Brain cancer is a cancerous tumour of the brain. Tumours can be benign or malignant.
Benign (non-cancerous) tumours are slow to form and most often remain isolated from neighbouring brain tissue. They do not spread to other parts of the brain or other organs and are generally easier to remove by surgery than malignant tumours.
Malignant (cancerous) tumours multiply and develop rapidly. It is not always easy to distinguish them from neighbouring tissues. As a result, it is sometimes difficult to remove them completely without damaging the surrounding brain tissue.
Brain tumours also differ according to their origin and location.
Benign and malignant tumors are classified into different groups:
Primary brain tumours are those that originate in the brain. They can be benign (non-cancerous) or malignant (cancerous). Their name comes from the brain tissue in which they develop.
Among the most frequent malignant tumours are:
• Glial tumours or gliomas (malignant tumours) represent 50 to 60% of all brain tumours. They are formed from glial cells, cells that act as a support structure for nerve cells (neurons).
• Medulloblastomas (malignant tumours) develop from the spinal cord to the embryonic stage. These are the most common brain tumours in children.
• Finally, among the benign primary tumors, which are rarer than malignant primary tumors, there are hemangioblastomas, meningiomas, pituitary adenomas, osteomas, pinealomas, etc.
Secondary or metastatic tumours are malignant (cancerous) and come from other organs where there is cancer and whose tumour cells have migrated to the brain and multiply there. Tumor cells are transported by the blood and most often develop at the junction between the white matter and the grey matter of the brain. These secondary tumours are more frequent than primary tumours. In fact, it is estimated that 25% of people who die from all types of cancer have brain metastases. Among the most common tumours that cause brain metastases: breast cancer, lung cancer, skin cancer (melanoma), kidney cancer, colon cancer, etc.
Brain cancer causes symptoms when it puts pressure on the brain or destroys brain tissue. Headaches can be caused by a brain tumour associated with nausea and vomiting.
• Vision and hearing disorders
• Dizziness or balance disorders
• Coordination problems
• Memory disorders
• Convulsive seizures
• Partial paralysis
• Loss of consciousness
• Loss of appetite
• Cancer of the breast, lung, skin, or blood cells (leukemia or lymphoma) can also spread (form metastases) to the brain, causing metastatic brain cancer.
• Ethnic origin
• Exposure to radiation therapy
• Exposure to chemicals
• Family history.
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Duration of hospital stay
3 to 8 days.
Depending on each patient, the duration varies.
Average length of stay
6 to 8 weeks.
The length of stay varies according to the patients.
Several stays may be necessary.
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The patient will have to undergo several examinations, such as magnetic resonance imaging (MRI), PET scan (positron emission tomoscintigraphy) and CT scan, to accurately locate the tumour. A biopsy (sampling of tumor tissue for analysis) is essential to determine the benign (non-cancerous) or malignant (cancerous) nature of the tumor.
Biopsy is performed by drilling a small hole in the skull bone and is performed under local or general anesthesia.
Patients will meet with a doctor to discuss the best treatment for their brain tumour. If the tumor is accessible, the doctor may recommend surgery to remove the entire tumor.
The patient will then meet a neurosurgeon who will perform the surgery. The neurosurgeon will explain the operation and answer any questions the patient may have.
Before the surgery, the patient will be advised not to eat or drink the day before the operation in order to prepare for general anesthesia. A neurological examination is performed before and after the operation to compare the pre- and post-operative results.
Surgical removal is done by craniotomy, under general anaesthesia: the patient's hair is first shaved about 1 cm wide on either side of the area to be cut. The skin of the skull is also incised and folded down to uncover the bone facing the tumour. The skull and then the meninges are opened a few centimetres.
The surgeon can then intervene: he/she removes part or all of the tumor tissue. The meninges are then sewn together, the bone rested and reattached to the rest of the skull by wires or metal fasteners. Finally, the skin is sutured for healing.
To ensure that surgical removal is as accurate and minimally invasive as possible, several technical aids exist:
Neuronavigation makes it possible to locate and access the tumour with great precision. A 3D image of the brain is first reconstructed by computer from the images obtained by MRI and/or scanner. Thanks to this image, the neurosurgeon can determine the best approach technique and the most appropriate and least risky surgical procedures in terms of sequelae. During the procedure, a camera system maps the images of the brain as recorded live to the 3D images that were previously reconstructed. The surgeon can then direct his surgical instruments to match their position to that which had been planned.
When the tumour is close to very well defined areas of the brain that control essential functions, the surgeon has the opportunity to stimulate them during the procedure. With a stylus, he delivers small impulses to the areas near the tumor and observes the functions they control: he can thus more precisely identify those associated with important functions that he must avoid during the procedure.
The duration of a craniotomy can vary. Depending on the complexity of the procedure, it generally lasts 3 to 5 hours but may last longer if the operation is very complex.
If the tumor is not accessible to traditional surgery, gamma knife radiosurgery may be considered. More precise and powerful than radiotherapy, this technique uses powerful radiant beams, directed at the tumor in a single step and precisely and directly on the tumor, for a few minutes or hours. It does not require a skull opening or a drill hole.
The patient who has undergone cranial surgery may suffer from headaches and local pain. These symptoms can be relieved with appropriate medication.
After the operation, the operated area may also bleed and the patient may have edema of the brain, face and eyes (related to retraction of the skin of the skull); these usually disappear after one week, during which specific treatment may be prescribed.
Healing of the skin usually takes place after one week. The bones of the skull are gradually re-soldered in a few days to a few weeks. The hair grows back normally and completely masks the scar after a few weeks.
In most cases, the symptoms that were due to the tumor resolve within a few days or months.
However, even if it is generally uncomplicated, brain surgery can sometimes lead to sequelae. This organ is particularly delicate to operate and its recovery capacity is relatively limited. The neurosurgeon therefore informs the patient of the potential consequences of the proposed operation.
It is sometimes difficult to eliminate all brain cancer cells. If some of them remain in the brain, the tumour may reappear. Regular monitoring and surveillance are therefore essential. Chemotherapy and radiotherapy sessions may be scheduled before and after the procedure.
In some cases, radiation therapy is directed to the tumor only. In others, the entire brain is irradiated after surgery, for example, to destroy the remaining tumour cells, or when several tumours are lodged in the brain (metastases) and cannot be removed by surgery.
Chemotherapy is also used to better control the disease. Innovative approaches include introducing a small disc directly into the brain after surgery to diffuse chemotherapeutic agents into brain tissue for a few weeks.
In addition, due to the possible neurological sequelae due to the tumour or its treatment, a rehabilitation period is often necessary. It requires the help of specialized practitioners with the help of specialized therapists (physiotherapist, occupational therapist, speech therapist, etc.).
**Once the cancer treatment is completed, a follow-up is performed to: **
• Monitor the response to treatment of the treated patient
• Identify any long-term side effects
• Monitor the general well-being of the treated person
• Check for any signs of cancer recurrence
• Monitor for the absence of the development of A second cancer.
Some complex diseases such as cancer can lead some patients to seek a second medical opinion. Almost 50% of patients using the second medical opinion have seen their treatment options evolve. Seeking a second medical opinion is perfectly legitimate when faced with a serious illness.
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