Brain cancer

Primary brain cancers are cancer that originates from the brain cells, generally named after the tissue which they originate from. Majority are glima arising from glial cells in the brain. These include:

• astrocytomas,
• oligodendrogliomas,
• ependymomas and
• mixed cell type gliomas.

The other forms of brain cancers are:

• meningiomas,
• medulloblastomas,
• chordomas and
• central nervous system lymphomas.

Brain cancers can be fast growing (high grade), such as glioblastoma - or slow growing (low grade), such as low grade astrocytoma.

Cancers from other organs can spread to the brain and are called brain metastases. Brain metastases comprise cancer cells from the original site of cancer, such as lung cancer cells and breast cancer cells.

How common is Brain Cancer?

This is an uncommon cancer in Singapore. Between 1968 and 2007 there were about 1903 cases reported. The most common cancer in the brain are brain metastases that originate from other organs. Among primary brain cancer, the most common are the astrocytomas of which glioblastoma predominates.

Age of Onset

Infants have been reported to have brain cancers as well. However, the risk increases after the age of 35 years. During the childhood years, primary brain and spinal cord cancers are the second leading cause of death from solid cancer.

Adults with brain cancers can present with fits or seizures. Other signs and symptoms that suggest increased pressure within the skull include persistent headaches associated with vomiting and double vision. Pressure builds up within the skull because the skull is a bony structure that cannot expand. A cancer growing within the brain inside the skull causes pressure to increase. Other patients may develop weakness and/or numbness of one side of their body that is similar to a stroke.

Little is known regarding the cause of brain cancer.

Computerised Tomography scans (CT) and magnetic resonance scans (MRI) of the brain are able to detect most brain cancers. These scans may also determine if there is increased pressure within the skull. The exact type of cancer will be determined after a biopsy of the cancer. Sometimes, because of the position of the cancer, a biopsy is not attempted because the risk of causing damage to neighbouring important structures is very high.

• Surgery reduces the amount of cancerous brain cells and also provides the pathologist (a doctor who looks at tissues under the microscope) with tissue to diagnose the exact type of brain cancer. Patients who have increased pressure within the skull because of the brain cancer sometimes need surgery to decompress the tumour and relieve the intracranial pressure.
• Radiotherapy is often recommended once the diagnosis of brain cancer is made. Radiotherapy consists of high-energy rays directed onto the cancer and the surrounding tissues. The amount and duration of radiation therapy administered depends on the type of brain cancer. Patients may experience hair loss and some lethargy during the treatment period.
• Chemotherapy is commonly used with radiation therapy in the treatment of astrocytomas. In primary brain lymphoma, chemotherapy is also the primary modality of treatment. Fast growing brain cancers respond better to chemotherapy than slow growing brain cancers. Patients who have recurrence after surgery and radiotherapy may also benefit from chemotherapy. Chemotherapy drugs are given orally as well as by infusion.
  
  Chemotherapy wafers can also beimplanted into the brain cancer at the time of surgery to reduce the growth of the cancer in the management of some patients with astrocytoma.
  

Prognosis of Brain Cancer

Clinical examinations, x-rays and pathology reports all help the medical team decide what the progress of an individual case of brain cancer may be. The appropriate course of treatment will then be put into action. The treatment strategy will vary from person to person. Features that influence the outcome of the cancers include the patient's exact type of brain cancer including its biological characteristics, the extent of brain function affected by the cancer, whether the cancer can be operated on and the age and functional status of the patients.

1. I have headaches all the time. Could I be suffering from brain cancer?
   Headaches have many causes, such as stress, eyesight problems, and migraine. Seek medical help if there are worrisome symptoms, such as vomiting, double vision, weakness on one side of the body, seizures or if the headache is getting progressively worse.
2. My mother had breast cancer. Now she has brain cancer. Why does she have so many illnesses? Will she die soon?
   When breast cancer spreads to the brain, the cancer cells there are still breast cancer cells. It is an advanced stage of breast cancer. With appropriate treatment, some of her symptoms may be controlled. Cancer that has spread to the brain does not necessarily mean that it is immediately life-threatening if appropriate treatment is sought.