A brain tumor is undoubtedly one of the most frightening diagnoses for a patient. In addition to mortal danger awareness, patients are frightened by the threat of losing important body functions – motor, tactile, visual, auditory, speech, etc. Possibility of a decline in cognitive abilities, which define us as a person and a human in the broad sense of these words, is frightening.
A brain tumor can develop in any person, regardless of age – both in children, and in young people, and in adults in the prime of life, and in elderly patients. Psychologically, this ordeal is experienced differently in each age group, but everyone feels a sense of hopelessness and confusion. Close relatives also feel the same. Making such a diagnosis can be a turning point in life and immediately set the vector for reconciliation with the disease or set it up for struggle. Therefore, in such cases, a complex approach to patient management is required with obligatory application of practical psychotherapy and a highly qualified oncologist.
Such specialists work in the Maimonides Multidisciplinary Medical Center. Our oncology department operates in close and fruitful cooperation with the best Israeli oncology centers. Adult oncology project is headed not only by the head of department at Maimonides Center, Dr. Stefanska Iryna, but also a responsible Israeli highly qualified specialist in the field of adult oncology. Each individual clinical case is monitored by Israeli colleagues. So if it is necessary, the attending oncologist can at any time ask for advice from his foreign colleague or even organize an online consultation for a specific patient. Thus, in Ukrainian conditions, our patients get access to the best and most effective Israeli medicine.
Modern treatment of brain tumors is an expensive process and, unfortunately, not everyone who needs it can afford it. Therefore, Maimonides Medical Center works under the patronage of “Keren Or for our Child” the Charitable Foundation, which provides financial assistance for seriously ill patients treatment.
Brain tumors are very complex diseases, but with properly organized help, they are completely curable .To increase the chances of recovery and further full life, in Oncology Department Maimonides Medical Center, a whole multidisciplinary team helps one patient – oncologists, neurologists, neurosurgeons, therapists, rehabilitators, radiation therapists, chemotherapists, speech therapists, physical therapists, psychologists and other necessary narrow specialists. They organize their practical activities only in accordance with modern recommendations and global treatment protocols, and do not use domestic instructions from 20 years ago, so the patient can be sure that he will receive only modern and effective treatmentbased on the principles of evidence-based medicine.
At the same time, the approach to each clinical case is individual. It means that doctor does not use one template or a single treatment scheme for everyone. Examination and therapy plan is selected for each patient separately (patient-oriented approach), taking into account his main diagnosis, tumor size and distribution, damaged brain functions, stage of the disease, age, comorbidities and wishes of the patient himself. This approach allows to get the best results both for the patient (improves the prognosis) and for the doctor (good compliance).
Only highly qualified specialists work in Maimonides Oncology Department, most of whom have repeatedly trained in world most famous oncology clinics. All of them perfectly master modern diagnostic and treatment procedures, have communication skills with oncology patients. If a certain narrow specialist or specific medical and diagnostic equipment is not available, the patient is redirected to affiliated institutions of Maimonides Medical Centeror our Israeli partner clinics, where he is guaranteed to receive the full range of necessary medical services, where he is guaranteed to receive the full range of necessary medical services.
Brain tumors causes and symptoms
Intracranial tumors can affect directly brain, or some structures in skull cavity – cranial nerves, meninges, cerebral vessels. They occur in people of all age groups – from children to elderly patients. Young and middle-aged people suffer most often, although cases of brain tumors among the elderly has increased significantly in recent years.
Despite the fact that some intracranial tumors are benign, all tumors in skull cavity are dangerous not only for health, but also for life. The fact is that cranial cavity is a closed space, and when an additional neoplasm appears inside it, which grows, it compresses the neighboring fragile nerve structures, increases intracranial pressure, and develops corresponding symptoms and complications. Therefore, any intracranial formation (benign or malignant) s extremely life-threatening and requires active treatment tactics.
Unfortunately, as with most oncological diseases, the exact brain tumors causes are currently unknown. There is a connection between the influence of certain factors and an increase in frequency of such neoplasms. Among the main risk factors for brain tumors development should be mentioned:
- Genetic susceptibility to tumors of certain species – certain mutations carriers in various genes have an increased risk of intracranial neoplasia.
