Sign, Symptoms and diagnosis of brain tumor

A chronic headache with nausea and vomitting is not a matter to take casually, as the incidence of brain cancer is increasing now a days, a proper knowledge about brain tumor, types of brain tumor and its mode of spread should be known. Details about the brain tumor and its type is given at An overview of brain tumor.

The sign and symptoms depends on the type of tumor and its location, mainly the symptoms are related to the pressure created intracranially due to the mass present.

Symptoms of brain tumors

Absent of any symptoms does not rule out any tumor, that doesnt mean one should regularly undergo a CT or MRI to see that but this is for an information that all tumors under go a silent period, then occurs focal symptoms, then symptoms due to raised intracranial pressure and lastly there may be brain displacement if the tumor grows large enough.

Initial period of silent growth

The initial silent period where there is no sign and symptoms varies in length of period according to position and rate of growth of tumor. For example if the tumor is in free space or an area where there is no structure nearby may have a longer silent period while a tumor near an structure like hypophysis or 4th ventricle may have lesser period.

Stage of focal syndromes

Stage of focal syndrome includes symptoms like seizures or fits. Epileptic fits or seizures first time in adult life should always be suspected due to tumor unless it is dissaproved, because more than 90 percent of idiopathic epilepsy occurs before the age of 30 years, so any seizure detected first time after 30 years should always be suspected for a brain tumor. As now a days we have advanced mode of diagnosis in the form of CT scan and MRI, small tumor like angiomas should be looked for even there is more probability od idiopathic epilepsy.

A steady and slow progression of focal syndrome is also indicative of tumors, though focal syndromes can also be seen in demyelination like in multiple sclerosis, any embolus etc.

Sign and symptoms due to raised intracranial pressure

Rise in intracranial pressure is due to space occupied by the mass which ompresses normal structure of the brain. The symptoms of brain tumor due to increased pressure is headache, vomitting, detoriation in the level of consciousness and even detoriation of visual equity.

The signs are lowered level of consciousness, increased blood pressure, slow pulse rate and papilledema. Papilledema is the swelling of eye lids and can be seen when there is large mass.

Symptoms due to brain displacement

When the tumor is enlarged enough, it occupies most of the place within the brain, displacing the normal structure. This stage is aslo called stage of coning. There may be herniation in cerebellar region and the symptoms depends on the part involved like ataxia, tremor etc. The consciousness level is extremely poor as the intracranial pressure is too high.

Investigation of brain tumor

Before going for an investrigation a proper history is very much indicative even it can give a hint for the site of brain tumor. If symptoms are of long standing it indicates a favorable tumor.

A proper clinical examination including neurological examination is done of all the cranial nerves. Though CT scan and MRI are the main investigations but some accessory investigations is done which is also very indicative for example a raised ESR may indicate a secondary tumor.


CT Scan

CT scan provides reliable information for the presence of a tumor in brain, by intravenous contrast enhancement it can also distinguish the type of tumor, however certain differentiation between a malignant tumor and an abscess may not be possible.

Magnetic Resonance Imaging (MRI)

MRI is the powerful tool to diagnose brain tumors. It is helpful in diagnosing almost all variety of brain tumors, however, the majority of patients, and especially those with supratentorial tumors, can be managed by using CT of which the quality has steadily improved.

Positron emission tomography (PET)

It uses short life isotopes. PET is developing as an investigation of the function of the parts of the brain.

Arteriography

Arteriography is done to see the blood circulation of the pathological tumors specially meningioma and glioblastoma multiforme.

Ventriculography

Ventriculography is valuable for posterior fossa tumor and 3rd ventricle tumor of the brain.

Accessory investigations

Accessory investigations include X ray chest which may diagnose lung cancer in which secondary brain tumor is most common, a skull x ray may show erosions and separation of sutures due to heavy mass in the brain.

Surgery is the mainstay of treatment of brain cancer, as mentioned above a slow progressing tumor is favorable. An early diagnosis may lead to almost full cure in most of the primary brain tumor. Details of treatment is given at Treatment of brain tumors.

