National Cancer Centre Singapore
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Brain Cancer

Overview
Causes and Risks
Symptoms
Diagnosis
Treatment Options
Frequently Asked Questions
National Cancer Centre Singapore
Contributed by National Cancer Centre Singapore

Overview

What is Brain Cancer?

Brain cancers are generally named after the tissue in which they arise. Majority are glima arising from glial cells in the brain. These include astrocytomas, oligodenrogliomas, ependymomas and mixed cell type gliomas. The other forms of brain cancers are meningiomas, medulloblastomas, chordomas and central nervious system lymphomas.

Brain cancers can be fast growing (high grade), such as glioblastoma multiforme or slow growing (low grade), such as pilocytic 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 1992 there were about 580 cases reported. Most were astrocytomas and glioblastoma multiforme.

Age of Onset

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


Causes and Risks

Little is known regarding the cause of brain cancer. These cancers are characterised by a variety of appearances at surgery and under the microscope and by gene analysis.


Symptoms

Symptoms and Signs of Brain Cancer

Adults with brain cancers are usually diagnosed after they developed 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 of one side of their body similar to a stroke.


Diagnosis

Diagnostic Tests

Computerised scans (CT) and magnetic resonance scans (MRI) of the brain are able to diagnose 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, biopsy is not attempted because the risk of causing damage to neighbouring important structures is very high.


Treatment Options

Treatment of Brain Cancer

Surgery reduces the amount of brain cells cancer and also provides the pathologist (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 to have a shunt put in surgically leading from within the skull to the abdomen. This shunt drains some of the fluid within the skull and therefore reduces some of the pressure within the skull.

Radiotherapy is often indicated once the diagnosis of brain cancer is made. Radiotherapy consists of high-energy rays directed onto the cancer and the surrounding tissues. Usually 5 to 8 weeks of radiotherapy is delivered. Patients may experience hair loss and some lethargy during the treatment period.

Chemotherapy is not always used. Fast growing brain cancers respond better to chemotherapy than slow growing brain cancers. Patients who have recurred after surgery and radiotherapy or patients whose cancers have not responded well to radiotherapy are considered for chemotherapy. Chemotherapy drugs are given orally as well as by injections.

Recently, the use of wafers containing drugs and implanted into the brain cancer at the time of surgery to reduce the growth of the cancer has been studied.

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. Then, the appropriate course of treatment will be put into action. The treatment strategy will vary from person to person. With prompt and appropriate treatment, the outlook for a person with brain cancer is reasonable. The doctor looks for certain features. Young patients survive longer than older patients with brain cancer. Other features that are important are the patient's exact type of brain cancer, the extent of brain function affected by the cancer and whether the cancer can be operated on.


Frequently Asked Questions

I have headaches all the time. Can I be suffering from brain cancer?

Headaches have many causes, such as stress, eyesight problems, and migraine. Seek medical consultation if there are worrisome symptoms, such as vomiting, double vision, weakness of one side of the body, seizures or if the headache is getting progressively worse.

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 spread to the brain does not necessary mean it is immediately life-threatening after appropriate treatment.

Cancer Resources on the internet

American Cancer Society : www.cancer.org
Cancer Care, inc. : www.cancercare.org
Cancer Information Service (National cancer Institute, USA): www.nci.nih.gov
CancerNet (National Cancer Institute, USA): www.cancernet.nci.nih.gov 


For further enquiries on brain cancer, please call the Cancer Helpline at (65) 6225 5655 or email to cancerhelpline@nccs.com.sg.