3^rd International Conference on Neuro-Oncology and Brain Tumor September 14-15, 2018 Singapore

Brain Tumor occurs when abnormal cells form within the brain. The symptoms of Brain stem tumors vary greatly and can include Ataxia, Cranial Nerve Palsy, headaches, problems with speech and swallowing, hearing loss, weakness, Hemiparesis, vision abnormalities, ptosis, and behavioural changes. Another possible symptom is vomiting. Any brain tumor is inherently serious and life-threatening because of its invasive and infiltrative character in the limited space of the Intracranial Cavity.

Neuroscience or Neural Science involves brain, spinal cord and nerves.  Cellular Neuroscience and Molecular neuroscience involves the study of neurons at a cellular and molecular level. Clinical Neuroscience is a branch of neuroscience focussing on the diseases and disorders of the brain and central nervous system. Clinical neuroscience serves as a future of Psychiatry.  Computational Neuroscience assists as a theoretical method for investigating the function and mechanism of the nervous system. It makes use of the essential features of the biological system at multiple spatial-temporal scales, from membrane currents, protein and chemical coupling to network oscillations and learning and memory.

Neoplasm is an abnormal growth of tissue, which forms a mass that commonly referred to as a Tumor. Neoplasm can be caused by an Abnormal Proliferation of Tissues, that which can be caused by Genetic mutations. Not all types of Neoplasms cause a tumorous overgrowth of tissue. Malignant Neoplasms derived from epithelial cells are called Carcinomas.

Neurosurgery or neurological surgery is the medical specialty focused on the prevention, diagnosis, and rehabilitation of disorders which affect any part of the nervous system such as brain, spinal cord, peripheral nerves, and extra-cranial cerebrovascular system. They help in the diagnosis of intra cerebral hemorrhage.

Metastasis is defined as the process by which Cancer cells spread to other parts of the body. Metastatic Cancer is called as Stage IV cancer among many stages of it. Metastasis is one of the hallmarks of cancer distinguishing it from benign tumors. And it can spread to distant parts of the body.

Meningioma is referred to as slow growing Brain tumors, but their origin is not from the Brain tissue. Meningiomas are often benign tumors arising from the Arachnoidal cells of Meninges of the brain and spinal cord.

Meningiomas usually grow inward slowly, causing pressure on the Brain or Spinal cord. They interfere with the normal functions of the Brain after reaching a large size. They represent about one-third of all Primary Brain Tumors and occur most frequently in middle-aged women.

Gangliocytomas are rare indolent CNS tumours which are made up of mature neurons arising anywhere within the Neuroaxis. They differ from gangliogliomas as they lack neoplastic glial cells. Treatment involves surgical removal of the tumor. These are Neuroepithelial Tumors which line the ventricles of the brain and produces Cerebrospinal fluid.

Choroid Plexus Tumor arises from Brain tissue that invades nearby tissue and spread widely via the cerebrospinal fluid. Like other brain tumors, choroid plexus tumors are also “graded.” Like other Brain Tumors, Choroid Plexus Tumors are also “graded.” Choroid Plexus Neoplasms are rare, Intraventricular, Primary Central Nervous System (CNS) tumors derived from Choroid Plexus Epithelium that are seen predominantly in children.

A Brainstem glioma is an aggressive and dangerous Cancerous Glioma Tumor in the brainstem which starts in the Brain or Spinal cord tissue and typically spread throughout the Nervous System. It is more diagnosed in children and young adults under the age of twenty. Symptoms of Brainstem glioma can develop slowly and subtly and may go unnoticed for months. A sudden onset of symptoms tends to occur with more rapidly growing, high-grade tumors. In other cases, the symptoms may arise abruptly. Unlike most Brain tumors, Brainstem Glioma is not often treated with Neurosurgery due to complications in vital parts of the Brain. Without treatment, the life expectancy is typically a few months from the time of diagnosis.

The Psychosocial and Neurocognitive functioning of several cancer patients and survivors deleteriously affected by various treatments of Malignant tumors such as Chemotherapy, Radiotherapy and Hormonal therapy. Oncology researchers and Clinicians are increasingly Cognizant of the negative effects of Cancer and its treatments on the Brain and its mental processes and Cognitive outcomes.

Neuropsychology in Cancer features the current findings on the Neuropsychological effects of the Cancers and their treatments along with the most promising Neuropsychological and behavioural health interventions available to mitigate these deficits.

