brain cancer

brain cancer

Contents
2019
1. Introduction.........................................................................................................3
2. Aim of work.........................................................................................................3
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3. Epidemiology.......................................................................................................3
4. The human brain.................................................................................................5
5. Types of brain cancer..........................................................................................7
5.1. Primary brain cancer.....................................................................................8
5.2. Metastatic brain cancer................................................................................8
6. General signs and symptoms............................................................................10
7. Causes and risk factors......................................................................................15
7.1. Common Risk Factors...............................................................................16
7.2. Possible/Potential Risk Factors................................................................21
7.3. Genetics....................................................................................................24
8. Diagnosis............................................................................................................25
8.1. Self-Checks...............................................................................................26
8.2. Physical Examination...............................................................................27
8.3. Imaging.....................................................................................................27
8.4. Labs and Tests..........................................................................................29
8.5. Differential Diagnoses..............................................................................31
9. Treatment..........................................................................................................33
9.1. Twists on Traditional Treatments...............................................................33
9.2. Antiangiogenesis.........................................................................................34
9.3. Using the Immune System..........................................................................34
9.4. How brain tumor are treated......................................................................35
10. After treatment...............................................................................................42
References:............................................................................................................45
Summary:.............................................................................................................. 48

Table of figures

Figure 1:anatomy of the brain.................................................................6

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Figure 2 :types of brain cancer................................................................7

Figure 3:symptomes of brain cancer.....................................................10
Figure 4:risk factors...............................................................................16
Figure 5:alarm thingsof brain cancer....................................................26
Figure 6:brain scan................................................................................28

Table of abbreviations
ANAP Anaplastic
BBB Blood-brain block
BCC Basal cell carcinoma
CCG Children’s Cancer Study Group.
CNS Central Nervous System. The brain, spinal cord and cranial nerves
CRT chemoradiation. Combined modality therapy with radiation and
chemotherapy
BX Biopsy
F(M)H Family (medical) history
NERD No evidence of recurrent disease
REG Radio encephalogram
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1. Introduction

In the body, cells constantly mature and die and new cells are created. The
growth of cells is controlled by genes. When cancer occurs a group of cells
reproduces and grows out of control because the gene that normally regulates
the rate of cell growth is defective.

When a brain tumor occurs, the ever-growing mass of cells compresses and
damages other cells in the brain, interfering with brain function. The tumor
pushes brain tissue around, creates pressure by pressing against the bones of the
skull and infiltrates (or invades) healthy brain tissue and the areas around the
nerves. As a result, the tumor damages the tissues in the brain.

There are more than 120 types of brain cancer. Unlike other forms of cancers
which are associated with lifestyle activities such as smoking, dietary factors, or
drinking there is little known about why primary brain cancer occurs. Most brain
cancer is the result of genetic mutations changes in the genes that normally keep
cells from reproducing an uncontrolled manner.

2. Aim of work
The aim of work is to provide an overlook on brain tumors, it’s epidemiology and
how often it happens, it’s types, causes and risk factors, how it can be diagnosed
and possible treatments.
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3. Epidemiology
Brain cancer accounts for approx 1.4% of all cancers and 23% of all cancer-related
deaths, the incidence of primary cerebral malignancies varies between 4 and
10/100.000 in the general population. This incidence tends to increase with age
(4/100.000 up to the age of 12 yr. 6/100.000 up to the age of 35 yr. 187100000 up
to the age of 55 yr.: 70/100.000 up to the age of 75 yr).

In 2002 over 35.000 (approx 6 per 100.000) Americans were diagnosed with brain
tumors (McCarthy et al.,2002).

The annual death rate from the group of conditions so classified is some
13.000/yr. Currently, in part owing to approved diagnostic methods, appro 16,800
brain tumour cases are diagnosed each years malignant, with poor prognosis :
However, even those cases that are classified as benign and are treatable are
significantly interfere with normal brain function that is essential for a normal
life .The continuing grim outlook for patients, the often-devastating impact of
even treatable low grade pediatric cancers and other benign disorders, as well as
breakthroughs in genetic research have given new impetus to cancer research.

Two types of epidemiologic studies, descriptive and analytical, have figured

prominently in the notable recent increase in research effort in brain tumours.
Descriptive studies characterize incidence, mortality, and survival rates associated
with brain tumors by category of histologic tumour type and patient demography.
such as age, sex, and geographie region. Analytic epidemiologic studies compare,
in cohorts the risk of brain tumors in people with and without certain
characteristics and histories, explore risk factors that can be implicated in the
development of cancer.
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A wide variety of risk factors, including diet, smoking alcohol occupation

exposures, radiation infections, allergies, head trauma, and family history are
being intensively investigated for their rote in brain tumors. In recent years, a
greater focus is being directed inherited polymorphisms in genes related to
carcinogen metabolism, and DNA repair, as well as. gene environment
interactions. The relative rarity of brain tumors makes the assembly of large
cohort studies difficult and, therefore, most commonly these analytic studies use
the case-control approach.

4. The human brain

Different parts of the brain control different physical and mental functions. The
biggest area of the brain is the cerebrum. It consists of two halves or
hemispheres, connected by a series of nerves the left hemisphere of the Brain
controls the right side of the body, and the right hemisphere of the brain controls
the left side of the body Each hemisphere is further divided into four sections
called lobes(Agostino .,2012).

Frontal lobes: Located at the front of the as they control reasoning, judgment,
inhibition, maid. attention, somebody movement and bowel and bladder control.
Damage to the frontal lobes can affect one's sense of consequences and notions
of good and bad, resulting in reckless or rule breaking behaviour.

Temporal lobes: Located the lower part of the cerebrum, they control hearing
related activity and long-term memory in most people, the left temporal lobe is
responsible for understanding language. In about 5 percent of people, the
language function is located in the right temporal lobe.
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Parietal lobes: Located in the upper center of the cerebrum they process sensory
information and spatial orientation They also play a role in reading writing and
performing mathematical calculations.

Occipital lobes: Located at the back of the cerebrum, they control vision. The
right occipital lobe processes information from the left eye, while the left occipital
lobe processes information from the right eye.

Below the cerebrum is the brain stem, which is divided into three parts; the
midbrain which is closest to the cerebrum, the pons and the medulla oblongata.
Information related to sight hearing, smell movement and balance is transmitted
from nerves through the spinal cord to the brain stem via twelve cranial nerves.
The areas that control sleeping and waking and involuntary body functions those
we don't control consciously such as the beating of the heart also located in the
brain stem. The brain contains two major types of cells nerve cells, which send
and

receive electrical signals and glial cells. which provide the supporting and
protective structure for the nerve cells (Freedman.,2009).
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Figure 1: anatomy of the brain

5. Types of brain cancer

Depending on where a brain tumor is located. it will affect difference aspects of

movement, senses, and behaviour There are a large variety of tumors. They
originate in various parts of the brain and grow from different types of cells. Some
types of brain cancer are seen more often in adults, while others are more
frequent in children. Most occur equally in men and women, but some are more
common in one gender than the other. Brain cancer is divided into two
categories: primary brain cancer and metastatic brain cancer (Freedman.,2009).