- Negative impact of some oncogenic viruses.
- Ionizing radiation effect, for example, a course of radiation therapy in past for another malignant disease.
- Carcinogenic effects of certain chemicals.
Symptoms caused by both primary tumors and metastatic lesions are identical. The vast majority of pathological manifestations are related precisely to an intracranial pressure increase against the background of neoplasm, that increases in size inside skull.
Headache is the most common symptom. It can be most intense in morning after a night's sleep. Headache also progresses as tumor grows, and may worsen in a horizontal position. With very high intracranial pressure, pain may be accompanied by vomiting and nausea, which do not bring relief to patient.
The second most frequent symptom is a variety of non-specific changes in the mental state . Among such manifestations are drowsiness, apathy, personality changes (for example, aggression appearance, which was not inherent until now), behavioral changes and cognitive impairment, especially in malignant brain tumors.
Focal brain dysfunction can cause a variety of symptoms – it all depends on tumor location in the brain. The most common are focal neurological symptoms (sensitivity impairment, mobility, vision, speech, hearing, etc.), endocrine disorders (especially with pituitary tumors) and convulsions (most often focal – a certain group of muscles, sometimes with secondary generalization).
Epileptic seizures are also possible (more often with primary brain tumors, less often with metastatic ones). Consciousness disturbance of varying degrees (stupor, sopor, coma) may be a cause of brain impingement in the large occipital foramen began, due to high intracranial pressure, brain stem damage by a tumor process, or diffuse bilateral damage to the cerebral cortex.
Some tumors lead to meninges inflammation, simulating meningitis.
Types of brain tumors in adults
As already mentioned, brain tumors, depending on their ability to grow and metastasize, are divided into benign and malignant. Both of them are dangerous to health, life and require active treatment in case of detection.
Also, brain neoplasms are divided into primary (appear and grow directly in skull cavity) and secondary (metastases of distant primary tumors, for example, lung or breast cancer). Brain metastatic lesions among adult population occur 10 times more often than primary neoplasms.
Most often, adults have to face the following types of brain tumors:
- Neuromas. These are benign neoplasms from Schwann cells (schwannomas). The roots of the spinal cord, peripheral nerves, including cranial nerves (auditory, trigeminal, visual, facial, etc.) are most often affected.
- Gliomas (astrocytomas). Basically this benign tumor are nerve cells, astrocytes. Gliomas grow slowly and require comprehensive treatment.
- Meningiomas. This is a benign type of tumor, but over time it transforms into a malignant one, spreading metastases to nearby tissues. It is formed from meningeal membrane tissues of brain or spinal cord.
- Craniopharyngiomas. This is a benign tumor located in pituitary gland. As the tumor grows, pituitary tissue is compressed and corresponding endocrine disorders occur. So such a tumor must be surgically removed.
- Pituitary adenomas. These are benign tumors that can be a source of hyperproduction of pituitary gland certain hormones. It means that, such tumors can be hormonally active, due to this corresponding symptoms of endocrinological disorders appear. Often there are also inactive adenomas that do not release additional portions of hormones. Adenoma danger lies not only in hormonal activity, but also in nearby anatomical structures compression. In particular optic nerves intersection which can cause the patient loses vision. Therefore, adenomas are subject to surgical treatment in case of hormonal activity or large sizes and optic nerve compression risk.
- Ependymomas – these neoplasms develop from ependymal cells that normally lined inside brain ventricles (cavities in brain filled with cerebrospinal fluid). Such tumors metastasize extremely rarely and mainly with cerebrospinal fluid flow. Although there are also primary malignant varieties, for example, anaplastic ependymoma.
- Hemangiomas and hemangioblastomas are a benign and malignant variant of tumor that primarily develops from blood vessels. First of all, such neoplasms are dangerous due to intracranial hemorrhage development.
- Dysembryogenetic tumors are rare pathology for adults, as these neoplasms are congenital and are diagnosed mostly in early childhood. Such tumors develop from embryonic (germ) cells. As a rule, they are malignant and have an aggressive course.
