TUMOUR HEADACHES: ORTHODOX TREATMENT
Orthodox treatment depends very much on the type of tumour, and its site. In an operation, a benign tumour is often easy to winkle out of its surrounding capsule. Once the tumour has been removed, the pressure on the brain tissue is reduced, and the brain can get back to working in its normal way again.
A benign tumour in the pituitary can also be removed, in an operation going through the top of the inside of the nose and approaching it from underneath.
Often it’s not possible to tell whether a tumour is benign or malignant until, at operation, bits of it can be snipped out and looked at under the microscope (a biopsy). Even if the tumour is malignant, all is not lost. Removing the area containing the tumour may be enough to get out all the cells, particularly if it is the primary site. Giving radiotherapy or chemotherapy afterwards may also help to kill off any remaining malignant cells.
Where the cancers are secondary treatment is quite different. Once a tumour has moved to the brain, it is likely to have spread elsewhere; and there won’t be just one growth within the brain. There will probably be a number, scattered throughout the brain tissue, all growing independently of the others. Clearly it’s not possible to remove all these secondary deposits in an operation. Therefore, we usually try to kill off secondary growths with radiotherapy or chemotherapy.
Radiotherapy involves shining various types of high-powered electro-magnetic rays (or in some cases, nuclear particles) at the tumour. Chemotherapy involves giving anti-cancer drugs, which are often very potent and also very toxic to normal body cells. Both these therapies work because cancer cells grow much more rapidly than do nerves (in fact nerves hardly grow at all). So, by specifically attacking those cells that are rapidly dividing, we target the effects of the chemicals and the X-rays on to malignant cells rather than those which are normal.
Chemotherapy and radiotherapy do, however, have the disadvantage of interfering with rapidly dividing normal body cells, such as the gut, hair follicles and bone marrow. This is why chemotherapy can make you temporarily bald. Both types of therapy can make you feel nauseous and generally unwell.
The big advantage of chemotherapy is that it attacks the cells that are rapidly dividing wherever they are. It doesn’t matter if one or two little groups of cells have seeded off and stuck in a part of the brain, well away from the other growths. The chemotherapy will get to those cells and will kill them off just as effectively as if they were part of the main group of malignant cells.
It’s a common mistake to think that surgery is better than radiotherapy or chemotherapy ‘because you can be sure everything’s been taken away’. In fact, this isn’t true. Although surgery may appear to remove everything that is malignant, this is not always possible. When there is doubt, chemotherapy and radiotherapy can often mop up cancer cells which the surgeon has not managed to remove.
Hormone therapy can also play a part, especially in secondary cancers derived from breast cancer. Many breast cancers need oestrogen to survive and by giving the anti-oestrogen drug tamoxifen, oestrogen receptors on the malignant cells can be blocked.
What about treatment of the headache from a brain tumour? The method of treatment is entirely dependent upon whether the tumour is benign or malignant. The pain of a benign tumour is almost always due to a general pressure rise within the skull, whereas local pressure gives localised side-effects – such as inability to speak. (This is why headaches are usually a later symptom, while localised effects on the brain occur earlier in the illness.) Remove the tumour, and the pressure goes away.
With a malignant tumour, pain is also usually related to pressure; but, in this case, it may be much harder, if not impossible, to remove the tumour. If the tumour is so far advanced, or else in such a position that surgery is impossible, then there are several courses of action that your doctor might take. Anything that shrinks the tumour is likely to remove or reduce the amount of headache, so radiotherapy, chemotherapy, or hormone therapy may help. In addition, steroid treatment may reduce the pressure; in particular, the drug dexamethasone can be amazingly effective in reducing the pressure within the brain, thus reducing headaches and vomiting, and allowing the brain generally to work much better.
But what about those many cases where the primary tumour has spread too far, or else the tumours are secondary and have got out of control?
Surprisingly, aspirin is enormously important for pain relief. While ’strong’ drugs such as morphine are sometimes unable to provide adequate pain relief, simple analgesics such as aspirin can do the trick. The pain of secondary cancer of the bone is often markedly improved with aspirin, which can make all the difference.
*72\20\2*