Figure 1 :types of brain cancer

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5.1. Primary brain cancer

is cancer that results from an abnormal growth of cells that starts in the brain
itself and tends to stay there, In the United States about nineteen thousand
people are diagnosed with primary brain cancer annually. Primary brain tumors
are divided into groups: glial tumors and non-glial tumors. Glial tumors grow from
cells in the fibers that support the nerve cells in the brain Non-Glial tumors grow
from the nerves hands or blood vessels in the brain (Francis,.2005).

5.2. Metastatic brain cancer

are more common. These cancers start somewhere else in the body and travel to
the brain. Lung, breast, kidney, colon, and skin cancers are among the most
common cancers that can spread to the brain(Francis,.2005).

5.1.1. gliomas: arise from the glial component of the nervous system and their
cells provide an interface between neurons and brain fluids They are the most
common primary brain tumor and account for more than 40% of all central
nervous system neoplasms with a peak incidence around age 60 yr. Despite the
fact that gliomas are derived from astrocytes, oligodendrocytes, or ependymal
cells, significant variations exist between them that may reflect the genes
involved in their genesis.

5.1.1.1. Astrocytoma: The tumor arises from star-shaped glial cells called
astrocytes. It can be any grade. In adults, an astrocytoma most often arises in the
cerebrum.
Grade I or II astrocytoma: It may be called a low-grade glioma.
Grade III astrocytoma: It's sometimes called a high-grade or an anaplastic
astrocytoma.
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Grade IV astrocytoma: It may be called a glioblastoma (GBM) or malignant

astrocytic glioma.
5.1.1.2. Oligodendrogliomas: develops from oligodendrocytes, which are cells
that produce the lipid covering of the axons of nerve cells. This type of tumor
occurs normally in the cerebrum, particularly in the frontal or temporal lobes, and
is more common in adults than in children and in men more than woman.

5.1.1.3. Ependymomas: These tumors develop from ependymal cells, which line
the ventricles of the brain and the central canal of the spinal cord. Ependymomas
may spread from the brain to the spinal cord via the CSF causing notable swelling
of the ventricle or hydrocephalus. Ependymoma account for 4-6 of all brain
tumors and occur mainly up to the age of 20 yr. (Louis.,2007).

5.1.2. Medulloblastomas: are malignant tumors originating from primitive or

poorly developed cells, constitute 35% of all brain tumors, but as much as 25% off
brain tumors in childhood. The disease most commonly occurs between the ages
of 3 and 8 yr., although occasionally, medulloblastoma are also observed in
adults, Because of the median location of the lesions and their association with
the fourth ventricle they are frequently accompanied by metastasis to the
ventricular system and the neuroaxis usually via the CSF. In 5% of cases,
metastases are already present at the time of diagnosis. Although
medulloblastoma is one of the most common pediatric malignancies, little is
known of the outcome of long-term survivors of childhood medulloblastoma.
Treatment of medulloblastoma with radiation has been implicated in the
development of secondary malignancies.
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5.1.3. Gangliogliomas: are tumors that contain both neurons and glial cells and
usually occur in the temporal lobes and cerebral hemispheres. They are highly
curable by surgery alone or by surgery combined with radiation therapy.

5.1.4. Schwannoma (Neurilemmoma): usually benign tumors, arise from

Schwann cells and often form near the cerebellum and in the cranial nerves
responsible for hearing and balance, these benign tumors are twice as common in
women as in men, and are most often diagnosed in patients between the ages 30
to 60yr.

5.1.5. Chordomas: are relatively rare neoplasms arising from embryonic

notochordal remnants and com prise less than 1% of intracranial neoplasms. They
typically occur along the neuroaxis, especially at the developmentally more active
cranial and caudal ends, notably in the spheno-occipital, sacrococcygeal, and
vertebral locations.

6. General signs and symptoms

Figure 2:symptomes of brain cancer

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There are many types of brain tumors. Some are cancerous (malignant) and some
are noncancerous (benign).Some malignant tumors start in the brain (called
primary brain cancer). Sometimes, cancer spreads from another part of the body
into the brain resulting in a secondary brain tumor. There are a lot of potential
symptoms of brain tumors, but one person is unlikely to have them all. Also,
symptoms vary depending on where the tumor is growing in the brain and how
large it is.

6.1. Headache changes

Worsening headaches are a common symptom, affecting about 50 percent of

people with brain tumors. A tumor in the brain can put pressure on sensitive
nerves and blood vessels. This may result in new headaches, or a change in old
pattern of headaches, such as the following:

 persistent pain, but it’s not like a migraine.

 It hurts more when first get up in the morning.
 It’s accompanied by vomiting or new neurological symptoms.
 It gets worse with exercise, cough, or change position.
 over-the-counter pain medicines don’t help at all.

Even by getting more headaches than person used to, or they’re worse than they
used to be, it doesn’t mean person have a brain tumor. People get headaches for
a variety of reasons, from a skipped meal or lack of sleep to concussion or stroke.
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6.2. Seizures

Brain tumors can push on nerve cells in the brain. This can interfere with electrical
signals and result in a seizure. A seizure is sometimes the first sign of a brain
tumor, but it can happen at any stage. About 50 percent of people with brain
tumors experience at least one seizure. Seizures don’t always come from a brain
tumor. Other causes of seizures include neurological problems, brain diseases,
and drug withdrawal.

6.3. Personality changes or mood swings

Tumors in the brain can disrupt brain function, affecting personality and behavior.
They can also cause unexplained mood swings. For example:

 Person is more easily irritated.

 used to be a “go-getter,” but has become passive.
 relaxed and happy one minute and, the next, starting an argument for
no apparent reason.

These symptoms can be caused by a tumor in:

 certain parts of the cerebrum.

 the frontal lobe.
 the temporal lobe.

These changes can occur early on, but can also get these symptoms from
chemotherapy and other cancer treatments. Personality and mood swings can
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also be due to mental disorders, substance abuse, and other disorders involving
the brain.

6.3. Memory loss and confusion

Memory problems can be due to a tumor in the frontal or temporal lobe. A tumor
in the frontal or parietal lobe can also affect reasoning and decision-making. For
example:

 It’s hard to concentrate, and easily distracted.

 often confused about simple matters.
 can’t multitask and have trouble planning anything.
 short-term memory issues.

This can happen with a brain tumor at any stage. It can also be a side effect of
chemotherapy, radiation, or other cancer treatments. These problems can be
exacerbated by fatigue. Mild cognitive problems can happen for a variety of
reasons other than a brain tumor. They can be the result of vitamin deficiencies,
medications, or emotional disorders, among other things.

6.4. Fatigue

Fatigue is more than feeling a little tired once in a while. These are some signs
experiencing true fatigue:

 completely exhausted most or all of the time.

 weak overall and limbs feel heavy.
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 often falling asleep in the middle of the day.

 lost ability to focus.
 irritable and out of sorts.

Fatigue can be due to a cancerous brain tumor. But fatigue can also be a side
effect of cancer treatments. Other conditions that cause fatigue include
autoimmune diseases, neurological conditions, and anemia, to name just a few.

