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Eye cancer

Brain can simply be defined as an organ of soft nervous tissue contained in the skull, functioning as the coordinating center of sensation, intellectual and nervous activity. Brain together with spinal cord form the central nervous system (CNS).

Structure and functions of central nervous system
Understanding structure and functions of the brain and spinal cord is important as it will help understand well tumors affecting these parts of central nervous system and their symptoms.

BRAIN
Brain is located inside the skull and between the brain and skull there is special fluid called cerebral spinal fluid (CSF) which help to protect the brain. Brain is made up of three major parts which are cerebrum, cerebellum and brainstem.

> Cerebrum is the largest part of the brain consisting of two cerebral hemispheres that are connected by white matter called corpus callosum. Cerebral hemispheres are further divided into frontal, parietal, temporal and occipital lobes whereby in these lobes is where specific functions of brain occur.

• Frontal lobe is responsible for controlling speech, reasoning, emotions, problem solving and movement.
• The parietal lobe is responsible for controlling sensations of touch, such as pressure, pain, and temperature. It also responsible for controlling parts of speech and visual-spatial orientation.
• The temporal lobe is responsible for controlling memory, ability to understand words (either spoken or written) and senses like hearing.
• The occipital lobe controls vision.


> Cerebellum is another part of the brain responsible for coordinating movement. Cerebellum is at the back side of brain below cerebrum. > Brain stem It is the lower portion of the brain connecting the brain to the spinal cord. It is the part that controls involuntary functions such as heart beats and breathing. Messages for the functions controlled by the cerebrum and cerebellum travel to the rest of the body through the brain stem. Brain stem consists of long nerve fibers for carrying those information to the rest of the body. Also it consists of pons and medulla oblongata through which the brain is connected to the spinal cord. Most of the cranial nerves start in the brain stem

SPINAL CORD
Spinal cord is simply the cylindrical bundle of nerve fibers which is enclosed in the spine and connected to the brain, with which it forms the central nervous system. Spinal cord is connected to the brain by medulla oblongata. Between spinal cord and spine there is fluid called cerebral spinal fluid which helps to protect spinal cord. Spinal cord is responsible for controlling muscles and sensation or feeling.

WHAT IS BRAIN TUMOR?
Brain tumor occurs when brain cells start to grow abnormally in uncontrollable way. Brain tumors can be either primary tumor or secondary tumor. Primary tumor is the one that originate in the brain itself while secondary brain tumor is the one that start somewhere else in the body and spread to the brain.

Types of brain tumor
There are various types of brain tumors depending on the cells from which it originates. This include Gliomas that start from brain supportive cells called glial cells that include astrocytes which is the origin of astrocytoma, oligodendrocytes which is the origin of oligodendroglioma and ependymal which is the origin of ependymoma.
• Astrocytes – astrocytoma
• Oligodendrocytes – oligodendroglioma
• Ependymal – ependymoma


Also there are those that don`t originate from glial cells (non-gliomas). These include the following;
• Meningioma
• Medulloblastomas
• Cranialpharyngioma
• schwannoma

Risk factors of Brain Cancer
The cause of most central nervous system (CNS) cancers are unknown, however there are some few risk factors for brain tumors.

• Family history. There are those who are born with some genetic diseases that increase their chance of developing CNS tumors at some point in their life. For example inheritance of diseases like neurofibromatosis, li-fraumeni syndrome, von-hippel lindau syndrome and tuberous sclerosis.
• Radiotherapy history. History of previous irradiation to the head for treatment reasons, also increase one`s chance of developing brain tumor at later stage of life.
• From individual cell mutation. There are some brain cancer cases that may result from individual cell mutation. These individual cell mutation are contributed by many factors including exposure to radiations and some chemicals like arsenic compounds.
• Electromagnetic fields. Although not proven, but there is ongoing discussion on contribution of electromagnetic fields that result from energy produced by power lines and cell phones. Due to this conflicting information, it is highly advised to limit the use of cell phones and prefer using hands free headset for both adults and children.

Possible ways of preventing CNS tumors
In order to prevent something you need first to know what causes it. When it comes to eye cancers, the exact cause of this cancer is not known so it is difficult to prevent development of this disease.

