Brain cancer is a tumoral lesion that develops in the skull. 5000 new cases are diagnosed each year in France. Brain tumors generally bear the name of the cells from which they develop (meningioma, glioma, etc.).
Brain cancer is a tumor lesion which develops in skull at different levels: parenchyma, cerebral hemispheres, cerebellum, brainstem, meninges (meningiomas), vascular structures (angiomas) or glandular structures (adenomas). The symptoms are given by the location, the morphological type and the evolution of the tumours. These are symptoms that are generally common to other neurological pathologies (headaches, epilepsy…). This is why for several years, a new specialty has appeared. We talk about the neuro-oncology and neuro-oncologists, doctors who are basically neurologists with special oncological skills concerning only neurological pathologies. Explanations with Dr. Vas Ciprian Barlog, neurologist specializing in neuro-oncology at Gonesse Hospital.
The intracranial tumors can be either benign or malignant. In adults, they are located mainly above the tentorium of the cerebellum, part of a meninge which separates the brain above, from the cerebellum below. Among the benign tumors which are most often located outside the brain tissue strictly speaking, we find essentially the schwannomes developed from a particular cell type, Schwann cells, and meningiomas developed in the meninges, one of the three membranes covering and protecting the brain. Malignant tumors are also of several types, but are located more voluntarily at the level of the parenchyma cerebral. A tumor discovered in the brain often leads to similar signs which initially do not allow the benign or malignant nature of the tumor to be defined, and even if the imaging points to an origin, a sample, or biopsy, is necessary to make the diagnosis. diagnostic.
There are a large number of different brain tumors. Depending on their location, their size and the speed at which they grow, these tumors do not cause the same symptoms and do not have the same severity. Brain tumors are usually named after the cells from which they grow.
• Gliome
These are the most well-known cancers, so called because the damaged cell is the glial cell that is found around neurons. The classification takes into account the degree of aggressiveness. There are several types, from I to IV, the first being the least aggressive.
• Glioblastome
“This is grade IV gliomas, it is the most aggressive and widespread. The treatments known today do not make it possible to cure this disease. He only has the means through chemotherapy and radiotherapy to extend life expectancy to a year, a year and a half” explains Dr. Vas Ciprian Barlog, neurologist specializing in neuro-oncology at Gonesse hospital.
• Meningioma
Le meningioma affects the cells of the meninges and can be localized around the brain and spinal cord. The most common form of meningioma is benign, and its prognosis is favorable. Doctor Barlog, specifies that there is also “malignant forms that require surgical treatment and radiotherapy”.
• Medulloblastoma
It is a malignant lesion in the spinal cord and cerebellum. This tumor lesion appears mainly in children and adolescents. “This causes as a symptom of gait and balance disorders, intracranial hypertension. There are specific treatments and the possibility of healing depending on the stage of intervention” specifies Doctor Barlog.
• Pituitary Adenomas
It is usually a benign tumor that develops in the pituitary gland. “This gland, located behind the optic chiasm, in the pituitary fossa of the sphenoid bone, contains cells which produce hormones regulating the activity of several organs. A pituitary adenoma can then create hormonal imbalances. Depending on the adenoma, the treatment will be medical or surgical. The pituitary adenomas are for the most part benign lesions. If they are malignant, the prognosis is favorable if they are treated in time. explains the doctor.
• Cerebral lymphoma
Cerebral lymphoma particularly affects immunocompromised patients and people over the age of 60. “Its treatment is not practiced everywhere, because it requires close monitoring, heavy chemotherapy. Some patients may have a very long remission and there are many recurrences. Specialists are studying advanced treatments from stem cells in order to improve the prognosis, which is still unfavorable at the moment. says Dr. Barlorg. Survival is greater in young people.
In France, according to the National Cancer Research Institute, there are around 5000 new cases of brain cancer, all types combined, per year. If the meningiomas are more common in womenother brain tumors are more common in men.
“If cancers like lung or liver have causes like tobacco or alcohol, there is not yet a risk factor incriminated in that of the brain” replies our interlocutor. “There are genetic forms, quite rare, that we can suspect, for example, if glioblastomas appear in a young patient or if he has family members who have had brain cancer” he specifies.
“Brain cancers growing inside the skull (which is rigid, inextensible), cause a intracranial hypertension which gives neurological symptoms common to both men and women. In general, women may be more prone to headache, nausea, vomitingalthough these symptoms also appear in men” report to Dr Barlog. “However, in the case of pituitary adenoma, which can cause hormonal disorders, some women will have milk secretions outside of pregnancy, amenorrhea.”
→ the headaches appear rather in the morning on waking and are often accompanied by nausea, even vomiting. They are caused by increased pressure inside the skull
→ epileptic seizures can also be a warning sign of a brain tumor (in women but also in men).
If the symptoms are very little differentiated by sex, Dr. Barlog points out that “men will have more epileptic seizures. Still in the case of a pituitary adenoma, and a disruption of sex hormones, men can suffer from impotence and gynecomastia (enlarged mammary glands)”.
“We are not talking about stages of development in brain cancers as for other cancers. Brain cancers are evaluated in histological grades, from I to IV, the I being the least aggressive then there are sub-categories according to different molecular criteria. Specialists rely on the type of cancer, its location, its size and its extension to set up a treatment and establish a prognosis. explains the neuro-oncologist
“There are two ways to discover brain cancer: either an acute event that leads to a visit to the Emergency Room, most of the time it is an epileptic seizure. We then make a brain scan which may reveal an abnormal mass in the brain. Or else, there is a progressive appearance of neurological symptoms: headaches, nausea, vomiting, neurological deficits, language and cognitive disorders. The general practitioner or neurologist will prescribe a CT scan or an MRI. The doctors then speak of suspicion of a tumor, to have confirmation, a neurosurgeon performs a biopsy or surgery. describes the neuro-oncologist.
“Once the diagnosis has been established, various medical specialists, neurologists, oncologists, neuro-surgeons meet in order to jointly establish a course of action for the treatment” explains our interlocutor.
→ If the tumor is not cancerous, it will be surgically removed, if it is in an area accessible to surgery.
→ For brain cancer, there are three main therapies : chemotherapy, surgery and radiotherapy. Chemotherapy consists of taking drugs that will destroy cancer cells. It can be used in addition to radiotherapy, before surgery to facilitate the procedure, or after surgery to destroy the remaining tumor cells. Surgical treatment consists of removing the tumour. Radiation therapy uses rays to destroy cancer cells.
It is difficult to give the overall chances of survival. The prognosis of brain cancer depends on the type and its grade. Life expectancy also depends on other factors, common to all brain tumours, such as age, general state of health, cardiovascular and respiratory risks, drug tolerance, and ability to neurological recovery.
Thanks to Dr. Vas Ciprian Barlog, neurologist specialized in neuro-oncology at Gonesse hospital.
See : le National Cancer Institute brain tumor booklet published in 2010.