5.5. Depression

Depression is a common symptom among people who have received a diagnosis

of a brain tumor. Even caregivers and loved ones can develop depression during
the treatment period. This can present as:

 feelings of sadness lasting longer than what seems normal for the situation.
 loss of interest in things.
 lack of energy, trouble sleeping, insomnia.
 thoughts of self-harm or suicide.
 feelings of guilt or worthlessness.
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7. Causes and risk factors

The cause of most brain and spinal cord tumors is not fully understood, and there
are very few well-established risk factors. but some of the risk factors that have
been identified include radiation exposure (both therapeutic and diagnostic), age,
obesity, northern European ethnicity, pesticide exposure, and more. In addition,
genetic factors may play a role, and those who have a family history of brain
tumors, as well as those with certain genetic syndromes have a higher risk of
developing the disease. There are also several possible risk factors, such as
exposure to electromagnetic fields related to cell phone use, that are still being
evaluated.

Figure4: risk factors

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The role of environmental exposures, though not well understood at this time,
deserves further research, as the incidence of brain tumors has been increasing
significantly in industrialized countries.

7.1. Common Risk Factors

A risk factor is something that is associated with the development of a disease

such as cancer but doesn't necessarily cause that disease. People who have a risk
factor for developing a brain tumor won't necessarily develop one. Likewise,
many people who develop brain tumors have no known risk factors for the
disease. Most of the time, a cancer is caused by a combination of factors,
something that is referred to as having "multifactorial" causes.

Knowing the risk factors, as well as the common signs and symptoms of brain
tumors may help people identify the disease as soon as possible if it should occur.
Some risk factors are "modifiable" meaning that measures can be taken to reduce
risk, an understanding of risk factors shouldn't be used to judge people or talk
about how they "caused" their tumor. Risk factors can vary depending on the
particular type of brain tumor, such as glioma, meningioma,
astrocytoma, medulloblastoma, and more, and may include:

Age

Brain tumors occur most commonly in children and older adults, though they can
occur at any age.
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Sex

In general, brain tumors are more common in men than in women (around 70
percent more common). That said, one type of brain tumor, meningiomas, are
more common in women than in men.

Race/Ethnicity/Socioeconomic Status

In the United States, white people are more likely to develop brain tumors than
blacks. Around the globe, the incidence of brain tumors in higher in northern
Europe than in Japan. People who have parents who were born in Sweden, in
particular, have a roughly 21 percent higher chance of developing a brain tumor.
It was found that children born to mothers who have a high education level have
a slightly increased risk.

Radiation Exposure

Exposure to radiation. either diagnostic (such as a CT scan or x-ray of the head),

therapeutic (such as with radiation therapy to the head to treat leukemia, or
when radiation was used to treat scalp psoriasis), as well as radiation related to
atomic bomb blasts are associated with a higher risk of developing a brain tumor
(gliomas and meningiomas).

The average amount of time between radiation therapy for cancer and the
subsequent development of a secondary cancer is usually 10 to 15 years. It’s not
known how significant diagnostic radiation is with regard to brain tumor risk, but
radiologists are practicing more caution when ordering CT scans, especially in ng
children.
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A Personal History of Cancer

Both childhood cancers, and cancers such as non-Hodgkin's lymphoma, leukemia,

and glioma in adults, are associated with an increased risk of developing brain
tumors. It's not known if this is related to the cancer itself, treatments for the
cancer (especially intrathecal chemotherapy, when chemotherapy drugs are
injected directly into the cerebrospinal fluid that flows through the brain and
spinal cord), or a problem (such as a gene mutation) that underlies both cancers.

HIV/AIDS

People who have HIV/AIDS have roughly double the risk of developing a brain
tumor.

Overweight and Obesity

People who are overweight or obese (have a body mass index greater than 30)
have an increased risk of brain tumors.

A History of Seizures

It’s known that having a seizure disorder has been associated with the
development of brain tumors, but similar to the chicken and egg scenario, it's not
certain whether having seizures increases risk, or if people with underlying
tumors may have seizures related to the tumor before it is identified. There is also
some thought that it could be the medications used to treat seizures that may
raise the risk. Some researchers have speculated that head injuries may be linked
with brain tumors, but any clear association is unknown at this time.
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Prenatal Factors

Prenatal birth weight, specifically a high fetal growth rate has been associated
with a significantly increased risk of medulloblastomas, ependymomas, and one
type of astrocytoma. The reason for this finding isn't certain, but researchers have
hypothesized that conditions such as gestational diabetes (diabetes related to
pregnancy) may play a role. Both children who are born large for gestational
age (over 4500 grams or 9.9 pounds in a full-term infant) and small for gestational
age (less than 2600 grams or 5 pounds 8 ounces in a full-term infant) or more
likely to develop a brain tumor than children who are of normal size for age at
birth.

There is some evidence that children born to mothers who eat cured meat (such
as bacon, ham, pastrami, or pepperoni) during pregnancy, have an increased risk
of brain tumors. In contrast, children whose mothers took a multivitamin during
pregnancy appear to have a lower risk. In addition, there is a small amount of
evidence that children born to mothers who eat a diet rich in fruits and
vegetables during pregnancy have a lower risk. (If there is a risk related to eating
too few fruits and vegetables, it's likely small, and parents of children who have
brain tumors should not chastise themselves.)

Medications

The use of anti-inflammatory medications such as Advil (ibuprofen) has been

associated with a reduced risk of brain tumors.
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Pesticide Exposure

There is some evidence that exposure to insecticides used in the home, such as
flea and tick products for animals, is associated with an increased risk of brain
tumors in children and ng adults. A 2013 review of 20 studies also seems to show
that children born to parents who are exposed to pesticides on-the-job have an
increased risk.

Occupational and Household Exposures

Many people are exposed to carcinogens (cancer-causing substances) at the

workplace. Some occupations that have been linked with an elevated risk of brain
tumors include firefighters, farmers, chemists, physicians, and those who work
with petrochemicals, power generators, synthetic rubber manufacturing, or
agricultural chemical manufacturing. It's not certain whether exposure to
solvents, rubber, or vinyl chloride increases risk.

Air pollution and living near landfills are possibly associated with an increased risk
(Lynne.,2018).

7.2. Possible/Potential Risk Factors

There are a number of risk factors that are uncertain or for which studies have
shown mixed results with an increased or decreased risk in some cases, but no
change in risk in others. Some of these include:
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Diet

As noted above, dietary habits during pregnancy (such as the consumption of

cured meats, fruits, and vegetables), may be associated with the risk of brain
tumors. Nitrosamines (formed in the body from nitrites and nitrates in cured
meats, cigarette smoke, and some cosmetics) have been correlated with an
increased risk of childhood and adult brain tumors, though the significance of the
link remains uncertain.

Electromagnetic Fields

Electromagnetic fields, first of concern for those living near high voltage power
lines (and still not clear), and now with the ubiquitous use of cell phones and
other wireless devices, are possibly associated with an increased risk of brain
tumors. Recently, a 2017 review of studies to date looking at the link between cell
phone use and brain tumors found that long-term cell phone use may be
associated with an increased risk of glioma, and the World Health Organization
has labeled cellular phones as "possibly carcinogenic." Older analog phones were
associated with the development of benign tumors known as acoustic neuromas.
Recent studies have instead found a link between cell phone use and gliomas, the
most common type of brain tumor.

