Depending on whether it affects young people or adults or the elderly, the disease has different characteristics
I brain tumors constitute a fairly diverse set of neoplasms. In this context it is first of all important to distinguish between those that originate directly in the central nervous system (primary tumors) and those that are born outside this body, which is reached later (brain metastases). The former, which in most cases are gliomasare much less frequent than the latter.
BRAIN TUMOR: initial symptoms and IDH MUTATION
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Another factor is also fundamental in the classification of brain tumors: the possible presence of the mutation of the Idh genes. This mutation, which is mainly observed in gliomas, is characteristic of juvenile forms of the disease, while it is very rarely observed in cases involving adults and the elderly. The typical onset symptom of tumors with Idh mutation are le Seizures. “About 30% of the time the diagnosis is reached before the manifestation of this symptom, often performing CAT scans or MRIs due to trauma or persistent headaches. Before the development of the disease or the initial epileptic seizure, patients frequently show behavioral disturbances, attention problems and alterations of higher cognitive functions” explains the professor Lorenzo Bello, head of the Oncological Neurosurgery team of the Irccs Galeazzi Hospital – Sant’Ambrogio in Milan. These tumors are slow growing and are often located in the most electrically irritable structures of the brain. Precisely the slowness of development allows the nervous system to reorganize itself after the onset of the disease until the stressed brain circuits give rise to the epileptic seizure. Instead, in typical adult forms the brain tumor grows faster and, as a result of the mass effect, is mainly manifested by neurological deficits and headacheswhile epileptic seizures are less frequent.
BRAIN CANCER: DIAGNOSIS AND TREATMENTS
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In addition to the neurological examination, instrumental tests such as the MRI and the Pet (positron emission tomography). The treatment of the disease involves the participation of a multidisciplinary team (which includes the surgeon, the oncologist, the radiotherapist, the psychologist and the neuropsychologist). “The first treatment is surgical and has two functions. On the one hand, the operation makes it possible to define the molecular histological profile which defines the diagnosis and is useful for setting up subsequent treatments. On the other hand, it allowsremoval of the neoplasm, considering that the extent of the resection is in itself a very important prognostic factor, regardless of the histomolecular profile of the tumour” continues Professor Bello. However, the removal of the tumor must be balanced with the maintenance of functional integrity of the brain, in light of the fact that gliomas are tumors that infiltrate the brain, well beyond the margins visible on MRI. In recent times the methods of resection, especially those based on techniques of brain mappinghave become more and more precise, optimizing this balance.
METASTASIS ARE ALMOST ALWAYS LOCAL
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Survival varies greatly based on the type of brain tumor. If one intervenes early and thanks to a wide excision, in the mutated Idh forms the average free time from the disease exceeds 8-9 years, with a less than 10% recurrence rate. About 70% of patients lead a normal life 15 years after diagnosis. “Unfortunately the picture is much worse in case of unmutated Idh forms. By surgically intervening and then with cycles of chemotherapy or radiotherapy it is possible to keep the disease under control for a couple of years, then other therapies are used, thanks to which a percentage between 30% and 40% of patients is alive at a distance 3-4 years after diagnosis” says Professor Bello. Typically, primary brain tumors they do not metastasize outside the brain. Secondary ones can instead derive from almost all systemic tumors, mainly from those of the breast, lung and melanoma.
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