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A chronic headache might be a brain tumor

Most often headaches are ignored not only by the patients but also by the doctors. But every time headache is not due to mild stress or tension. If it is associated with nausea and vomitting, the probality is that it may be due to increase in pressure of the brain caused by a mass or a brain tumor. Thus one should be aware and alert if suffering from chronic headache.

Study reports suggests that brain tumor is increasing in incidence not only in USA but globally. In India, according to reports of the National Brain Tumor Foundation (NBTF) in 2007, totally 80,271 people are affected by various types of brain tumours.

What are the types of brain tumors

Cancer of brain can occur at any age, in fact it is the most common of all solid tumors in children. Though studies reports its occurance as most common in children between three to 12 years old, and adults 40 to 70 years old.

Normally brain tumors are those which occur within the brain itself called primary tumors and those in which cancer that begins in other parts of the body spreads to the brain called metastatic tumor or secondary tumor. Secondary tumors in brain are more common than primary one.

As the secondary tumors in the brain are more common, so there is chances of malignant cancer more than a benign one, though a brain tumor can also be benign, which is usually circumscibed and does not spread od metastasize or a malignant one which may spread to adjacent organs or even distant organs. The classification of benign and malignant brain tumors applies to primary tumors.

What are the causes of brain tumor

The cause of primary brain tumors are not known exactly. Though there are certain issues like exposure to certain chemicals, radiations etc may be a predisposing or risk factors.

There were myth that artificial sweetener has been a risk factor foe brain cancer, but studies has proved it false and is just a report limited to some internet sites without any reality. There are also rumor about use of cell phones and many researcher had doubt that the vibration of cell phones may be a risk factor for brain tumors but still nothing clear reports has been published.

The secondary brain tumor may be due to deposits from metastasis of cancers of lung, breast, colon etc. It metastasizes through hematogenous route. In brain the most common site of occurance of secondaries is cerebral cortex.

Metastatic brain tumors

Metastatic brain tumor or secondary tumors are most common brain cancers in adults. The most common location in intraparenchymal, an area beneath the grey and white junction. In adult male it is the lung cancer which most commonly metastasize to brain while in adult female it is breast cancer as the most common one form secondary cancer at brain.

Secondary brain tumor can have a single metastasis or multiple metastasis where there may be tumor at more than one place in brain. The source of single brain metastasis are more commonly from cancer colon, breast cancer and renal cell cancer, while sources of multiple brain metastasis include malignant melanoma and lung cancer.

The sign and symptoms of the brain tumor mainly occurs due to mass there which increases intracranial pressure. The mainstay of diagnosis of brain tumor is CT scan and MRI but there are various other investigations too which are required most often like Isotope scan, encephalogram etc. Details about sign, symptoms and diagnosis is given at Diagnosis of brain tumor.

Regarding treatment surgery is the main mode of treatment. Some brain tumors may require microsurgery. In secondaries palliative treatment is given. For details about treatment please see Treatment of brain tumors.

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Dietary management for weight loss after childbirth

One should always keep in mind that gradual weight loss based on sensible nutrition and enjoyable physical activityis the best path to permanent weight loss. This applies to weight gain due to any reason either it may be pregnancy, thyroid abnormalities or dietary reasons, but when one is dealing with all the changes and adjustment in life that comes along with a new born, it is all more important to follow a slow and steady approach so the new mother does not add to her stress level.

There are several things to be taken into consideration while going for a dietary management for weight loss especially after childbirth, where diet cannot be compromised to extreme level as it may lead to lack of lactation which may not be good for the newborn. The following approach should be taken by the women after childbirth in their diet.

Intervening to modify diet

Weight management focuses on a gradual approach to a healthy eating on food pyramid, behavioural changes and a gradual increase in daily activity without adding much strain to the new mother.