With concerns such as this, it's important to discuss the latency period or the
period of time between exposure to a carcinogen (cancer-causing substance or
event) and the later development of cancer. It is because of this latency period,
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that is may not be known for decades the impact of a particular exposure. Cell
phones have not been in use that long. In comparison, if cigarettes only became
available a few decades ago, doctors might be wondering whether they really
increase the risk of cancer. Now it's very clear they do.

At the same time, people don't need to become fanatical and abandon their
phones. For those who are concerned, especially parents who have children who
use phones, the FDA suggests some steps can be taken to reduce exposure. These
include:

 Using the phone only for short conversations

 Using a landline instead when available
 Using a hands-free device to put more distance between the phone and the
head. (With these devices, the source of energy in the antenna is not
against the head.) Hands-free devices significantly reduce the amount of
radiofrequency energy exposure.

As a final note, it could also be that electromagnetic fields work in conjunction

with other exposures to increase risk. For example, exposure to petroleum
products appears to increase brain tumor risk on its own, but exposures to
solvents, lead, pesticides, and herbicides have been found to raise the risk of
glioma primarily in people who are also exposed to at least moderate amounts of
electromagnetic radiation.

Infections
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Researchers have looked at the role of several infectious diseases relative to an

increased or decreased risk of brain cancers. It has been found that having
chickenpox as a child is associated with a lower risk of developing a brain tumor.
The question is less clear when it comes to Epstein Barr virus infections (the virus
that causes mono) and cytomegalovirus infections. While CMV has been found in
the brains in people with brain tumors, and these infections may increase the risk
of central nervous system lymphomas, it's not certain if there is any link with
brain tumors.

Medical Conditions

For reasons unknown, having allergies as an adult has been associated with a
lower risk of developing glioma. There appears to be a lower risk as well for
people with allergic skin diseases (atopic dermatitis) such as eczema.

Smoking

Unlike many cancers that are associated with smoking, there is little evidence that
smoking raises the risk of brain tumors such as gliomas and meningiomas. There is
also little evidence that alcohol consumption plays a role in these tumors. A
single older study found an increased risk in malignant gliomas in women who
smoked marijuana, but not in men. In this study, the risk of gliomas was also
increased for those who drank seven or more cups of coffee daily (Lynne.,2018).

7.3. Genetics

Having a family history of brain tumors is associated with an increased risk of

developing the disease, and it's thought that 5 percent to 10 percent of brain
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tumors are "hereditary" in nature. Having a first degree relative (mother, father,
sibling, or child) with a brain tumor increases risk by a factor of 2.43.

There are also several genetic syndromes that are associated with an increased
risk. Some of these include:

 Neurofibromatosis type I.
 Neurofibromatosis type II.
 Tuberous sclerosis.
 Li-Fraumeni syndrome.
 von Hippel Lindau syndrome.
 Turner syndrome.
 Cowden's syndrome.
 Turcot syndrome.
 Gorlin syndrome.
 Nevoid basal cell carcinoma syndrome (Lynne.,2018).

8. Diagnosis

A brain tumor can be diagnosed using imaging tests that view the structure of the
brain, along with a biopsy, which can carefully assess a sample of a
suspected brain tumor under a microscope. Generally, before these tests are
ordered, a physical examination is done to determine whether there are
neurological changes that suggest the presence of a brain tumor. In the end,
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diagnosis of a brain tumor can involve an MRI, CT scan, blood tests, lumbar
puncture, and biopsy.

There are several types of brain tumors, and some are cancer, which grows
quickly and can invade nearby tissue, while some are not. These diagnostic tests
can help a doctor tell whether or not a person has a brain tumor and, if present,
what type of brain tumor it is.

8.1. Self-Checks

Figure 3:alarm things of brain cancer

A brain tumor is located inside the skull, so there are generally no changes that
person is able to see on his own. However, there are a few signs of brain
P a g e | 26

tumors that should be aware of, especially because they can be subtle and slowly
progressive.

 Persistent headaches*
 Vision changes
 Coordination problems, such as an inability to stand up straight or difficulty
using one of the hands
 Unexplained vomiting
 Weakness, numbness, tingling of the arms or legs
 Difficulty speaking or understanding speech
 Seizures

*While persistent headaches can be a sign of a brain tumor, they—in the absence
of other symptoms—are rarely owed to one(peter.,2019).

8.2. Physical Examination

physical examination can help determine if there is a possible brain tumor.

In general, neurological abnormalities that correspond to a section of the brain

are associated with brain tumors, while those that correspond to an artery in the
brain are caused by a stroke. These subtle differences can help neurologist or
neurosurgeon efficiently plan diagnostic workup so that can get the right
diagnosis sooner. Signs of a brain tumor on a physical examination can include
weakness as well as a tremor, coordination problems on both sides of body, or
jerking movements of eyes.
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Most importantly, close examination of eyes using an ophthalmoscope can reveal

swelling, which is evidence of increased pressure in the brain caused by a brain
tumor(peter.,2019).

8.3. Imaging

Imaging can assess the size of a tumor and its location within the brain, as well as
characteristics that help to differentiate one type of tumor from another.

For example, brain metastases tend to be located near small blood vessels, where
tumor cells are more likely to cross the blood-brain barrier. Another type of brain
tumor, glioblastoma multiforme, tends to be a large tumor that spreads across
several different areas of the brain. A brain tumor called an oligodendroglioma
may have bright spots on a brain CT scan due to calcium deposits within the brain.

The most common imaging tests for brain tumors are magnetic resonance
imaging (MRI) and computed tomography (CAT scan, CT scan). These tests are
usually done with injected contrast material, which is fluid that surrounds solid
areas, such as brain tumors, to better define the edges.

Figure 4:brain scan

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Other tests often used for research purposes and sometimes surgical planning
include magnetic resonance spectroscopy (MRS) and functional MRI (fMRI),
which detect differences in metabolic activity that may occur with a brain tumor.
A diffusion-weighted image uses MRI linked to software that calculates changes in
the diffusion of water, which also may be altered when someone has a brain
tumor.

Similarly, a positron emission test (PET) is similar to a CT scan and can detect
microscopic changes in blood flow and oxygen consumption, which may occur
with some brain tumors.

These types of imaging tests may not be available in every hospital, and the
results are not considered as reliable or consistent in brain tumor diagnosis as
contrast-enhanced brain CT or brain MRI, but they are valuable because they
detect subtle changes that scientists use to learn more about brain disease.

Some other imaging tests can be used in surgical planning. For example,
an angiogram uses CT, ultrasound or MRI to observe blood vessels, and can be
used so that surgeon can see if the tumor is near a blood vessel (peter.,2019).

8.4. Labs and Tests

Blood tests can also help in assessing some types of brain tumors, and a lumbar
puncture may help in diagnosing metastatic (aggressively spreading) tumors in
the brain. A biopsy is a major procedure, and it is the most definitive test for brain
tumor diagnosis.
P a g e | 29

Hormone Blood Tests

Some brain tumors, such as pituitary tumors, can produce hormones that are
detected in the blood. If have a pituitary tumor, may have an abnormal
concentration of hormones such as growth hormone or thyrotropin (a hormone
that stimulates the thyroid gland) in blood. These are not routine tests, so r
doctor would only order them if there is a high suspicion of a hormone-producing
brain tumor.

