Brain cancer treatment
Brain cancer unites more than 100 neoplasms, which differ in origin, but growth from the brain tissues. Headache is the main sign in more than half of patients. In addition to traditional surgery, radiation and chemotherapy, there are now more modern methods: immunotherapy (dendritic cells vaccines, CAR-T therapy), radiosurgery (GammaKnife and CyberKnife), or Optune device.
A malignant brain tumour is a collection of uncontrolled cells in the brain, increasing in number. In cases originating from the brain tissues, tumours are classified as primary. If the cancer is diagnosed in other organs and has spread to the central nervous system, such a process is called secondary. Unfortunately, the last one occurs much more often.
More than 100 types of central nervous system neoplasms (CNS) are distinguished today. However, glioma is the most common primary brain malignant tumour. Approximately 33% of all brain cancers are formed from glial cells that surround and support neurons in the brain, including astrocytes, oligodendrocytes, and ependymal cells. Therefore, when establishing a diagnosis of "glioma", a distinction is made between high-malignancy and low-malignant:
- Astrocytomas are low-grade gliomas. Slowly growing in the brain, they can initially be located in the cerebellum and central parts.
- Glioblastomas are aggressive and formed from the cells which support nerves.
- Oligodendroglioma is formed from oligodendrocytes - brain and spinal cord cells that produce a substance for nerve cell protection. In most cases, oligodendrogliomas are found in middle-aged men.
- Ependymoma develops from ependymal cells that line all the brain's ventricles from the inside.
Specialists also distinguish different types of brain cancer depending on the location:
- Intraventricular cancer arises from the tissues of the ventricular system and grows inside. In particular, choroid plexus carcinoma, subependymoma, malignant meningioma, subependymal giant cell astrocytoma, and neurocytoma.
- The tumours of the pineal gland are neoplasms in the area of the pineal body - an organ responsible for endocrine functions. They include pineal gliomas, teratomas, germinoma and pineoblastoma.
The term "brain cancer" covers a large number of various diagnoses. Most of them are named after the part of the brain or the type of cell from which cancer originates. For example, oncologists and neurosurgeons distinguish ganglioglioma, gliosarcoma, medulloblastoma, craniopharyngioma, and central nervous system lymphoma.
Brain cancers make up about 9% of the total number of all neoplasms. They can occur in a person of any age. However, children under the age of 15 and people over 65 make up the majority.
What causes brain cancer?
The exact reasons are unknown. However, many years of research have shown the existence of factors that can provoke the formation of malignant brain neoplasms:
- With age, the risk increases (from 45 to 65 years). At the same time, certain types of gliomas (including ependymomas and pilocytic astrocytomas) are more common in children and young adults;
- Patients who have undergone radiation therapy are at risk. Ionising radiation, as an oncology therapy, increases the likelihood of brain pathologies in the future;
- Bad habits: smoking, drinking alcohol, living in an unfavourable environment;
- Brain injuries, in which inflammation can lead to cell transformation;
- The presence of polyomavirus SV40, herpesvirus HHV-6 or cytomegalovirus;
- Prolonged exposure to toxic, chemical substances, radiation, and ionisation;
- In rare cases, brain and spinal cord cancers are inherited. Patients with "genetic cancer" usually have many tumours that first appear young.
If a patient is in the risk group, it is necessary to undergo regular preventive examinations. It will help the doctor to detect the disease in the early stages and start timely treatment.
Brain cancer symptoms
Brain cancer signs appear slowly and, at first, might be barely noticeable. However, some do not cause any changes and can be found when diagnosing other objections.
General symptoms occur during the development of a tumour in any part of the brain. They are caused by increased intracranial pressure and intoxication of the body. Local tumour manifestation depends on the location of the lesion and damage to nearby structures.
A malignant neoplasm can press or penetrate other brain parts, preventing the organ from functioning normally. Small tumours can sometimes cause more symptoms than large neoplasms that develop inside the skull for years. Therefore, it depends on the head neoplasm's size, stage, and location.
