In this article information about Brain Tumors and Brain Cancer Symptoms and information. Before the introduction of CT in 1973, elderly patients often received limited evaluations because angiography and pneumoencephalography were too hazardous.
It is also likely that more metastatic tumors are verified histologically for the same reasons. Worldwide annual age-adjusted rates vary markedly and correlate with socioeconomic levels, suggesting that better detection is the underlying critical factor.
Brain Tumors Examination
The neurologic signs (findings on the neurological examination) produced by brain Cancers are related to the site and size of the mass but are by no means specific for tumor.
The rate of increase of neurologic signs, rather than the signs themselves, may suggest a brain tumor.
Steadily progressive hemiparesis (weakness on one side), gait (walking) impairment, or aphasia (inability to speak) implicate a mass lesion that may be a tumor or even a nonneoplastic mass, such as an abscess. (prostate cancer)
Secondary effects cause false localizing signs that are misleading in terms of localizing the brain lesion. The most common is a sixth nerve palsy (inability to move the eyes laterally).
In a classic report of this topic, observers studied patients with meningiomas, tumors that do not infiltrate the brain. The associated false localizing signs were, therefore, attributable to secondary phenomena caused by the tumor.
Fourteen of 250 patients with meningiomas and increased intracranial pressure had sixth-nerve palsies, ipsilateral or contralateral to mass (or bilateral) that increased the intracranial pressure. Where it is susceptible to compression by brain shifts.
Ipsilateral (same side) third-nerve palsies are common with uncal herniation. But may appear contralateral to the tumor. The pupillomotor fibers (controlling diameter of the pupils), arrayed most superficially in the nerve trunk, are most susceptible to compression.
A dilated or sluggishly reactive pupil may be the earliest manifestation of a third-nerve palsy. Unilateral or bilateral fourth-nerve palsies are less common and are probably similar to sixth-nerve palsies in their mechanism because the fourth nerve has an even longer and more tortuous intracranial course.
Eighth nerve (hearing and vestibular function) involvement may manifest as hearing loss that is ipsilateral, contralateral, or bilateral; there may be vestibular manifestations of dizziness, vertigo, or nystagmus.
Secondary hydrocephalus may be responsible for false localizing signs. A gait disorder that is difficult to differentiate from cerebellar ataxia may be due to obstructive hydrocephalus.
Dilatation of the anterior third ventricle can lead to compression of the chiasm to cause bitemporal hemianopia and confusion with a para sellar lesion.
Rarely the enlarged third ventricle may compromise the hypothalamus to cause signs of endocrine deficiency. (prostate cancer)
That compress or invade the tectum and dorsal midbrain. These tumors also frequently obstruct CSF flow, distending the proximal aqueduct to cause other disorders of ocular motility:
convergence-retraction nystagmus, lid retraction (Collier sign), paralysis of downgaze, ptosis, or limited accommodation or convergence. In children, there may be a downward deviation of the eyes at rest and lid retraction, the setting sun sign.
Ipsilateral hemiparesis may be seen when uncal herniation shifts the midbrain. And compresses the contralateral midbrain against the tentorium.
Herniation may interfere with the posterior cerebral artery circulation on either side or bilaterally, leading to homonymous hemianopia or cortical blindness.
Likewise, upward herniation caused by a posterior fossa tumor can lead to superior cerebellar artery ischemia and may cause unilateral ataxia to become more severe or bilateral.
Enlargement of the blind spots
Enlargement of the blind spots and constriction of the visual fields are characteristic. Papilledema is attributed to obstruction of slow axoplasmic flow in the optic nerve.
The increased intracranial pressure is transmitted to the optic nerves by the meningeal spaces surrounding the nerve.
Usually, increased intracranial pressure causes bilateral papilledema. Unilateral papilledema may be due to asymmetric swelling of the optic nerves.
Atrophy in the ipsilateral optic nerve with papilledema in the other. The Foster Kennedy syndrome was believed to be pathognomonic for sub frontal tumors.
