Primary tumours of the brain comprise about 5 per cent of the human cancers in adults and 20 per cent of the childhood cancers. The peak age of developing primary tumour of the brain is 50 to 60 years in adults and 5 to 10 years in children, however it may occur at any age. A primary tumour of the brain may be benign or malignant in character but even a benign tumour of the brain has devastating effects because the skull cannot expand to accommodate the growing tumour mass. Some tumours of the brain such as neurofibroma, haemangioblastoma, craniopharyngioma and retinoblastoma have a familial tendency. Risk factors of the primary brain tumours include viral infections, tuberous sclerosis, cranial irradiation and environmental factors. Certain benign tumours of the brain may transform into a malignant tumour.
The brain tumours usually remain asymptomatic (silent) in early stages of the disease. Symptoms start appearing as the tumour grows in size. The brain tumours may present with symptoms related to the focal cerebral disturbances and the generalised symptoms. The cerebral symptoms vary depending on location of the tumour.
Common symptoms of the brain tumours include headache, nausea, vomiting, malaise, convulsions and the focal neurological deficit. There may be subtle changes in the mental functions including personality, intelligence and memory. The raised intracranial pressure may lead to headache (early morning headache), vomiting, papilloedema, hypertension, bradycardia and decreased level of consciousness.
The most common symptom of a spinal cord tumour is pain that may be localised in the back or radiating to the extremities. The pain gets characteristically aggravated on coughing or straining. There may be spinal dysfunctions including the motor deficit, paraesthesia and numbness in the legs due to direct compression of the spinal cord.
Malignant tumours of the brain usually do not metastasise to the extracerebral sites but metastases to other parts of the brain may occur. Procedures used in diagnosis and evaluation of the brain & the spinal cord tumours include X-rays, CT scan, MRI, EEG, cerebral angiography, spinal tap, CSF cytology pneumoencephalography and biopsy.
The brain and the spinal cord tumours are classified according to the histopathological grade of the tumour and the type of cells of their origin. Approximately 50 per cent of the primary intracranial malignant tumours are gliomas (astrocytomas). In adults, the glioma is usually located in the cerebral hemispheres, whereas in children the glioma is usually located in the cerebellum and the brain stem. Other primary intracranial malignant tumours include oligodendroglioma, medulloblastoma, ependymoma, and microglioma (cerebral lymphoma). Oligodendroglioma and cerebral lymphoma are usually located in the cerebral hemispheres and occur in adults, whereas medulloblastoma and ependymoma are usually located in the posterior fossa and occur in children. Benign intracranial tumours include meningioma, neurofibroma, craniopharyngioma, pituitary adenoma and colloid cyst.
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