If the symptoms listed below appear, contact a specialist without delay:
- About 50% of people with brain tumours have headaches and dizziness;
- Imbalance, unsteadiness when walking;
- Difficulties with speech, vision, and memory;
- Change in behaviour;
- Nausea and vomiting;
- Epileptic seizures, mental disorders;
- Paralysis, convulsions;
- Change in tactile and pain sensitivity.
Compression of specific brain structures gives appropriate unique signs. In addition to physical disorders, mental symptoms can also be a sign. For example, olfactory, gustatory and auditory hallucinations are observed in the case of damage to the tissues of the temporal lobe. Pain in the limbs is characteristic of cancer of the brain's parietal lobe.
Some of the above symptoms do not necessarily mean brain cancer. Such manifestations accompany many other conditions. Therefore, getting a timely and correct consultation with a neurologist is crucial.
What is the proper diagnosis for malignant brain tumours?
To methods of detecting brain cancer and establishing a clinical diagnosis, specialists refer to:
- Consultation of a neurosurgeon. The doctor will check your vision, hearing, balance, coordination, strength, and reflexes. Problems in some areas of the brain can provide clues about which part of the body the tumour has affected.
- Magnetic resonance imaging, with or without contrast, is often used to diagnose brain formations. It allows doctors to scan the soft tissues, identify the localisation of the neoplasm and make a 3D model.
- Functional MRI and magnetic resonance spectroscopy help to determine information about chemicals and their changes in the brain using magnetic resonance.
- Computed and positron emission tomography may also be prescribed to assess the tumour and plan treatment. A multi-layered study of the brain allows neurosurgeons to see all the features.
- Angiography is an X-ray contrast study that visualises the blood vessels feeding the tumour and their changes. It is carried out for the operation planning.
- Electroencephalography makes it possible to detect inflammatory diseases, problems with blood vessels, and the development of neoplasms in the brain in the early stages. The device used for this procedure (electroencephalograph) checks for brain bioelectrical activity.
- Tumour biomarkers allow specialists to identify specific biochemical, genetic and protein components that can be associated with the tumour.
- Collection and tumour tissue testing (biopsy). Depending on the location, a needle biopsy may be performed before treatment or during the operation. A stereotaxic puncture biopsy allows examining brain cancer in sensitive or hard-to-reach places.
A comprehensive diagnosis is important and allows neurosurgeons to select an effective treatment strategy. The brain cancer staging process is very different from other types of cancer. They are graded based on potential growth and aggressiveness. Treatment of brain cancer depends on the degree of spread of the disease. There are four stages:
- I - formations that do not have malignant signs and grow slowly.
- II - slow growth, but the neoplasm is already beginning to acquire malignancy; the cells become atypical.
- III - rapidly growing malignant formations.
- IV - very rapid growth and aggressiveness of the neoplasm, sprouting into neighbouring tissues of the brain, compression of its parts.
Latest treatment approaches for brain cancer
The treatment method for different brain malignancies can vary significantly. Depending on the tests, a doctor may prescribe chemotherapy, radiation therapy or surgery. In complex cases, treatment is carried out by several methods at once.
Surgery is considered the most effective and potentially curative solution. The operation is used if the tumour is located so that surgeon will not damage the brain tissue and its functions. Neurosurgeons can perform open surgery (cranial trepanation) through small openings (neuroendoscopy) or the nose (transsphenoidal).
At the same time, a single or a drug combination can be used for chemotherapy. Some medications are administered in the form of plates directly into the brain, delivering the dose to the tumour.
Radiation therapy may be combined with surgery and chemotherapy to treat brain cancer. Patients have usually prescribed radiotherapy after surgery, following the treatment regimen. Sometimes the brain is placed with implants for internal radiation therapy - brachytherapy. For some hard-to-treat cases, your radiation oncologist might think about proton beams.
GammaKnife and CyberKnife are modern and innovative radiosurgery technologies carried out with the help of radiation exposure right to a malignant tumour. As a result, the radiation dose is minimal, and the risk of damage to healthy tissues is practically impossible. Moreover, radiosurgery allows to achieve stable remission and improves the prognosis.