- Glioblastoma is a primary malignant tumor characterized by rapid invasive growth and rapid metastases spread.
- Choroid papilloma is a benign tumor from the vascular plexuses of brain ventricles, which can block cerebrospinal fluid outflow and lead to intracranial hypertension, and even hydrocephalus in children.
- Metastatic lesions of the brain.
Diagnosis methods of brain tumors
The stage of diagnosis is extremely important for a successful fight against a disease, and even more so with oncological one. Examination process should be quick and 100% reliable. At Maimonides Clinic, every patient can count on accurate and quick diagnosis. All our doctors masters modern examination methods, accurately interpret obtained data after testing. So error risk is close to zero. Alco modern and safe equipment makes examination process quite comfortable for the patient.
Diagnosis begins with an in-person doctor's consultation, complaints gathering, making up a history of life and illness. Besides complete examination of organs and systems, complete neurological examination is conducted. Next, depending on what pathology the specialist suspects, patient is directed to a number of additional diagnostic methods:
- Various blood and urine, determination of specific tumor markers in the blood.
- Lumbar puncture and obtained cerebrospinal fluid examination.
- Ultrasound examination.
- Head, neck, spine vessels vessels angiography.
- Modern methods of medical neuroimaging – CT, MRI with or without contrast, digital radiography of skull, PET-CT, PET-MRI for scanning the whole body (allows to accurately detect primary tumor and existing metastases).
- Neurophysiological diagnosing methods of brain functional state – EEG, Echo-EG and others.
- Target biopsy if necessary (when tumor type cannot be established based on data obtained from additional neuroimaging methods), cytological and histological examination, tissue samples immunohistochemical and immunofluorescence examination (for example, parts of tumor) to determine tumor subtype, the most effective for this type of neoplasms treatment regimen.
An indisputable advantage for our patients is that all biopsy samples are sent to the best molecular laboratories and pathogistological clinics in Israel, USA, and Germany for revision. Thanks to such “double checks”, we are absolutely sure of diagnosis correctness and selected treatment regimen efectiveness.
If it is necessary to obtain part of the tumor tissue before surgery for histological examination, such an innovative procedure as stereotaxic biopsycan be applied,also using a fluorescent marker (ALA5). This is a surgical procedure aimed at taking brain tissue samples for pathohistological (or other) examination.
A stereotaxic biopsy is most often provided in cases where a process has been found on brain MRI, the nature of which is unclear, or when an accurate diagnosis (including a molecular profile) is required before oncological personalized treatment began.
A biopsy is performed by inserting a biopsy needle through a tiny 2-millimeter hole in skull bone into previously identified tumor. This procedure is provided under sophisticated neuroimaging tools control with digital navigation system help. It which allows to achieve an extremely high level of accuracy even for tumors localized deep inside brain.
To make sure that biopsy is suitable for further research, that is, the sample is taken from exact area of tumor (and not at the edge of healthy tissue), a fluorescent marker (ALA5) is used. Patient takes it orally (drink) a few hours before surgical intervention. ALA5 marker must stain the tumor with a fluorescent dye. After this, with one of neuroimaging techniques assistance, under the control of which biopsy is provided, the neurosurgeon will see stained area illumination and definitely won't go wrong with place where the tissue sample is taken.
Molecular diagnostics (molecular genetic research) is an integral part of oncological diseases modern diagnostics. The direct cause of many tumors is a mutation in a certain gene, due to which it begins to function incorrectly, and such mutation cell acquires signs of malignancy and ability to divide and grow uncontrollably. Thanks to molecular genetic diagnostics, we can find these mutations and choose the most effective therapy regimens, because the response to certain drugs effect depends on the type of mutations. One such test system for molecular genetic testing is Foundation One panel and Caris Molecular Testing. Our patients have access to such innovative diagnostics.
Many innovative and modern diagnostic methods are used in our clinic. Their selection is the responsibility of oncologist, depending on clinical situation of each patient. All necessary diagnostic procedures can be provided directly at Maimonides Medical Centerwithout leaving Ukraine.
