Brain Tumors

A brain tumor is an abnormal and uncontrollable growth of cells in brain tissue that results in a mass in the brain. A brain tumor can be benign or malignant, but whether cancerous or not, brain tumors affect brain function if they grow large enough to compress surrounding tissues. When describing a brain tumor, the terms "benign" or "malignant" do not provide information about the actual condition and severity of the tumor. Many factors such as the pathological report of the tumor, the success level of the surgery, the area where the tumor is located and the clinical picture it shows on the patient should be evaluated together.

Types of Brain Tumors:

Although there are many different types of malignant brain tumors, the most common tumor types are glial tumors and metastatic tumors.

1- Malignant (Malignant) Tumors

A-Glial Tumors: They are the most common tumors of the brain. They account for the majority of brain tumors. They contain cells with uncontrolled proliferation. They grow rapidly and extend into the healthy tissue around them, and in very rare cases they can spread to the spinal cord and even to other organs of the body. Staging is done in four groups. Stage I and Stage II "low stage", while Stage III (anaplastic astrocytoma) and Stage IV (glioblastoma multiforme) are called "high phase" is considered. Some other tumors in this group are ependymoma, medulloblastoma, oligodendroglioma. Survival is related to pathologic staging, radiotherapy, chemotherapy and age. Survival is longer in low-stage glial tumors. Low-stage tumors can transform into high-stage tumors. For high-grade gliomas, the average survival is much shorter.

B-Metastatic brain tumors: Vücudun başka yerindeki bir tümörün beyne yayılması sonucu gelen tümörlerdir. En fazla akciğer, meme, kalın bağırsak, mide, cilt ya da prostattan kaynaklanırlar. Ancak bazen köken aldığı organ saptanamayabilir. Onkoloji kliniklerinde tanı konup, tedavi amacıyla yatırılmış hastaların %20-40’ında beyin metastazları görülmektedir. Bu oran tüm beyin tümörlerinin %10’unu oluşturur. Kötü huylu beyin tümörlerinde tedavi seçenekleri; cerrahi girişim, biyopsi, ışın tedavisi, ilaç tedavisi ve radyo-cerrahidir. Tedaviye yanıt, tümörün köken aldığı odak, yayıldığı organ sayısı, metastatik lezyon sayısı, hastanın yaşı, ek hastalık bulunup bulunmaması gibi faktörlerle ilişkilidir. Bu nedenle sağkalım süreleri farklıdır. Yani her hastayı kendi özelinde değerlendirmek gerekmektedir.

2- Benign Tumors

These are tumors that usually develop inside the skull but outside the brain tissue. Meningiomas, pituitary adenomas, craniopharyngiomas, dermoid and epidermoid tumors, hemangioblastoma, colloid cyst, subependymal giant cell astrocytoma, neurinomas are the most common lesions of this group.

Menengiomalar bu grubun önemli bir kısmını olusturur. Diğer organlardaki iyi huylu tümörlerin aksine, iyi huylu beyin tümörleri bazen hayatı tehdit edecek durumlara neden olabilirler. Bazıları (örneğin menengiomalar) nadir de olsa kötü huylu tümöre dönüşebilirler. Genellikle çevrelerindeki beyin dokusuna yayılım göstermedikleri için ameliyatla tam çıkarılabilme şansları yüksektir. Ancak az oranda da olsa yeniden ortaya çıkabilirler. Meningiomaların tümüyle çıkarılma durumunda bile 10 yılda %20’sinin tekrarlayabildiği, özellikle önemli bölgelere yapışık olanlarda cerrahi sonrası komplikasyonların olabileceği bilinmektedir.

What are the symptoms of a brain tumor?

Brain tumor symptoms  Usually;

Prolonged severe headache

Dizziness and loss of balance

Blurred vision or double vision

Seizures (such as fainting, twitching, loss of consciousness)

Loss of strength and numbness on one side of the body

Nausea and vomiting

Mental problems such as forgetfulness, personality and behavior

Hearing loss or hearing instability

Severe headache (especially in the morning)

The most typical symptom of a brain tumor is headache. A tumor that grows uncontrollably in the brain can put pressure on the surrounding cells. The pressure of the tumor on the brain cells causes headache. In addition, the swelling caused by the growing tumor in the brain will also increase intracranial pressure, causing headaches. Headaches caused by brain tumors are usually more common in the morning hours.

Dizziness and loss of balance

As a brain tumor grows, it presses on the surrounding brain tissue and causes changes in function. If the tumor is in an area of the brain that helps control balance, this can cause dizziness and balance problems.

