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Brain tumor


 
Two years ago, Ben Brabyn, a forty year old former British Royal Marine and investment banker turned entrepreneur, visited his doctor with headaches that another doctor had diagnosed as sinusitis. The second doctor suspected a brain tumour and immediately called for an ambulance to take Ben to Charing Cross Hospital, London. Scans showed a fist-sized tumor on the right side of his forehead, see above. Undetected, Ben's tumor could have killed him within days
 
Any brain tumor is serious and life-threatening because of its invasive nature in the limited space of the intracranial cavity. The threat a brain tumor poses depends on its type, invasiveness, location, size and the state of its development. A tumor may be particularly deadly because it can push against or invade important parts of the brain, as well as cause a lot of swelling that can result in blackouts, fits and other serious health challenges.
 
Within hours of being admitted to hospital, surgeons removed a large panel of bone over Ben's right eye and excised his tumor, which turned out to be a benign meningioma. Most meningiomas are benign and tend to be more common in middle-aged or elderly women than in men.  Ben is now fully recovered. 
 
Brain tumor deaths are increasing
Each year, around 165 million people in Europe are affected by some form of brain-related disorder, which suggests that almost every family in Europe is likely to be affected. Not everyone however will be as lucky as Ben Brabyn.
 
In the US, over 688,000 people are living with primary brain tumors, some 138,000 are malignant and about 550,000 are non-malignant. Since 2004 the incidence of brain tumors in the US has increased by 10%.  In 2013 in the US, an estimated 70,000 new cases of primary brain tumors are expected to be diagnosed. In 2012 an estimated 13,700 deaths were attributed to primary brain tumours.  

Brain tumors are the second-leading cause of cancer deaths in American children. In 2013, approximately 4,300 Americans younger than 20 will be diagnosed with primary brain tumors.
 
In the UK the situation is equally bleak. Over 9,000 people are diagnosed with brain and spinal cord cancer annually and it kills nearly 5,000. Over the past decade there has been a 16% increase in brain tumor deaths. The largest group of primary brain tumors is gliomas; a broad term that includes all tumours arising from the gluey supportive tissue of the brain. These make up 30% of all brain and spinal cord tumors and 80% of malignant brain tumours. 
 
Malignant brain tumors
Over the past 30 years, the outcomes for patients with malignant brain tumors have been poor and have not changed substantially. Compared with the survival rates of other cancers, brain cancer has one of the lowest: only about 19% of those diagnosed with brain cancer in the UK between 2006 an 2010 were alive in 2011.
 
Average survival rates remain between 12 and 15 months and those surviving more than three years are rare. Not only are brain tumors devastating for patients and their families and friends, but the cost of their treatment is high and rising rapidly. In Europe alone the cost of treating brain tumors is estimated at €1.5 million every minute.
 
R&D increasingly dependent on charities
Although brain cancer is the second leading cause of cancer-related deaths in children and young adults, brain cancer research is relatively poorly funded. Over the past few years, several pharmaceutical companies have closed their neurosciences R&D because financial returns do not justify the investment. This means that fewer therapies are being developed and as a consequence the costs of brain related drugs are rising.
 
The burden for brain tumor R&D is increasingly falling on charities and the overwhelming majority of these tend to serve the big cancers. In the UK for example, 60% of cancer research funds go to five of the 48 main types of cancers. Research into brain tumors receives one of the lowest levels of funding: about 1.4% of total UK research-spend. Also, partly due to the complexities of the brain, brain cancer research does not benefit significantly from cancer research in general.
 
But there is hope. According to Stuart Essig, a leading figure in the American Children's Brain Tumor Foundation and Chairman of Integra LifeSciences Corporation, the world's largest neurosurgical company, "Many children's tumor specialists are excited about treatments currently being researched and developed. They expect to see advances in several areas: less traumatic surgeries, new chemotherapeutic drugs and combinations of drugs that effectively could replace surgery and radiation therapy, chemotherapy with fewer side effects, treatments that marshal the body's own immune system to kill cells and gene therapy."  
 
A leading clinician's view
"Although a brain tumor is a devastating diagnosis for both patient and doctor, there is some good news", saysChristos Tolias, a leading UK neurosurgeon from King's College Hospital, London and the London Neurosurgery Partnership.  "Benign tumors can often be removed using a combination of surgical and non surgical methods, which are constantly evolving".
 
"Neurosurgical techniques, such as endoscopically assisted transphenoidal approaches (through the nose) and image guidance (computer assisted navigation), permit the successful removal of large tumors with minimal trauma for patients. Also, Gamma or Cyber Knife therapies can result in excellent outcomes without surgery".
 
"When we're dealing with a glioma; more invasive therapy is necessary and the results are still not very effective. However, special techniques such as gladiolan guided surgery (special dye, which allows the tumor cells to be visible in the operating room) as well as more aggressive resections combined with multidisciplinary support, are steadily achieving meaningful results for patients".
 
Christos Tolias and his colleagues are, "excited about some novel treatments at the experimental stage in King's College. One, in clinical trials, is designed to boost the immune response and there is basic research being carried out that may allow us to deploy gene and cellular level treatments". But, Tolias stresses, "The need for continued research support is imperative".  
 
Recognising the Symptoms
However, as Ben Brabyn discovered, early detection is extremely important. But because the brain is so well protected by the skull, diagnoses is challenging and detection only occurs when diagnostic tools are directed at the intracranial cavity. Thus, late detection is frequent and often when the presence of the tumor has caused unexplained symptoms.
 
Warning signs depend on the size and location of the tumor and can be general and misleading, but common symptoms include: (i) short-term memory loss and difficulty concentrating and using words, (ii) severe headaches that mainly occur in the morning, (iii) nausea or vomiting, (iv) seizures in people who do not normally suffer them, (v) problems with speaking, reading, writing and recognising names of objects and (vi) vision problems.
 
Costly but effective screening
The safest and quickest way to detect a brain tumor is with an MRI scan. However, most patients do not receive their first MRI until they are already experiencing symptoms, which is often too late. Although expensive, MRI screening, as part of a regular annual medical check-up, is the most effective way of detecting a brain tumor. 

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