Lumbar Puncture (LP)

For this test, commonly referred to as a spinal tap, a doctor extracts fluid from
lower spine using a needle, which is then tested. It can help identify infections,
inflammation, or cancer cells.

Cancer cells can appear in the cerebrospinal fluid (CSF) if have carcinomatosis—a
condition in which multiple areas of one organ are affected by metastatic cancer.
Carcinomatosis in the brain can occur due to cancer that started somewhere else
in the body or due to the spread of brain cancer within the brain.

However, LP is not usually a reliable test when it comes to evaluation of brain

cancer because cancer cells may or may not appear in the CSF.

If have possible brain cancer, doctor may decide against an LP if the brain tumor
appears large on imaging studies. The alteration of fluid flow that results from an
LP can cause dangerous movements in the brain itself if have a large brain tumor.

Biopsy
P a g e | 30

A biopsy is a sample of tissue taken for examination under a microscope, and may
need one based on the results of imaging studies.

Usually, brain tumor type can be determined based on imaging tests. When a
tumor appears to be metastatic, a biopsy can be done to identify the tissue from
which it came.

A biopsy is also used for grading primary brain tumors from grade I to grade IV.
Low-grade brain tumors are considered less aggressive than high-grade ones. A
pathologist can estimate the tumor's predicted rate of growth and likelihood of
invasion based on characteristics in the appearance of the cells under a
microscope.

Finally, a biopsy can also determine how sensitive the tumor will be to different
types of treatments by using stains to assess various characteristics of the tumor.
This information can guide doctor's recommendations on the best line of care.

A brain tumor biopsy requires a surgical procedure under general anesthesia,

usually involving removal of a section of the skull to access the brain tissue.
Because a biopsy is no less invasive than brain surgery, doctors will try to remove
the whole tumor during a biopsy procedure so that will not need another surgery
if possible.

It will take several weeks to recover from a brain biopsy, even if the sample is
small. There is a risk of bleeding or swelling in the brain after the procedure, and
team will closely monitor for neurological changes after biopsy(peter.,2019).

8.5. Differential Diagnoses

P a g e | 31

A brain tumor can cause symptoms that are similar to those of other conditions.
diagnostic evaluation can differentiate between a brain tumor and another
neurological condition that may initially manifest in similar ways.

 Brain abscess: An abscess is an enclosed area of infection. Depending on

the circumstances, a person may have one or more abscesses in the brain.
These infections tend to be quite rare, but they can be mistaken for brain
tumors due to their symptoms and appearance on imaging tests. Usually,
repeating imaging studies can help differentiate an abscess from a brain
tumor, but sometimes an abscess is diagnosed with a biopsy.
 Encephalitis: Inflammation of the brain that can be caused by an infection
or an autoimmune disease, encephalitis causes a variety of
symptoms depending on the region of the brain that is affected.
 Tuberculosis (TB) meningitis/ TB encephalitis: An uncommon infection that
appears as spots on a brain imaging test, the lesions of TB meningitis tend
to be smaller and greater in number than lesions of a brain tumor. This
infection can be diagnosed with an LP, and the presence of TB elsewhere in
the body can help doctors determine whether lesions on meninges or in
brain could be caused by the infection as well.

 Neurosarcoid: An inflammatory disease that appears very similar to TB

meningitis on brain imaging, the spots that are seen on brain imaging with
neurosarcoid can appear as multiple metastatic brain tumor
lesions. Because they tend to be small, it is usually safe to have an LP,
which can show inflammatory cells that are characteristic of neurosarcoid.
P a g e | 32

 Multiple sclerosis (MS): Generally appearing as many small lesions of

demyelination (loss of fat around the neurons) throughout the brain, MS
may have an unexpected appearance with only a few large lesions. Often,
repeating brain imaging tests with contrast can help differentiate MS from
a brain tumor when the conditions appear similar (peter.,2019).

9. Treatment
Tumors growing in the brain are difficult to treat. One type of treatment is
external beam radiation, in which radiation passes through the brain to the
tumor. Unfortunately, this exposes healthy brain tissue to potentially damaging
radiation. Another treatment is surgical removal of the tumor, if possible,
followed by chemotherapy. All of these treatments are difficult to go through and
pose risks to the patient. Unfortunately, many gliomas grow back even after
treatment.

There are several reasons why it is hard to get rid of these types of brain tumors.
Some drugs can't get into the brain because of a special filtering mechanism in
the body (called the blood-brain barrier). Some tumors spread into (infiltrate) the
tissues around them with tiny projections. Many tumors have more than one kind
of cell in them, so chemotherapy directed at one kind of cell in the tumor will not
kill the other cells.

9.1. Twists on Traditional Treatments

New ways of treating brain tumors are being investigated, including modifying
existing treatments as well as developing new ways to give the treatments.
P a g e | 33

To get chemotherapy drugs past the blood-brain barrier, for example, researchers
are increasing the dosages and injecting the drugs directly into the blood vessels
of the brain. A new method puts the chemotherapy right at the tumor site. After
surgery, small biodegradable plastic wafers can be put in where the tumor was.
These wafers release chemotherapy drugs right there.

Something similar can be done with radiation therapy. After a tumor is removed,
a surgical balloon is put in the cavity left by the tumor. The balloon is filled with
liquid radiation, and over the next week, it radiates the tissue around it to kill off
any remaining cancer cells.

9.2. Antiangiogenesis
Researchers are looking at tumor treatment from many exciting angles. One of
these approaches is antiangiogenesis. This means cutting off the blood supply to a
tumor so that not only will it not grow, it will shrink and die. One study tried
an antioangiogenic drug, Thalidomide, with patients who had very serious gliomas
that hadn't responded to radiation and/or chemotherapy. One year after starting
the drug, 25% of the patients were still alive, although their tumors were still
growing. The researchers suggested that perhaps Thalidomide could be tried in
newly-diagnosed patients, and combined with radiation and chemotherapy
(Carmeliet.,2011).

9.3. Using the Immune System

Another approach to glioma treatment being examined is using the body's own
immune system to fight off the tumor. Researchers in a study took 19 patients
with gliomas, made a vaccine for each one using his/her own tumor cells, and
after the vaccination stimulated each person's production of white blood
cells (which fight off infection). Seventeen of the patients showed a response to
P a g e | 34

the vaccine. In eight patients, the researchers could see the response on x-ray,
and five of the patients actually improved. Some of the patients lived as long as
two years after the treatment.

9.4. How brain tumor are treated

A brain tumor requires surgical treatment and, in some instances, chemotherapy
or radiation. The treatment is tailored to the type of brain tumor, the size of the
tumor, the location in the brain, and the number of tumors in the brain and
elsewhere in the body. Treatment may consist of a one-time surgical removal of
the whole tumor, or it may involve repeated interventions if the tumor is known
to be aggressive or if it recurs.

prescriptions

Medications used for brain tumors include chemotherapy, hormonal

treatments, anticonvulsants, and pain medications. Chemotherapy works
to shrink or eliminate brain tumors, while the other prescription medications are
used to control symptoms while the tumor is being treated.

