Brain Tumors: An Overview of Brain Tumors
Guest: Dr. Sunil Patel – Neurosurgery
Host: Dr. Linda Austin – Psychiatry
Dr. Linda Austin: I’m Dr. Linda Austin. I’m interviewing Dr. Sunil Patel who is Chief of Clinical Neurosurgery here at the Medical University of South Carolina. Dr. Patel, one of your areas of great interest and contribution has been in the surgical treatment of brain tumors. Now, everybody who’s ever had a bad headache has wondered if they might have a brain tumor. So, let’s talk about just what is such a tumor and what are the common ways, first, that a patient might be aware that they have the symptoms of a brain tumor.
Dr. Sunil Patel: The brain, like any other organ in the body, is prone to having tumors. There are tumors in the lung, tumors in the kidney, like that. You can have a variety of tumors occurring in the brain. In general, tumors, by definition, are tissue that grows in an uncontrolled fashion. And, depending on the growth rate and a variety of other characteristics, generally, tumors in the brain are divided into benign tumors and malignant tumors. That’s a very basic differentiation. There are a lot of gradations between benign and malignant.
Typically, what we mean by malignant tumors is that these tumors are not curable with one mode of therapy, that surgery alone is not enough, that they would tend to come back after surgery. In many cases of malignant brain tumors, the tumors require radiation or chemotherapy, things like that.
Then, at the other of the spectrum are the benign brain tumors where the tumor is much slower-growing, better contained, easier to remove surgically or easier to treat with simple treatments. There are some very rare tumors that you can treat without surgery. Most of the benign brain tumors are curable with surgery alone. That’s sort of a broad view of brain tumors and the types of brain tumors that occur in the brain.
Dr. Linda Austin: Just to go a little bit further, as I understand, sometimes these tumors originate in the brain, sometimes they may have originated somewhere else in the body and spread to the brain.
Dr. Sunil Patel: That’s correct. So, what I just finished talking to you about are what we consider primary tumors of the brain, meaning, tumors that originate in the brain. Secondary tumors are what we call metastatic tumors, or cancers, such as lung or breast or any other, that spread to the brain. And neurosurgeons do involve themselves in taking care of metastatic brain tumors.
In fact, interestingly, statistics show that we’re seeing more and more patients with metastatic brain tumors because patients with cancers elsewhere are living longer. When those patients live longer, they tend to progress with their cancers more with metastatic disease, and often the brain is a common location for tumors to spread to. So, we, in neuroncology, which is the field in neurosurgery that deals with brain tumors, are getting busier now with metastatic cancer. And it certainly has given us added challenges to treating that type of cancer.
Dr. Linda Austin: Let’s start with just talking about what some of the presenting symptoms might be and what you, as a neurosurgeon, would do in order to evaluate that. What are the most common symptoms patients complain of?
Dr. Sunil Patel: If you look at the list of symptoms that occur with brain tumors, you’d be surprised to see that about any symptom can be related to a brain tumor. But there are some very common symptoms to be aware of. Probably the number one would be headaches. A mass in the brain causes pressure and any pressure inside the head is going to give headaches. That doesn’t mean that every patient with a headache has a brain tumor, because, as headaches go, brain tumor is the least common cause. So, it would have to be a headache that’s constant and worsening, not a steady headache, but a headache that worsens over a period of weeks to months.
Dr. Linda Austin: And typically doesn’t go away?
Dr. Sunil Patel: And typically doesn’t go away with regular medications. It’s a progressive headache. It may start as a mild headache and a week later, it becomes the worst headache, worse than ever before. So, it’s a progressive headache. But headache alone is not a very good symptom to hang your hat on in terms of diagnosing brain tumors. Remember, this is the brain and it’s probably one of the most functional organs in the body, if I may say so. It has many different functions that it does, including our ability to see, hear, move things, feel things. So, if you have a brain tumor in any location in the brain, it’s going to affect some function.
If you think of it that way, then a headache associated with a loss of some sort of bodily function, say, a weaker arm or a weaker leg, an inability to see or hear, taste, difficulty talking, now you have, associated with the headache, a neurological symptom of some sort. Some people may recognize it as a stroke, as something’s not working. So, those two combinations are beginning to sound like you’ve got a mass lesion in the brain.
Then there are additional things. As a mass grows in the brain and the pressure is created, you not only have a headache but the pressure also creates effects on your visual pathways. So, patients with large brain tumors will come in complaining of a headache and blurry vision. And that blurry vision comes from increased pressure in your head.
The other common symptom of increased pressure in your head is nausea, an unrelenting nausea, not just feeling a little sick to your stomach and then it gets better, but nausea that just doesn’t go away, associated with significant vomiting. These are some extreme symptoms. But, most of the time, brain tumors are going to cause some sort of neurological problem, something not working right.
Dr. Linda Austin: How about seizures?
Dr. Sunil Patel: You can have seizures. Seizures are a manifestation of a number of different things, not just brain tumors, but any irritation of nerve cells will cause seizures, and brain tumors can certainly do that.
Dr. Linda Austin: So, let’s imagine a patient comes to you complaining of those symptoms, what are some of the first things you do to try to evaluate what might be going on?
Dr. Sunil Patel: Obviously, the first thing is to get a good history on the patient and to see how long they’ve had the symptoms, and to make sure that they don’t have any associated neurological things. Examining the patient, obviously, is very important, and we look for some tell-tale signs, look into their eyes, see how their arms and legs function, their balance, how their cognitive functions are, how their memory is, just sort of a global examination of the functions of the brain.
The real test, of course, are the pictures that we get. There is no field, that I know, in medicine that depends more on imaging than neurosciences. If you look at the one thing that’s made the greatest progress in our ability to treat neurological disorders, it’s our ability to image the brain and the nervous system. So, I would say that neurologists and neurosurgeons would image the brain and, of course, the gold standard these days is an MRI scan. A CT scan can show you some of the lesions, or most of the lesions, but the most sensitive test is an MRI with contrast.
Dr. Linda Austin: I would guess it must be close to 100 percent of the time, if there is a tumor, you can see it with an MRI. Am I right on that?
Dr. Sunil Patel: Mostly, you are right. There may be some small lesions that you cannot see. But, to date, the most sensitive test is MRI.
Dr. Linda Austin: If you see a tumor, how much information does that give you about whether that it’s a benign or malignant tumor?
Dr. Sunil Patel: There are a lot of things that can tell you before you actually take the specimen and examine it whether the tumor is benign or malignant. First of all, the history, if a patient has had a very short period of symptoms, it tells you that something is growing fast and it’s probably malignant. If someone is presenting to you with a very slow onset of symptoms, gradually developing over a year, you know it’s probably not malignant. So, the history is important.
The second thing is, of course, the characteristics on MR. There are over 300 to 400 different types of brain tumors that you can have. And, of course, there are about 5 or 10 very common ones. So, on an MRI scan, you can pretty much tell, based on the MR characteristics, what type of tumor it is. I think 80, 90 percent of the time, by the time we get a history, physical and an MRI scan, we know what kind of tumor we’re dealing with, based on the MR. In some cases, about 10 percent of the time, pathology tells you, so the surgeon is needed to remove the tumor, and the neuropathologist can tell you what it is.
Dr. Linda Austin: Dr. Patel, we’re going to be talking in another podcast how one treats these tumors. Thanks so much.
Dr. Sunil Patel: Thank you.
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