Changing concepts in diagnosis and treatment of brain tumour

‘There is a misconception that every brain tumour will either kill or result in coma with multiple problems, mental and physical. However, a large majority of brain tumours can be treated successfully and most patients resume their normal life. The incidence of tumours in the central nervous system in Pakistan ranges from around 10 to 17 cases per 100,000 persons for intracranial tumours and 1-2 per 100,000 persons for intraspinal tumours.”

These statistics and facts were shared by eminent Prof Abdul Sattar M. Hashim, ex-head of the neurosurgery department, Jinnah Postgraduate Medical Centre, Karachi, on Saturday at a webinar organised by the prestigious Neurospinal and Cancer Care Institute.

“There are 120 types of brain tumours and at least 45 per cent of the brain tumours are non-cancerous and therefore timely treatment can lead to patients having a normal survival and normal function. Although a complex fatal disease, adequate diagnosis, evaluation and timely treatment can save many lives,” he said.

Highlighting the early signs and symptoms of brain tumours, Prof Hashim said: “The symptoms of a brain tumour depend on its location, because each part of the brain controls specific functions in the body. The symptoms also depend on the rate of growth and the rapidity with which the pressure rises inside the brain.

“Headache with persisting or projectile vomiting, altered sensorium or loss of consciousness, unexplained confusion even in normal things, seizures or fits in an adult, blurring of vision, impaired hearing or abnormal sounds in the ear, hormonal imbalance, drastic behavioral changes, difficulty in balancing are some of the few symptoms of brain tumours,” he said.

“Till date, the cause for brain tumour is not established though many theories are being pursued. Children who have got radiation in the head are at higher risks of developing brain tumours,” Prof Hashim further explained.

“Diagnosis of brain tumour begins with a physical exam and a look at the patient’s medical history. After the physical tests, the doctor will recommend further tests including MRI, CT scan etc.” he added. Not all brain tumours are alike. Cases can vary according to age and other factors, along with timely follow-ups and monitoring. Hence, the treatment of every tumour is decided by the location, size and stage, etc. “The treatment of brain tumours can include microscopic or endoscopic surgery, radiotherapy, chemotherapy, etc. The ongoing progress in medical science and technology has made treatment more advanced and chances of a patient resuming a normal routine are getting higher.

“Undoubtedly, major surgeries come with the risk of complications like weakness, hormonal imbalance, impaired vision or other problems, but in most cases after timely and proper treatment, patients can lead healthy lives.”

Prof. Hashim explained that a non-invasive Gamma Knife treatment is like getting a new lease of life for many brain tumour sufferers.

“Gamma Knife Stereotactic Radiosurgery is a gold standard in brain tumour treatment making it possible to completely eradicate brain tumours non-invasively (without surgery) with maximum precision. With the flexibility of the treatment to be done in one to five sessions, it provides comfortability to the patient and the maximum level of restricting the tumour from spreading further. The main advantage of Gamma knife radiation therapy is that it directly alters the individual deposits inside the brain without affecting the brain functioning,” shared Prof Hashim

Most importantly, stereotactic radiosurgery (SRS), i.e. Gamma Knife Icon, has been available at Neurospinal & Cancer Care Institute, Karachi, since 2009, which is indeed a very significant advancement in the treatment of brain tumours in Pakistan. This is an advanced treatment through sophisticated computer guidance to deliver a highly targeted and high dose of radiation that conforms to the shape and size of a tumour with fewer side effects.

For some patients, this single-day, high-dose treatment can replace the daily delivery of lower doses of radiation over a course of therapy that can last up to six weeks. Most patients tolerate the treatment very well, and because it’s typically done in one day, it causes very little or no interruption in the delivery of other treatments such as chemotherapy.

In addition, many patients can resume their normal activities the day after treatment. Awaiting patients for stereotactic radiosurgery include patients with the disease not surgically accessible or too advanced for neurosurgery, as well as those who cannot tolerate anesthesia. Despite being an expensive type of treatment worldwide, all state-of-the-art treatment facilities for brain tumour are provided free of cost to the deserving patients at the Neurospinal & Cancer Care Institute.

“The structure of brain is very complex. It can only be handled by highly qualified and experienced doctors. Negligence in treatment of diseases like brain tumour can be fatal and the only solution to avoid complications is proper and timely treatment from a recognised institute. Fortunately, in Pakistan we have most modern treatment technologies with low risks and better outcomes. To avoid any unpleasant situation, cured patients should also regularly undergo follow-up checkups.”