For months, 37-year-old Afsana misinterpreted her headaches and occasional nausea as a casual ailment and consumed painkillers. But since the symptoms persisted after momentary relief, she decided to consult a doctor. She was shocked when she was advised scans and diagnosed with a brain tumour, which had silently grown the size of a leather cricket ball. She had no clue that her mild headaches were a sign of meningioma, usually a benign growth that masses up slowly and is a primary central nervous system (CNS) tumour. It took an eight-hour surgery and nine days of hospital stay to pull her away from the edge of a precipice. Says Dr Ravindra Srivastava, Director, Neurosurgery, Primus Hospital, Delhi, “Silent tumours are tricky due to zero or mild symptoms that can easily be attributed to other health conditions. These can occur in the brain, breast, ovary, pancreas, rectum and lungs as well. Most of them are benign in the early stages. The patient is likely to get frequent headaches, blurry vision, weakness, seizures, loss of balance and infertility. Surprisingly Afsana did not complain about any of the above and just had mild headaches with no difficulty in walking or seizures. Perhaps, she did not feel them as she was caught in her chores and daily activities. An MRI showed a lesion, measuring 4.6 x 4.1 x 3.7 cm, in the tentorium cerebelli. We had to decompress and excise it without wasting any time. Thanks to advanced tools and technology, the patient was discharged on the ninth day after the procedure, which could have otherwise taken longer.” The tumour was located in the occipital lobe, which is above the tentorium (supratentorial region). Says Dr Srivastava, “Meningioma tumours are benign in nature which makes surgical resection an effective method of managing them. But Afsana’s case shows the dangers of popping headache pills at the drop of a hat without first consulting a doctor about the many reasons that can cause it. The easy availability of over-the-counter painkillers means patients delay diagnosis and need late stage medical intervention.” Afsana’s husband, a resident of Delhi’s Nehru Vihar, says that even when they consulted some doctors, they prescribed routine medication given that headaches happen for a number of reasons. In fact, Dr Srivastava warns about aberrations in vision as a possible reason for brain tumour because a growing mass can exert pressure on the optic nerves, disrupting their function in ensuring clarity of vision. Alka Budhiraja had more pronounced symptoms than Afsana though she had meningioma too. “She came to our OPD in a wheelchair with a headache, difficulty in speech, weakness of limbs and clouding of consciousness. So, we did an MRI of her brain, which revealed a large tumour that required surgical intervention. Post-surgery, we kept her in ICU for one night and in hospital for four days. She recovered gradually and by the time she was discharged, she was walking on her own and had regained her speech,” says Dr Ashish Gupta, Director, Department of Neurosurgery, Max Superspeciality Hospital, Patparganj. “So here the message is that not every brain tumour is malignant. With advances in surgical armamentarium and quicker diagnosis, we can avert a crisis. Often surgery ensures complete cure and there is no need for adjuvant radiotherapy or chemotherapy. We removed her tumour with the help of a microscope and now the patient is fully recovered and leading a normal life,” he adds. As for Budhiraja, she is happy to have reclaimed her life as it was without much damage to her faculties. “There was a time when everyday was slipping out of my control and I never thought I would remember anything anymore. Timely surgery saved me,” she adds. What is most concerning though is that the incidence of Central Nervous System (NNS) tumours is increasing in India. Says Dr Sunita Kapoor, Consultant Pathologist, Founder and Director of City X-Ray & Scan Clinic, Delhi, “The prevalence ranges from 5 to 10 per 1,00,000 population. Almost 40,000 new cases of brain tumours are diagnosed each year in the country. Prevention of brain tumours is challenging as most cases are not associated with identifiable risk factors. Yet early detection is key to a better prognosis of this disease as it can accelerate treatment. Usually, Magnetic Resonance Imaging (MRI) is the first step to diagnose a brain tumour. It can help doctors find out if it is a primary brain tumour or if it is metastatic cancer.”
