Brain Stem Tumor or glioma cost in India

Know More About Procedure & Surgery

What is Brain Stem Tumor?

Brainstem glioma generally refers to all gliomas that are located in the brainstem. Typically these tumors are astrocytomas, and can be grades I-IV. Because of their location in the brainstem (which controls many critical functions like breathing, swallowing, and heart rate), treatment for these tumors require certain considerations. Astrocytomas that develop in different regions of the brainstem behave very differently from each other. Gliomas that occur in the midbrain and medulla (the top and bottom segments of the brainstem, respectively) are usually low grade (grade I). However, those that arise in the pons (the mid-portion of the brainstem) are usually grade IV tumors and typically grow much faster and progress more rapidly. The reason for the very rapid growth of these tumors in this particular area of the brain is still unknown.

Symptoms

These tumors can impact normal brainstem function, leading to common symptoms that include the following:

• Abnormalities in eye movement
• Weakness of one side of the face
• Numbness or weakness of the extremities
• Difficulty with balance
• Headaches
• Nausea

Types of Brainstem Tumor

Brainstem glioma or tumor refers to all subtypes of astrocytomas .that occur in the brainstem. Some brainstem tumor can be classified based on certain growth characteristics:

• Focal brainstem gliomas: These tumors grow more slowly, and are restricted to one area of the brainstem (usually the midbrain and medulla). These tumors are typically easier to treat, and have more favorable outcomes.
• Diffuse intrinsic pontine gliomas (DIPG): These grade IV tumors are extremely aggressive and although they appear to start in the pons, they can grow throughout the brainstem and neighboring structures. As the name suggests, the tumor cells spread out and invade neighboring tissue. DIPGs belong to a larger group of diffuse midline gliomas which occur in midline structures (including brainstem, thalamus, and spinal cord) and have specific genetic changes in common. 

Diagnosis

The following tests and procedures may be used:

• Physical exam and health history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
• Neurological exam: A series of questions and tests to check the brain, spinal cord, and nerve function. The exam checks a person’s mental status, coordination, and ability to walk normally and how well the muscles, senses, and reflexes work. This may also be called a neuro exam or a neurologic exam.
• MRI(magnetic resonance imaging) with gadolinium: A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the brain. A substance called gadolinium is injected into a vein. The gadolinium collects around the cancer cells so they show up brighter in the picture. This procedure is also called nuclear magnetic resonance imaging (NMRI).

A biopsy may be done to diagnose certain types of brain stem glioma.

If the MRI scan looks like the tumor is a DIPG, a biopsy is usually not done and the tumor is not removed. When the MRI scan results are uncertain, a biopsy may be done.If the MRI scan looks like a focal brain stem glioma, a biopsy may be done. A part of the skull is removed and a needle is used to remove a sample of the brain tissue. Sometimes, the needle is guided by a computer. A pathologist views the tissue under a microscope to look for cancer cells. If cancer cells are found, the doctor will remove as much tumor as safely possible during the same surgery.

Treatment

For grade I brainstem gliomas, surgery alone is often curative. If most of the visible tumor cannot be removed with surgery, then treatment with radiation therapy can be very effective as an additional treatment. However, most brainstem gliomas are grade II-IV and grow rapidly, which can begin impacting critical brainstem functions. In these cases, surgery to remove the tumor may not be possible, depending on the spread of the tumor. This because the brainstem controls many vital functions necessary for survival, including control of breathing, heart rate, and blood pressure. At the same time, if the tumor continues to grow, those functions can be affected directly by the tumor itself. This is why treatment must be started as quickly as possible to control tumor growth.

The most effective and most common initial treatment is radiation therapy. This is typically done over a 6-week period. In some cases, physicians may add various forms of chemotherapy either during and/or after the radiation. If chemotherapy is given, it will be continued for as long as it works to control tumor growth.

Risks Involved

Side effects from cancer treatment that begin after treatment and continue for months or years are called late effects. Late effects may include the following:

• Physical problems.
• Changes in mood, feelings, thinking, learning, or memory.
• Second cancers (new types of cancer).

Recovery

Recovery time in the hospital is usually 4 to 6 days, although this depends on the size and location of the tumor, the patient’s general health, and whether other treatments are given. Healing around the surgery site usually takes several weeks.