Sunday, February 27, 2022

Cardinal Santos Medical Center's Multidisciplinary Approach to Brain and Spine Tumor Management


Brain and Spine Tumor Management- Purple Plum Fairy
Diagnosis of a brain or spine tumor is devastating

What was it like to be diagnosed with a golf ball-sized brain tumor? Any patient diagnosed to have a brain tumor, cancer or any life-threatening disease would surely be devastated. I recently attended a webicon on a multidisciplinary approach to brain and spine tumor management organized by Cardinal Santos Medical Center Hospital. And I was glad to know more about the latest treatment innovation in medicine for brain and spine tumor management as well as certain cancers. 

According to a panel of doctors, a brain tumor is a mass or growth of abnormal cells in your brain. There are actually a lot of different types of brain tumors that exist. Some brain tumors are noncancerous (benign), and some brain tumors are cancerous (malignant). Brain tumors can begin in your brain (primary brain tumors), or cancer can begin in other parts of your body and spread to your brain as secondary (metastatic) brain tumors.

How quickly a brain tumor grows can vary greatly. The growth rate, as well as the location of a brain tumor, determines how it will affect the function of your nervous system.

Brain tumor treatment options depend on the type of brain tumor you have, as well as its size and location. 

What are the signs and symptoms of brain and spine tumors?




* Vision problems

*Speech difficulty

*Hearing difficulty

*Weakness in Arms and Legs


*Balance difficulty

But contrary to what most people believed, headaches are not necessarily caused by tumors. In fact, it is rarely caused by a brain tumor. It may be the presenting symptom in 25% of brain tumors. It arises from increased pressure from tumor growth and swelling. 

What headache symptoms require immediate medical care?

*Progressive headaches

*Headaches associated with neurologic symptoms

*Headaches that awaken you at night

*Headaches that worsen with exertion or physical activities

Nausea and vomiting are usually from increased intracranial pressure from an enlarging tumor. Involvement of structures near the vomiting center.

Blurring of vision or double vision: Can present as blurred or double vision, abnormal eye movements, and restricted field of view.  Causes may arise from increased pressure in the brain or compression of specific brain structures. 

Signs and Symptoms of Seizures: Uncontrolled jerking movements of the extremities, loss of consciousness/awareness, temporary confusion, cognitive or emotional symptoms, fear, anxiety, abnormal smell. 

FACTS: Most seizures are not caused by brain tumors. Seizures from brain tumors are usually focal in character. A late-onset seizure/epilepsy should raise suspicion for a possible anatomic cause (stroke, tumor)


From impingement of brain structures that control coordination. May be accompanied by dizziness and cranial nerve dysfunction (facial pain/numbness/weakness, hearing loss, swallowing, and speech pattern). 

Tumors in different parts of the brain or spinal cord can cause different symptoms. But these symptoms can be caused by any abnormality in that particular location — they do not always mean a person has a brain or spinal cord tumor.

Tumors in the parts of the cerebrum (the large, outer part of the brain) that control movement or sensation can cause weakness or numbness of part of the body, often on just one side.

Tumors in or near the parts of the cerebrum responsible for language can cause problems with speech or even understanding words.

Tumors in the front part of the cerebrum can sometimes affect thinking, personality, and language.

If the tumor is in the cerebellum (the lower, back part of the brain that controls coordination), a person might have trouble walking; trouble with precise movements of hands, arms, feet, and legs; problems swallowing or synchronizing eye movements; and changes in speech rhythm.

Tumors in the back part of the cerebrum, or around the pituitary gland, the optic nerve, or certain other cranial nerves can cause vision problems.

Tumors in or near other cranial nerves might lead to hearing loss (in one or both ears), balance problems, weakness of some facial muscles, facial numbness or pain, or trouble swallowing.

Spinal cord tumors can cause numbness, weakness, or lack of coordination in the arms and/or legs (usually on both sides of the body), as well as bladder or bowel problems.

The brain also controls functions of some other organs, including hormone production, so brain tumors can also cause many other symptoms not listed here.

Having one or more of the symptoms above does not necessarily mean that you have a brain or spinal cord tumor. All of these symptoms can have other causes. Still, if you have any of these symptoms, especially if they don’t go away or get worse over time, see your doctor so the cause can be found and treated, if needed.

Cardinal Santos Medical Center's Brain and Spine Institute is a leading force in the field of neurosciences in the Philippines. It provides a full spectrum of neurological services for adults and pediatric with disorders of the brain, spine and neurovascular abnormalities through its subspecialty centers: the Philippine Gamma Knife Center, the Brain and Spine Tumor Center, the Philippine Movement Disorder Surgery Center, the Cardinal Santos Spine Center, the CSMC Stroke Service, the Neurophysiology Center, and the Cardinal Santos Memory Center. It is a recognized referral center for neurological diseases in the country.

