Situation with head tumors is becoming menacing
The Ministry of Health announced 2015 to be the Year for Cancer Prevention and Control in Latvia, with the main focus on early diagnosis of oncological diseases as well as timely and effective patient treatment and care.
Different oncological diseases are quite a common topic for discussions, yet brain cancer is often overlooked in the society. While it is not the most common type of cancer, it is more life-threatening than others, as it affects the most important organ – the brain.
More light on the situation is shed by Prof. Dace Baltiņa, Associate Professor at Riga Stradins University, Chief Specialist for Oncology and Residency at Riga East Clinical University Hospital and Chief Specialist for Oncology at the Ministry of Health; Daina Apškalne, Assistant Professor at Riga Stradins University, Neuro-Oncologist and Chemotherapist; and Egils Valeinis, Head of the Neurosurgery Clinic at Paul Stradins Clinical University Hospital, who speak about what tumors are and how they are formed, about cancer diagnosis and treatment as well as about the situation and statistics in Latvia and how to handle such issues correctly.
Head tumors cause various symptoms
People still associate tumors in the head with an incurable disease. However, in recent years there has been a rapid development in the diagnosis and treatment methods, making it possible to successfully defeat the disease.
Brain and central nervous system tumors are new tissue formations which can develop in the brain or the spinal cord. These tumors are categorized into two major groups: benign and malignant tumors, of which malignant tumors are subdivided into primary tumors and secondary or metastatic tumors. Primary tumors initially develop in the brain, while secondary ones are the metastases of other malignant tumors in the brain. Depending on their location and size, tumors can cause general and local symptoms. General symptoms include nausea, headaches, vomiting, especially in the mornings, dizziness, mental change (such as character change and even personality change, slower mental processes, etc.), visual disturbances and epileptic seizures. Local symptoms occur depending on which brain centers are affected by the tumor. These symptoms may include sensory disturbances in a side of the body, weakness of the limbs as well as vision and speech disorders.
The symptoms of these tumors manifest themselves depending on whether the tumor affects the flow of the brain fluid, subject to the tumor’s size and location. If the flow of the brain fluid is blocked, general symptoms are most common. It should be noted, however, that there will be no complaints for a while – the symptoms will progress when the tumor reaches a critical mass. If the tumor does not affect the flow of the fluid, local symptoms are more common. Since other diseases may also present in a similar way, there is a risk that the person does not pay particular attention to the symptoms – he or she just tries to relax and sleep more as well as uses over-the-counter medicines. Nevertheless, the complaints do not subside – on the contrary, they intensify. As there is very little room in the head, any new formation affects the brain, the meninges and the flow of the fluid.
Nowadays, it is possible to make a quality diagnosis and effectively treat and even stop the spread of brain tumors. It is equally important to acknowledge the crucial role of the timely detection of the tumor and whether the tumor is malignant or benign. Although it is not common for benign tumors to spread rapidly, these tumors also cause serious symptoms and disorders. In this context, Assistant Professor Daina Apškalne calls for a correct use of the concepts of brain cancer and brain tumor: “All tumors are divided into four grades of malignancy, where the first grade represents completely benign tumors and the fourth grade means cancer. Speaking of primary brain cancer, this term is used around the world to represent only brain tumors corresponding to the 4th grade of malignancy. The rest are tumors. In turn, all brain tumors are divided into primary and metastatic tumors, of which most metastatic tumors are the metastases of cancer tumors localized elsewhere.”
These days, medical practitioners often have to deal with patients with brain metastases from tumors in other organs. This is confirmed by Egils Valeinis, Head of the Neurosurgery Clinic at Paul Stradins Clinical University Hospital: “In recent times, the number of primary brain and spinal cord tumors has virtually remained unchanged, but the tendency toward diagnosing tumors that are actually metastases is proportionally becoming more common. There are a growing number of patients with metastases in the brain: almost every day we have a new patient with brain metastases. The most common are breast cancer metastases in women and lung cancer metastases in men. There are also metastases from kidney cancer, skin cancer or melanomas, gastrointestinal tract tumors, etc., but they are less common. Their manifestation is quite similar to that of brain cancer.”
