Neurologic Diseases: Stage 4 Brain Cancer

Stage 4 brain cancer is the most advanced stage of brain cancer.

A tumor in the brain can occur almost at any age, although the incidence is more around childhood and old age. For a detailed article on Brain Tumors click on the link. Here more discussion is done on the advanced stage of brain cancer.

A varieties of tumors in the brain occur but not all of them are destined to become caners, and some of them remain as benign tumorous condition, e.g. certain tumors like lipoma remains benign (non cancerous) usually forever. Tumor like meningioma generally remain benign however some of them do become cancerous. Certain brain tumors like GBM (given below) are always cancerous at the time of diagnosis.

There are varieties of brain cancers and some important examples include;

• GBM (Glioblastoma multiforme)
• Anaplastic astrocytoma
• Malignant Lymphoma
• Metastatic tumors in the brain
• Medulloblastoma etc

GBM is the most frequent brain cancer in adults and medulloblastoma enjoys similar bad reputation in children. GBM is a type of astrocytoma and a typical exmple for a stage 4 brain cancer. Metastatic tumors do not originate in the brain rather come from outside.

These tumors are usually graded into four stages; stage one to four. Stage one is the most benign stage where as the stage four is the most advanced or cancerous stage with highest complications including death. Stage 3 tumors (e.g. anaplastic astrocytoma) although not as aggressive as grade four tumors (e.g. GBM), nevertheless themselves are considered quite malignant.

In general what you see under microscope depends upon what kind of tumor you are dealing with. The following findings are generally seen especially with GBM. You see lot of anaplastic cells (tumor ells). These cells differ from normal cells in several ways. One important difference is their phenomenal ability to divide and proliferate. Areas of necrosis, layering of cells, hyperplastic blood vessels may be seen too.

The proliferation of cells produces the mass or growth of a tumor. This infiltrates the surrounding tissue, sometimes even spreading distant areas within the brain and causes more and more dysfunction.

Necrosis (cell death), bleeding, swelling, suppression of the normal brain function in the affected areas of the brain all contribute to the complications including the death.

Clinical manifestations of a stage 4 brain cancer is similar to the other stages in many ways including seizures, headache, focal weakness etc.

However the difference lies in the rapidity of progression. In general almost all advances stage brain tumors progress rapidly unless some appropriate intervention is done, but even then they are almost invariably fatal at this moment.

• CT or MRI of brain
• If tumor is metastasic then investigations to detect the primary tumor
• CSF (cerebrospinal fluid) analysis if tumor spread to meninges is suspected (carcinomatous meningitis)
• Brain biopsy etc

Treatments (implemented on case to case basis)

• Steroid to decrease brain swelling
• Chemotherapy
• Radiotherapy
• Surgical resection (either conventional or radiation related)
• Experimental therapeutic modalities including immunotherapy, gene therapy, protein therapeutics etc
• Symptomatic treatment etc.

Unfortunately no reliable brain cancer cures are yet available but lot of research activities are going on and let us hope for the best!

Neurologist, neurosurgeon and oncologists (tumor specialists) are commonly involved in the care of these patients.