Brain Tumor Treatment Treatment Cost in India

As normal cells grow old and damaged they slowly die and they are replaced by new cells. But in some conditions, the process gets disturbed and new cell formation takes place even when the body does not require and old and damaged ones do not perish as they should. When extra cells are formed in the brain, they are called brain tumor and they can be either be harmless (benign) or harmful (malignant).  The benign ones do not have cancer cells

• The benign ones are removed, and they rarely recur
• They have different frontiers and do not invade tissues and therefore do not spread
• They can press on sensitive areas of the brain and cause serious health troubles
• There can be a case when benign brain tumors grow potentially harmful and turn malignant. 

Malignant ones contain cancer cells and can pose a serious threat to life.

• They grow very rapidly and invade the healthy brain tissues nearby
• The cancer cells can break free and spread to other healthy parts of the brain or affect the spinal cord
• They seldom affect any other body parts

Brain tumors can be graded by doctors on the basis of how the cells look under the microscope

• Grade 1: The tissues resemble normal cells and the growth is very slow with the tissue being benign.
• Grade 2: The tissue is malignant, and the cells look slightly less normal
• Grade 3: In this case, the cells look quite different and they are anaplastic (characteristic of cells or tissues that have lost their mature or specialized features) in nature or rapidly growing
• Grade 4: They look most abnormal and growing at a rapid pace.

With time the low-grade tumors can turn into higher grade ones and this change is found mainly in adults compared to children.

Primary kinds of brain tumors among adults can be of the following types:

• Meningioma: They are slowly growing benign tumors that are formed from the outer covering of the brain right below the skull. It is formed in the meninges and it grows slowly and is or grades 1,2 or 3.
• Oligodendroglioma: The fatty substance that covers and protects the nerves gives rise to this kind of tumor and it is most common among middle-aged adults and may be of grade 2 or grade 3.
• Astrocytoma: Formed from star-shaped glial cells called astrocytes and can be of any grade. They usually arise in the cerebrum of the brain.

The most common types of tumors found among children are:

• Medulloblastoma: The tumor has its origin in the cerebellum and called a primitive neuroectodermal tumor. The grade is IV.
• Grade I or II astrocytoma: This kind of tumor among children can occur anywhere in the brain. The most common astrocytoma among children is juvenile pilocytic astrocytoma. It's in grade 1.
• Ependymoma: This type of tumor that emerge from the cells that are around the ventricles and the central spinal cord channel. Grades range from 1 to 3, and are often found in young adults and children.
• Glioma of the brainstem: This can be a low grade or high-grade tumor in the lower part of the brain. Intrinsic pontine glioma is one of the most common types of tumors.

The brain tumor symptoms are highly dependent on the size of the tumor, it's kind and its location. Symptoms are manifested when the tumor presses hard on nerve and tissues or cause problems to the brain. Symptoms can also arise when the tumor blocks the flow of fluid through and around the brain and or when the brain swells with fluid buildup. Some of the brain tumor symptoms are

• Headaches
• Vomiting and nausea
• Changes and trouble in vision, hearing or speech
• The trouble with walking and balancing
• Memory problems
• Seizures and convulsion with muscle jerks and twitches
• Tingling sensation in arms and legs accompanied by numbness

The above symptoms are not exclusive to a brain tumor and if one finds these symptoms first they should talk to their healthcare provider to find whether there is any other underlying cause that is giving rise to these troubles.

If the doctor feels that the symptoms are close to a brain tumor then the doctor will give the following tests and exams to be conducted:

• Neurologic exam: vision, hearing alertness, muscle strength, and reflexes are checked.
• MRI: Magnetic Resonance Imaging is done to take detailed images of the head
• CT Scan: An X-ray machine linked with a computer to take images of the brain.
• Angiogram: Injection of dye to detect blood vessels that feed the tumor
• Spinal tap: A sample of cerebrospinal fluid is removed for checking the presence of cancer cells.
• Biopsy: affected tissue cells are removed to look for cancer cells or any other abnormal growth.

Surgery: Unlike many other treatment options for various ailments, surgery is treated as a last resort but in the treatment of brain tumor it can be the first option considered.

The patient is given general anesthesia and the region where an incision is required will be shaved off.  A craniotomy approach where the skull is opened may be adopted. The surgeon makes an incision in the scalp and then uses a special kind of saw for the removal of a bone from the skull. The patient can be awake when the surgeon is removing the part of the tumor or the total tumor. To check the cognitive abilities of the patient the surgeon may keep asking them for movement of legs and hands or may ask simple questions to be assured that all other parts of the brain are working properly. The skull opening is sealed by the surgeon with the aid of metal or cloth after tumor removal and places the bone flap behind it. Then the surgeon closes the incision in the scalp.

There can be many times when surgery may not be an option if in case the tumor is in the brain stem or any other areas when the surgeon is unable to access without causing any harm to normal tissues of the brain.

