Low-grade gliomas, such as oligodendroglioma, occur in younger patients, whereas vysokozlokachestvennye, such as glioblastoma multiforme, common in older patients. In patients with glioblastoma multiforme the most unfavorable prognosis, the two-year survival rate of 30% in patients younger than 20 years and 2% in patients older than 65 years.
Meningiomas - extracerebral tumors are more common in older people, and their relatively favorable prognosis (overall five-year survival rate - 81%, five-year survival rate meningosarkome - 55%). By the appearance of gliomas few men are more prone to meningiomas - women.
Genetic lesions and abnormal expression of genes play a major role in the development of gliomas. They run overexpression of platelet-derived growth factor, which allows cell proliferation, cell migration and glioma TP53 gene inactivation, which normally inhibit the growth of abnormal cells. Patients with this syndrome, as neurofibromatosis and Cuspal sclerosis, significantly more likely to develop brain tumors. Only 2-10% of the patients were genetically predisposed to tumors of the brain, and only 5% of gliomas could be hereditary.
Swelling increases the intracranial pressure and thus presses the entire brain. This phenomenon is the cause of many of the symptoms associated with brain tumors, both benign and malignant. Primary brain tumors arise directly from the brain, but they occur much less frequently than secondary metastatic tumors that spread to the brain as a result of cancer in any part of the body. Symptoms appear gradually, depending on what part of the brain affected. Primary brain tumors are rare, accounting for only about 2 percent of all cancers.
Causes brain tumor
- The cause of primary brain tumors is unknown;
- metastatic tumor can spread as a result of lung cancer, liver, intestine, breast, skin or other body parts.
Many genetic factors and life determine the development of primary tumors of the brain, although it is difficult to establish the specific cause and communication. Epidemiological studies of brain tumors are difficult because of the low incidence, clinical and histological heterogeneity of diversity. In the future, perhaps, to understand the etiology of brain tumors will help molecular markers.
Diagnostics brain tumor
- The need for detailed medical history and physical examination.
- To determine the tumor may require computed tomography.
- Frequently performed spinal (lumbar) puncture (using a needle to take a sample for analysis of cerebrospinal fluid surrounding the spinal cord). Pumping of cerebrospinal fluid should not be performed if other means of diagnosis revealed the presence of a large mass, which puts pressure on the brain. Under these circumstances, a lumbar puncture is dangerous.
- To confirm the diagnosis of a tumor biopsy is desirable.
- To measure the electrical activity of the brain and evaluation can be carried out electroencephalography.
- In preparation for the surgery can be used to detect cerebral arteriography of the arteries supplying blood to the tumor.
Symptoms brain tumor
- Frequent headaches, which are enhanced in the supine position.
- Nausea with or without vomiting.
- The weakening of vision or double vision.
- Seizures.
- Difficulty thinking, confusion, or even coma.
Classification brain tumor
Due to the presence of different brain cell types classification of brain tumors is complex. Attempts were made to classify tumors and are constantly being made. Currently, the most commonly used classification of the WHO in 1993 and amended in 2000.The largest group of tumors of the brain integrates neuroectodermal tumors (60%). The largest share of these tumors are astrocytal series (35-42%). Malignant astrocytoma forms dominate the benign (1.3 times among males and 2-fold among women).
According to the classification of WHO nervous system tumors (Lyon, 2000) tumor of neuroepithelial tissue divided into:
Astrocytic tumors:
- Diffuse astrocytoma:
- Fibrillary astrocytoma;
- Protoplasmic astrocytoma;
- Gemistotsiticheskaya astrocytoma;
- Anaplastic astrocytoma;
- Glioblastoma:
- Giant cell glioblastoma;
- Gliosarcoma;
- Pilocytic astrocytoma,
- Pleomorphic ksantoastrotsitoma;
- Subependimarnaya giant cell astrocytoma.
- Oligodendroglioma
- Anaplastic oligodendroglioma.
- Oligoastrocytoma;
- Anaplastic oligoastrocytoma.
- Ependymoma:
- Cell;
- Papillary;
- Clear-;
- Tanitsitarnaya;
- Anaplastic ependymoma;
- Miksopapillyarnaya ependymoma;
- Subependimoma.
- Choroid plexus papilloma;
- Cancer of the choroid plexus;
- Astroblastoma;
- Gliomatosis of the brain;
- Hordoidnaya glioma III ventricle.