Early detection and screening

Currently there are no recommended tests for screening of brain tumors hence the only possible way of knowing if someone has brain tumor is through routine general checkup

But for those at high risk of developing brain tumors like those with inherited genetic diseases like neurofibromatosis, tuberous sclerosis and Li- Fraumeni syndrome, are advised to have physical examination more often from their young age as this may help to detect brain tumor at an early stage.

Signs and symptoms of CNS tumors Signs and symptoms of tumor in the brain are grouped into two types. There are general signs and symptoms and those that are specific (occur when tumor is at a certain area of the brain only). Below are some of those signs and symptoms although experiencing them does not always mean you have cancer because they may be caused by other medical reasons

General signs and symptoms

• Headaches
• Changed mental status
• Nausea
• Vomiting
• Body weakness
• Ataxia (loss of control of body movements)
• Changes in your vision
• Seizures, these can be of different levels such as; single or multiple muscle twitches, loss of consciousness which may be followed by muscle twitching and loss of control of body functions.


Specific signs and symptoms
• Total or partial loss of vision when tumor is in temporal or occipital lobe of cerebrum
• Inability to look upward which occur when tumor affects pineal gland.
• Changes in speech, problem in understanding or retrieving words, memory, hearing and change of emotional state such as aggressiveness. These occur when frontal and temporal lobe of cerebrum is affected
• Difficult in swallowing, facial weakness or numbness and experiencing double vision which occur when tumor is in brain stem.

Diagnosis
After realizing that, you may have brain or spinal cord tumor, doctors will run some tests to see if it is really a tumor or something else. And if it is tumor you will have some tests to see which type of brain tumor, to see if it has spread to other parts of CNS or even other parts of the body which is not common for brain and spinal cord tumors and finally they use tests to see which type of treatment option is best for that case.

Below are some of the diagnostic procedures used for brain and spinal cord tumors.

• Medical history and physical examination.

Medical history is very important procedure when dealing with patients. In our case medical history may dictate even which further diagnostic procedures are suitable to the patient. For example a person with pace makers cannot have MRI tests as it could lead to further medical complication. Also medical history can lead to some of treatment options to be unsuitable for the patient.
When dealing with brain and spinal cord tumor physical examination include checking strength of limb muscles, testing sensations, some brain exercises and check body balance through walking.

• Computed tomography (CT scan). It is one of the important diagnostic tests used when assessing brain and spinal cord tumors. This test uses X-ray beams to take pictures of inside your body. In order to be able to differentiate between tumor and normal tissue, contrast dye is used during the scan. For those who are allergic to iodine or their kidneys have problem, doctors may opt not to use contrast or even recommend the use of another suitable diagnostic test.

• Magnetic resonance imaging (MRI). MRI is the test that use magnetic field to produce picture of various parts of your body. MRI is considered to be better imaging test when it comes to brain and spinal cord tumors compared to CT scan as its images can provide more detailed information about the these tumors compared to those produced by CT scan. But MRI scan images cannot give proper information about bones so they cannot reveal about the extent of tumor to the skull or spine.

There are other different types of these MRI scans that are done for diagnostic purposes of these brain and spinal cord tumors, these tests include;

• MRS- magnetic resonance spectroscopy reveals chemical makeup of the brain that can be altered by brain tumor.
• MRA- magnetic resonance angiography used to look blood vessels in the brain and it is more important for those requiring surgery.
• MR perfusion scan- a scan done to check blood supply throughout the brain as with tumor will require more blood than normal areas.
• Lumber puncture. This is the test done to check cancer cells in cerebral spinal fluid (CSF). In this test a small hollow needle is used to draw CSF from spinal column. This is more helpful to those brain tumors known to spread through this fluid to other parts of central nervous system. For example ependymoma.
• Biopsy. Biopsy require small sample of tumor cells (a small portion of affected area) in order to learn of more detailed information about tumor such as knowing which type of tumor. For brain cases this can be done through either using a small needle to get a sample (stereotactic biopsy) or by using surgical biopsy (craniotomy) through which biopsy is taken during surgery and tests are done quickly before surgery is over in order to know the extent of surgery.
• Blood tests. Blood test is an important test which is done before starting treatment and also is done during treatment period especially for those that use chemotherapy and radiotherapy.

