Cancer is a word that can instil anxiety and fear in a common person and used by writers and film-makers to incite melodramatic pathos and teary endings, while employed by doctors and health awareness campaigners for education and clarity. Its literal meaning in Latin is crab, probably named so for the tendency of some cancers to have visible finger-like projections resembling the limbs of a crab, but it also applies to the ability of these groups of diseases to have a crab-like hold on the patient and be resistant to the then available treatments.
While modern medicine has done much to loosen the crab’s grip on patients to the extent that many common cancers are now curable if detected early, the grip that the word “cancer” has on the common person’s psyche is as strong as ever. Perhaps the most intimidating is “brain cancer”.
Brain cancers, or technically neoplasms/tumours of the brain, are a large heterogeneous group of diseases that have more differences than similarities between them except for the fact that they occur inside the skull. The most common brain tumours are gliomas, which originate from the brain tissue per se , meningiomas, which arise from the coverings of the brain, and pituitary adenomas, which arise from the pituitary gland.
The unique thing about tumours in the brain in comparison to other parts of the body is that the symptoms caused are a combination of the physical presence of tumour and the compression of the part of the brain most adjacent to it. Thus a tumour located in the right half of the brain at or near the part that controls movements of the left half of body causes weakness of the left arm and leg, a tumour near the speech area can cause alteration of speech patterns which might either increase or decrease fluency of speech and a tumour near the visual apparatus can cause disturbances in vision such that the patient feels a curtain is drawn over part of his or her eye.
The downside of this is that sometimes tumours grow to a large extent before they become symptomatic because the part of the brain that they are pressing on has functions whose absence is not readily detected.
Common symptoms of brain tumours are headache, vomiting (especially when not associated with nausea), seizure (uncontrolled movements of face, arms and legs with or without loss of consciousness), weakness of arms and legs and changes in personality, speech or behaviour.
When detected early, most of these meningiomas and pituitary adenomas are curable by surgery alone, whereas gliomas might require additional treatment in the form of radiotherapy or chemotherapy.
Which brings us to the next prevalent fear among people: the fear of surgery on the brain. Somehow most people are agreeable to surgeries on the eyes, stomach, uterus, nose, hands, legs and even the heart, but have an exaggerated fear of surgery on the brain. Part of the reason may be that most common surgeries on the brain are not for tumours but for trauma such as motor vehicle accidents where brain surgery is often done on an unconscious person and other factors compound the outcome.
Surgery for brain tumours has now evolved to a never-before stage where tools such as intraoperative monitoring, awake craniotomy, high-end microscopes, minimally invasive endoscopic methods (such as operating through the nose for pituitary tumours) and modern anaesthetic techniques have combined to drastically reduce the complication rate of brain surgeries. Add to this the ever-increasing armamentarium of molecular diagnostics, newer chemotherapeutic drugs and safer radiotherapy techniques, the number of brain tumours that can be treated successfully has increased exponentially over the past few decades.
Most people undergoing surgery for brain tumours have a complete recovery in a few days. Surgeries on the brain can also be performed without the need for hair removal in case of women. In certain instances, an awake surgery can be done where the patient is kept awake during surgery to elicit key functions of the brain. Brain tumours can also occur in children but with modern neurosurgical methods almost all of these children can undergo and recover from surgery successfully.
Still the grip of the words brain cancer on a person’s mind remains strong as ever and will need a lot more awareness and education to eradicate. The biggest single piece of information worth spreading is perhaps a modification of our institutes slogan —“Your fear should not be of brain cancer but of the delay in detecting and treating brain cancer.”
(The author in an Associate Professor and Neurosurgeon at the Cancer Institute, Adayar)
i.vijaysundar@cancerinstitutewia.org
