Definition

A brain tumor is an abnormal growth or mass of tissue in the brain originating from brain tissue. There are various types of brain tumors. Some brain tumors are benign (non-cancerous) while others are malignant (cancerous). Brain tumors can originate in the brain (primary) or be spread from tumors in other organs (metastatic). This article will focus on primary brain tumors.

Brain tumors affect approximately 3.7 per 100,000 men and 2.6 per 100,000 women worldwide. These rates are higher in developing countries (5.8 for men and 4.1 for women) and lower in developed countries. In Indonesia, the 2013 Basic Health Research (Riskesdas) data does not include the incidence rate of brain tumors. Data from RSUPN Cipto Mangunkusumo from 2011-2015 show that the average age of patients with primary brain tumors is 48 years, with a higher prevalence in women. The most common type of brain tumor is astrocytoma (47%). Data from RS Kanker Dharmais from 1993-2012 indicate that brain tumors account for 1% of all malignancies.

Causes

Primary brain tumors originate from brain tissue or surrounding tissues such as the meninges (the membranes covering the brain and spinal cord), cranial nerves, pituitary glands, and pineal gland. The growth of primary brain tumors begins when normal cells change due to mutations in their DNA. These mutations cause abnormal cell growth and division, leading to continuous growth and survival of these cells, forming a tumor. In adults, primary brain tumors are less common than metastatic brain tumors.

Some types of brain tumors based on their cell type include:

• Gliomas, which originate from the brain or spinal cord and include astrocytomas, ependymomas, glioblastomas, oligoastrocytomas, and oligodendrogliomas.
• Meningiomas, which originate from the meninges and are generally benign.
• Acoustic neuromas (schwannomas), benign tumors originating from cranial nerve VIII, responsible for balance and hearing.
• Medulloblastomas, which are most common in children, originate from the lower part of the brain and spread through cerebrospinal fluid.
• Pituitary adenomas, originate from the pituitary gland at the base of the brain, regulating hormones.

Risk factor

Factors that increase the risk of primary brain tumors include:

• Radiation exposure. Individuals frequently exposed to radiation have a higher risk of brain tumors. Examples include radiotherapy for cancer treatment or exposure to atomic bomb radiation.
• Family history of brain tumors. A small number of brain tumors are hereditary and influenced by genetics.

Symptoms

Symptoms of brain tumors depend on the tumor's location, size, and stage of development. Common symptoms include:

• Changes in headache onset or pattern
• Increasingly severe and frequent headaches
• Nausea and vomiting
• Vision problems, such as blurred vision, double vision, and loss of peripheral vision
• Progressive loss of sensation and movement in the arms
• Sudden seizures without a history of epilepsy
• Hearing loss
• Balance problems
• Speech difficulties
• Disorientation and confusion
• Difficulty making decisions
• Difficulty performing routine tasks and following simple instructions
• Changes in behavior and personality

Diagnosis

If a doctor suspects you have a brain tumor, several tests may be performed, including:

• Neurological exams to assess vision, hearing, balance, coordination, muscle strength, and reflexes to help identify the presence and location of the tumor.
• Radiological exams like MRI scans of the head, often with contrast injections, to diagnose brain tumors.
• Tissue biopsies, which can be part of surgical procedures to remove the tumor. Tissue samples are examined under a microscope to evaluate the tumor's type and malignancy.

Management

Treatment options for brain tumors depend on the tumor's location, size, and type. Doctors may use a combination of therapies, including:

• Surgery. If feasible, a neurosurgeon will perform surgery to remove the tumor.
• Radiotherapy. High-dose radiation can help destroy or kill tumor cells. Some patients may undergo radiotherapy first to shrink the tumor before surgery.
• Chemotherapy. Chemotherapy uses drugs to kill cells, administered orally or intravenously.
• Targeted therapy. Targeted therapy focuses on abnormalities in cancer cells to stop their growth.
• Post-treatment rehabilitation. Rehabilitation may be necessary to restore motor, speech, vision, and cognitive functions. Doctors may refer patients to medical rehabilitation, occupational therapy, and speech therapy as needed.

Complications

Primary brain tumors rarely spread to other organs. Complications may include weight loss, bone pain (in the back, ribs, and skull), abdominal swelling, breathing difficulties, and abnormal head shapes. These complications can worsen and become life-threatening. Brain tumors can cause bleeding and inflammation in the brain, increasing intracranial pressure, an emergency requiring immediate treatment. Brain herniation, where part of the brain is compressed due to high intracranial pressure, may occur, characterized by changes in breathing patterns and consciousness levels.

Brainstem tumor treatments can cause side effects such as anemia, digestive issues, skin and nail changes, prolonged fatigue, hair loss, increased bleeding risk, low immunity, and nausea.

Another complication is meningeal carcinomatosis, where brain tumors spread to the surrounding meninges, causing symptoms like fever, stiff neck, seizures, and/or decreased consciousness.

Prevention

Brain tumors cannot be entirely prevented, but the risk can be reduced by avoiding radiation and toxic substances, such as smoking. Early detection of symptoms can help with prompt treatment, preventing complications.

When to see a doctor?

If you experience the above symptoms, find them highly disruptive, notice worsening symptoms recently, or have a family history of brain tumors, seek medical attention promptly. Symptoms to watch for include:

• Persistent vomiting
• Severe and worsening headaches
• Breathing difficulties
• Weakness in arms or legs, changes in sensation, and speech problems
• Loss of consciousness
• New or worsening seizures

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