Medical Problems

Brain tumours lie at the intersection of three major medical problem fields:

-         They are a form of cancer, and especially the high grade intracranial tumours have a high mortality.

-         They are a rare disease. This implies a lack of treatment options because of the relatively low number of patients. Companies are not enthusiastic about development and/or registration of new drugs. Authorities stick to their legislation, and because of this there is not enough dynamism in this field. Europe has emitted the “Council Recommendation on Action in the Field of Rare Diseases” in June 2009, which has the following principles: treatment in centres of excellence, systematic exchange of data comprising the exact diagnosis and the treatments, and cooperation at the international scale. Please do find the text of the recommendation:

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Council Recommendation on Action in the Field of Rare Diseases

-         The survivors have a chronic neurological disease (acquired brain deficiency, non-congenital brain disorder). They are disabled people in the sense of the “UN-Treaty of Rights of People with Disabilities” of 13.12.2006.

Incidence

   The incidence of brain tumours is similar in the whole western world. For low grade (also called benign) brain tumours and high grade (also called malignant) brain tumours together the incidence is about 16.5 new cases/100.000 people/year. For the European Union this means 79.200 intracranial brain tumours per year.

   Brain tumours are the second most common kind of cancer with children, after leukaemia. The incidence is 4,5/100.000/year.

   Source: Central Registry for Brain Tumors of the United States, statistical report 2007-2008, www.cbtrus.org . 

Symptoms – diagnosis  

   In its first stage a brain tumour may cause rather vague symptoms such as nausea, tendency to vomit, severe or mild headache, dizziness, disorder of consciousness, reduced concentration, changes of personality, hormonal imbalances,… The fact that these symptoms are not very distinct makes the diagnosis very difficult in the early stage.

   As soon as the tumour reaches a certain volume, generally more than 1,5 cm, it begins to pressure on the surrounding brain. Several neurological symptoms may appear: numbness of an area, loss of eyesight, partial or generalized epileptic fits, … The symptoms may also depend on the location of the tumour in the brain.

   Sudden appearance of neurological symptoms is always suspect. If your MD has reason to believe that you may have a brain tumour, he will direct you immediately to a specialist for further examination. Taking a MRI-scan may confirm the presence of a brain tumour. MRI stands for “Magnetic Resonance Imaging”. This examination is totally painless and does no harm. It gives better information than the older CT-scan, which may be harmful indeed, because it works with ionizing radiation.

Classification of Brain Tumours  

    There are more than 120 kinds of brain tumours. Primary brain tumours develop in the brain-tissue itself. Secondary brain tumours are metastases from other cancers in the body and have their origin outside the brain. The incidence of secondary brain tumours is much higher.

   For a general overview of   any kind of brain tumour you may consult the classification established by the World Health Organisation (WHO): “WHO Classification of Tumours of the Central Nervous System”, David N. Louis, Hiroko Oghaki, Olmar D. Wiestler, Webster K. Cavenee.

Primary brain tumours

   Primary brain tumours develop mostly in the supporting tissues of the brain, the so-called glia-cells or astrocytes and oligodendrocytes. The tumours are called glioma, astrocytoma or oligodendrocytoma. They do not    give rise to metastases in the rest of the body.

   We make a difference between:

-          low grade brain tumours, sometimes known as “benign” brain tumours, though this does not really apply. In the long run they can mute into high grade brain tumours or cause the same symptoms.

-          high grade brain tumours, sometimes called malign brain tumours. They have a very fast evolution and infiltrate the brain. Recurrency happens very often.

   The classification of the most common type is as follows:

-          Astrocytoma grade 1: low grade, conservation of function.

-          Astrocytoma grade 2: still low grade, fibrillar.

-          Astrocytoma grade 3: high grade, anaplastic.

-          Astrocytoma grade 4: high grade, necrotic, also called glioblastoma multiforme.

   Low grade brain tumours have a (very) slow evolution and do not necessarily mean a threat for your health or even your life. After some time they may cause the same symptoms as high grade brain tumours. Sometimes it is decided to have a follow up at regular intervals before starting a treatment.

   High grade brain tumours have a (very) fast evolution. They always mean a threat to your health and even your life. They need to be treated immediately.

   Besides glioma, astrocytoma and oligodendrocytoma there are various types that occur less frequently, such as:

-          Meningioma: this is a cancer of the cerebral membranes. They are usually low grade.

-          Cushing’s disease: a low grade tumour from the pituitary gland. It causes hormonal imbalances.

Secondary brain tumours

   They originate in cancers outside of the brain. Lung cancer for instance often gives rise to metastasis in the brain. They occur much more often than primary brain tumours. The treatment depends on the cancer of origin, but recently techniques have been developed to threat brain metastasis as well. Before they were regarded as the final stage of the disease.

Childhood brain tumours

   24 % of all cancers with children under 15 are brain tumours. Most frequent are glioma, ependymoma and medulloblastoma. Though they are generally high grade, chances of recovery are high. More than 70 ù of the children survives.

The origin of brain tumours

   The knowledge about the aetiology of brain tumours is very little. Comparative studies about life and food patterns have not resulted in significant differences. Food, consumption of alcohol ore smoke seem to have no influence on the origin of primary brain tumours.

   There is a controversy about the use of cellular phones, especially by children. We recommend having a precautionary attitude, and restricting the use as long as there is no scientific certainty about the possible dangers.

   The situation is different with secondary brain tumours: smoking can lead to lung cancer, which may induce brain tumours. The incidence of secondary brain tumours is higher with people smoking.

Epilepsy and brain tumours

   Epilepsy may be described as an electrical storm in the brain. The information transfer in the brain works on electrical base. Epilepsy is a general denomination for several diseases. There are two major categories: generalized fits and focal insults.

   Grand mal: is a general fit originating in both brain hemispheres at once. Symptoms: seizures of arms and legs, loss of consciousness, tongue bite, incontinence.

   Petit mal: gives a partial loss of consciousness, strange behaviour, blinking one’s eyes.

   Partial or focal fits: these have their origin in one hemisphere of the brain. They give contractions in one side of the body. They can stop after a while, but they can also generalize towards a grand mal. These are often caused by a lesion in the brain. The cause may be brain haemorrhage, brain stroke, scar tissue or the presence of a brain tumour.

   Epileptic fits may be an indication or a symptom for brain tumours. Ask your MD for a MRI-scan and an EEG (electroencephalogram) if you get a sudden epileptic fit to find out the origin of the problem.