It is important to educate the post partum womenthat her goal should be to achieve and maintain a healthy weight to reduce health risks in later life and also about realistic expectations and the myth of fad dieting.

Dont restrict energy intake

Low calorie diets are not recommended for obese during lactation due to the possible effects on decreasing milk production. Women who have difficulty in losing weight following delivery should be monitored for high-calorie, low nutrient-dense foods in their diet and portion control.

Postpartum women on the heavier side can control their calories by excluding high calorie foods and following a diet containing low nutrient-dense foods.

Increase the intake of complex carbohydrate

Postpartum women with excess weight can be advised to modify the source of carbohydrates. They can include high fibre carbohydrates like whole grains, raagi, leafy vegetables and fresh fruits and vegetables. Increased intake of complex carbohydrates also increases the fibre content of the diet.

Decrease fat intake

A weight management program focusing on the intake of fat is more beneficial and easier to follow. Decreased fat consumption needs to be implemented along with decreased calorie intake. Hence one should not over indulge in protein and carbohydrate rich food.

There should also be a reduction in portion size of animal based products and fried foods.

Focus on regular meal pattern

Currently our eating patterns reflects a decrease in regular meals and a lack of portion control, which in turn hamper a person's ability to maintain an appropriate intake of calories. Regular meal eating patterns can help a person to maintain normal blood glucose levels and stimulates the satiety region in the hypothalmus. This process will help to moderate hunger and will also provide energy throughout the day.

Add fibres in the diet

High fibres, low calorie foods like green leafy vegetables, fruits, other vegetables, whole grain cereals and pulses can help one to lose their extra kilo. Inclusion of high fibre foods has many advantages as

* Low in calorie density.

* Foods like greens provide most of the micronutrients, whose requirement is often difficult to meet in a restricted diet.

* Provide satiety.

* Help in the regulation of proper bowel movements.

* Reduce blood cholesterol.

* Promotes chewing and decreases the rate of ingestion.

Higher intake of fibre automatically cuts down fat and calories and leads to significant reduction in body weights without any side effects.

Include plenty of fluids

Last but not the least, fluids can be taken liberally as it aids in the elimination os wastes from the body. A glass of water before every meal will help to cut down the food intake also.

A good rule of thumb for getting the nutrients at any age is to :

* Aim for variety, eat from five food groups.

* Try to eat three or more servings of fruits and vegetables a day.

* Eat when hungry.

* Eat small meals every four hours.

* Drink plenty of water throughout the day.

* Think smart snacking.

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Health Insurance : How much necessary

The cost of the health services are increasing exponentially day by day and every new day a new disease comes in the news creating a panic as now a days Swine flu is in hot news. With the change in life style, fooding habits, work places, pottutions and occupational hazards, the incidences of cancers like mesothelioma, bladder cancer, leukemia are on increasing trend and so are heart diseases. Diabetes had now become an epidemic in Country like India.

Though medical science has advanced a lot and most of the disease especially most cancers are curable now a days, but the greatest laggard is the cost of the treatment which is usually unaffordable, sometimes even in high middle class society.
This establishes a need of health insurance or medical insurance. Though there are 100,s of health insurances companies, all claiming to be the best but their real image comes out when you really need a help. Thus it is very much necessary to choose the best option out of it.

How to Choose a Health Insurance Plan

This should always kept in mind that no insurance plan can fulfill all your demands, thus it is necessary to plan the coverage you require for you and your family. You should always think of the following before selecting any health insurance plan.

* Do you visit the doctor very often? How much of a monthly premium can you afford?

* Can you meet your deductible in order to get full coverage?

* If you choose a managed-care plan, how much more will it cost to go out of the provider network?

* Is there a limit to the amount you'll have to pay and to the amount paid to you by your insurance carrier?

What are the options for health insurance plan

There are various health insurance plans and you have to decide which one to opt.

Health management organization (HMO) plan

One is Health management organizations (HMOs). This is of low cost but you have to choose a doctor or primary care physician (PCP)who will take care of your health, but when you require the service of a specialist, a referral from your PHP is must.