Staging of brain and spinal cord tumors Staging is the process of grading cancer depending on how large it has grown or even how far it has spread. This process is different when it comes to brain and spinal cord tumors as these tumors of CNS behave in a different way compared to the way cancers of other parts of the body behave.

Normally brain and spinal cord tumors do not spread (metastasize) to other parts of the body like the way other cancers do, but these tumors remain within central nervous system. So for this reason there are no formal staging systems for brain and spinal cord cancers.

Treatments Following cancer diagnosis, the doctor will break the news and it is normally not very easy to accept that it is cancer. The doctor will be there to help the patient process the news and to help the patient in taking the next steps.

After the patient receives and processes the news that he/she has cancer, one of the most important steps that will follow is decision making. The doctor will present to the patient (relatives/parents/guardians) with all the possible treatment options and explain what they mean. Then with the help of the doctor, the patient (relatives/parents/guardian) will have to choose which treatment option is good depending on benefits of such option.

Despite all the information given by the doctor, sometimes the patient may still be unsatisfied with what he/she has been told. In such situation, the patient is free and advised to seek a second opinion. Second opinion is the opinion that the patient may seek from another specialist (doctor) regarding his/her health problem and in this case it is cancer. Second opinion may include confirmation of the diagnosis, more clarification on your primary doctor recommendations or even reassurances that all the options have been explored.

In addition to standard care treatment options, sometimes there are those new treatments or drugs or combination of treatments that have not been approved yet to be used as standard care treatments for a particular cancer (disease) but have shown some promising results that they may help. These type of treatments are called clinical trials.

If there are some clinical trials for your case, the doctor may present to the patient or the patient may ask if there are any clinical trials for the particular cancer case. Over the years, have improved treatments and led to better outcomes to people diagnosed with various diseases including cancer. If you have decided to take part in clinical trial, you can also withdraw at any time

Treatment options
The main treatments for brain and spinal cord tumors are surgery, chemotherapy and radiotherapy. These treatment options can be given in combination or alone. In addition to those, there steroids and ant conversant (ant-seizure medications) that can be given to relieve symptoms of the disease.

Surgery Surgery is an option that involve removing the tumor by operation. Surgery involving central or peripheral nervous system is called neurosurgery and it is performed by a doctor called neurosurgeon. In case of brain and spinal cord tumors, surgery may be total resection (removing entire tumor) or partial surgery (removing part of tumor).

Partial surgery can be done if tumor is at a site where surgery cannot reach or it is close to a vital area like part of the brain controlling speech and movement.

Side effects and management after surgery


Soon after surgery you will be closely monitored in order to see if there is anything wrong during your recovery process. Usually after surgery that involve opening the skull (craniotomy) your face and eyes may be swollen or bruised, but this is usually not painful and it should go away after several days.
Headaches and nausea after surgery can be relieved using by medications. Some people may have a buildup of fluid in the brain which is called hydrocephalus. In case of those experiencing hydrocephalus, surgeon may place a long, thin tube that will draw fluid from the brain into the abdomen where these fluids will enter into blood stream and reduce pressure in the brain. This tube is called shunt.
For those who had spinal cord surgery, a nurse will be there to monitor them closely to check movement and sensation in their arms and legs.

Radiotherapy

Radiotherapy is an option that involve using high energy X-rays or other radiation particles to destroy cancer. Radiation beam is specifically targeted at treatment site in order to reduce effects to healthy cells. Treatment itself is not painful although you may experience side effects after treatment and some of the side effects can go away on their own upon completion of treatment or they can be managed using medications.