The Response Assessment in Neuro-Oncology (RANO) Working Group is an international, Multidisciplinary effort to develop new standardized response criteria for Clinical trials in Brain tumors. The Surgery Working Group of RANO identified surgically related End-point evaluation problems that were not addressed in the original Macdonald criteria. Macdonald criteria led to the initiation of an International effort in Neurooncology to develop Novel Response and Progression Assessment Criteria. 

Para Neoplastic Neurological Syndromes (PNS) are defined as the remote effects of cancer on the Nervous System. They are due to the presence of Cancer and exclusion of other known causes of the Neurological symptoms, but this criterion does not separate “true” PNS from Neurological syndromes that are coincidental with a Cancer. 

In low-grade Gliomas, stereotactically guided conformal Radiotherapy should lead to a significant reduction in Radiation-associated late toxicity, while in selected groups of high-grade Gliomas the use of adjuvant or Neo-adjuvant Chemotherapy may improve survival. In primitive Neuroectodermal Tumours Prognostic Biological markers have been identified that are undergoing prospective evaluation. In infants the use of post-surgical chemotherapy alone may allow the postponing of Radiotherapy in selected cases. For patients with localized Medulloblastomas a new standard treatment is emerging that uses reduced-dose Craniospinal Radiotherapy followed by Platinum-based chemotherapy, while in Supratentorial primitive Neuroectodermal tumours future treatment will be aimed at improving local control.

The upcoming implementation of a Neurosurgical ablation device that provides controlled therapy for brain lesions those are difficult to reach and treat. This tool, will allow us to introduce the probe into the tumor and destroy it without having to perform a Surgical Operation or Craniotomy.

Recent advances have made treatment for brain tumors much safer and more successful. Some of these newer techniques include:

•Antiseizure/Antiepileptic Drugs (AEDs)

•Steroids

•Surgery: The goal of surgery in the treatment of metastasis is to maximally remove tumor while leaving patients with good function

•Radiosurgery: A non-invasive technique that delivers numerous narrow, precisely aimed, highly focused beams of ionizing radiation that converge at a specific point.

•Radiation therapy: X-rays and other forms of radiation can destroy tumor cells or delay tumor   growth.

•Chemotherapy: The use of drugs to kill rapidly dividing cells. It can be taken orally or intravenously.

•Targeted therapy: The focus on a specific element of a cell, such as molecules or pathways required for cell growth, in order to use them as a target.

The following are the steps involved in Brain Tumor Diagnosis;

·        A neurological exam: A neurological exam may include, among other things, checking your vision, hearing, balance, coordination, strength and reflexes. Difficulty in one or more areas may provide clues about the part of your brain that could be affected by a brain tumor.

·        Imaging tests: Magnetic Resonance Imaging (MRI) is commonly used to help diagnose brain tumors. In some cases a dye may be injected through a vein in your arm during your MRI study.

   A number of specialized MRI scan components — including functional MRI, perfusion MRI and Magnetic Resonance Spectroscopy

Other imaging tests may include Computerized Tomography (CT) scan and Positron Emission Tomography (PET).

·        Tests to find cancer in other parts of your body: If it's suspected that your Brain tumor may be a result of Cancer that has spread from another area of your body, your doctor may recommend tests and procedures to determine where the cancer originated. One example might be a CT scan of the chest to look for signs of Lung Cancer.

·        Collecting and testing a sample of abnormal tissue (biopsy): A Biopsy can be performed as part of an operation to remove the Brain tumor, or a Biopsy can be performed using a needle.

A stereotactic needle biopsy may be done for brain tumors in hard to reach areas or very sensitive areas within your brain that might be damaged by a more extensive operation. Your Neurosurgeon drills a small hole into your skull. A thin needle is then inserted through the hole. Tissue is removed using the needle, which is frequently guided by CT or MRI scanning.

The Biopsy sample is then viewed under a microscope to determine if it is cancerous or benign. This information is critical to establish a diagnosis and prognosis and, most importantly, in guiding treatment.

Neuroradiology uses primary imaging modalities including computed tomography (CT) and magnetic resonance imaging (MRI) to focus on Endovascular or minimally invasive diagnosis and characterization of abnormalities of the Central Nervous System or head and neck lesions such as Tumors, Aneurysms, Vascular malformations, or Stroke. It involves different types of Imaging Studies like Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) for characterization of various Neurological disorders.

