We all know that the brain is the maestro of the body. Everything, every function, and every organ in our bodies is controlled by the brain. Even the slightest finger movement is controlled by the brain. 

We all know that the brain is the organ that is present in the skull and is surrounded by some sort of a liquid, but really, what is the brain in terms of science? 

The brain is the complex organ that controls thought, emotions, memory, touch, motor skills, vision, breathing, temperature, hunger, thirst, and every other process that regulates body functions.  

Together, the brain and the spinal cord that extends from it, form the central nervous system or the CNS. 

In the average adult, the brain weighs about three pounds and is about 60% fat. As for the remaining 40%, they are a combination of proteins, water, carbohydrates, and salt. Some people might be confused about the nature of the brain. Because some say, “train your brain”, you might wonder, is it muscle? 

The brain itself is not a muscle. It contains blood vessels, nerves, neurons, and glial cells. 

You may happen to have heard a doctor say that the brain is made up of grey matter and white matter. 

So, what is grey matter and white matter? 

The central nervous system- the brain and spinal cord- has two different regions. In the brain, grey matter refers to the darker outer area of the brain. While white matter describes the lighter inner section underneath the grey matter. 

On the other hand, in the spinal cord, the order is reversed; the white matter represents the outer portion while the grey matter makes up the inner portion. 

But why is the grey matter grey and why is the white matter white? 

The grey matter consists of rounded central cell bodies or also known as neuron somas. When the cell bodies are condensed together, they appear darker. On the other hand, the white matter is mostly made of axons; the long stems that connect neurons together. These axons are wrapped in a myelin sheath; a protective coat that is white in colour.  

So, in conclusion, the different components of the two parts are why the two areas appear in different shades on certain scans. 

And now, let’s understand how the brain works. 

Normally, the brain sends and receives chemical and electrical signals throughout the body. 

Different signals mean different processes and the brain can interpret what every single signal means. 

Some signals make you feel touch, while others make you feel pain. 

Some signals and messages are kept in the brain while others are sent through the spinal cord and across the body’s huge network of nerves to extremities. 

The brain can do this very fast depending on the huge number of nerve cells in the human body. 

I will give you one example. If you want to move your thumb, how much time does it take between thinking to move your thumb and actually moving it? Almost no time.  This is mainly because our bodies have billions of nerve cells so that signals take no time to reach the targeted organ or part. 

In addition to white matter, grey matter and neurons, the brain at a higher level is divided into three parts: the cerebrum, brain stem, and cerebellum. Each of them has a specific job. For example, the cerebrum which is the largest part of the brain is responsible for the initiation and coordination of movements, regulating temperatures, enabling speech, thinking, judgment, and reasoning. 

That’s why any damage in a specific area of the brain can show a different set of symptoms and signs. 

But what kind of damage can occur to the brain? I mean, it is well protected within the skull bones. 

Of course, the brain is well protected, but what if the damage is from the inside? 

What if the damage is in the form of tumors? 

Have you heard about brain tumors before? 

A brain tumor is a collection or a mass of abnormal cells that begins in the brain. And because the skull is very rigid, any growth inside this restricted space can cause severe problems. 

And just like other tumors, brain tumors can be cancerous (malignant) or noncancerous (benign). 

But regardless of the type, when a malignant or benign tumor grows in the brain, it causes the pressure inside the skull to increase, which will eventually lead to damage of the brain. 

There are many various types of brain tumors. 

What are the types of Brain tumors? 

Brain tumors are categorized as primary or secondary tumors. 

Let’s start with primary brain tumors. 

Primary tumors are the tumors that originate from the brain itself or tissue close to it such as the membranes covering the brain called the meninges, the cranial nerves, the pituitary gland, or the pineal body. 

The tumor begins when normal brain cells develop a mutation in their DNA. This mutation tells the cells to divide and grow out of control and keep living beyond their lifespan. Eventually, this abnormal growth leads to mass formation. 

In adults, primary brain tumors are much less common than secondary tumors. 

There are different types of primary brain tumors, each one involves a different cell type, such as: 

• Gliomas. This tumor can begin in the brain or the spinal cord and include specific brain cells such as astrocytoma and ependymomas. 
• Meningiomas. It is the tumor that arises from the meninges that surround the brain of the spinal cord. Most of these tumors are benign. 
• Acoustic neuromas. They are benign tumors that develop in the cranial nerve that is responsible for balance and hearing. 
• Pituitary adenomas. They originate from the pituitary gland at the base of the brain. It can disturb the levels of the pituitary hormones in the body. 
• Medulloblastoma. It is a cancerous brain tumor and most commonly develops in children. However, it can occur at any age. It usually starts in the lower back part of the brain and spreads through the spinal fluid. 
• Germ cell tumors. This type may develop during childhood in the sites of the testicles or ovaries. But sometimes it affects other body parts such as the brain. 
• Craniopharyngiomas. These are rare brain tumors that originate near the pituitary gland. As it grows bigger it affects the pituitary gland and other brain parts. 