For brain and spinal cord tumors, radiotherapy is generally of external beam radiotherapy where the beam is directed to tumor from the machine and not internal radiotherapy (brachytherapy) where radiation source (implant) is inserted inside the body(tumor site). This can be given in various techniques;

• Conventional radiation therapy: In this, treatment is given basing on anatomical landmarks and x-ray images. This is more appropriate when irradiating whole brain for those brain metastasis cases.
• 3D-conformal radiation therapy (3D-CRT): This technique uses CT scan and MRI images to create a 3D model of a tumor and surrounding tissues, then radiation beam is directed to the site basing on those images.
• Intensity modulated radiation therapy: This is the advanced mode of 3D-CRT but this technique effective compared to the previous as it gives more dose to tumor and less dose to normal tissues.
• Proton therapy: This technique uses protons and not X-rays to kill (destroy) cancer cells. This is mostly used when less radiations are needed because of tumor location like it is near optic nerve or at the base of skull.
• Stereotactic radiosurgery: This is a specified type of radiotherapy and not surgery. This type of radiotherapy directly precisely high dose of radiation to the tumor in such a way that surrounding tissues are unlikely to be affected. This process is non-invasive and sometimes it is called gamma knife or cyber knife treatments depending on the type of machine used during the procedure.


Side effects and management after radiotherapy
The side effects of radiotherapy of may vary depending on whether a person had radiotherapy of brain or spinal cord but some of the effects are similar. The side effects normally occur during the course of treatment and fed away soon after completion of treatment or may last for few months or in some cases may last for years. These effects include the following;

• Nausea: This commonly occur during the course of treatment and fade away after completing treatment
• Headaches: Normally occur during treatment of brain tumor and but it can be relieved by medications.
• Hair loss: This may occur during brain tumor treatment
• Fatigue or tiredness: This may occur during treatment of both spinal cord or brain tumor and it will fade away over time.
• Diarrhea: This may occur during treatment of spinal cord tumor and can be relieved with medication. But if medication don`t work the doctor will provide another solution.
• Swallowing problem (dysphagia): This may occur during treatment of spinal cord tumor.

Chemotherapy Chemotherapy is an option that involve taking drugs with the ability to kill or destroy cancer cells. Chemotherapy can also be used to stop growth of cancer cells remaining after surgery or given in combination with radiotherapy which can bring better results compared to when radiotherapy is given alone.

Treating brain tumor is more trick because brain has self-protection mechanism called blood-brain barrier which prevent harmful agents and chemicals from entering and affecting the brain. But there are some special drugs that can get through that blood-brain barrier that are used to treat brain tumors. For example drug called temozolomide which is mostly used.

These drugs can be given in two ways, either through injection into veins or pills (capsule) that is swallowed orally.

Side effects of radiation therapy
The way your body responds to chemotherapy will be regularly monitored through blood tests that will be taken during the course of treatment. The way your body respond may guide even your doctor to change your treatment schedule.

Side effects may vary depending on the type of drug used. The possible side effects include the following;

• Increased risk of infection
• Nausea, vomiting and loss of appetite
• Tiredness or fatigue
• Diarrhea or constipation
• Feeling of pins or needles (due to nerve damage)
• Breathlessness due to low red blood cells.


Steroids


These can naturally be produced in the body but they can also be artificially made and are given commonly to those with brain tumors. Steroids are given for the purpose of reducing swelling in the brain and hence reduce pressure in the brain. These can be given before, after or during surgery and radiotherapy. Dexamethasone is the most common used steroid for this purpose.

Chemotherapy
Chemotherapy is the use of special drugs to kill cancer cells. This type of treatment is given by a specialized doctor known as medical oncologist. Generally chemotherapy is can be given through injection into vein (intravenously) by using a needle or given as a pill or capsule that is swallowed (orally). Chemotherapy can sometimes be given in combination with radiation therapy. For eye cancers chemotherapy is mostly used to those with lymphoma of the eye.

Side effects
Side effects of chemotherapy depend on the dose given, type of drug used and periodic time by which it has been used. Most of those side effects will stop after completion of treatment while some of them can be relieved by medication if they become serious during and after treatment course. Some of the possible side effects include the following;

• Hair loss
• Loss of appetite
• Nausea and vomiting
• Diarrhea
• fatigue

TACASO is dedicated to eliminating cancer as a major health problem, and improving the lives of those living with cancer

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