The Immunotherapy treats the Immune system in Injury and repair during wide range of Neurological disorders, Inflammatory and Autoimmune Diseases of the Nervous system such as Multiple Sclerosis (MS) and Neuromyelitis Optical (NMO) and several Brain Tumor conditions. There were numerous Radiological studies to improve Diagnosis and treatment of these diseases. The main focus is to develop the so-called Neuroprotective (nerve cell protecting) treatment approaching and establishing Modern examination procedures such as MRI (Magnetic Resonance Imaging), OCT (Optical Coherence Tomography) and Motion Analysis.

Neuroimaging is the Mapping of human Brain using functional Magnetic Resonance Imaging (fMRI). It determines how difference and change in Cerebral structure, complexly relates to Behavior and Cognition at Multiple levels of Analysis. It includes Multimodality imaging like CT, MRI, PET, to offer most precise information noninvasively, on type of the Tumor and grade; it also guides therapeutic choices and also assesses the effects of therapy

Neuroimaging development, testing, and implementation of advanced MRI and PET Imaging biomarkers for the characterization of Brain Tumor biology and response evaluation in Clinical trials able to detect the biological behaviour of Brain Tumor more accurately.

A Metastatic Cancer is one which has spread from the primary site of origin into different area of the body. That occur in about one-fourth of all cancers that spread through the body.  Treatment for Metastatic Cancer aims to slow the growth or spread of the Cancer. Treatment depends on the type of cancer, where it started, the size and location of the Metastasis, and other factors.

The primary tumor may be found by examining tumor tissues from the brain. Tests may include; Cerebral Angiography, Mammogram, Chest x-ray, CT scans of the Chest, Abdomen, and Pelvis to find the original tumor site, MRI of the Brain, Lumbar puncture, EEG.

Occurrence of Cancer related complications are seen during Chemotherapy because the dividing blood cells in bone marrow are also prone to damage from medications used in treatment also many of these side effects can be attributed to low blood counts. In rare cases, some Chemotherapy drugs can cause Heart damage or trigger another cancer such as Leukaemia. Some complications seen are

•  Infection
•  Fatigue
•  Bruising
•  Bleeding
•  sleep disturbances

Preventive measures should start before cancer therapy begins, reducing the occurrence of further problems brought about by different treatment modalities.

To study the effect of drugs on the cellular function in nervous system is called as Neuropharmacology. It is of two types such as; Behavioral neuropharmacology and Molecular neuropharmacology. It explains the drug dependence and addiction effect of brain. The science dealing with the study of the effects of the poisons on the nervous system is called as Neuro toxicology. It happens when nervous system gets affected by the neurotoxins.  It occurs due to the exposure of the chemotherapy, radiation treatment, drug abuse, pesticides etc.

Neurological Nursing is a nursing specialty dealing with assessment, nursing diagnosis and management of brain and nervous system disorders, tumors, brain injuries, trauma, spine injuries, stroke, seizures aneurysms and many more conditions. Critical illness defines severe damage of vital organs like Central nervous system failure, brain damage, and spine injury and there is a chance of life threatening deterioration in the patient’s condition. Critical care is time dependent and delivered by physician to a critically injured patient and requires high complex decision to assess, monitor, manipulate and support vital organ function in order to treat vital organ system failure.

Pediatric neurooncology encompasses a wide-variety of areas Pediatric neurosurgeons are quite completely different from those ordinarily seen by general neurosurgeons. Because Pediatric neurosurgical issues often are present for life, children with nervous system problems frequently require close, on-going follow-up from childhood — sometimes as early as the new-born period — through the teenage years.

Neurosurgery is one in all the newer surgical disciplines to develop, originally gaining recognition in the early 1900s. However, it's currently one in all the foremost leading edge medical disciplines within the world of science and drugs and involves the utilization of a number of the foremost advanced technologies presently offered.

These areas include: developmental, contextual, and psychosocial factors that can contribute to Pediatric psychological and physical issues. It additionally includes: the assessment, diagnosis, and treatment of Pediatric medical conditions, prevention of Pediatric medical conditions (physical and psychological), educating the general population on Pediatric health, promoting health-related behaviours, advocating for child and family public policies, and improving Pediatric healthcare delivery services.