The National Cancer Institute defines Glioblastoma as “a fast-growing type of central nervous system tumour that forms from glial (supportive) tissue of the brain and spinal cord, with cells that look very different from normal ones. Dr. Olufemi Bankole, a Consultant Neurosurgeon at the Lagos University Teaching Hospital (LUTH) explained what Glioblastoma is all about and how to manage it. GERALDINE AKUTU reports.
What causes brain cancer (Glioblastoma)?
First, it is important to say the term ‘brain cancer’ refers to a mix of different types of tumours occurring in different parts of the brain and with different outcomes.
The preferred term among doctors is malignant brain tumours, though not all tumours of the brain are malignant, as some are classed as ‘benign’. Benign brain tumours are, however, not harmless as the name may imply.
Rather, they are slow growing, hence given more time to treat and with better outcomes.
Like most cancers, malignant brain tumours grow more rapidly than their benign counterparts and affect the brain in many different ways depending on the part of the brain they are located.
Unfortunately, like most cancers in other parts of the body, the exact cause(s) of brain cancer is unknown.
Glioblastoma itself is not the only form of brain cancer, though it is the most common and most aggressive type.
Other malignant brain tumours include, Medulloblastomas, Lymphomas and Anaplastic Astrocytomas, to mention a few.
Various risk factors linked to developing cancer in the brain include over exposure to radiation and some rare inherited conditions.
In all of these cases, the exact connection/link remains a mystery, but we do see a pattern of occurrence.
What are the common brain cancer signs and symptoms?
Again, unfortunately, there are no symptoms that will immediately tell someone they are developing a malignant brain tumour.
However, there are some common things to look out for, when a person develops a mass/growth in the brain, either benign or malignant.
These include a bad headache, but not the type one gets after spending hours in Lagos traffic or a stressful day.
This headache is usually worse in the morning and persistent over several weeks.
It may be associated with a feeling of wanting to vomit (nausea) or actually vomiting, which tends to make the person feel better.
There is also a general feeling of fatigue, and people may notice a change in behaviour or memory loss or some loss of other body function, for instance, vision or speech.
Actually, the symptoms really depend on which part of the brain the tumour is located and as such, can be quite diverse.
Sometimes, patients may also have seizures (convulsions), but this is not so common with malignant tumours, since the progression of symptoms is much more rapid.
Loss of consciousness is also a way of presentation, which can sometimes look like the patient has had a stroke.
Who is mostly at risk of developing brain cancer?
While most cancers of the brain occur in elderly people (typically people in their 60s or older), malignant brain tumours can occur at any age, even in children.
Specifically, Glioblastomas are more common among elderly people and presents the same way in them as in younger people.
However, sometimes it is mistaken for strokes or just the memory loss that one associates with ageing.
Is it hereditary?
No. Although there are some hereditary conditions that may increase the risk of developing brain cancer, the vast majority of people who go on to develop brain cancer did not ‘inherit’ them.
Is there a cure for brain cancer?
Unfortunately, at the moment there is no cure for brain cancers. While there are many therapies that are being tried and a lot of experimental work going on, we are yet to find a cure.
How can it be treated?
Malignant brain tumours are usually treated with a combination of surgery, radiotherapy and chemotherapy.
Sometimes, newer options like hormone therapy; immune therapy and others are also used. Which option is offered depends on the type of cancer involved.
Surgery remains a main part of any treatment regime, since it allows for accurate diagnosis and also reduces the amount of tumour the body has to fight against.
Many people are understandable quite worried, when they hear about “surgery for the brain.”
However, this type of surgery has been around for a long time and is readily performed in certain tertiary/teaching hospitals in Nigeria.
When a patient has a malignant brain tumour, the reason for surgery is slightly different from if the tumour is thought to be benign.
Hence, the type of operation performed will be made to suit the suspected diagnosis.
Sometimes, only a biopsy (during which a small part of the tumour is taken and sent for further tests) is needed.
In other cases, an attempt is made to remove as much of the tumour as possible to allow the radiotherapy and chemotherapy be more effective.
The Neurosurgeon will discuss these options with the patient and relatives and agree on the best option.
Survival after the surgery is the expected outcome, but this may not have much impact on the overall survival from the disease.
A good example is the late U.S. Senator John McCain, who had surgery last year and eventually succumbed to the disease a few days ago.
What is the life expectancy for patients post diagnosis?
Life expectancy following a diagnosis of malignant brain tumour also known as brain cancer really depends on the type and what is achieved by the given treatment.
For patients with Glioblastoma, the average life expectancy is between 12 and 18 months, but it can be as low as 6 months without treatment.
Other malignant tumours have slightly longer survival times of five to 10 years, again depending on the type and treatment received.
For now, almost all patients with a diagnosis of Glioblastoma will not survive beyond two years from time of diagnosis.
How can brain cancer be prevented?
Preventing cancers can be difficult, especially when one is not sure what causes them in the first place.
Obvious things like avoiding unnecessary exposure to (bad) radiation, smoking (though not directly linked to brain cancers) and healthy diet rich in ‘antioxidants’ have all been advocated as a means to help prevent cancers in general.
A healthy lifestyle, which includes diet and exercises among others, are thought to build the body’s immune system, which will help ward off cancer cell formation.
Antioxidants are found in nuts (groundnuts, almonds and cashew, among others) and vitamins.
Other items like fruits and vegetables are beneficial at all ages and should be encouraged.
More recently, the World Health Organisation (WHO) has raised awareness on the negative impact of radiation exposure (even from cell phones) to young immature brains.
The message there is to reduce the amount of radiation our children are exposed to.
For adults, the impact is less, since the skull bone is thicker. The impact of social vices like smoking and alcohol consumption, though not clear, is also best avoided.
What should government and healthcare providers know/do?
Government needs to realise that these conditions are quite common and provide more facilities for early diagnosis and treatment.
Such equipment as MRI machine must be readily available across the country to enhance diagnosis.
The scarcity of Radiotherapy machines in the country has already been highlighted by previous events and is again important in the treatment of this condition.
The teaching hospitals need to also be equipped to perform proper neurosurgery, as this is the first step in any treatment programme.
Support groups for people (and their relatives) are also an important part of the puzzle, as this helps improve the quality of life of patients.
Healthcare providers also need to be more aware of the condition and order necessary tests to make diagnosis early and refer appropriately.
More importantly is for the general public to take their health seriously. Many people run away from the hospital, when they are told they have a serious condition.
This is not helpful, because eventually when the things go bad, they still end up coming back to that same doctor or some other doctor somewhere else.
But by then, the disease may have gone out of control and not much can be done. Not all brain tumours are malignant or cancer.
A lot can be done for people with benign conditions, and for those with malignant tumours, we can still care.