Immunotherapy stimulates the patient's immunity to slow down or stop tumour growth at the molecular level. Modern oncologists consider biotherapy more effective than others and less toxic to the body. This method includes the use of monoclonal antibodies, vaccines and gene tactics.
- Last year, T-cell therapy, which allows reprogramming the T-cells of the patient's immune system to find and kill tumour cells, was recognized as an innovative development in cellular cancer treatment.
- In addition, antitumour vaccines based on DCs (dendritic cells) have already been developed. They are similar to the T-cell approach but target dendritic cells to help find and fight the tumour.
- CAR-T therapy (CAR technology) allows the immune cells to be reprogrammed outside the patient's body to create a CAR-T that can hunt and eliminate cancerous cells.
MRI-guided laser ablation is a neurosurgical method of treating brain cancer. In this minimally invasive procedure, a laser fibre is placed in the area under stereotaxic MRI guidance. It burns cancer with millimetre precision.
In 2015, FDA approved the Optune device for glioblastoma treatment. It looks like a helmet placed on the head. At the same time, four electrodes are connected so that their action is aimed at the tumour. The neurosurgeon controls the process using MRI.
After the treatment, your doctor may prescribe an MRI to check cell growth and observe changes in the tumour. Neurosurgeons and neuroradiologists closely monitor the patient to determine whether the brain cancer recurs. If so, the neurosurgeon may recommend another surgical procedure.
The earlier the patient is diagnosed, the more chances we have for a good forecast. The best result is possible when the disease is detected at the 1st stage. Neurological symptoms appear already at the 2nd stage. A patient's life expectancy is shortened when cancer is diagnosed in stages 3 and 4 since the course of the disease is active, and the tumour rapidly increases.
Brain cancer is prone to relapse in the first few years after treatment. Therefore, a favourable prognosis and subsequent patient quality of life depend on the treatment approach. The 5-year survival rate for patients with brain cancer is nearly 36%, and the 10-year survival rate is almost 31%. Survival decrease with age: the rate of people younger than 15 is more than 74%. However, the 5-year survival rate for people aged 40 and older is only about 21%.
Can I live an everyday life with brain cancer?
Depending on your age at diagnosis, cancer may grow slowly and respond to the treatment. These depend on the type of malignancy, the localisation, and how it progresses.
Can I get cured of brain cancer?
A malignant brain tumour's outlook depends on its location, size, and grade. It can be removed and cured if detected early, but brain cancer often returns. Nevertheless, many cases of successful treatment with long-term remission are known. And after the rehabilitation period, it is possible to resume working capacity and return to everyday life.
Is surgery only the option for brain cancer?
Not all brain tumours can be surgically removed due to their location in hard-to-reach places or their large size. Therefore, traditional chemotherapy and radiotherapy are also options for brain cancer treatment. However, many non-invasive methods have now been invented. They include targeted and immunotherapy, MRI-guided laser ablation, Optune device and brachytherapy.
Is brain cancer treatment abroad better?
The main advantages of brain cancer treatment abroad are compelling and modern methods, the latest medical equipment and drugs that are not always available in the native country. And advanced diagnostic devices allow doctors to detect diseases in the early stages.
What are the latest treatment options for brain malignancy?
Where can I get Brain cancer treatment?
What are the best clinics for Brain cancer treatment?
Who are the best doctors for Brain cancer?
Prof. Dr. med Harald-Robert Bruch, MSc, PhD from Oncological and Haematological Praxis Clinic Bonn
Prof. Dr. med. Bernhard Meyer from University Hospital rechts der Isar Munich
Prof. Dr. med. Florian Bassermann from University Hospital rechts der Isar Munich
Dr. med. Peter Madjurov from Academic Hospital Bundeswehr Berlin
Dr. med. Gerhard Siebenhuner from Centre of Advanced Medicine Frankfurt am Main