That compresses the ipsilateral optic nerve and enlarge to increase intracranial pressure. More often, the syndrome is due to an orbital or base of skull tumor that compresses both optic nerves asymmetrically.
Sequential optic nerve ischemia (the pseudo-Foster Kennedy syndrome) appears similar. The Loss in the eye with disc edema. (prostate cancer)
Brain cancer Symptoms
Symptoms of intracranial tumors can be divided into those due to the tumors themselves and those that are related to the secondary consequences, including peritumoral edema (swelling), hydrocephalus, or shift of critical structures. It may not be possible to differentiate Tumors of tumors cannot be different.
In the brain, the anterior frontal regions and the nondominant temporal lobe fall in this category. In addition, tumors that produce ‘negative’ symptoms because of the loss of neurologic function are symptoms of symptoms.
That lead to positive ‘symptoms, such as seizures or headaches. The rapidity of tumors is important. There may be an enormous tumor with a shift on CTR in a neurologically normal patient.
The clinical picture is therefore critical in evaluating imaging studies. And can provide an estimate of the rate of tumor growth. Conversely, a small neoplasm with enormous surrounding edema suggests a rapidly growing tumor.
Brain Cancer Tumor Symptoms
A headache occurs in 50 to 60% of patients with primary brain tumors. And in 35 to 50% of patients with metastatic tumors.
It is not necessarily serious but tends to be persistent and gradually increases in intensity or duration. No pattern is diagnostic of brain cancer.
but a typical headache is semi localized in the vicinity of the tumors. And may cause the patient to sleep. It is worse in the morning, disappears minutes or hours after sitting or standing, and responds to mild analgesics.
With time, other symptoms appear or a headache. Becomes so unremitting Hydrocephalus may cause headaches indistinguishable from a common or classic migraine. Brain cancer Brain cancer brain cancer Brain cancer
Injury to a brain Headache
Some patients are treated with antimigraine therapy for weeks or months. Before lethargy or persistent vomiting. Injury to a brain Headache results from direct or transmitted pressure on cerebral arteries, especially at the base of the brain, venous sinuses, dura or several cranial nerves (typically the fifth).
Headaches associated with nausea or vomiting imply increased intracranial pressure or distortion of brain stem chemoreceptor trigger zone in the fourth ventricle.
Dizziness, true vertigo, hearing loss, and tinnitus are other brain stem symptoms. That is seen with increased intracranial pressure. And compression or twisting of the pons.
With massively increased intracranial pressure, especially in children, a Cushing reflex may lead to arterial hypertension and bradycardia.
Brain stem or cerebellar tumors that cause direct vomiting Projectile is a misnomer; The powerlessness of the ejection The term more appropriately refers to vomiting without antecedent nausea or a headache.
Intense headaches may develop abruptly, within seconds; intracranial pressure monitoring shows that the peak pressure coincides with plateau waves.
The headaches last only a few minutes and terminate as soon as they come.
Facial pain is a significant sign of a tumor
Facial pain is a significant sign of a tumor invading the skull base from the nasopharynx or the sinuses, or with metastatic disease to the craniofacial bones.
Trigeminal facial sensory damage, with deep facial pain, should arouse suspicion of a destructive tumor Perineural. And temporal facial pain in patients with lung tumors is a nonmetastatic syndrome. Attributed to referred pain in the vagus nerve in the thorax.
Seizures are the presenting symptoms in 30% of brain tumors
Seizures are the presenting symptoms in 30% of brain tumors and may be given a tumor early in its growth. They are more common with lesions affecting the cortex.
Especially astrocytomas and oligodendrogliomas. Which are usually started in cortical or subcortical areas? Seizures are much less common with tumors that affect the deep gray matter (such as primary CNS lymphoma) or intraventricular tumors (ependymomas).
The onset of focal seizures in an adult raises strong suspicion of a brain tumor. Localized paralysis or hemiparesis that lasts for minutes or days after a seizure (todd paralysis) carries the same connotation.