- Gangliotsitoma;
- Gangliotsitoma dysplastic cerebellum (Lermigta-Duclos);
- Desmoilasticheskaya astrocytoma / ganglioma in children;
- Dizembrioplasticheskaya neuroepithelial tumor;
- Ganglioglioma;
- Anaplastic ganglioglioma;
- Central neyrotsitoma;
- Cerebellar liponeyrotsitoma;
- Paraganglioma terminal filament.
- Olfactory neuroblastoma (esthesioneuroblastoma);
- Olfactory neyroepitelioma;
- Adrenal neuroblastoma and the sympathetic nervous system.
- Pineotsitoma;
- Pineoblastoma;
- Pineal parenchymal tumors of intermediate differentiation.
- Medulloepitelioma;
- Ependymoblastoma;
- Medulloblastoma:
- Desmoplastic medulloblastoma;
- Large cell medulloblastoma;
- Medullomioblastoma;
- Melanin medulloblastoma;
- Supratentorial primitive neuroectodermal tumor (PNEO)
- Neuroblastoma;
- Ganglioneyroblastoma;
- Atypical teratomatous / rhabdoid tumor.
Most neuroepithelial tumors are gliomas. Gliomas account for 60% of all primary brain tumors. Malignant gliomas - glioblastoma multiforme and anaplastic gliomas (anaplastic astrocytoma, anaplastic oligodendroglioma and anaplastic oligoastrocytoma) are the most common infiltrative primary brain tumors. Histologically, they are classified into four grades of malignancy, different versions of which are of unequal frequency, and vary according to the forecast. The most common are astrocytomas, oligodendrogliomas, and glioblastomas.
Tumors astrocytal series together as a common origin of astrocytic tissue, a hook and a number of specific features: glial-fiber component, the nature of growth, and the frequent recurrence of malignancy, metastasis is relatively rare, even with high malignancy. According to domestic and foreign authors such tumors account for 55% of all brain tumors.
Astrocytomas by morphological structure are a heterogeneous group of primary brain tumors. Given that astrocytomas develop from astroglia, along with the division on the histological grade of malignancy spend differendirovku by type astrocyte (fibrillary or pilocytic), which is the basis of proliferation. Such a division is of great prognostic importance, as pilocytic astrocytomas rarely ozlokachestvlyayutsya unlike fibrillar (infiltrative) astrocytomas and can be almost completely removed. Diffuse astrocytomas make up 25-30% of the hemispheric gliomas in adults. Age greatest occurrence supratentorial astrocytomas 20-50 years, which is generally 10 years earlier than in glioblastomas. These tumors can develop in any part of the brain with respect to the lower frequency of lesions occipital lobes. When the tumor is localized to the deep divisions, there may be a two-way invasion. In the pathological process involved both white and gray matter of the brain. Benign astrocytoma have a better prognosis than malignant form. Overall prognosis of these lesions is always unfavorable. Life expectancy at astrocytomas ranges from 2.5 to 10 years. Moreover, it is known that about 10% of benign lesions eventually transform into malignant forms.
50% of surgically treated malignant astrocytomas were transformed to anaplastic astrocytomas and glioblastomas. You may also experience a progressive increase in fibrillary astrocytoma without increase of malignancy.
The histological structure of the tumor astrocytal number reflects the degree of malignancy. Typical astrocytoma - a group of tumors of different smallest degree of malignancy and the most benign course includes three major histological variant of astrocytomas: fibrillary, protoplasmic and mixed (fibrillar protoplasmic). The division of diffuse gliomas at the stage of malignancy is an important moment in the development of treatment strategies and the subsequent prognosis. Some authors believe that the ideal would be to classify cerebral gliomas based on the presence or absence of malignant cells. Unfortunately, with the rise of anaplastic transformation in diffuse astrocytomas increases as the morphological and genetic heterogeneity, making the histopathological classification and separation stage problematic. Furthermore, the process of tumor growth may not be static, as may be revealed significant changes in the degree of malignancy with the passage of time. Traditionally, diffuse astrocytic gliomas are distributed in accordance with the degree of malignancy of the growth of low-grade astrocytomas to glioblastomas.
The criteria for malignancy are the presence of nuclear and cellular polymorphism of vascular endothelial cell proliferation, the presence of mitosis and necrosis.