Aside from the services mentioned above, they also cater to  the following services as well: 
Adult and Pediatric Brain and Spine Tumors
Congenital, Traumatic, Infectious and Degenerative Spine Disorders
Neurovascular Disorders
Congenital Brain Disorders
Neuromuscular Disorders
Neuropathic Pain Diseases
Dementia and Memory Disorders
Neurodevelopmental Disorders
Sleep Disorders

During the said webicon, Dr. Theodore S. Vesagas, MD, Director of Philippine Gamma Knife Center also discussed Gamma Knife Radiosurgery process and treatment. Gamma Knife surgery is a painless computer-guided treatment that delivers highly focused radiation to tumors and lesions in the brain. Gamma Knife surgery is used to treat brain tumors, arteriovenous malformations, trigeminal neuralgia, acoustic neuroma and tremors.

Gamma Knife radiosurgery is nearly 90 percent successful in killing or shrinking brain tumors or stopping their growth. And it doesn't hurt or require anesthesia. Treatment takes just one session, and patients can return to normal activities almost immediately.

Gamma Knife radiosurgery results in the failure of tumor cells to reproduce. The tumor may shrink over a period of 18 months to two years, but the main goal of Gamma Knife radiosurgery for benign tumors is to prevent any future tumor growth.

Gamma Knife surgery is a treatment method that uses radiation and computer-guided planning to treat brain tumors, vascular malformations and other abnormalities in the brain. Despite its name, this procedure does not involve any incisions, not even a skin incision. The Gamma knife is actually a treatment that delivers beams of highly focused radiation. Some 192 "beamlets" of radiation converge and are precisely focused on the targeted area of brain, specifically in the shape of the tumor or lesion, while sparing the surrounding normal tissue.

Photo taken from Cardinal Santos Brain and Spine Institute

Gamma Knife surgery is also known as stereotactic radiosurgery, Gamma Knife radiosurgery and Gamma Knife radiation.

What conditions does Gamma Knife surgery treat?

Gamma Knife surgery can treat several brain disorders, including:
Brain tumors (both cancer [malignant] and non-cancer [benign]): These tumors including brain metastases, pituitary adenomas, pinealomas, craniopharyngiomas, meningiomas, chordomas, chondrosarcomas and glial tumors.
Acoustic neuroma (vestibular schwannomas): This is a non-cancerous tumor that develops around the balance and hearing nerves that connect the inner ear with the brain.
Arteriovenous malformations (AVMs): This is an abnormal, snarled tangles of blood vessels.
Tremors: Tremors due to conditions including essential tremor or Parkinson’s disease.
Trigeminal neuralgia: This is an ongoing condition that affects a certain nerve in the face, causing extreme pain.
Some types of epilepsy.

Cardinal Santos Medical Center had always invested in groundbreaking technologies, which in turn has enabled it to offer some of its most innovative services like Gamma Knife Surgery. Considered to be the gold standard technique in Stereotactic Radiosurgery, Gamma Knife Surgery allows neurosurgeons to make no incisions as they treat sensitive ailments of the brain, making the procedure simple, painless, and straightforward.

The Gamma Knife may be helpful if you have a brain lesion or tumor that can’t be reached by traditional surgery techniques or if you’re unable to undergo surgery due to your condition or age. It can also be combined with traditional surgery to prevent tumor regrowth. The Gamma Knife is also used for some conditions that require urgent treatment.

Depending on the type and size of the tumor or lesion, more than one treatment session may be needed. Your neurosurgeon and/or radiation oncologist will review your treatment plan with you.