Chemotherapy

Chemotherapy for brain tumors is tailored to the type of tumor, which is

determined with a biopsy examination.

Some chemotherapeutic regimens include:

P a g e | 35

 Temodar (temozolomide) is a recommended chemotherapeutic medication

for people who have glioblastoma multiforme (GBM), a tumor with a
particularly poor prognosis. Temozolomide is usually given daily for five
days every 28 days for six to 12 cycles. Temozolomide increases the risk of
hematologic complications such as thrombocytopenia (low platelet count,
which can lead to clotting issues), so blood tests must be checked 21 and 28
days into each cycle of treatment. Other side effects include nausea,
fatigue, and a decreased appetite (Marsh.,2013).
 A combination of chemotherapeutics called procarbazine, lomustine, and
vincristine (PCV) is another option in the treatment of brain tumors. The
combination may cause reduced immune function, bruises, or bleeding.
Fatigue, nausea, numbness, and tingling may also occur.
 Gliadel (carmustine) is a chemotherapeutic medication that is implanted in
the brain in the form of a wafer that gradually disintegrates to produce its
tumor-fighting effect. Gliadel wafers may decrease the size of some
malignant brain tumors. Potential side effects include infection and brain
swelling.

 Avastin (bevacizumab) is an antibody that binds to vascular endothelial

growth factor (VEGF). This therapy interferes with the production of new
blood vessels that provide nutrients to the growing tumor. It has been
associated with neutropenia (decreased immunity), hypertension, and
thromboembolism (blood clots).

Hormone Treatments
P a g e | 36

Hormonal treatments may be needed to counteract the effects of hormone-

producing pituitary tumors. Depending on the size and grade of the tumor,
hormone treatments may be needed for a short time or the long term.

For example, if a pituitary tumor causes excessive growth hormone in the body, it
may be removed. Because this will stop the production of even adequate
amounts of growth hormone, might actually need long-term replacement to
compensate.

When a tumor is not removed, it can continue to produce excess hormones that
cause physical problems. In this instance, may need to take a different hormone
therapy to counteract the effects.

Anticonvulsants

Anti-seizure medications are used to control seizures caused by a brain tumor.

may need to take an anticonvulsant even after tumor is completely removed,
because scar tissue, which can trigger seizures, may remain.

Corticosteroids

Most people experience some swelling and inflammation as a result of a brain

tumor. If the swelling is a significant issue, may need to take oral or IV
(intravenous) steroids to reduce the inflammation. Generally, would only need to
take steroids for a limited time, but the need for steroids may recur if the
inflammatory swelling recurs.

Pain Medications
P a g e | 37

Depending on the severity of tumor-induced pain or post-surgical pain, may need

prescription pain medication. This may include prescription NSAIDs, opiates,
anesthetics, or anticonvulsants that are used for pain control, such as Neurontin
(gabapentin).

Radiation

Radiation therapy uses powerful radiation energy directed toward the tumor to
destroy cancer. Often, radiation is done prior to surgery to reduce the size of a
brain tumor.

There are several different techniques used for radiation therapy, and may need a
combination, which is determined based on the size, type, and location of the
brain tumor (Chiocca.,2011).

Techniques used in radiation therapy for brain tumors:

 Involved-field radiation therapy (IFRT) focuses on a 1- to 3-centimeter

margin around the tumor to reduce destruction of healthy, normal cells.
 3D conformal radiotherapy (3D-CRT) uses special software to make
treatment plans to reduce irradiation of normal brain.
 Intensity-modulated RT (IMRT) varies radiation across treatment areas,
which is useful when the tumor is near sensitive areas of the brain.
 Fractionated radiation therapy delivers multiple small doses over a
prolonged period of time.
P a g e | 38

 Stereotactic radiosurgery (SRS) delivers precise, high-dose radiation to

small targets in the brain.
 Radiation may also be delivered by placing radioisotope seeds in the
resection cavity or the tumor itself, leading to continuous dose delivery.

One of the side effects of radiation therapy includes radiation necrosis,

which is the death of normal brain tissue due to radiation. Other
complications include blood vessel narrowing, hair loss, and headaches.

For each type of brain tumor, a maximum dose of radiation is calculated.

Radiation that exceeds it has no anticipated additional benefit, but may
come with increased side effects.

Specialist-Driven Procedures

Often, surgery is needed to remove as much of a tumor as possible. In general,

removal of a brain tumor is the best way to prevent growth and recurrence.
Surgeons are faced with the great challenge of taking out the entire tumor while
preserving normal brain tissue.

After surgery, the tumor removed is examined under a microscope to determine

whether the margins (the areas surrounding the tumor) are cancerous or normal
tissue.

There are several types of brain surgery, and the type that is best for depends on
the size and location of brain tumor.
P a g e | 39

 Craniotomy: This is the most 'open' type of brain surgery, in which a

section of the skull is removed, the meninges (membranes covering the
brain and spinal cord) are opened, and surgeon has a view of the brain and
the tumor. It takes time to recover from a craniotomy, and this type of
surgery is often needed for large tumors.
 Endoscopy: When the tumor can be accessed without opening the skull,
surgeon may opt to make a small hole in the skull or even reach the tumor
through the deep openings inside the nasal cavity. He is able to visualize
the area by threading a thin tube with a camera through the opening;
special instruments are used to remove the tumor. Endoscopy may be used
to remove smaller tumors or tumors that are in deep regions of the brain.
 Laser ablation: This is a minimally invasive procedure in which a laser is
used to reduce or completely destroy the tumor using thermal energy. It
requires anesthesia, in contrast to radiation therapy, which directs
radiation to an area without an incision or anesthesia.

There are several risks of brain surgery, and these apply to all types of brain
surgery.

 Swelling with an accumulation of fluid in brain tissue, called cerebral

edema, may occur. This can cause neurological problems such as
numbness, weakness, or difficulty with speaking or movement. Cerebral
edema may be reduced by medications such as corticosteroids and tends to
go away on its own within a few weeks. If fluid buildup or swelling is
persistent, may need to have a ventriculoperitoneal shunt placed to reduce
excess fluid volume.
P a g e | 40

 Blood clots may form more readily after brain surgery, so preventive
treatments may be needed.
 Injury to nearby structures can occur. If the tumor is at the skull base, for
example, cranial nerves in the area may be at risk during the surgery.

Sometimes surgery may not be possible if a tumor is in an area of the brain

that is near major blood vessels or in the brainstem, where vital functions
could be disrupted. It may also be impossible for to have surgery if body
cannot safely tolerate the procedure.

Even after brain surgery, malignant tumors and metastatic tumors can
recur. Nevertheless, surgery can help improve response to chemotherapy
and radiation, improve quality of life, and prolong survival, even if tumor is
aggressive.

Complementary Medicine (CAM)

There have been some studies showing that alternative treatments may help
relieve some of the symptoms of brain tumors. Brain tumors cannot be treated
with alternative therapies, although some studies suggest that alternative
therapies may hold some promise in conjunction with traditional methods.

