Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: TUESDAY, July 25, 1995 TAG: 9507250037
SECTION: EXTRA PAGE: 3 EDITION: METRO
SOURCE: BY JANE BRODY
DATELINE: LENGTH: Long
Brain tumors are on the rise and no one knows why. It would be hard to find a family in which at least one member or friend has not had a brain tumor.
Since most brain tumors produce symptoms, like headaches, that are commonly caused by far less devastating disorders, they often are ignored or dismissed as unimportant. As a result, a correct diagnosis is not made until the tumor reaches a size that may make definitive treatment impossible.
Many brain tumors, if caught early, are curable. And even those that cannot be cured can often be treated in a way that gives patients years of quality life.
Dramatic improvements in diagnosis and new and improved treatments, including the use of a noninvasive radioactive ``knife'' and chemotherapy and still-experimental immunotherapy and gene therapy, offer hope for cure or at least long-term control in patients who just a decade ago would have been doomed.
Thus, lay people and doctors alike are being urged to be alert to the symptoms of brain tumors and to pursue a proper medical work-up when such symptoms have no obvious explanation.
Although brain scans are costly, they are safe and readily available and may reveal a tumor - or some other hazard in the brain - early enough for cure. It is important to remember that even when a growth is technically classified as benign it is not; although it may not be malignant, any growth in the brain is trapped in an unyielding skull and can press on and ultimately destroy vital brain tissue.
In the mid-1980s, about 55,000 Americans were found to have brain tumors. Experts expect the number this year will exceed 100,000, including about 17,000 primary brain tumors (those that arise in the brain) and at least 80,000 metastatic cancers that have spread to the brain from elsewhere in the body.
Tumors that originate in the brain are the second most common cancer in infants and young children, occurring about as often as acute lymphoblastic leukemia.
In adults, primary brain tumors are as common as ovarian cancer. About half of primary brain tumors are benign; they grow very slowly, do not invade surrounding tissues and usually can be successfully treated. The rest are malignant: aggressive and invasive but often treatable, although usually incurable.
To be sure, modern imaging techniques like computerized tomography, better known as a CT scan (a cross-sectional X-ray of the brain), or more often these days magnetic resonance imaging, better known as an MRI, have greatly improved diagnosis, but better detection does not appear to account for most of the rise in brain tumors.
For metastatic brain tumors, an important factor is likely to be the growing success oncologists have had in controlling cancers elsewhere in the body, allowing patients to live long enough to experience a recurrence in the brain years later.
Drugs that kill cancer cells often fail to cross the so-called blood-brain barrier, and cancer cells that have escaped to the brain may survive there and grow.
In treating breast cancer, for example, chemotherapy given after surgery and radiation often can eradicate cancer cells everywhere in the body except the brain, and cancer cells that reached the brain before treatment could result in a relapse.
Improper function of the immune system is believed to account for part of the rise in brain tumors. Among those affected are patients who have undergone organ transplants and require lifelong treatment with immunosuppressive drugs; those who years earlier underwent cancer treatments that suppress the immune system; people with AIDS, which causes immunological failure; and the growing numbers of elderly people whose immune functions gradually decline with age.
Although some researchers have suggested that environmental factors like exposure to electromagnetic fields may contribute to the rise in brain tumors, none of those theories has been established as fact.
Workers in the rubber industry have been shown to face an unusually high risk of developing brain tumors, perhaps from exposure to an occupational chemical.
The real challenge of brain tumors is finding them when they still are small and amenable to treatment. Symptoms depend on the size of the tumor and where in the brain it occurs. A benign tumor may grow very slowly for years before it causes enough pressure on the brain to produce a recognizable symptom.
One of the most common symptoms is persistent headaches, especially those that occur at night or are present upon awakening in the morning or, particularly in children, headaches accompanied by nausea and vomiting.
Other common symptoms include personality changes; vision or speech difficulties; behavioral disorders; weakness, numbness or paralysis on one side of the body or unsteadiness in walking that gets progressively worse; epileptic-like seizures; and sensory disorders, like a sensation of smelling something burning.
Too often, symptoms like personality or behavioral changes are attributed to a psychological disorder or to the aging process and are not taken seriously until it is too late to cure the tumor.
by CNB