Brain tumor symptoms are similar to symptoms of a stroke and other cerebrovascular diseases, which is the reason why these diseases are often confused. Doctor Egils Valeinis also provides examples when patients’ tumors have been mistaken for other diseases. One female patient was experiencing neurological symptoms that were considered by the family doctor to be signs of a stroke, but in fact the patient had a large brain tumor. “We cannot really blame the family doctor, because it is often the case when cerebrovascular disorders and strokes are found in the elderly patients, resulting in neurological disorders. However, quite often there are cases when it is impossible to make a distinction, because a lot also depends on where the tumor is localized. If it is present in the frontal lobe, the patient has no problems with mobility, but he or she may experience thought disorders and memory impairments. The patient becomes strange and odd,” dr. Valeinis says, mentioning a patient who initially was referred to a psychiatric hospital, as he was behaving inadequately, but after a more thorough examination he was diagnosed with a tumor.
Situation with brain tumors in Latvia remains dire
The data of the Center for Disease Prevention and Control shows that the total number of registered patients with malignant brain tumors was 822 at the end of 2014, while the average annual number of new cases is 215 in all age groups, including young people. The rate of benign brain tumors diagnosed in Latvia is almost the same. Although the numbers of early diagnosed and advanced cases are relatively balanced, treatment would be more successful if tumors were discovered earlier.
Professor Dace Baltiņa also points out that a major problem in Latvia is a high ratio of neglected cases to those diagnosed in time. In her opinion, the reason lies both in the shortcomings in the primary medical care and in human ignorance as a whole: “In case of brain tumors, it is very important not to lose courage and not to give up on seeing a doctor. In oncology, we often speak of 3 weeks when we can wait and watch whether the complaints persist, whereas procrastination in case of brain cancer may be fatal. Therefore, if the complaints do not subside within a few days or get worse, it is better to call an ambulance and not try to get an appointment with the family doctor and then undergo tests.”
What is worth special attention?
Speaking of symptoms specific for tumors, Professor Dace Baltiņa describes the symptoms which may indicate a tumor and which require immediate action:
“These are the symptoms caused by the increase in the internal pressure of the head due to the tumor mass and surrounding swelling or blood pooling: headache, vomiting (also without nausea) and pupillary dilatation on the side of the formation. Similar symptoms may also be triggered by a smaller size tumor if it somehow interferes with the normal flow of the brain fluid. Increased intracranial pressure can cause deviation of the brain hemispheres from the central axis and even compression of the vital centers. In very young children, bulging fontanelles can be observed, which is not the case in adults.
Another group of complaints, which are based on functional impairment of a particular part of the brain, is associated with compression of the brain tissue or invasion (infiltration) of the tumor tissue. These complaints may include behavioral disturbances, confusion, impaired memory and reasoning, disorientation in space, time and identity, emotional disturbances, numbness on one side of the body, altered sensation of pain, inability to clearly pronounce words, impaired hearing, facial paresis (distortion), double vision and dizziness. In more severe cases or in cases when professional help has not been sought, paralysis of one side of the body and a range of neurological disorders may occur.
Naturally, these symptoms may also be caused by other factors, such as injuries; therefore, seeing a doctor without delay is all the more important on condition that the reason is unknown.
Finally, the reason for complaints may be the irritation of the brain substance and the meninges – both mechanical and chemical, which can cause abnormal fatigue, weakness, tremor and also manifestations similar to epileptic seizures.”
How to detect a tumor?
There are two main methods that are used to detect tumors in the brain and the spinal cord: computed tomography and magnetic resonance imaging. Computed tomography is an X-ray examination method that produces a series of cross-sectional images of the body and organs. Later they are combined in several dimensions, and measurements are obtained, thus assessing the structure of the anatomical characteristics of the organs and the body and the spread of any pathological processes. This method of diagnosis is relatively widely available in Latvia and it can initially prove the presence of a tumor. If computed tomography reveals processes that are not typical of a healthy body and gives rise to the suspicion of the presence of the tumor, magnetic resonance imaging is carried out for precise diagnosis. Magnetic resonance imaging produces cross-sectional images of the body with the help of a strong magnetic field and radio waves, resulting in more extensive and accurate information than that obtained by computed tomography. “If magnetic resonance imaging is performed by highly qualified specialists, very accurate results are obtained in 50% to 70% of cases. Apart from surgery, magnetic resonance imaging for the time being is the best method of diagnosis,” Assistant Professor D. Apškalne comments.
