Brain Tumour: Signs, Diagnosis & Treatment | Dr. Harsh Jain | Manipal Hospitals Kolkata

Good evening ladies and gentlemen welcome to our show neurosurgeon Dr. Har Jan senior consultant neurosurgeon manipal hospital sir welcome to our show sir thank you >> our top today our topic is brain tumor understanding science diagnosis and treatment brain tumor brain tumor Dr. >> [clears throat] >> Bangla English mixed technical basically tumor any form of any type of growth anywhere in the body which is a collection of abnormal cells which are rapidly growing body clump or bunch of cells they grow out of turn that forms a mass and that is called a tumor. Tumor. So that is in simple language what a brain tumor is. That is what ultimately matters and that is what creates maximum anxiety. So cancers benign but non-cancer non-cancer. So answer to your question is that not every brain tumor or any tumor not every tumor for that matter is cancerous. It can be benign. >> Okay. So brain tumor. It can be benign, it can be cancerous like mobile. Very interesting question. And in fact Amrajani for example smoking causes lung cancer causation has been established. Okay. Similarly there are many other GI cancers lung cancers etc. direct cause and effect relationship but unfortunately brain tumor is not applicable. >> In fact there are no known causes. There are some very rare genetic variants. Okay. NF2 etc. But these are exceptionally rare. >> Okay. >> But apart from that there is no really known positive common perception mobile phone usage. I don't think there are any studies which show that excess these are all perceptions >> that is to large extent perception. >> Okay. So there's no as such. Modifiable lifestyle factor is family history. That's right. Rare there are some very very rare conditions where you know there is some role of genetics. Apart from that brain tumor is what we call denovo. That's right. But is there any kind of warning signs that we shouldn't avoid the signs important observation the thing is brain tumor science either it has attained a very large size >> or it is occurring in a very critical location. >> Okay. The skull is a closed box, closed cavity. There is no room for expansion. And these are the three main things which are there. Any fourth thing they add oil then it causes an increased pressure in that closed compartment. >> Exactly. So then you can imagine then where it is it is outstripping the capacity of the brain to accommodate a newer fourth thing. >> Exactly. >> Which is [clears throat] in you know science what we call the pressure volume curve. >> So so then come back to what your question is that when does it cause symptoms >> exactly? So it causes symptoms as I said now that if you understand the pressure volume that means brain tumor then symptoms etc one part of the brain it is responsible for controlling the movement of the opposite side of the body that is a what is called a very eloquent critical area. Okay. It will cause early signs like seizures. Okay. >> So that is the common. So that is what I want to say that the symptoms of brain tumor depend on two things. One is the size >> and other is one is the location and size. patients come to us with huge brain tumors after a long time. Okay. Exactly. So that is the trick then that when it is slowly growing >> which means these are benign tumors mean non-cancerous. >> Okay. So that if you build the story that if you have a non-cancerous tumor, benign tumor which means it is slowly growing that means they happen over a long period of time so they come late. >> Okay. >> Whereas cancerous tumors because of the very nature that they're cancer which medically means very rapidly dividing cells. >> Exactly. >> So they come with a shorter history but they come earlier to us. >> Okay. So there is no such symptoms but there is if it is benign then but if it is cancerous then there is a shorter length of history. >> Okay because of the nature of the disease >> because of the nature of the growth nature of the growth how rapid and so as a correlary to that patient they have some psychiatric symptoms. Okay. Behavioral changes. Okay. Personality change, happy joy becomes very depressed or is someone who was quite you know you know withdrawn and you know otherwise you know acts in a different manner. So any personality change, memory change etc. So then a lot of the times because there are no other symptoms so-called common symptoms like headache >> like headache exactly >> patient say they are treated by psychiatrists for year on year >> okay >> for knowing the facts >> unknowing the fact for personality changes and this typically happens frontal lobe frontal lobe which is as you know is responsible for our judgment our behavior our whole personality those areas are affected and sometimes they treated for psychiatric illnesses and later on when it goes to a very big size and then they come to us because of size. >> Okay. Exactly. >> So and then we see a very large tumor. It is interesting but if you understand the process then one can even think about anticipate. Okay. Okay. So symptoms headache is one of the symptom headache each and every person is having headache we take a paracetamal or any [gasps] pills. So this headache is not normal right >> this headache is giving me some other signs >> other signs right very very very important to touch upon this. So as you very rightly said headache is a very common symptom. Exactly. >> And nowadays with our kinds of lifestyles, work habits, sleep habits, dietary habits, it is becoming all the more common. >> Exactly. >> But there are certain uh and that is where the importance of you know a clinician the patient coming to the doctor and a proper history taking