As for secondary brain tumors, they are the tumors that originate elsewhere in the body then spread to the brain as a secondary metastatic tumor. They most often occur in people who have a previous battle with cancer. 

In adults, secondary brain tumors are far more common than primary ones. 

Any type of cancer can spread to the brain, but common types include: 

• Breast cancer. 
• Colon cancer. 
• Kidney cancer. 
• Lung cancer. 
• Melanoma. 

Secondary brain tumors are always malignant. 

Let’s assume that someone has a brain tumor and doesn’t know. What are the symptoms or signs that can tell someone that they need a check-up on their brain? 

Symptoms of brain tumors are very different from one person to another.  Symptoms will also vary according to the tumor’s size, location, and rate of growth. 

Symptoms include: 

• New onset or change in the pattern of headaches. 
• Unexplained nausea or vomiting. 
• Headaches that become more frequent and severe. 
• Confusion. 
• Behaviour or personality changes. 
• Vision problems such as blurred vision or double vision. 
• Losing sensation or movement in one arm or leg gradually. 
• Balance difficulty. 
• Speech difficulties. 
• Seizures. 
• Trouble concentrating. 
• Projectile vomiting unrelated to meals. 
• Tiredness. 
• Difficulty making decisions. 
• Difficulty following simple rules. 
• Hearing problems. 

But what causes Brain tumors in the first place? 

In people with primary brain tumors, doctors don’t yet know the causes. As a general concept, tumors usually arise when there is a DNA mutation in the cells. 

However, some risk factors increase the risk of brain tumors, including: 

• Radiation exposure. People who have been exposed to ionizing radiation are at a higher risk of developing brain tumors. Ionizing radiation is the type of radiation used in the treatment of cancer. 
• Family history of brain tumors. Some people -who have a brain tumor- have a family history of brain tumors or a family history of genetic syndromes that increase the risk of brain tumors. 
• Exposure to certain chemicals. 

So, are Brain tumors common? 

Unfortunately, they are common. For example, in 2013 in the Republic of Korea, a total of 11,827 patients were diagnosed with primary brain and CNS tumors. The most common tumor was meningioma. 

And because “Prevention is better than cure”, is there a way to prevent brain tumors? 

In fact, you cannot prevent brain tumors, but you can reduce your risk of developing brain tumors by avoiding factors that increase the risk such as smoking and excessive radiation exposure. 

Our role today is to answer most of your questions regarding Brain Tumors. Today we have Doctor Park who is a leading doctor at The Catholic University of Korea, Bucheon St. Mary’s Hospital in Korea. He is going to discuss with us everything about Brain Tumors from an experienced medical point of view.

Interview

What is brain tumor?

Brain tumor is cancer that affects all parts of the brain and its surrounding structures. 

What is the usual cause of brain tumor?

All brain tumors are caused when the normal cell division and life cycle of the cells is disrupted and results in uncontrolled cell division and growth at a rapid pace. It affects the normal cell’s ability to function normally. When the tumor mass grows very slowly, we call it benign tumor. And when the tumor mass grows very fast, we call it malignant tumor. So even with brain cancer, we divide them into benign and malignant tumors. Precisely what causes the tumors is not yet fully known. So, in a nutshell, brain cancer is an uncontrolled, rapid growth of cells but the reasons as to why is not yet known.

We just talked about the types of brain tumors, right? Are all of them malignant?

Cancers can be divided into benign and malignant types. If malignant we treat them right away but if it is benign, we tend to wait and see. We see in brain cancer; we see about 50% malignant and 50% benign. Of course, if malignant, we treat it immediately but sometimes even if benign we have to treat it surgically or via chemotherapy if the tumor is significant in size and affects the brain’s functions. SO, about half of the cases are malignant and the other half are benign.

What are the symptoms, usually that patients with brain tumors have?

The symptoms of a brain tumor depend on the size of the tumor. When small, there are no symptoms. But as the tumor grows and the brain pressure increases, typical symptoms include headaches when woken up in the mornings, then the pain subsides by noon time. The progression of the headaches in this pattern is a typical symptom of brain tumor. But if the tumor spreads, the legs, arms or parts of the body that deals with speech, even if the tumor is small, there can be loss of energy, strange sense of touch, speech impediments or even suffer loss of full vision. So, depending on the location of the tumor, the symptoms can vary. If the tumor is large, regardless of location, due to increased brain pressure there can be morning headaches, which are typical symptoms.

