Brain Tumours and Brain Cancer

Surgery:

Surgery is often the first line of treatment to remove as much of the tumour as possible.

• Craniotomy: A portion of the skull is removed to access the tumour.
• Minimally Invasive Surgery: Small incisions with the use of endoscopes or robotic systems for hard-to-reach tumours.
• Awake Brain Surgery: Performed while the patient is conscious to ensure no critical functions (e.g., speech) are impacted during tumour removal.
• Challenges: Tumours near critical brain regions may not be fully removable, requiring additional treatments.

Radiation Therapy

Radiation therapy uses high-energy rays to destroy tumour cells or shrink them.

• External Beam Radiation Therapy (EBRT): Directs radiation from outside the body over multiple sessions.
• Stereotactic Radiosurgery (SRS): Delivers highly focused radiation in a single or few sessions (e.g., Gamma Knife, Cyber Knife). Ideal for small, inoperable tumours.
• Proton Therapy: Uses protons as conventional radiation therapy to minimize damage to surrounding healthy tissue.
• Side Effects: Fatigue, hair loss, and brain swelling can occur, requiring supportive care.

Chemotherapy

Chemotherapy drugs stop tumour growth or kill cancer cells directly.

• Administration Methods: Directs radiation from outside the body over multiple sessions.

1. Oral: Pills taken at home.
2. Intravenous (IV): Delivered directly into the bloodstream.
3. Intrathecal: Injected into the cerebrospinal fluid for central nervous system cancers.

• Common Drugs: Temozolomide (for glioblastoma) and Carmustine.
• Challenges: Chemotherapy can lead to side effects like nausea, hair loss, and lowered immunity.

Targeted Therapy

This approach blocks specific molecules or mutations that drive tumour growth.

• EGFR Inhibitors: Effective for tumours with EGFR mutations (common in glioblastoma).
• VEGF Inhibitors: Prevent tumour blood vessel formation.
• mTOR Inhibitors: Blocks proteins involved in cell growth and survival.
• Advantages: Fewer side effects than chemotherapy since healthy cells are less affected.

Immunotherapy

Immunotherapy enhances the body’s natural defences to fight cancer cells.

• Checkpoint Inhibitors: Blocks proteins that prevent immune cells from attacking the tumour.
• Vaccine Therapies: Trains the immune system to target tumour-specific antigens.
• CAR-T Cell Therapy: Immune cells are modified to recognize and destroy brain cancer cells.
• Limitations: Brain tumours can evade immune detection, so immunotherapy may not always be effective alone.

Rehabilitation and Supportive Care

Since brain tumours affect critical functions, patients may need rehabilitation during or after treatment.

• Physical Therapy: Restores strength and mobility affected by surgery or radiation.
• Occupational Therapy: Helps patients adapt to changes in cognitive or motor functions.
• Speech Therapy: Addresses communication challenges if speech areas are impacted.
• Counselling and Mental Health Support: Supports patients and families in coping with emotional stress and life adjustments.

Clinical Trials

Patients can access cutting-edge treatments not widely available through clinical trials.

• Emerging Therapies: New drug combinations, gene therapies, and advanced surgical techniques are tested.
• Eligibility: Trials may have specific criteria, such as tumour type and previous treatments.