Brain tumors modern treatment
Brain tumors are very complicated diseases, as almost all vital functions of the body can suffer. In our Oncology Department, a whole multidisciplinary team works on one patient’s treatment, all decisions are made in consultation, and treatment plan is coordinated with the best Israeli specialists in the field of adult oncology.
Brain tumors treatment is a complex process with applying of certain combinations of traditional methods (surgery, radiation therapy, chemotherapy) and modern ones (targeted therapy, immunobiological therapy, etc.), and sometimes even experimental methods.
At Maimonides Medical Center, most brain cancer surgeries are provided applying minimally invasive techniques through transnasal endoscopy. This technique involves endoscope introduction and necessary microsurgical instruments through the nasal cavity, without skull integrity violation. For example, using transnasal endoscopy method, neurosurgeons of our department provide the most complex surgeries to remove pituitary tumors. Because of minimal surrounding tissues traumatization, patient recovers after surgery in a few days without complications.
In cases where access to a brain tumor is difficult or impossible through transnasal access, neurosurgeons provide open surgery on brain structures – craniotomy. This technique involves skull small opening creation, through which specialists gain access to the tumor.
As a rule, craniotomy is provided under general anesthesia, but neurosurgeons also use in their practice a modern technique of surgical intervention an awake craniotomy is performed (craniotomy in consciousness), which involves intervertion in brain structures under local anesthesia. During surgery, patient is in conscious and communicates with doctor, following the necessary commands. This approach allows the doctor who removes tumor to monitor work of functionally important areas of central nervous system and not to damage them. The entire surgery takes place under the control of modern equipment.
Chemotherapy is one of the main treatments methods for brain cancer and is almost always used in combination with surgery and/or radiation therapy. Modern chemotherapy drugs are used to destroy residual atypical cells and small metastases after tumor surgical removal. Sometimes, in inoperable patient’s treatment(for whom surgery is not indicated due to significant spread of the process or surgical procedure is contraindicated due to other circumstances), and patients diagnosed with medulloblastoma and lymphoma (the most sensitive to chemotherapy), chemotherapy is the main treatment method. Chemotherapy can be systemic, which is used most often, and local.
An example of local chemotherapy for brain tumors (brachytherapy) can be implantation in the patient's cranium, after neoplasm surgical removal, such a plate with Gliadel chemotherapy drug. These are special tanks with a chemotherapy drug that destroys tumor cells. Acting directly on affected tissues, drug destroys the smallest malignant cells without causing significant side effects like systemic chemotherapy. Gliadel plates implantation significantly reduces recurrence risk of brain cancer in future.
At Maimonides Oncology Center, only the latest generation chemotherapeutic drugs are used for cancer treatment, which have a minimal number of unwanted reactions from healthy organs and tissues. Doctors select chemotherapy drugs for each patient individually, based on the results of modern molecular genetic tests. This approach allows us to find the most effective medicine for a specific tumor, accurately calculate the required number of chemotherapy courses and their duration.
Radiation therapy is also actively applied in complex brain tumors treatment. Both remote radiation therapyusing linear accelerator devices and various modern modifications of radiotherapy are used. For example, radiation therapy using RapidArc technology, which allows us to increase irradiation intensity by 80% and shorten of session duration by approximately 5 times.
Modern stereotaxic radiosurgery devices are also actively used. This treatment technique involves radioactive radiation impact on neoplasms from several sides at once. Procedure is provided under MRI control using a modern TrueBeam device. The power of this device allows non-contact removal of small brain neoplasms in one session. Due to such planning and navigation system, the surgery is provided with maximum accuracy, without damaging healthy surrounding tissues.
Immunobiological and targeted therapy are used in modern cancer centers to help patients with brain cancer. Thanks to patient's immune system activation with their own, specially "trained" to attack malignant cells, leukocytes, oncologists manage to slow down the growth and stop tumor metastasis, improve the general condition and well-being of cancer patient. Biological treatment advantage over radiation and chemotherapy is the possibility to use it for elderly and severely debilitated patients.
At Maimonides Clinic all treatment schemes for patients with brain tumors are developed by world experts in the field of health care organization, they have successfully passed the test, have a large evidence base, and are honed by our specialists to the smallest detail. It makes the entire diagnostic and treatment process fast, convenient and efficient.