OK. If somebody is suspected to have a brain tumor, what kind of tests can be done to confirm it?

The diagnosis of brain tumors is hard to tell through symptoms. CT or MRI is needed for an accurate diagnosis. MRI is especially an important diagnosis tool. Through MRI we can even find tumors less than a centimeters in diameter. We can even differentiate between benign and malignant tumors. So, to diagnose brain tumors we need MRI or at least CT, but CT’s resolution is lower. To precisely diagnose brain tumors, we need an MRI scan.

In the case that it is confirmed that it is a brain tumor, is it curable or there is no cure for it?

Like we said before, there are malignant and benign tumors. Benign tumors are usually cured with surgery. Malignant tumors can be seen as two types – those that spread to the brain and those that started in the brain. For tumors that spread to the brain, we must find where it started. For example, in the lungs, liver, stomach cancers and its stage. In these cases, chemotherapy together with surgery is typically sufficient to successfully treat without recurrence. Just looking at the brain, treatment tends to be successful. But the original tumor can affect the lifespan of the patients. For cancers that originate in the brain such as glioblastoma multiforme, even after surgical, chemotherapy treatment, the patient's lifespan is shortened significantly. Usually less than two years. Brain tumors that start in the brain are difficult to cure. 

In the cases where surgery is hard to be done, can it be treated with other kinds of treatments?

The standard treatment for brain tumors is surgery. In the process we remove the tumor as well as study the issue. We do resort to radiosurgery when the location is hard to reach and, in the process, collateral damage is likely. The radiotherapy focuses on the cancer cells alone in order to stop the uncontrolled growth of the cancer.  And in the case, we discussed where there is malignancy, we supplement with radiation therapy after the surgery about every six months or so. We use the radiation in this case to the entire brain and the cancerous cells react particularly to the radiation. So, where surgery cannot remove all the cancerous cells, we supplement the treatment with radiation therapy. We also use chemotherapy in malignant tumors. Chemotherapy is administered after radiation therapy in order to prevent the growth of tumors. So, in treatments we have surgery, radiation, and chemotherapy – basically three types of treatments.

OK. In the case of full treatment. How likely is it that it will recur?

When benign, surgery alone does the job. With malignant tumors that have spread into the brain, surgery and radiation is usually enough to cure. But malignant cancer that started in the brain is not very promising. We must also distinguish by tumor’s stages. We can look at grades three and four, for grade three, on average a patient may have 5 to 8 years. For grade four, it is often less than 2 years. It is the most malignant.

We talked about surgery. Can you develop or explain how surgery is done?

For all brain tumor surgeries, we take MRI or CT scans to precisely locate the tumor’s location. Nowadays, we use neuro-navigation in the surgery room to ascertain the location. Instead of opening the whole head, we only open the location where the tumor is. We make an incision as the tumor lies inside the brain. Then remove the skull bone of the incision area. Then we open the brain for access. After locating the tumor, we only remove that alone. We preserve the normal parts of the brain and limit the collateral damage as much as possible. We use electric probes into the brain to monitor it in order to prevent any unnecessary damage. Since we monitor in real time any blood blockings and excessive pressures, our success rates have climbed significantly relative to ten to 15 years ago. In the past there were many side effects, now we only have about one percent with side effects. It has become very good.

OK. Is there any surgical method to minimize the wound after the surgery?

Yes, even in that category it has improved quite a lot. The type I do often, minimally invasive surgery is helpful. I open an incision in the eyebrow area instead of the skull. For this type of procedure, we need navigation, high-definition surgical loupes, endoscopes, etc. We use all these tools to minimize the scars. This way, recovery is faster and the psychological burden on the patient is lower, too. Normally, when someone gets brain surgery it can traumatically affect emotionally but with the minimally invasive method penetrating the eyebrow area instead of the skull helps the patient believe it is a less severe surgery which positively affects the psychological well-being and expedites recovery.

Are there any precautions that a person should take after brain tumor surgery?

Even after surgery, there is no difference in what a person can do. So, instead of feeling down and depressed, one should carry out a normal life and that will help in the recovery process, too. Without regular movement and exercise, the side effects such as headaches get worse. Lack of coordination and depression can occur if left alone. So, I recommend the patient does everything he or she did prior to the surgery. Also, keep movements and exercises.

Conclusion

Brain tumors are tumors that affect any part of the brain. They occur when there is disruption of normal cell division and the life cycle of cells, leading to uncontrolled and rapid cell division and growth. However, the exact cause of these cancers is not yet clear. Brain tumors can be benign or malignant, the predominance is equal in both cases. Symptoms are dominated by morning headaches, with damage to other body functions as the tumor progresses.The basic treatment is surgery for benign tumors, surgery supported by radiation therapy and chemotherapy for malignant tumors.