Radiation therapy: With the help of high energy X Rays, gamma rays or streams of proton, tumor cells are killed in radiation therapy. It can be an independent procedure or can be followed after surgery to ensure that any tumor cell remnant in the area is killed with the help of radiation therapy. Different types of external and internal radiation therapies are used for treating brain tumors.

There can be many times when surgery may not be an option if in case the tumor is in the brain stem or any other areas when the surgeon is unable to access without causing any harm to normal tissues of the brain.

External radiation therapy: The patient will visit a hospital where large machines are placed for targeting beams of radiation on the head. Cancer cells have a tendency to affect normal tissues around the tumor. The radiation is aimed at the tumor as well as nearby brain tissues or completely on the entire brain. Some patients require radiation to be aimed at the spinal cord and the treatment schedule depends on the age of the patient and size and type of the brain tumor.  Patients are usually subjected to fractionated external beam therapy. The radiation time period is stretched over a few days to several weeks which ensures more protection of healthy tissues nearby. Treatment time does not exceed more than a few minutes while the whole visit lasts for an hour.

There are centers that are identifying other methods of delivering the external beam radiation therapy and they are:

Intensity-modulated radiation therapy or 3-dimensional conformal radiation therapy: Computers are used for getting better results in terms of accuracy to prevent harm to any other healthy tissues around it.

Proton beam radiation therapy: The radiation source comprises of protons and not x-rays. The dose amount of radiation is lower than that of x-rays.

Stereotactic radiation therapy: from different angles narrow beams of gamma and x-rays are targeted at the brain tumor. A rigid head frame is worn by the patient and therapy can get completed in one single visit.

Internal radiation therapy or brachytherapy: internal radiation is not used very commonly for the treatment of brain tumors and is still under research. In small implants called seeds the radioactive materials are packed and from these, radiation comes. These seeds are implanted in the brain and kept for months to emit radiation and do not require removal after the radiation dies down.

Chemotherapy: This is the use of drugs for killing the cancerous cells which is also used for treating brain tumors if they have cancer cells. Drugs are administered in the following way to patients:

Intravenous (by vein or by mouth):  This kind of therapy can be started after radiation therapy. The drugs will enter the bloodstream and move around throughout the body. In this kind of treatment, the patient can even stay at his or her home and in very rare cases one may need hospital stays. Side effects of chemotherapy is dependent on the dosage and the kind of drug prescribed which includes, loss of sleep, headache, nausea, and vomiting, weakness, fevers, and chills. If the drug works by lowering the levels of healthy cells,  the patient will suffer from infection, bruises and feel extremely tired. Some of the side effects can be dealt with as the healthcare provider checks for side effects periodically.

Wafer patterns put inside the brain:  in the case of adults who have high-grade glioma, the surgeon implants quite a few wafers inside the brain. The wafers are of the sizes of dimes and throughout a period of several weeks the wafers get dissolved and the drug is released into the brain. The cancer cells are killed by the drugs. It may help prevent the recurrence of tumors in the brain after surgical removal. Signs of infection has to be always monitored for people who will undergo such implantation. In case there is an infection then the patient should be administered antibiotics.

The patient can suffer from discomfort and headache right after a few days of post surgery. Medicines can be effective in bringing some amount of relief but before the surgery, one must discuss the plan for further pain relief with the healthcare team. After surgery, the healthcare team may adjust the plan required for relief. The patient can feel tired and worn out and the time of recovery is different for different patients and may require longer stays in the hospital.

The other problems after surgery can be swelling and accumulation of fluid with build up in the skull. These conditions will be monitored regularly, and the patient may receive steroids to bring relief from swelling. In some cases, a second surgery may also be required for fluid drainage. A shunt is placed in the brain to collect the liquid which is routed to the abdomen where it gets absorbed and in some cases,  it can be drained to heart.

Harm to normal tissues around the brain can be serious damage. The patient will have serious problems in thinking, seeing or even speaking. There can be problems in personality too with seizures and cognitive impairment.  With time most of these problems get taken care of but in some unfortunate cases the damage can be permanent, and the patient may require physical therapy, speech therapy or any kind of occupational therapy to bring them back to normal life.

In radiation therapies, some patients can suffer from side effects. A feeling of nausea may persist hours after the radiation therapy ends. Radiation therapy gradually weakens the patient and doctors always advise keeping them active and a good amount of rest is also recommended.

The part of the head that was treated may undergo some amount of hair loss because of therapy. But within a few months, hair grows. Radiation therapy can also have effects on skin, scalp, and ears turning them red and very tender. The healthcare provider will advise the patient on ways to relieve these problems. In some cases, brain tissues swell because of radiation and the patient may experience headaches and pressure. This can also be taken care of through medications. In only rare cases, if healthy tissues get affected patients can suffer from seizures, headaches and even death.

Harm may be caused to other parts of the brain and the pituitary gland. This can have adverse effects in the lives of children as it can slow down their development and growth and children can have trouble learning. Radiation can also pose harm in terms of developing secondary tumors in later stages of life.

Brain tumor surgery cost may range between $4500 to $7000.