Preferred Provider Organization (PPO) plan

Another plan is Preferred Provider Organization or PPO. In this plan the health service is provided at a discounted rate. There is no need of a primary care physician, but after annual deductible payment, you can seek any type of medical aids at any hospital. PPO plans offer flexibility in choosing your providers, however, make sure that you familiarize yourself with the plan's provider network before choosing a PPO plan. You may wish to make sure that your favorite doctor or local hospital belongs to the network. If you have children who need to make regular visits to the doctor, be sure that you're aware of the plan's benefits for preventive and well-child care.

At the time of payment in PPO plan you will be required to make a co-payment for most hospital or nursing home visits.

Point of service plan

Another plan is point of service plan (POS) which is actually a combination of both HOM and PPO. In this a primary care physician is selected but one can take treatment at any hospital referred by him with lowest expenses possible. The advantage is that here you don't have to meet the deductible. This is only for your own network, but if you go outside your network, there POS acts like a PPO and you have to make a copayment to the health service provider.

A proper review is very much necessary before selecting a health insurance company. Everyday news breaks that certain people were ditched at the time of need. There are few sites where you can get some trusted reviews for health insurance plans. These are

Gadget reviews and reviews of insurances

India Review channel

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What is hernia and how it is treated?

Hernia is a swelling of the anterior abdominal wall and is due to the bulging of internal content through week abodominal wall. It may be due to weakening of muscles or following an incision for any operation with improper healing called incisional hernia.

The swelling from other disease like any lump or tumor and swelling of hernia is differentiated by seeing the nature of swelling as the swelling of hernia dissapear on changing position like in lying down or can be reduced by pushing it back in the abdomen.

Types of hernia

Most common type of hernia is inguinal hernia which is present in the inguinal region, others are femoral hernia, umbilical hernia which is present in children and is due to most probably weak umbilical scar. Though the second most common type of hernia is incisional hernia and femoral hernia is third most common and more present in women.

There are some special type of hernia like Spigelian hernia, Littre,s hernia, Cloquet,s hernia, Maydle,s hernia which depends on the site of occurance. Though the basic pathology of hernia is same as protusion of internal objects due to weakening of the covering muscles.

Symptoms of hernia

The main complaints from the patient is of swelling which often dissapears on changing position and reappears on strain like coughing or sneezing. Gradually the size of swelling increases and often pain is associated which becomes intense and unbearable if there is any twist or strangulation of the hernia which is an indication of surgical emergency. In this the swelling does not disappear, not even by reducing it manually and there is unbearable pain. The abdominal contents in thsi case ets trapped in the hernia and becomes necrosed and gangrenous. Thus emergency surgical operation is required in these condition.

In some cases of hernia there may be herniation of intestine, and this is a risky situation and the chances of mortality increases.

Treatment of hernia

Even if any one claim,it should be clear that there is no treatment of hernia with medicines whether it may be allopathic, ayurvedic or homeopathy. The one and only treatment of hernia is surgical treatment.

Even in the initial stage of hernia if there is no symptoms like pain or discomfort, still one should not delay in treatment as there is always a risk of twist and strangulation leading to formation of gangrene of the trapped abdominal contents. This condition may be life threatening, thus treatment should be done beofre this condition arrives.

How hernia is repaired

The repair of herinia is done by a mesh. There are two methods of hernia repair, one by open surgery in which abdomen is opened and other is laproscopic or key hole surgery.

Open surgery for hernia repair

In open surgery abdomen is opened by a wide incision and the protuded object is reduced and the wall is repaired by a mesh. This type of operation is though less time taking but patient has to remain in hospital for 1 or 2 weeks, bleeding is more, there may be pain and discomfort and the chance of infection is much more. Even after discharge from hospital patient has to take precautions for 3 to 6 months as there may be a chance of incisional hernia at the operation site if one carries heavy weight or there is any infection.