Blurred and double vision

Pressure on the optic nerve from a brain tumor causes blurred vision, double vision or increased blind spot. As the tumor grows, it will compress the optic nerve and the pressure will be greater. Depending on the pressure applied, even blindness may occur.

Fainting and seizures

A brain tumor damages neurons in the brain, causing muscle spasms, twitching, numbness and tingling, and seizures such as fainting and loss of consciousness.

Numbness on one side of the body

Tumors in the cerebrum, the area of the brain that controls movement or sensation, can cause weakness or numbness, usually on one side of the body. Apart from weakness on one side, it can also cause problems with speech or even understanding words.

Nausea and vomiting

The pressure of the tumor on the brain tissues and the obstruction of the flow of fluid in the brain cause an increase in the pressure inside the skull. As an effect of the cerebrospinal fluid in the skull and the pressure created by the brain, nausea and vomiting are experienced.

Forgetfulness and difficulty remembering

One of the common symptoms of a brain tumor is forgetfulness. A tumor that develops in the areas that play a role in speech and memory processes, known as the frontal lobe and temporal lobe of the brain, disrupts the function of the cells, causing problems such as forgetfulness and difficulty remembering.

Personality change

A common symptom of a brain tumor is personality changes and mood swings when the tumor presses on the brain or causes it to swell. These mood changes are more commonly associated with brain tumors in the frontal lobe, which is highly influential in regulating personality and behavior.

Hearing loss and tinnitus

Another symptom of a brain tumor is that it can cause hearing problems. When the tumor presses on the auditory nerve or causes the release of toxic substances, it presses on the cochlear nerve, the auditory nerve, causing hearing loss and hearing instability.

Diagnostic Methods

Clinical evaluation, computed tomography (CT) or magnetic resonance imaging (MRI) of the brain are usually used to make the diagnosis. These examinations can also be repeated with the administration of contrast medium to better define the tumor boundaries and characteristics. The definitive diagnosis is made after pathologic examinations.

Treatment Methods

Surgical removal of the tumor is generally considered the first option for almost all large brain tumors. In a small number of cases, partial removal or radiotherapy and follow-up is recommended due to the high complication rate. Some of the benign lesions localized in the brainstem can be surgically removed and some can be radiosurgically treated. In short, the degree of malignancy and location of the tumor, the patient's age, general condition and the presence of additional systemic problems determine the surgical decision and the limits of surgical tumor removal.
In summary; today, in the treatment of brain tumors, follow-up, surgery, radio-surgery and chemotherapy (drug treatment) methods are used separately or in combination depending on the pathological diagnosis of the tumor.

Possible Complications After Surgery

Postoperative complications are not independent of the type of tumor, location, age and general condition of the patient. Seizures, severe headache, nausea, vomiting, bleeding, worsening of the existing neurological condition, deterioration in vision, speech and perception, hydrocephalus, swelling and redness of the extremities, delayed wound healing, infection, thromboembolism, some psychiatric problems are some of the possible complications of surgery. Most of these complications may resolve with postoperative medical care, but some (e.g. worsening of neurological status) may be permanent. One or more of these complications may develop in the same patient. However, the most important point to remember is that in the presence of a tumor in the brain, the systemic problems caused by this tumor are often life-threatening.

Brain Tumor Surgery Process

Brain tumor surgery is a complex surgical procedure and consists of many stages. It includes a pre-operative assessment, determining the patient's general health condition and the location of the tumor. Depending on the type and size of the brain tumor, the surgical team prepares an appropriate surgical plan. The surgery is performed under general anesthesia and involves opening the patient's skull (craniotomy). Performing these surgeries as a team with experienced anesthesia, nurses and staff integrity is another important factor in the success rate of the surgery. The surgery is performed under intensive observation and brain functions are continuously monitored with special monitors.

Risks of Brain Tumor Surgery 

Brain tumor surgery involves serious risks. There are risks of infection, bleeding and brain damage. Complications such as leakage or swelling may also occur in the postoperative period. It may not always be possible to remove the tumor completely and some permanent effects or neurological complications may occur. However, these risks do not apply to all operations and most operations are successful.

Life Span and Quality of Life after Brain Tumor Surgery

The duration and quality of life after brain tumor surgery depends on many factors. The success of the surgery, the type of tumor, its staging and the patient's general health are some of these factors. Complete removal of the tumor usually provides the best results, but in some cases the tumor cannot be completely removed and is surgically reduced in size.

After surgery, it is important that patients are closely monitored and adhere to their treatment regimen. Radiotherapy, chemotherapy or other treatment modalities may also be required. Postoperative physical and mental rehabilitation can also be applied to improve the patient's quality of life.