CT may fail to detect small tumors or infiltrating glial tumors, so all patients with new-onset seizures should also be studied with MRI Even so, an occasional patient with negative imaging studies develop
The symptoms of brain cancer depend on the type of tumor, as well as the location, size, and rate of growth.
General Neurological Symptoms and Signs:
General neurological symptoms include a headache, vomiting and blurred vision.
Brain cancer:- Headache
A headache is often worse Headache is the initial complaint of over 70% of patients with brain tumors. And is made worse by straining or by coughing in many cases.
Brain cancer:- Vomiting
Emesis is caused by increased intracranial pressure, due to the expanding tumor within the skull. The vomiting is sometimes accompanied by nausea
Brain cancer:- Blurred Vision
The blurred vision is caused by swelling in the optic nerve head, resulting from the increased pressure. Papilledema is seen in over half of patients with primary (glioma) brain tumors and is bilateral in over 90 percent.
Brain cancer:- Focal Neurological Symptoms and Signs
Paralysis: If the tumor is growing near the “motor strip” of the brain, or near the fibers of the brain that lead from the motor strip to the spinal cord, weakness may result.
Brain cancer:- Cranial nephropathy
If the tumor is growing near the origins (nuclei) of the cranial nerves or is pressing on a nerve itself (e.g. meningioma pressing on the oculomotor nerve), dysfunction of the nerve may result. Example: Patients may have double vision or “diplopia” due to paralysis of cranial nerve VI that controls lateral movement of the eyeball.
Brain cancer:- Frontal Lobe
Tumors in the frontal lobes can produce changes in cognition, behavior, and movement. Tumors of the medial prefrontal area can affect, focus, problem solving and judgment. Abstract thought is lost
Brain cancer:- Temporal Lobe
Tumors in the temporal lobes can affect hearing, speech, equilibrium, vision, and movement. Localization of sound (direction) may be impaired.
Brain cancer:- Parietal Lobe
Tumors here cause deficits in “discriminative” sensation (telling where a stimulus is located on the body or in space). Inability to name a result Damage to the fibers connecting the parietal.
And frontal lobes on the dominant side can result in loss of speech (Wernicke’s aphasia, or conduction aphasia.) Speech can be made, but the patient is aware that his / her speech is not understandable
Brain cancer:- Occipital Lobe
Occipital tumors impair vision. Visual illusions or hallucinations Only 5 percent of patients with occipital tumors will have normal visual fields.
Types of Brain cancer
Tumors derived from the “glial” cells of the brain. The glia is “interstitial” cells of the brain that provide nutritional and mechanical support for the neurons of the brain.
Tumors include “benign” gliomas (pilocytic astrocytoma), “fibrillary” gliomas, anaplastic (malignant) gliomas and the glioblastoma multiforme (GBM) (malignant).
The oligodendrocytes are a subset of the glial cells and may result in the oligodendroglioma. More aggressive tumors of this type include the anaplastic oligodendroglioma and the malignant oligodendroglioma.
The “meningeal” cells may result in a “meningioma.” The menacing line The “arachnoidal cap cells” (just under the “dura” may form meningiomas) Meningiomas are benign and include syncytial, fibroblastic, angioblastic and transitional variants.
More aggressive tumors of this type include the atypical meningioma and the malignant meningioma.
The cells for the vestibular nerve result in an acoustic neuroma (vestibular schwannoma). This tumor is almost always benign tumors are rounded and enhanced on MRI.
Symptoms are hearing loss, ringing, and balance Treatment is surgery vs. radiosurgery (or even observation)
The pineal cells result in pineocytoma. The more aggressive form of this tumor is called the pineoblastoma.
The pituitary cells may result in pituitary adenoma. These may be “functional” or make “non-functional” (no endocrine function).
The treatment for functional pituitary adenomas may be medication (bromocriptine for prolactinoma), surgery or radiotherapy (including radiosurgery).
Surgery is particularly reasonable for large pituitary adenomas that press on the optic nerve and causing decreased vision.