headache. I mean I I can you know not take it lightly but I can ascribe into medical terms or where I should be more watchful. So certain red flag signs that say it is a shorter history on 30year-old lady can come and say every few days okay then I feel it is unlikely to be representing a tumor. which is growing rapidly. >> Okay. >> Whereas if a 40y old person come and say perfectly well and fine but last 3 four months I feel there is a headache constant that headache is more and sometimes nausea vomiting feeling and vomiting that relieves the headache. >> Okay. >> This is a warning sign. >> Okay. Or if the headache is associated with some blurring of vision. So it can be or it can be associated with other more obvious like body tingling weakness. Okay. >> So headache on its own. So to rec recap all the benign headaches >> man which are not surgically not this thing are they usually happen over a long time >> and they usually have a predictable pattern. >> Okay. >> Whereas worrying headaches that means which they may signify brain tumor they have a relatively shorter onset history they have these red flag signs. red flags like blurring vision morning this thing morning sickness vomiting blurring vision seizures etc. >> So therein that history taking and initial evaluation is very important >> very important yes so if I consider if I take from your answers that this kind of a symptoms you shouldn't ignore so if someone having seizures if someone has having blood vision then they should immediately with headache they then they should immediately contact to the doctors. >> Right. >> So I' I'd ask my viewers that you shouldn't any kind of ignore any kind of these kind of a symptoms if you're having this kind of a symptoms. So brain tumor through CT scan through MRI through biopsy. So forunately CT scan. So whenever there is suspicion based on the symptoms discuss the first thing and the easiest thing and the least expensive thing is to do a CT scan CT scan CT scan proper report that's right largely most things okay initial CT scan report basis then we order further investigations and ultimately for brain tumor diagnosis and treatment. A contrast MRI is the gold standard. >> Gold standard. Okay. >> That is that is the final that will tell us what the diagonally diagnosis. >> So diagnosis is all done that some person is having brain tumor. Now what is the treatment procedure like operation radiation or any other methods you want to you want to apply? So if you can we have come to this stage main decision making counseling as you say treatment now broadly speaking treatment the number one and gold standard treatment is surgery. surgery. Okay. >> And but number one treatment is surgery >> and usually for if we take the benign tumors that mean the non-cancerous tumors usually these can be treated and cured by surgery that means fully removed >> and cured by surgery. research >> and it is these malignant or cancerous tumors which unfortunately cannot be cured but they can be greatly helped by operating first and then followed by adjuven treatments additive treatments like radiation radiation and chemotherapy. Okay. Okay. So expecting visions Now I can understand that is the first question and that is the measure of success. >> Exactly like quite rightly that is the news that everyone wants to hear. >> Yes. But especially with regards to benign tumors and a lot of the time they are located in very critical areas what we call the skull baseact base of the skull important nerves and arteries and veins. >> Okay. >> So the current modern treatment of tumors >> benign tumor especially is what we call enkofunctional balance. >> Okay. In simple language functional balance >> in simple language it means that we want to maximize the removal of tumor safely >> maximum safe removal of tumor but preserving the function of the patient. Now this may seem very obvious the thing is when you know previous surgery and the whole tenet and everything that the whole idea is to remove the full tumor. >> Okay. >> Okay. But Over the years experiences has been as I said tumor important nerves and arteries. So if for whatever reason not willfully but if for whatever reason they are endangered then the patient can have devastating paralysis or you know eye movement or any other nerve problem. >> Exactly. Exactly. >> So we are willfully leaving that part of the tumor behind knowing that it is a benign tumor. >> Okay. These grow very very slowly. >> Plus we have some very very effective important adjuvent methods now like focused radiation stereotactic radiation. >> Okay. >> So if we know that a young person who's got a benign tumor is likely to live a normal full life. >> Okay. >> Why endanger a part of his say cranial nerves etc. Whereas we can give him a very good quality of life by removing the most amount of tumor and subject following him to radiation if requag. So that is the best case scenario. Exactly. Patient intact functionally intact in other way and tumor is removed and the patient is stable. >> And if it has happened with the cancerous man. >> So here the game changes completely. The picture is completely different. Unfortunately there is no cure for cancers you know brain cancer especially. >> Uh but having said that akal of course first as a main stay is surgery. So good micro surgery that is the number one main state diagnosis biopsy hisystologology diagnosis advance to a genetic level that mean each tumor can now be separately classified key genetics etc. And those genes have also been mapped and now there are certain targeted therapies for each type of tumor. >> Yes. Yes. >> Targeted gene therapies etc. for specific types of tumors and very advanced radio surgical I mean radio surgery techniques