Like every year, International Brain Tumour Awareness Week is being observed from October 26 to November 2, 2024. This initiative was started by the International Brain Tumour Alliance (IBTA) in 2005.
 
Any form of malignant tumour is dangerous and can't be ignored. It is no different for brain tumours. According to the Asian Heart Institute, Brain Tumour Foundation of India, and other research papers, the number of people affected by brain tumours in India is estimated to be between 40,000 and 50,000 annually. This number includes both adults and children.
 
Recognising the widespread lack of awareness about brain tumours among the general public, midday.com reached out to Dr Kaustubh Mahajan, Consultant Neurologist, SL Raheja Hospital, Mumbai and Dr. Ravikiran Vutha Consultant Neurosurgery, Apollo Hospital Navi Mumbai to shed some light on brain tumours.
 
What are the causes of brain tumours?
Vutha: The causes of brain tumours are complex and often elusive, as they can stem from a variety of factors, some of which remain unidentified. Clinically, genetic mutations are a primary cause, where the DNA within brain cells undergoes abnormal changes, leading cells to grow uncontrollably and form a tumour. Some individuals may inherit genetic conditions like neurofibromatosis, Li-Fraumeni syndrome, or Von Hippel-Lindau disease, which increase their risk for brain tumours. Additionally, prolonged exposure to ionising radiation, often from medical treatments like radiotherapy, is linked to a higher risk. For many, the cause remains unknown, making it challenging to implement preventive measures. The lack of clarity on the causes can be emotionally taxing for patients and families, as it leaves them grappling with "why" this happened, underscoring the importance of psychological support in treatment.
 
Mahajan: There's no definite cause for any particular brain tumour. But usually, we divide them into genetic causes and environmental causes. But most of the tumours, we don't find the cause, in that some environmental causes are mainly related to radiation exposure, like x-ray radiation, atomic radiation, and the one that can be coming from phones or network towers.
 
Are there different types of brain tumours?
Vutha: Yes, brain tumours are varied and classified into two main categories: primary and secondary. Primary brain tumours originate within the brain itself and include both benign (non-cancerous) and malignant (cancerous) forms. Some common primary types are:
●  Gliomas: Including astrocytomas, oligodendrogliomas, and glioblastomas, these arise from glial cells and are often aggressive.
●  Meningiomas: Typically benign, these tumours arise from the meninges, the layers surrounding the brain and spinal cord.
●  Medulloblastomas: More common in children, these malignant tumours form in the cerebellum and can spread through the cerebrospinal fluid.
Secondary (metastatic) brain tumours originate elsewhere in the body, such as the lungs or breasts, and spread to the brain. This classification informs treatment plans, as benign tumours may only need observation or limited surgery, while malignant tumours often require a multi-faceted approach involving surgery, radiation, and chemotherapy. Each type has unique characteristics and impacts, affecting patients' daily lives in different ways, from cognitive functions to mobility.

Mahajan: The different types of brain tumours are divided basically from where they arise in the brain, and from which cells they arise. There are many different types of cells in the brain, like glial cells, which cause glioma, and meningeal cells, which are the covering of the brain, which cause meningioma. Pneumos are the most common type of brain tumours. Also, we can divide these brain tumours into grades. Where grade 1 and grade 2 are low-grade tumours, called benign or non-cancerous tumours, while grade 3 and grade 4 are high-grade tumours, which can be classified as malignant or cancerous tumours
 
3. What are the early signs and symptoms of brain tumour?
Vutha: Early symptoms of a brain tumour are often nonspecific, meaning they can be mistaken for more common health issues. Persistent headaches, especially those that worsen upon waking or with coughing and sneezing, are a hallmark sign. Additionally, changes in vision or hearing, unexplained nausea or vomiting, memory lapses, and difficulty with coordination or balance may occur. As the tumour grows and affects specific brain regions, symptoms may intensify, causing muscle weakness, seizures, or speech difficulties. The varied presentation of these symptoms makes it crucial for patients and their loved ones to seek medical evaluation promptly, as early detection can improve outcomes.
 
