August 9, 2022

BRAIN TUMORS… Together we are stronger!

World brain tumor day was celebrated last month to raise awareness about brain tumors and dispel related misconceptions and with theme “together we are stronger”, Heeding the advocacy call-to-action for increased awareness, this piece aims to enlighten us about brain tumors, the risk factors, symptoms, and treatment options.

Brain tumors are abnormal growths within or around the brain.

The brain is a complex organ that is vulnerable to insults from trauma, infections, tumors, drugs including alcohol, metabolic disorders, to mention few. Nature’s way of protecting the brain from external insults was to keep it enclosed within the rigid skull (cranium). It is also shielded from within using what we call the ‘blood- brain barrier’ to keep foreign agents at bay.

Each part of the brain is dedicated to a specialized function, for example, movement of a body part, speech comprehension, vocalization, swallowing, consciousness, hormonal balance, behaviour, memory, emotion, motivation, coordination of movements, breathing, temperature, feeling of hunger and satiety, amongst others. With long-standing compression of the brain by a tumor, parts of the brain start to wither to accommodate the tumor such that even after tumor removal, the functions of these representative areas of the brain may never be fully regained despite aggressive rehabilitation therapy.

Brain tumors can be classified as benign or malignant, or as primary or secondary. Benign tumors are non- cancerous, tend to grow slowly and have less chance of recurring once completely removed at surgery. Malignant tumors however are cancerous and often grow rapidly, with high propensity to recur despite surgical intervention. Primary tumors arise from structures within and around the brain whilst secondary tumors get to the brain via spread (metastasis) from other tumors like breast, lung, thyroid cancers, etc.

Brain tumor size is not often proportional to the severity of symptoms, as a bean-sized tumor in a delicate part of the brain for example, the brain stem, can present devastating symptoms as opposed to a tennis-ball-sized tumor located in a less delicate part of the brain.

The cause of brain tumors is largely unknown. However, risk factors include family history of brain tumors, genetics, exposure to ionizing radiation, certain chemicals, and viruses. There have been studies to define the association of brain tumors with the use of cell phones, but no convincing data has emanated. However, there is suggestion that chronic use of cell phones for at least 10-years may increase the risk. The World Health Organization (WHO) recommends limiting cell phone use and promotes the use of hands-free headset.

Symptoms in persons with brain tumors include acute or persistent headache, often worse in the early hours of the morning and associated with vomiting. An adult having a first-time seizure has a likelihood of this being caused by the presence of a tumor (commonly) or some other pathology in the brain. Other symptoms could include worsening eyesight, hearing loss, milky nipple discharge, personality changes, new-onset unsteadiness of gait, weakness or heaviness of a limb or body part (sometimes misdiagnosed as stroke), uncoordinated motor movements, new- onset difficulty speaking or comprehending spoken words, altered consciousness, etc.

Diagnosing brain tumors begins with clinical review by a neurosurgeon, neurologist, or any experienced clinician. Investigations are done to look-into the brain and sometimes to assess its function. Treatment options are discussed once a brain tumor is detected.

Treatment options for brain tumors include surgery to remove the tumors. The goal of surgery is complete tumor removal, preservation of normal brain function, and acquisition of tumor sample for laboratory confirmation of its nature. These surgeries are done by neurosurgeons who employ a wide range of gadgetry to safely take out the tumor. In some instances, especially in the Nigerian setting where late presentation to the hospital is common, complete brain tumor removal may not be feasible. In such scenarios, the surgeon may plan a subsequent surgery or offer other treatment modalities to address the residual tumor.

Malignant (cancerous) brain tumors have a high propensity for recurrence. For these tumors, adjuvant treatment like radiotherapy, and sometimes chemotherapy is employed. Some pituitary (a gland attached to the brain) tumors may be amenable to the use of medication.

The prognosis (expectation or outcome) in patients with brain tumors depends on a host of factors such as the tumor type, size, the presence or absence of brain deficits, patient’s age and fitness level, co-existing illness, etc. The role of multidisciplinary care and rehabilitation therapy in managing patients with brain tumors is critical.

As the phrase goes, “Time is Brain”. In pathologies relating to the brain, be it trauma, infection, tumors, stroke, etc, it cannot be over- emphasized that early diagnosis and treatment is crucial.

Brain tumor survivors and individuals with brain tumors require our support. With appropriate treatment, they have the chance of leading normal lives like their counterparts without tumors. Let’s spread love and not stigmatization. Together, we are stronger.

Author: Dr. Edward Jolayemi

Dr Edward Jolayemi is currently a Neurosurgeon at Evercare Hospital Lekki with experience in a diverse range of brain and spine pathologies.

He is a radiates of the College of Medicine, University of Lagos. He had his neurosurgical training at the Lagos University Teaching Hospital, with additional neurosurgical exposure at the Groote Schuur Hospital, Cape Town South Africa. 

Dr Jolayemi’s competence spans the fields of neuro- trauma, neuro- oncology, paediatric neurosurgery, pituitary surgery, neurovascular and spine surgeries.

He is a Fellow of the West African College of Surgeons, and of the National Postgraduate Medical College of Nigeria. He is an active member of both local and international neurosurgical professional bodies.

Article written by Dr Olaoluwa Edward Jolayemi.