also radiation >> so here also the same enko functional principle applies >> okay >> jamra uh and what perhaps I did not emphasize earlier on mostly benign tumors they don't happen inside the brain they usually from the coverings of the brain and they tend to push the brain the brain Everything is happening. Everything is happening inside the skull. >> But because they are actually growing from outside the brain surface, they are pushing the brain. So they actually provide a kind of a plane where we can take them out. Whereas in terms of cancer, they occur inside the brain. >> Okay? >> That means they're actually occupying, invading, displacing the brain tissue. brain tissue. >> So a situation a complete removal becomes even more challenging because the adjacent area surrounded by normal brain. >> So when we operate on these kind of tumors in fact we have to probably use more technology. >> Okay. >> Because now we have advanced imaging technologies. We have what is called neuron navigation because which can tell us exactly where in the skull to open, how deep to go, what are the important normal fibers near the tumor. In fact, some certain times we even do what is called awaketomy when a patient under anesthesia operation and the patient is talking >> and we ask the patient to move the hand the foot name objects etc. when we are operating on very eloquent areas knowing that even if there is a slight disturbance then we can stop. >> Okay. >> So, so now it has gone to a completely you know there's a whole new uh system of functional neurosurgery technology and everything. >> So the net idea is that maximum safe removal and to preserve a good quality of life. >> Exactly. So my next question be since we are discussing about the surgery my next question be that how is the postsurgery life looks looks like like they can lead a completely normal life or the or any kind of rehabilitation is a big playing a good big part >> so this again you know then just extends to jatam rag so when we are princ operating on the principles of enco balance >> yes >> and util utilizing all the technology. So then our surgery and hence post-operative outcome becomes safer. >> So you can have a patient who has gone into the operating room and comes out looking exactly the same. And uh nowadays with minimally invasive techniques, keyhole techniques, endoscopic techniques, our openings are becoming smaller. They are becoming more focused, goal directed. So the idea is to disrupt normal tissue as least as possible. So coming to your question that you know postoperatively patient can be look feel exactly the same as normal. Okay. In certain areas of the brain as I said eloquent areas despite everything there will still be some disturbance to cal of course physiotherapy right or partly usually physiootherapy rehabilitation has a big role big role to play >> but in terms of the actual recovery from the actual brain operation cutting of the skin and the bones and everything with current modern reconstructive techniques techniques virtually within a few weeks patient looks exactly the same >> because of the minimally invasive treatment. >> That's right. That's right. Nowadays in fact I I don't even shave the hair of the patient. So because it's such a big psychological you know barrier trauma to the family to the patient and you know you have a young person or any person for that matter. >> So it is more the the your own philosophy how you approach something. >> Exactly. So tmund that if you want to preserve everything then a psychological aspect is very important is important >> definitely. >> So this whole thing runs its course. So one more question I want to add here that tumor right so certainly so when we talk about malignant tumors cancerous tumors MRI scans at distinct intervals MRI scan plus symptoms to the patient unfortunately malignant tumor because as I said right in the beginning there is no cure for malignant brain tumors but the quality of life and uh length of survival has increased with the given treatment modality treatment. So good surgery, good quality of surgery, good quality of adjubant treatment, regular surveillance, early detection of recurrence. >> So the quality of life, length of survival has certainly increased. >> For benign tumors, as we already discussed, these are very slowly growing anyway. Exactly. Complete removal. Recurrence is very very low. Maximum safe removal some remaining tumor. But we can do surveillance. >> Okay. >> Regular MRI and then if there is any evidence yet about we can give radiation therapy. in fact we have actually answered all those okay number one misconception is headache brain tumor right so it's very very clear not every headache is a brain tumor And there are certain warning signs, red flags to a story. If we do early diagnosis, then everything else follows. Treatment follows. That is the >> probably the most important myth. Number two, brain tumor money end of you know, end of life end of the road life. That is a thing that is really changing now with all the kinds of technology, knowledge, diagnostics, surgical treatment and uh the amount of technology now involved in the surgical treatment. The patient safety, the outcomes have improved dramatically. >> Agn. >> So having a brain tumor is no longer the end of the road for the patient. He can lead a normal life, normal productive life. an definitely Dr. Jen has cleared almost all our misconception about this brain tumor and everything. So then also we must have some question. If you have any question please do comment in our comment box. We'll try to answer your queries as early as possible. Thank you. Thank you for connecting with us. Thank you Dr. Ch. Thank you for having me. Thank you.