Brain tumour: a neglected disease

Everyone was talking about the newly admitted patient in the ward. Curiosity took me to her bed before the start of the morning ward round. When I saw her, my worst fears were confirmed. After a period of silence during which I gathered myself, I managed to greet her. The strength in her voice, to my surprise, lit the whole room.

The tumour which was initially inside her brain was now outside it and had spread to the skin of her scalp. Her forehead was obscured by huge bumps which were the extended part of the tumour. I noticed the wall mirror next to her bed was missing. Her silence spoke a million words.

Hers was a meningioma, a tumour which arises in the layers surrounding the brain. She had the atypical variant which is the tumour’s aggressive form. Before coming to us, she was operated on twice. Both times negligence, lack of awareness and societal barriers ruined her chances of a cancer-free life. A fate shared by many patients in our country.

Brain cancer patients initially report symptoms such as headache, dizziness, weakness and/or nausea which are easily cast aside by family members as sweet nothings. Those fortunate enough to get investigated in a hospital and later operated on sometimes fail to undergo the subsequent treatment (radiotherapy) like the patient mentioned above. She was first operated on years ago, when exactly she could not recall but she remembered not being able to receive the postoperative radiotherapy sessions. The reason she stated was a death in her family. Over the years I have witnessed patients leaving the hospital against medical advice and deferring treatment just because they have to be present at a deceased relative’s house. Most patients cannot bear the travel expense of returning back to the hospital and end up with worsening health conditions. At times and especially for female patients, the roadblock is often an inconsiderate husband or a grumpy mother in law and at other times a general lack of awareness.

It was not a surprise that the brain tumour of the patient mentioned above recurred and she had to undergo a second surgery to remove the cancerous mass. It was more than a surprise to find out that she failed to follow up yet again. Fast forward — she came to us in the neurosurgery department of Rawalpindi’s Holy Family Hospital with a tumour that had spread to her forehead. Here she was operated on for the third time in unison with the plastic surgery department. The neurosurgeons successfully took the tumour out while the plastic surgeons took care of the forehead skin which the tumour had engulfed with the hope that this time she would actually go for the subsequent postoperative radiotherapy sessions.

In Pakistan, approximately 150,000 new cases of brain cancer are diagnosed every year, causing about 60-80% deaths. Interestingly, the number of neurosurgeons who share this national burden can easily fit in one room.

Brain tumour patients have to live every day in fear not knowing which breath would be the last. This death sentence can be reduced to a simple parking ticket if people are given enough awareness about when to see a doctor. The red flag signs and symptoms are a new onset headache, frequent and severe headaches, unexplained nausea or vomiting, arm or leg weakness, seizures and visual, balance or memory problems.

The story of the patient used in this article is based on true events. The unnamed patient serves for us three important lessons. First, life is given to us by God for safe keeping and so we should take utmost care. Second, never ignore any symptom how trivial it may seem. Third, never leave the hospital mid-treatment against a doctor’s advice or you would end up with three surgeries instead of one.

Published in The Express Tribune, December 11^th, 2021.

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