Fibrillary astrocytoma feature is their tendency to generate biologically more aggressive cells. This trend changes in malignant astrocytomas fibrillar implies that some tumors may have a well-differentiated and anaplastic components. The presence of these components creates a problem of selecting the material for the study because If only well-differentiated tumor elements fall into the biopsy material, it can prevent the selection of appropriate treatment.
The second important criterion in the treatment of fibrillary astrocytoma related to prognosis, is a close relationship between patient age and life expectancy. Patients older than 60 years with anaplastic astrocytomas and glioblastomas have a significantly lower life expectancy, but it is also true for patients in this age group with well-differentiated astrocytomas. Well-differentiated tumors usually occur in people in the 4th decade of life. The tumor has no clear boundaries and has an infiltrative growth. Some of hemispheric tumors have areas of calcification, but it is more common in oligodendrogliomas.
Macroscopically benign astrocytomas have a uniform character of the tumor tissue and visualized as a node. The border of the tumor to the surrounding matter of the brain sharp.
Thus, the criteria for the classification of brain tumors may be different: histological, tomography, surgical, clinical, but to the forecast. The purpose of neuroradiological diagnosis is to distinguish tumor from non-tumor process accurately determine the location of the tumor, to characterize the structure of the tumor (solid, cystic structure), the presence of hemorrhage, necrosis, calcification, its vascularization.
In addition, there are four degrees where I-II show a low degree of malignancy, III-IV - high. Low-grade tumors include pilocytic astrocytomas and highly differentiated astrocytomas and oligodendrogliomas. Vysokozlokachestvennye tumors include anaplastic astrocytoma or anaplastic oligodendrogliomas, these tumors belong to the III WHO grade. The most malignant (IV degree) are considered to glioblastoma multiforme, which are the most common subtype and have the worst prognosis. The criteria for malignancy are the presence of nuclear and cellular polymorphism, vascular endothelial cell proliferation, the presence of mitosis and necrosis.
Vysokozlokachestvennye glioma (anaplastic astrocytoma and glioblastoma multiforme) can be classified as primary or secondary malignant astrocytoma. Primary malignant astrocytomas typically occur in older patients without a history of low-grade tumors. These tumors are characterized by high expression of the abnormal receptors of epidermal growth factor (EGFR) and TP53 mutation possess. Secondary malignant astrocytomas are commonly found in younger patients come from decaying primary low-grade tumors. Low-grade gliomas can remain stable for many years. When they break up, then characterized by TP53 mutations and other genetic changes.
Cells in these heterogeneous tumors, cancer cells grow more rapidly, leading to irregular shape and their different tumor differentiation. Over time, they degenerate in high grade tumors. Some of the molecular factors associated with the progression of the tumor, has already been discussed, for example, overexpression of platelet-derived growth factor, which causes the proliferation of cells, which is important during the early transformation LOW-grade astrocytomas in vysokozlokachestvennye. Genetic damage manifested in highly malignant tumors, in particular loss of heterozygosity on chromosome 10q.
The rapid growth of glioblastomas in the first weeks of the onset of the disease causes damage to the surrounding areas of the cortex of the brain and the appearance of neurological symptoms corresponding to the affected area. Changes in brain tissue originate from compression as neoplasm or germination, and as a result damaging effects of toxic factors related to the activity of tumor cells, leading to the development of edema and necrosis of the cerebral cortex on the periphery of the tumor.
Differentiation of tumors according to the degree of malignancy is crucial both in terms of prognosis and to select the method of treatment. When tumors III-IV grade 50% survival rate is only 9-10 months, and the tumors I-II degree of 50-75% of patients reaching 5-year survival rate.
Treatment brain tumor
- Tumors in the brain surface can be removed surgically. In many cases, however, can only remove part of the tumor, because complete removal due to the large brain damage. Nevertheless, even after removal of the tumor may occur during improvement by reducing intracranial pressure.
- Tumors located deep in the brain, treated with microsurgery, laser surgery or radiotherapy.
- The presence of primary tumors after surgery may be used radiotherapy or chemotherapy. Before the operation may also be performed exposure.
- Your doctor may prescribe corticosteroids to reduce swelling of the brain tissue, and anticonvulsant drugs to control seizures and relieve the pain.
- Contact your doctor if you have had a seizure.
- Consult your physician if you feel a constant severe headache, especially if it is enhanced in the morning and in the supine position.
- Contact your doctor if you have seen double vision, weakness, numbness, or loss of sense of touch.
Prophylaxis brain tumor
- Get regular checkups to detect cancer in any part of the body before it starts to spread.
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