While the promise of alternatives may be appealing, know that research on some
options is far too limited for them to be considered recommended treatments.
It's imperative that speak to oncologist before trying any.
P a g e | 41

 Ginger: Ginger, whether eaten in fresh form or used in tea, can reduce
nausea and headaches. Brain tumors are often associated with headaches,
and chemotherapy often causes nausea.
 Poliovirus: The poliovirus is being studied in a research setting for the
treatment of brain tumors among people with GBM, medulloblastoma, and
other tumors. At this point, results look promising and the treatment is
approved by the U.S. Food and Drug Administration (FDA) for use in clinical
research trials.
 Acupuncture: An alternative remedy that is largely considered safe,
acupuncture can improve pain in some people with side effects of
chemotherapy.
 Chinese herbs: Extracts of the herbs yiru tiaojing (YRTJ) granule and peony-
glycyrrhiza decoction were used in a laboratory setting for treatment
of prolactin-secreting pituitary tumor cells. The extract diminished the
hormone secretion in the laboratory setting but has not been used in
humans, and no recommended dosing or method has been developed for
cancer treatment.

 Evodiamine (EVO): A component of Evodia rutaecarpa, an herbal remedy,

Evodiamine (EVO) was used in a laboratory setting with glioblastoma tumor
cells. It induced apoptosis (cell death) of glioblastoma cells. Again, this was
in a laboratory setting, and it was used in a cellular solution, so there are no
recommendations regarding the use of this herb in humans with brain
tumors.
P a g e | 42

10. After treatment

Care for people diagnosed with a brain tumor does not end when active
treatment has finished. health care team will continue to check that the tumor
has not come back, manage any side effects, and monitor overall health. This is
called follow-up care.

follow-up care may include regular physical examinations, medical tests, or both.
Doctors want to keep track of recovery in the months and years ahead.

Watching for recurrence

One goal of follow-up care is to check for a recurrence, which means that the
tumor has come back. A tumor recurs because small areas of tumor cells may
remain undetected in the body. Over time, these cells may increase in number
until they show up on test results or cause signs or symptoms.

During follow-up care, a doctor familiar with medical history can give personalized
information about risk of recurrence. doctor will ask specific questions about
health. Some people may have blood tests or imaging tests done as part of
regular follow-up care, but testing recommendations depend on several factors
including the type and grade of tumor originally diagnosed and the types of
treatment given.

Many brain tumors are very likely to recur, so should be routinely monitored for
new symptoms and with regular MRI scans. How often schedule follow-up visits
and have scans depends on the type of the tumor and other factors, so health
care team will talk with about exact schedule.
P a g e | 43

The anticipation before having a follow-up test or waiting for test results can add
stress. This is sometimes called “scan-xiety”.

Managing long-term and late side effects

Most people expect to experience side effects when receiving treatment.

However, it is often surprising to survivors that some side effects may linger
beyond the treatment period. These are called long-term side effects. Other side
effects called late effects may develop months or even years afterwards. Long-
term and late effects can include both physical and emotional changes.

Talking with doctor about risk of developing such side effects based on the type of
tumor, individual treatment plan, and overall health. a treatment known to cause
specific late effects, may have certain physical examinations, scans, or blood tests
to help find and manage them.

As described in previous sections, a brain tumor and its treatment can affect how
brain functions and overall well-being. For this reason, it is important for health
care team to evaluate quality of life and cognitive and functional abilities through
specialized tests. These tests are typically given by a neuropsychologist. A
neuropsychologist is a psychologist who has special training in the brain’s capacity
and behaviors.

These evaluations could identify situations when specific rehabilitative therapies

would be helpful. Options for rehabilitative therapy include:

 Speech therapy

 Occupational therapy

 Counseling with a social worker

P a g e | 44

 Medications to reduce fatigue or enhance memory

 Neuropsychological testing, which looks at the behavioral and mental

changes from the tumor and its treatment

The goal of rehabilitation is to help people regain control over many aspects of
their lives and remain as independent and productive as possible.

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P a g e | 47

Summary:

 A brain tumor occurs when abnormal cells form within the brain. There are
two main types of tumors: cancerous (malignant) tumors and benign
tumors. Cancerous tumors can be divided into primary tumors, which start
within the brain, and secondary tumors, which have spread from
elsewhere, known as brain metastasis tumors.
 All types of brain tumors may produce symptoms that vary depending on
the part of the brain involved. These symptoms may include headaches,
seizures, problems with vision, vomiting and mental changes. The headache
is classically worse in the morning and goes away with vomiting.
 Other symptoms may include difficulty walking, speaking or with
sensations. As the disease progresses, unconsciousness may occur.
 The cause of most brain tumors is unknown. Uncommon risk factors
include inherited neurofibromatosis, exposure to vinyl chloride, Epstein–
Barr virus and ionizing radiation.
 Studies on mobile phone exposure have not shown a clear risk. The most
common types of primary tumors in adults are meningiomas (usually
benign) and astrocytomas such as glioblastomas.
 In children, the most common type is a malignant medulloblastoma.
Diagnosis is usually by medical examination along with computed
tomography (CT) or magnetic resonance imaging (MRI). The result is then
often confirmed by a biopsy. Based on the findings, the tumors are divided
into different grades of severity.
P a g e | 48

 Treatment may include some combination of surgery, radiation therapy and

chemotherapy. Anticonvulsant medication may be needed if seizures occur.
Dexamethasone and furosemide may be used to decrease swelling around
the tumor. Some tumors grow gradually, requiring only monitoring and
possibly needing no further intervention.
 Treatments that use a person's immune system are being studied. Outcome
varies considerably depending on the type of tumor and how far it has
spread at diagnosis.
 Glioblastomas usually have very poor outcomes, while meningiomas usually
have good outcomes. The average five-year survival rate for all brain
cancers in the United States is 33%.
 Secondary, or metastatic, brain tumors are about four times more common
than primary brain tumors, with about half of metastases coming from lung
cancer. Primary brain tumors occur in around 250,000 people a year
globally, making up less than 2% of cancers.
 In children younger than 15, brain tumors are second only to acute
lymphoblastic leukemia as the most common form of cancer. In Australia,
the average lifetime economic cost of a case of brain cancer is $1.9 million,
the greatest of any type of cancer.
‫‪P a g e | 49‬‬

‫‪ :‬الملخص العربي‬

‫سرطان الدماغ وتشمل أورام المخ كل أنواع األورام التي تظهر داخل القحف أو في قناة العمود الفقري‬
‫المركزية‪ .‬وهي تنجم عن انقسام غير طبيعي للخاليا وال يمكن السيطرة عليه‪ ،‬غالًبا ما يكون ذلك في المخ‬
‫نفسه‪ ،‬لكنه يحدث أيضًا في النسيج الليمفاوي‪ ،‬وفي األوعية الدموية‪ ،‬وفي األعصاب القحفية أو في أغلفة المخ‬
‫(السحايا)‪ ،‬أوالجمجمة‪ ،‬أو الغدة النخامية‪ ،‬أو في الغدة الصنوبرية‪ .‬داخل المخ نفسه‪ ،‬يمكن أن تكون الخاليا‬
‫التي يحدث بها االنقسام عبارة عن خاليا عصبية[محل شك] أو خاليا دبقية‪ ،‬والتي تشتمل على الخاليا النجمية‬
‫والخاليا الدبقية قليلة التغصن وخاليا البطانة العصبية)‪ .‬كما يمكن أن تتسبب السرطانات الموجودة في‬
‫‪ .‬األعضاء األخرى (األورام الخبيثة) في انتشار أورام في المخ‬