Today, the problem with the diagnosis is that patients may have to wait six months to get magnetic resonance imaging funded by the national health care system, while it is very important for any patient with a brain tumor confirmed by computed tomography to get the MRI done immediately.
If no objective evidence of the type of the brain pathology is found through the above methods of diagnosis, a stereotactic biopsy is performed to identify the problem, by collecting tissue samples for histological examination. Assistant Professor D. Apškalne emphasizes that a biopsy is not so straightforward: “If the radiologist establishes a differential diagnosis and the tumor is localized in a functionally important area where it cannot be surgically removed, it is reasonable to perform the biopsy. The same is true for cases when the tumor is small and localized in a functionally important area where its removal may cause a major defect. However, performing a biopsy in these areas is often very difficult. In such cases, it is even better to carry out a number of specially-targeted magnetic resonance imaging examinations, combined with other advanced methods of examination.”
The situation in neurosurgery and neuro-oncology is much better: a patient with a brain tumor may have access to state-funded surgery within a few days, without having to wait in a long line. Since it is essential to surgically remove brain tumors as accurately as possible, Latvian specialists use world-class technology, including microscopes, neuronavigation systems, ultrasonic pumps as well as devices monitoring the patient’s body movements during the surgery, thus reducing other neurological damage while performing the surgery. Although the availability of adequate methods of brain tumor diagnosis and treatment in Latvia is of a good standard, medical practitioners increasingly have to deal with patients whose tumors are at a very advanced stage and who have initially been diagnosed with other diseases.
Brain tumors are often undetected until late
Dr. Egils Valeinis says that it is a common case in Latvia when patients are diagnosed with brain metastases from another organ’s tumor, which has not even been detected: “It happens quite often that a patient is admitted due to neurological symptoms. We perform examination and find metastases in the brain. So we begin looking for where there is a tumor. I think it is in 50% of cases that we start carrying out primary diagnosis through the brain metastases. This is awful! The diagnosis of the primary process is still limping behind. Of course, there are individual cases where metastases occur when the primary process is very small, for example, in a female patient with a very small breast cancer.”
This situation on the one hand is attributed to the lack of specialists in the areas outside the capital city and difficulties in reaching specialists in Riga, but on the other hand patients do not seek professional help, even if specialists are available. “A family doctor must act like a manager who is able to pinpoint the patient’s problem and refer him or her to the needed specialist, rather than erroneously treat non-existing diseases. Perhaps it is better to perform an extra examination and not to miss a tumor or start treating an imaginary disease without diagnosis and without knowing what actually requires treatment. Treating undiagnosed functional brain problems with cerebral circulation-improving drugs actually means feeding a brain tumor,” dr. Valeinis adds.
Describing the share of cases detected at a late stage, Assistant Professor D. Apškalne highlights the fact that people do not go to the doctor for various reasons: these can be either financial difficulties or simple laziness. It can also happen that a person undergoes examination, but it is not properly performed. Assistant Professor also recalls that a number of common symptoms may often indicate a tumor, and a lack of money should not be an excuse for not getting examination done. Diagnostic devices have become much more accessible and a person does not necessarily have to spend money to see a specialist in Riga: the diagnosis can also be carried out outside the capital city.
Although there is a lot of talking about raising the public awareness in health care as a whole, each individual person must take control of his or her health: in case of any unknown changes in the health status, it is essential consult the family doctor or see a specialist if necessary and get examinations. These steps will help in early diagnosis of the disease and help fight it with better success rates. Being aware of the importance of their health, patients must keep in mind that they have the right to request the family doctor’s referral to get the needed examinations and tests.
Despite public education in different areas related to health, each individual person must take care of his or her health. In case of any sudden change in the health status, it is vital to see the family doctor to detect and fight the disease as early as possible. Since health is very important, patients with complaints and symptoms should ask the family doctor for a referral to have examinations and tests.