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Brain Tumours |
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Neurosurgery Information |
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Brain Tumours ...... |
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Peripheral Nerve |
Functional |
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Paediatric Neurosurgery |
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Brain tumours are the 3rd or 4th most frequent cause of cancer-related death in middle-aged males and the 2nd commonest cause of cancer-related death in children. While brain tumours are uncommon compared to common tumours like lung, breast and colon cancers, the extent of the morbidity brought about by brain tumours is severe.
Like all other tumours, brain tumours can be benign (non-cancerous) or malignant (cancerous). Cancer kills by invading and destroying neighbouring tissue. It can spread to distant sites (metastasis) but this is rare in brain tumours. Although benign brain tumours are not as invasive / destructive as malignant tumours, benign brain tumours can kill if they grow too large as the brain is enclosed by a fixed skull and cannot accomodate extra volume well. Sometimes, benign brain tumours press on crucial brain structures like vital nerves and arteries, causing severe morbidity.
The classification of brain tumours can be complex. This is simplified below with useful links which would help you in your understanding. |
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Benign Meningioma |
| What are the different types of Brain tumours? |
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The WHO classfication of brain tumours was developed in 1979, revised in 1993, then again in 2000. Today, this remains the most comprehensive and widely used system.
Primary brain tumours can arise from brain tissue itself (neuroepithelial orgin) or from other contents in the skull other than brain tissue. Such primary tumours are commonly know was glial tumours (eg, astrocytomas, oligodendrogliomas, ependymomas etc). Gliomas can be low grade cancer tumours with a relatively long life expectancy. High grade gliomas called gliobastoma multiforme (GBM) are very aggressive tumours with a poor prognosis.
Secondary brain tumours are metastatic tumours that arise from outside of the brain but make their way into the brain where they grow and destroy. Metastatic tumours are the most common brain tumour seen today and its incidence may still be rising partly because of improved oncological care. In general, metastatic tumours (3 or less) with stable primary disease can be treated with surgery or radiosurgery. |
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| What are the symptoms of a brain tumour? |
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Singapore Cancer Society |
Brain tumours typically cause symptoms by:
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1. Raised pressure in the skull - headache, nausea, vomiting and drowsiness
2. Focal neurological deficits - eg, limb weakness,
3. Seizures - |
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| Low Grade Gliomas (LGG). How can they be treated? |
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| LGG include the subtypes of fibrillary astrocytoma, oligodendroglioma and mixed oligoastrocytoma. Prognosis in this group of patients is relatively better, with a median survival of 4 to 10 years and a 10 year survival rate of 15 to 45%. Management of such tumours remain controversial and include observation alone (without a biopsy), biopsy alone for diagnosis followed by observation and surgery (including aggressive resection +/- radiotherapy). |
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Low Grade Gliomas. Observation, Biopsy or Resection? |
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It may seem inconceivable for a doctor to tell a patient he has a brain tumour and yet not want to perform a biopsy to confirm it. This option is sometimes recommended in selected patients, especially so if the tumour is in a crucial location where the risks of biopsy are relatively high. Close observation and intervention only when the tumour appears to be growing is sometimes the most appropriate treatment. |
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What are the risks of a Biopsy? |
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In most instances, when a diagnosis of a low grade glioma is made on imaging, the neurosurgeon would procede to a stereotactic biopsy for histological confirmation. There is a 3 to 8% chance of bleeding, but if this occurs, it is usually asymptomatic. Neurosurgeons who advocate surgery believe that the resection of a new low grade tumour is 'potentially' more effective than when it has become agressive. Studies however do not show any survival benefit in surgery for LGG. |
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Anaplastic Astrocytoma and Gliobastoma Multiforme. What are they? |
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These are high grade malignant tumours with a poor prognosis; the approximate life expectancy is about 2 years for anaplastic astrocytomas and less than 1 year for gliobastomas (GBM). Treatment includes surgical resection, radiation therapy anc chemotherapy. Although the length of survival may not change, the quality of life may improve significantly. |
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