‫ويكون أي ورم في المخ بطبيعته خطيًر ا ويمكن أن يؤدي إلى الوفاة بسبب طبيعته الغزوية واالرتشاحية في‬
‫المساحة المحدودة في التجويف الموجود داخل الجمجمة‪ .‬ومع ذلك‪ ،‬فإن أورام المخ (حتى تلك الخبيثة) ال‬
‫تكون قاتلة بصفة دائمة‪ ،‬خصوًص ا الورم الشحمي الذي يكون حميًدا بطبيعته‪ .‬ويمكن أن تكون أورام المخ أو‬
‫األورام التي تظهر داخل القحف سرطانية (خبيثة) أو غير سرطانية (حميدة‪ ،‬ومع ذلك‪ ،‬تختلف تعريفات‬
‫األورام الخبيثة أو األورام الحميدة عن تلك المستخدمة بشكل شائع في األنواع األخرى من األورام السرطانية‬
‫أو غير السرطانية في الجسم‪ .‬ويعتمد مستوى التهديد على مجموعة من العوامل مثل نوع الورم وموقعه‬
‫وحجمه وحالته من ناحية التطور‪ .‬ونظًرا ألن المخ يكون محمًيا حماية جيدة من خالل الجمجمة‪ ،‬فإن‬
‫االكتشاف المبكر ألورام المخ ال يحدث إال عندما يتم توجيه أدوات التشخيص تجاه تجويف داخل الجمجمة‪.‬‬
‫‪.‬وغالًبا ما يحدث االكتشاف في المراحل المتقدمة عندما يسبب الورم أعراًض ا ال يوجد لها تفسير‬

‫وفي الغالب‪ ،‬تظهر أورام المخ الرئيسية (الحقيقية) في الحفرة القحفية الخلفية لدى األطفال وفي الثلثين‬
‫األماميين من نصفي الكرة المخية لدى البالغين‪ ،‬رغم أنها يمكن أن تؤثر على أي جزء من المخ‬

‫سرطان الدماغ‪ ,‬او الورم داخل القحف‪ ,‬يحدث عندما تتشكل خاليا غير طبيعية داخل الدماغ ‪ ,‬هناك نوعان‬
‫‪.‬رئيسيان من األورام‪ :‬الورم الخبيث (السرطاني)و الورم الحميد‬

‫األورام السرطانية تقسم إلى أورام اولية التي تبدأ داخل الدماغ او أورام ثانوية التي تنتشر من مكان اخر‬
‫لتنسقر داخل الدماغ او ما يعرف النقيلة في الدماغ‪ .‬في هذه المقالة سنتعامل مع االورام االولية‪ .‬جميع أنواع‬
‫األورام قد ينتج عنها أعراض تختلف حسب موقع الورم في الدماغ األعراض ثشمل‪ :‬الصداع‪ ,‬تشنجات‬
‫عصبية‪,‬مشكالت بصرية‪ ,‬استفراغ و اختالالت عقلية ‪ .‬الصداع بشكل تقليدي يكون في اسوأ حاالته خالل‬
‫‪P a g e | 50‬‬

‫الصباح‪ ,‬و يخف هذا الصداع عند االستفراغ ‪ .‬المشاكل األكثر تحديدَا تشمل‪ :‬صعوبة في المشي‪ ,‬الكالم و‬
‫‪.‬االحساس‪ .‬مع تطور المرض قد يصل المريض إلى حالة الالوعي (الغيبوبة)‬

‫سبب معظم أورام الدماغ غير معروفة‪ .‬تشمل عوامل الخطر العوامل الجينية الوراثية والمعروفة باسم الورم‬
‫العصبي الليفي‪ ،‬وكذلك التعرض للكيماويات الصناعية مثل الفينيل كلوريد ‪ ،‬وفيروس ابشتاين بار و‬
‫االشعاعات المؤينة ‪ .‬كانت هناك بعض المخاوف من اشعاعات الهاتف المحمول‪ ،‬لكنها لم تثبت علميًا‪ .‬األنواع‬
‫األكثر شيوعا من األورام األولية في البالغين هي‪ :‬السحائية (عادة تكون ورمًا حميدة)‪ ،‬و مثل الورم األرومي‬
‫الدبقي‪ .‬في األطفال أكثر االنواع شيوعَا هوالورم النخاعي الخبيث‪ .‬التشخيص يكون عادَة عن طريق الفحص‬
‫الطبي باالضافة للتصوير المقطعي المحوسب أو التصوير بالرنين المغناطيسي‪ .‬يثبت ذلك عادًة بأخذ خزعة‪.‬‬
‫‪ .‬بناء على نتائج االبحاث; نقسم األورام الي درجات مختلفة من الشدة‬

‫قد يشمل العالج الجمع بين الجراحة و العالج اإلشعاعي و العالج الكيميائي ‪ .‬قد تكون هناك حاجة إلى أدوية‬
‫اإلختالج في حالة حدوث النوبات‪ .‬يمكن أن يستخدم ديكساميثازون وفوروسيميد لتقليل التورم حول السرطان‪.‬‬
‫بعض األورام تنمو تدريجيا‪ ،‬األمر الذي يتطلب مراقبة فقط‪ ،‬وربما ال تحتاج إلى أي تدخل آخر‪ .‬حاليَا يتم‬
‫دراسة العالجات التي تستخدم النظام المناعي للشخص‪ .‬تختلف النتائج كثيرا تبعا لنوع الورم ومدى انتشاره‬
‫في التشخيص‪ .‬الورم األرومي الدبقي عادة ما تكون نتائجه سيئة في حين أن األورام السحائية عادة نتائجها‬
‫جيدة‪ .‬ويبلغ متوسط معدل البقاء على قيد الحياة لمدة خمس سنوات ‪ ٪33‬لمرضى سرطان الدماغ في الواليات‬
‫‪ .‬المتحدة‬

‫أورام المخ الثانوية أو المتنقلة هي أكثر شيوعا من أورام الدماغ األولية ‪ ،‬و ما يقارب النصف من‬
‫االنبثاثات تكون قادمة من سرطان الرئة‪ .‬تحدث أورام الدماغ األولية في حوالي ‪ 250000‬شخص سنويا‬
‫على مستوى العالم‪ ،‬التي تشكل أقل من ‪ ٪2‬من السرطانات‪ .‬في األطفال الذين تقل أعمارهم عن ‪15‬‬
‫أورام الدماغ تأتي في المرتبة الثانية بعد سرطان الدم الليمفاوي الحاد كسبب للسرطان‪ .‬في أستراليا‬
‫التكلفة االقتصادية في متوسط حالة سرطان الدماغ ‪ 1.9‬مليون دوالر‪ ،‬أكثر من أي نوع من أنواع‬
‫‪..‬األورام‬