Laproscopic surgery of hernia

Laproscopic surgery is the modern method of hernia repair where instead of large incision, only three holes of 5 to 10 mm are made to insert the laproscopic tool and the hernia is repaired with a mesh. This is a patient friendly operation and the pain and discomfort is much less than open type of surgery. The patient can leave hospital within 2 days, the chances of infection is less and the patient can resume his normal duty within a week. Though the laproscopic surgery need a highly skilled surgeon and is a costly affair. One should go for laproscopic surgery only in renound hospitals like Apollo, Wockhardt hospitals.

There are several medical insurances which pay 100% of the cost of treatment including the post operative medicines.

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Surgery as a treatment mode for cancer

Cancer surgey is an important mode of cancer treatment worldwide. The role of surgery starts right from investigating a cancer as in biopsy to major surgery like excision of a tumor, amputation and reconstruction.

Though the indication for surgery may vary at different levels of cancer but in most cases it is indicated in early cases and where the cancer is localized or circumscibed.

The indication for surgery in cancer depends on the stage of cancer, site of the cancer, its consistency and nature. A benign tumor is almost always treated by surgery. The surgical mode of treatment has gradually evolved over the past century and mordernised tremendously during fast few decades.

The general and special role of surgery in the field of cnacer treatment have been dealt with in this article.

Surgery as a diagnostic modality of cancer

In cancer surgery not only plays an important role in the treatment but also in diagnosing a cancer. Biopsy is a procedure by which most of the cancers are diagnosed. It is a painless, harmless and outpatients procedure. Details about biopsy is already written at Biopsy a diagnostic tool to diagnose cancer and other disease

Fine needle aspiration cytology is another diagnostic tool whjich can diagnose the type of cancer whether it is benign or tumor, however the confirmatory diagnosis is only done by biopsy.

Surgery as a treatment modality of cancer

In most of the benign tumor surgery is considered as the treatment of choice and is the lone treatment. In many tumors doctors perform biopsy after excision of the tumor to know the nature of it and when it is diagnosed as malignant then surgery should not be considered as sufficient. In early disease may be surgery of radiotherapy as a single mode of treatment may be adequate. However as the disease progresses surgery alone becomes inadequate and a combined modality may be required with surgery, chemotherapy and radiotherapy.

For the best result of treatment a proper planning is essential, an aggressive treatment with surgery may not benefit upto the mark if there is improper planning. Thus one should consider that surgery in cancer is important but is only a part of the complete treatment of cancer.

Principle of surgical treatment in cancer

During surgery for a cancer there are few things which should be taken care of by a surgeon and the most important is the to know the intention of surgery whether it is for cure or as a palliative measure. Palliative measure is meant for symptomatic relief.

After obtaining the consent, the tumor should be widely excised with wide margin with control of depth of invasion. There should be pre plan for reconstruction surgery which should be sufficient according to the width of excision. The tissue lost should be replaced by either local, regional or free flaps.

Conservative and Radical surgery for cancer

It was earlier days when the organ affected by cancer was entirely removed along with some healthy tissues present at the margins and this used to be most depressing for the patients for example if a breast is removed from a young lady. But now a days the modified surgery is there where only part of the organs are removed whereever feasible and that too is reconstructed by reconstructive surgery. For example in some breast cancer only a part of the breast is removed and rest of the breast is reconstructed adequately. Now a days there are even procedures which is very less invasive.

Minimally invasive surgery

Minimally invasive procedures are less invasive, thus it improves the quality of life both physically and psychologically. There are few techniques like Carbon dioxide laser or photodynamic therapy which causes less pain and bleeding thus preserve function much better than conventional surgery.

Many abdominal surgery are noe done by laproscope where only a hole is made instead of long incision.

Coming to the conclusion, it is clear that in spite of being an excellent surgeon, one cannot provide excellent cancer treatment, hence a complete team of surgical, medical and radiological oncologist should be considered together with proper paramediacal caring to treat a cancer patient.

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