These tumors arise from tumors outside the brain and include lung, breast, colon, skin (melanoma), thyroid and others. The best treatment depends on the ability of the patient to self-care the age.
The control of the tumors outside of the brain, and the status of the “primary” tumor that started out of the brain. Surgery and radiosurgery are important options Radiosurgery offer non-invasive control of brain metastases with a high success that is equivalent to surgery. Surgery is needed
For all of these tumors, the treatment (surgery vs. radiotherapy vs. radiosurgery vs. chemotherapy vs. combined treatment), is determined by the type of tumor, the size of the tumors, the symptoms, the rate of progression of the symptoms, and the rate of the tumors as seen on the MRI. (prostate cancer)
Volume: The Brain cancer is the growth of cells in the brain resulting in a “mass” or volume.
The “histology” of brain cancer is the appearance under the microscope as determined by the pathologist. The tumors can be benign or malignant.
Benign Cancer has “pushing” edges, rather than “infiltrating” (like tentacles) into the surrounding normal brain. @Benign tumors grow slowly. Under the microscope, the benigCancers show low or absent cellular division (“mitoses”).
The nuclei of the tumor cells show the normal or near-normal architecture, without “atypia.” Examples of benign tumors include acoustic neuromas, meningiomas (optic nerve sheath meningioma, cavernous sinus meningioma, convexity meningioma), pituitary adenomas, craniopharyngiomas, pinealomas, choroid plexus papillomas, pilocytic astrocytomas, and cerebellar astrocytomas, epidermoid tumors, desmoid tumors, lipomas,
Malignant tumors are similarly characterized by the microscopic. Radiographic and clinical presentations.
Under the microscope, the malignant tumors show high percentages of cells undergoing division (mitosis), cellular atypia (bizarre shapes of nuclei and cells).
And a high ratio of the size of the nucleus to the size of the surrounding other volumes of the cell (cytoplasm).
Radiographically, malignant tumors can “infiltrate” (spread) into the surrounding normal brain. On the MRI the malignant tumors can show much swelling or “edema” in the surrounding normal brain.
Surgically, these factors make complete removal difficult or impossible without damaging large volumes of surrounding normal brain. Examples are the
Include glioblastoma multiforme (GBM), anaplastic astrocytoma, anaplastic oligodendroglioma, gliosarcoma.
Invasion of the normal brain is the hallmark. Hemangiopericytoma, meningeal sarcomas are variants. Meningeal melanoma, osteosarcoma, leptomeningeal gliomatosis are rare.
Brain Metastases: Sources include lung, breast and colon cancers.
Lymphomas and Sarcomas: Rare
Gliomas are the most common, constituting almost 60% of primary intracranial tumors, followed by meningiomas (20%). Meningiomas are more common in women than men (3:2); gliomas are slightly more common in men.
The frequency of brain tumors is high in children (1 to 5 per 100,000 per year) because of cerebellar astrocytomas and medulloblastomas, drops slightly in the adolescence, and then rises steadily…
About 24,000 primary brain Cancer and an equal number of metastatic tumors are diagnosed in the United States. Each year assuming a population of 280,000,000.
Most primary brain Cancer is verified histologically. But 80% of metastatic tumors are diagnosed and treated empirically.
Estimated age-adjusted rates for primary brain cancers range from 5.9 per 100,000 in the Connecticut Tumor Registry to 8.2 per 100,000 population in Rochester, Minnesota. In Rochester, both case ascertainment and autopsy rates are higher than elsewhere.
The overall estimated frequency of primary brain neoplasms in the United States was 7.0 per 100,000 per year.
Data from the National Cancer Institute show a nominal (<0.5%) annual rise in mortality from brain cancer. The overall population but a dramatic (almost 8%) annual rise after age 65.
After age 65, instead of a declining incidence with advancing age, current data show a steady rise to age 85.
Imaging with CT or MRI and histologic diagnosis by stereotactic needle biopsy are major factors but not necessarily the entire explanation for this increase.