While brain surgery is the most common treatment for brain tumors, there are other options for treatment:
  • Steroids—When many people hear ‘steroids’ they think of the steroids used by athletes to build muscle. These are not the same steroids used to treat brain tumors symptoms. Steroids given to a patient for use before, during, or after surgery are called corticosteroids and can help to reduce brain swelling and the buildup of fluids around a tumor.
  • Chemotherapy—This treatment may be used to treat the tumor, but is more known for treating malignant or higher-grade tumors. Chemotherapy drugs are used in an attempt to prevent tumor cells from reproducing (cytostatic) or to kill the tumor cells (cytotoxic). Chemotherapy can be administered into the bloodstream through an artery, vein, muscle, the skin or taken by mouth (systemic delivery) or can be delivered closer to the tumor site to avoid the drugs traveling throughout the body (local delivery)
  • Radiation-—This is a common cancer treatment for brain tumors. High doses of radiation are administered to the tumor to stop or slow its growth. Radiation can be used alone or in addition to surgery or chemotherapy.
  • Stereotactic Radiosurgery—Most people associate surgery with going under the knife. That is not the case with this treatment. Stereotactic Radiosurgery (SRS) is similar to radiation, however, radiation cannot tell the difference between tumor cells and healthy cells. Because doctors can deliver a more focused delivery of treatment to the brain tumor than conventional radiation treatment, this highly focused form of radiation is called radiosurgery.  This treatment is usually used to treat small brain and spinal cord tumors, blood vessel abnormalities in the brain, defined areas of cancer, certain small lung and liver tumors, and neurological like movement disorders. SRS can be delivered in two ways:
  • Linear Accelerator (LINAC)—uses high-energy X-rays to treat tumors. Microwave technology is used to accelerate electrons which are targeted at a heavy metal target located in the LINAC, which creates high-energy X-rays. For many cancers, LINAC therapy is one of the most precise and advanced forms of radiation treatment available.
  • Cobalt-60 Therapy—unlike LINAC therapy, patients are put under local anesthesia for treatment delivery. This treatment is a beta-emitting radioactive isotope of cobalt. The gamma radiation created is used to treat tumors.
  • Proton Therapy—Hydrogen nuclei or protons are accelerated by a cyclotron. The protons are then directed at the tumor through beam shaping blocks, which match the shape of the tumor.
  • Particle Therapy—similar to proton therapy but larger, heavier particles are used to treat the disease with higher relative biological effectiveness than X-rays or protons.
  • Alternative & Integrative Medicine—Some people choose alternative healthcare treatments or wish to combine conventional and alternative therapies – integrative medicine. Given that not all alternative methods are adequately tested and proven, patients should beware that the treatment may not be safe or effective. Caution should be exercised and your conventional doctor consulted when considering integrative therapies. Many doctors may accept some alternative treatments alongside conventional treatments when appropriate.
Some of these treatments may not necessarily be available in the country, but at least we all have options to choose from. 

Cancer that begins elsewhere and spreads to the brain

Secondary (metastatic) brain tumors are tumors that result from cancer that starts elsewhere in your body and then spreads (metastasizes) to your brain.

Secondary brain tumors most often occur in people who have a history of cancer. Rarely, a metastatic brain tumor may be the first sign of cancer that began elsewhere in your body.

In adults, secondary brain tumors are far more common than are primary brain tumors.

Any cancer can spread to the brain, but common types include:

  • Breast cancer
  • Colon cancer
  • Kidney cancer
  • Lung cancer
  • Melanoma

Risk factors

In most people with primary brain tumors, the cause of the tumor isn't clear. But doctors have identified some factors that may increase your risk of a brain tumor.

Risk factors include:

  • Exposure to radiation. People who have been exposed to a type of radiation called ionizing radiation have an increased risk of brain tumor. Examples of ionizing radiation include radiation therapy used to treat cancer and radiation exposure caused by atomic bombs.
  • Family history of brain tumors. A small portion of brain tumors occurs in people with a family history of brain tumors or a family history of genetic syndromes that increase the risk of brain tumors.
During the said webicon, they also had a guest patient who had undergone an operation in November 2020 after doctors in Dubai had found out about his medium lemon-sized tumor on his brain. Rodel Perez, 45, is an OFW based in Dubai. He recalled how he discovered his brain tumor. According to him, it was all by accident. He experienced severe dizziness and went for a checkup with his first diagnosis of having vertigo. So he was then recommended to go for a CT scan, in which they've found out he has a brain tumor. 

Brain tumor patient Rodel Perez,and OFW

After studying the pros and cons, two of his friends recommended having an e-consult with Dr. Gimenez of Cardinal Santos Medical Center. It was the height of the pandemic and he had faced some difficulties because right after his quarantine, he went straight to the hospital to undergo an operation. With friends and family's support, he put his life into God's hands and trusted his doctors who assured him, things were going to be okay. In a few months, he's back at work and in the pink of health. 

Rodel Perez after his brain surgery

8 months after his operation, Perez is back to his work and up on his feet.

According to another doctor from Cardinal Santos, they also helo even indigent patients. Upon diagnosis, they educate their patients with the procedures and they have residents service programs as well as foundations that give free treatments and sometimes even free medicines. They also help process papers from LGUs and DSWDs. They find ways to help their patients. 

With early detection, proper treatment, and the doctors' multidisciplinary approach, brain and tumors as well as cancers are still curable. 

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