Brain tumour: Not always a death sentence
View(s):By Dr. Ruvini Abeygunaratne Karunaratne
The diagnosis of a brain tumour whether arising from brain matter itself or spreading from a tumour elsewhere in the body is devastating news. The impact on the patient’s prognosis is life altering. But although traditionally thought to be a death sentence, this may not always be the case.
Traditionally having a diagnosis of a secondary brain tumour (or metastasis: one which has arisen from a tumour elsewhere in the body) was considered a death sentence. This concept is now changing. In some instances these tumours maybe amenable to removal and thereby improving the survival time of the patient. The treatment and management of these patients should be individualised taking into consideration multiple factors.
What are metastatic brain tumours?
- commonest type of brain tumour
- occur in 30% of all cancer patients
- commonest tumours that spread to the brain are those which arise from:
bladder cancer
breast cancer
kidney cancer
skin cancer
colon cancer
lung cancer
- Normally spread via the blood stream to other parts of the body-haematogenous spread, but can also spread from other methods.
The main problems associated with metastatic brain tumours arise from the tumour giving rise to pressure effects and swelling of brain tissue. This may give rise to serious symptoms:
Headaches
Vomiting/nausea
Visual problems
Seizures
Weakness of one side of the body
Problems with speech
Coma
Management options
Currently the treatment of metastatic lesions takes the form of three types of treatment or a combination of them. Surgical resection and consideration of resection is indicated by the factors mentioned below. As adjunct to surgery whole brain radiation may be given. Stereotactic radiosurgery which is now established is fast gaining popularity and is a form of targeted radiotherapy which is given after surgery or if there are multiple lesions. The evidence of improved prognosis is widening due to combination treatment thereby giving hope to those patients diagnosed with metastatic brain tumours.
All the above methods may or may not be in combination with chemotherapy depending on the type of the tumour and its origin.
Factors to be considered if surgical resection indicated
Type of tumour: certain tumours have a poorer prognosis than others- for example small cell lung cancer compared to breast cancer. Some tumours are more of a surgical challenge -for example the risk of bleeding intraoperatively is much more significant in melanomas compared to breast metastasis
The number of metastasis and the accessibility to surgery: Current guidelines suggest that up to three metastasis can be removed if they are in a surgically accessible location but the number can be more and it is left to the surgeon’s discretion
The prognosis of the patient needs to be more than six months and the status of other metastasis needs to be considered
Patient needs to be physiologically fit to undergo surgery
Patient requires to be compliant and be able to give informed consent
The surgical lesion may require to be removed palliatively because it is causing significant mass effect
The patient will need to be able to tolerate further treatment such as radiotherapy or chemotherapy or a combination
In general taking the above factors into account and using a multi-disciplinary approach working in close collaboration with the oncologists who will be the lead clinician involved in the patient’s management, anaesthetists, specialist nurses and the surgical team the patient can be managed safely to improve their prognosis.
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