Know yourself, know your enemy, and you will never be defeated
Overview of Hong Kong
Brain tumours are relatively uncommon in Hong Kong, with approximately 1,000 new cases reported annually (an average incidence rate of about 15 per 100,000 people). Among primary malignant brain tumours (brain cancer), glioblastoma accounts for around 80 new cases each year.
The brain is the body’s control centre, governing thinking, memory, language, emotions, and movement functions. When cancer cells invade the brain, these functions can be impaired to varying degrees, making treatment more challenging compared to other cancers.
Brain cancer can be classified into primary and secondary types.
Primary brain cancer refers to malignant tumours that originate in the brain. These tumours are typically named after the brain cells from which they arise. The most common type is glioma, such as astrocytoma, which develops from abnormal astrocytes.
Secondary brain cancer, also known as “Brain Metastasis,” occurs when malignant tumours from other parts of the body spread to the brain through the bloodstream. Cancers that frequently metastasise to the brain include lung cancer and breast cancer. Secondary brain cancer is more common than primary brain cancer.
Symptoms of Brain Cancer
Different areas of the brain control different functions, so a patient’s symptoms depend on the tumour’s location. Some patients may have no symptoms at all, with the cancer being discovered incidentally during routine check-ups, while others may experience multiple symptoms simultaneously.
Symptoms of brain tumours can be categorised into four main types: increased intracranial pressure, seizures, systemic disorders, and localised neurological dysfunction.
1. Increased Intracranial Pressure: Common clinical symptoms include headaches, vomiting, visual disturbances, and impaired consciousness.
2. Seizures:
New-onset epilepsy in adults should first raise suspicion of a possible brain tumour, making comprehensive brain examinations essential. Nearly all types of seizures can occur in brain tumour patients, including both focal and generalised seizures.
3. Endocrine Disorders:
Hormonal imbalances may lead to abnormalities in growth, body shape, and sexual function. For instance, hormone-secreting pituitary tumours can cause gigantism or acromegaly, infertility, and menstrual irregularities. Alternatively, brain tumours may compress surrounding structures, resulting in symptoms of hormonal deficiency.
4. Focal Neurological Deficits:
Patients may experience localised neurological symptoms such as weakness or clumsiness in one limb, abnormal sensations on one side of the body, unsteady gait, speech difficulties, personality changes, visual field defects, and focal seizures.
Understanding Cancer Causes
The exact causes of brain cancer remain unclear, but the following risk factors may be associated with its development:
Common Diagnostic Methods
Diagnosis involves clinical examination, imaging tests, and pathological analysis:
To determine the most appropriate treatment plan and assess prognosis, the World Health Organisation (WHO) classifies primary malignant brain tumours into four grades based on microscopic tissue characteristics:
Grade I:
The least malignant brain tumours have cells that appear nearly normal under microscopy. These tumours can often be effectively treated with surgery alone, and patients typically have longer survival times.
Grade II:
Microscopic examination reveals mildly abnormal cells. These tumours grow slowly but may invade nearby brain tissue or progress into higher-grade tumours.
Grade III:
Microscopic analysis shows abnormal cells. These tumours tend to invade surrounding brain tissue and are considered more aggressive.
Grade IV:
The most malignant brain tumours are characterised by rapidly proliferating abnormal cells with high cellular density and proliferation rates. These tumours invade adjacent brain tissue extensively, stimulate abnormal blood vessel formation, and exhibit vascular endothelial proliferation. Necrotic cells are commonly found at the tumour centre. Glioblastoma multiforme (GBM) is the most prevalent example, with most patients surviving less than two years.
Primary Treatment Approaches
This section focuses primarily on treatment methods for glioblastoma multiforme (GBM).
GBM treatment options include surgery, radiation therapy, chemotherapy, targeted therapy, and the latest Tumour Treating Fields (TTFields) therapy. Doctors tailor treatment plans based on individual patient conditions, often combining multiple approaches, such as surgical tumour removal followed by radiation or adjuvant drug therapy, to minimise recurrence risk.
Surgery is the cornerstone of GBM treatment, aiming for maximal tumour resection while preserving critical brain functions. However, when tumours invade, encase, or adhere to vital brain structures and nerves, surgical risks increase, making complete removal difficult. In some cases, only partial resection is possible, requiring follow-up radiation and chemotherapy to target residual tumour cells.
Radiotherapy uses high-energy radiation to destroy cancer cells and inhibit their growth and spread. Advanced techniques include:
These technologies deliver higher radiation doses to tumours while minimising damage to healthy surrounding tissues.
Chemotherapy employs drugs to kill cancer cells. Temozolomide (TMZ) is the most common drug for brain cancer, as it can cross the blood-brain barrier (BBB) to target tumour cells. However, it may also affect healthy cells, causing side effects like nausea, vomiting, hair loss, fatigue, and increased susceptibility to infection. Studies show that combining TMZ with post-surgical radiotherapy improves survival rates in GBM patients.
Bevacizumab, a monoclonal antibody targeting vascular endothelial growth factor (VEGF), is used for GBM. It inhibits tumour angiogenesis, cutting off nutrient supply to slow tumour growth. A significant side effect is the risk of bleeding.
TTFields is an innovative treatment that uses low-intensity alternating electric fields to disrupt cancer cell division, slow growth, and induce cell death. Patients wear four electrode arrays connected to a portable device on the scalp for ≥18 hours daily, replacing patches every 2–3 days. TTFields is typically used after surgery and concurrent chemoradiation, alongside TMZ maintenance therapy.
The most commonly used medications include anti-epileptic drugs to control generalised or focal seizures, as well as steroids to alleviate issues such as oedema in tissues surrounding the tumour.
The tumour itself and its treatment may cause damage to different areas of the brain, potentially leading to varying degrees of neurological impairment. This can affect hearing, vision, speech, or limb mobility. As a result, patients may require physical therapy, speech therapy, and occupational therapy. Through structured rehabilitation exercises, patients can regain some of their functional abilities. Additionally, maintaining a healthy lifestyle and dietary habits, engaging in regular exercise, keeping a consistent sleep schedule, managing stress appropriately, and staying positive can all contribute to recovery.
Regular Follow-Up Appointments
Patients must attend follow-up visits as directed by their doctor. This helps address any treatment-related complications early and allows for timely detection and appropriate intervention if the cancer recurs.
Family Support
Although brain cancer is a challenging condition to treat, patients can reduce unnecessary anxiety and build confidence in their treatment by understanding their diagnosis and available therapies. Open communication with family members about the illness is encouraged, allowing for joint discussions about treatment plans and family responsibilities. Rather than facing the journey alone, family support can make a meaningful difference in managing the disease.
▣ The information on this website has been reviewed by the HEAL Medical Team and is regularly updated according to the most recent clinical evidence. All content is provided for general informational purposes only and should not replace professional medical advice. Please consult your doctor or another qualified healthcare professional for personalized medical guidance.
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