Mahajan: Brain tumours usually give signs and symptoms from where they are arising, like which part of the brain they are coming from. In some parts of the brain, like the frontal lobes of the brain, tumours can become very large and people may not come to know, and there will be very subtle signs mild changes in behaviour, irritability without any obvious cause. Then, that can be a sign of a frontal lobe tumour, or sometimes there can be side effects, like cataract issues; there is no obvious cause of that happening, but still, you notice these patients are patients having changes in their behaviour.
● Seizures: When tumours increase in size and press the adjacent normal brain tissue. And then the brain, whatever it is responsible for, that deficit is seen in the patient. So for example, you will get a seizure if the brain tumour is coming from the right side of the brain, then start getting left focal seizures, which are in the left side. Seizures are small jerky movements in one part of the body, which can sometimes increase and involve the whole body. 
● Headache: It usually comes last if the brain tumour is really large and it is coming from inside and stretching the covering or obstructing the circulation of the brain or drainage of the blood in the brain. Brain parenchyma is painless. It's only the coverings of the brain when stretched, when you experience pain, or only when the venous system or the drainage system, when stretched or there is a clot, you get pain. If a person is used to having headaches, then suddenly the pattern changes, or it's a different kind of headache, or there is a sudden severity change in the headache. Patterns and decisions, or a new onset headache or early morning headaches, especially which wakes you up from your sleep. So these are what we call red flags and addiction, and neurological signs and symptoms should not be ignored and be immediately shown to a neurologist or a neurosurgeon. 
● New neurological deficits: like blurred speech, imbalance, and blindness 
● Vomiting: This is very important. Headaches are associated with vomiting. Otherwise common in migraines. But not when it is tumour-related. Usually, the vomiting is not associated with prior nausea. Vomiting and headaches can be classically seen early in the morning when you wake up or when it wakes you up from your sleep, and third, the nausea component before vomiting will not be there. 
 
4. Which age group and gender is most likely to get brain tumours? Are people with a particular type of past health history more vulnerable to it?
Vutha: Brain tumours can affect any age group, but the risk often correlates with age, and certain types are more common in specific demographics. In children, tumours like medulloblastomas are more prevalent, while older adults are at a higher risk for gliomas and meningiomas. Research suggests a slight male predominance in brain tumours overall, although specific tumours like meningiomas occur more frequently in women. Individuals with certain health histories, including those with previous cancer treatments (especially radiation), genetic predispositions, or family histories of brain tumours, may have heightened vulnerability. For these individuals, clinicians often advise regular monitoring, as early signs can otherwise go unnoticed, potentially leading to late-stage diagnosis.
 
Mahajan: Yes, people who have risk factors for cancer, like smoking or having certain habits like tobacco, then definitely have cancer in the body, which can spread in the brain. Sometimes, the brain tumour is the first symptom, which is the seizures, and then the primary cancer is detected. Sometimes, people who have trauma frequently, like falls, bleeding tendencies in the brain, and an already existing benign tumour can bleed in the brain, which can give rise to symptoms. The cause of brain tumours is not very definite. Many times we cannot find the cause, but radiation, chemical exposures, and cancer, which can be either familial, genetic, or environmental risk factors, like tobacco and smoking. Age groups, again, certain tumours are specific to children, like retinoblastoma, which is present very acutely. Certain tumours are specific to the elderly, like benign tumours which are usually cancerous, but there is no specific rule. And even if it's a benign tumour, it will be very slowly growing, and it will present at an elderly age. So the elderly population is more prone to having tumours.
 
5. When should a person consult a doctor about a brain tumour? Are timely checkups advisable?
Vutha: Persistent symptoms, particularly those that interfere with daily functioning—such as unrelenting headaches, sudden changes in vision or personality, or unexplained nausea—warrant prompt medical consultation. Delaying evaluation could result in a more advanced diagnosis, complicating treatment. Regular check-ups may not be common for everyone, but individuals with genetic predispositions or those previously exposed to high doses of radiation are encouraged to monitor their health more closely. Early intervention can provide more treatment options and, potentially, a more favourable prognosis, emphasising that timely action can be lifesaving.
 
Mahajan: If any of these signs and symptoms are there, then definitely one should approach a doctor.
● Headaches: Mainly if it is a headache, change headache pattern or is associated with vomiting. 
● Neurological deficit in the form of deep slurring, imbalance, visual symptoms, or any particular hand that is getting weak. Hand weakening, in simple words, is paralysis, many people use the term where your hand starts getting hand or one side of the body starts getting weak, or if it is a sudden thing like suddenly your arm got weak but two minutes back, it was perfectly okay, or when you slept in the night, that time it was okay, but you woke up in the morning, it was weak. This kind of weakness is usually seen in a stroke, but in a tumour-related paralysis, it will usually be over the period, slowly over the weeks, progressing step by step.  Initially, it was only the hand and the thumb that were weak. Now the whole hand has got weak. Now the whole arm has gotten weak over a period of weeks. 
● Seizures, which can be catapulted, but if it is a focal seizure, then usually some people may miss it.