memory changes
• Lethargy
• Nausea
• Vomiting
• Sleep disturbances ^[3].

Some specific symptoms depend on the location of the tumor:

• Pain or pressure near the tumor
• Cerebellum-Impaired motor skills and loss of balance
• Frontal lobe-apathy, lethargy, muscle weakness or paralysis
• Occipital lobe or temporal lobe- partial or complete loss of vision
• Frontal and temporal lobe- impaired speech, hearing, memory. Untypical emotional behavior
• Parietal or frontal lobe-altered perception of touch or pressure, extremity weakness on one side of the body
• Pineal gland- inability to look up
• Pituitary tumor-symptoms connected to increased level of pituitary gland hormones, like immoderate growth of palms and feet, altered menstrual cycle in women
• Brain stem- difficulty swallowing, double vision, facial muscle weakness^[3].

All the mentioned symptoms vary in severity and regularity of occurrence. Patient can experience some of them together or possibly no symptoms at all. Some of the symptoms might have a different cause, unrelated to brain tumor. For example, tongue cancer can cause difficulty swallowing and trouble moving jaw or the tongue ^[4]. Spinal cancer can cause paralysis, decreased sensitivity to pain, and loss of sensation which mimics some symptoms of brain cancer ^[5].

Causes

Primary brain tumors originate from the brain or surrounding tissue. They can originate from the covering membranes of brain (meninges), pituitary, and pineal gland. Each cell has its own life cycle. Normally, cells are programmed to die and renew in a certain pace.

Tumors form, because of mutations in cell DNA, which disrupt this normal cycle. Cells start to divide uncontrollably, and continue living, when normal cells would die. The cause of the mutations to begin in the first place is hard to recognize. It can be a variety of things, like environmental factors, exposure to radiation, genetic predisposition.

Secondary brain tumors develop from another tumor in the body. Brain metastases are usually caused by breast, liver, kidney, colon and skin (melanoma) cancer. Secondary tumors occur more often than primary [6]. Blood cancers, like acute myeloid leukemia can also cause brain damage, and therefore the same symptoms as brain cancer ^[7].

Diagnosis

There are a number of tests and procedures that have to be done:

• Neurological exam- checking vision, balance, reflexes, strength, movements
• Imaging:
  • Magnetic resonance imaging- most commonly used for diagnosing brain tumors.
  • PET scan- uses radioactive substance, that is injected in the body, in order to find possible tumor or metastases
  • CT scan- best represents bone structures
• Biopsy- collecting and testing abnormal tissue, to determine if the tumor is malignant or benign [8].

The differential diagnosis of brain tumor can be very difficult. There are a number of conditions that can cause symptoms similar to brain tumor. For example, Vipoma– an endocrine cancer, which presents with a diarrhea, can cause a severe disbalance of electrolytes in the body, causing a variety of symptoms that can be related to brain tumor ^[9].

Treatment

In case of inoperable brain tumor there are a variety of treatment options:

• Radiation therapy- uses external source of radiation to kill the tumor cells
• Stereotactic radio- surgery- uses multiple beams of radiation focused on the tumor cells. This option causes less damage to the surrounding tissue.
• Chemotherapy- drugs, that are used or killing the tumor cells. There is a variety of side effects that might occur, therefore additional drug treatments might be assigned, such as anti nausea medication, vitamins.
• Targeted dug therapy- focuses on specific abnormalities in the tumor cells and works to block them.

Prognosis

The prognosis depends on the type of tumor and the stage that it has been diagnosed. There are several examinations that have to be made, in order to determine both type and stage. The tumor grade describes specific features that are connected with a certain outcome. The lower the grade, the better is the possible outcome. Other factors that describe the prognosis are the age of the patient, existence of concomitant diseases, location of the tumor and metastatic spread.

Survival rate

Table 1. Survival rate for most common brain tumors

The survival rate gives the patient and doctor an approximate idea of the prognosis for certain types of tumors. Doctors usually refer to the 5-year survival rate. The 5-year survival rate describes the percentage of people that lived at least five years after being diagnosed with certain kind of tumor. These statistics are obtained by doing extensive research of the past patients. Some examples of relative 5-year survival rate are given in the table (Courtesy of www.cancer.org).

References

1. http://www.brain-surgery.com/inoperable-brain-tumors/
2. http://braintumor.org/brain-tumor-information/understanding-brain-tumors/tumor-types/
3. http://www.cancer.net/cancer-types/brain-tumor/symptoms-and-signs
4. http://www.cancercenter.com/oral-cancer/types/tab/tongue-cancer/
5. http://www.mayoclinic.org/diseases-conditions/spinal-cord-tumor/symptoms-causes/dxc-20117316
6. http://www.mayoclinic.org/diseases-conditions/brain-tumor/symptoms-causes/dxc-20117134
7. http://www.webmd.com/cancer/lymphoma/acute-myeloid-leukemia-symptoms-treatments#1
8. http://www.mayoclinic.org/diseases-conditions/brain-tumor/diagnosis-treatment/diagnosis/dxc-20117172
9. http://emedicine.medscape.com/article/125910-overview

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