Brain and CNS Cancer

Overview

The brain is a vital organ that contains billions of nerve cells and is the control centre of the body and mind. The central nervous system (CNS) contains the brain, spinal cord and the nerves which control everything from how we feel, our vision, hearing, movement and much more.

Brain and spinal tumours are a mass of abnormal cells that have grown out of control, these tumours can grow anywhere in the brain and spine, they can be benign (non-cancerous) or malignant (cancerous). Tumours that grow directly in the brain or spinal cord are called primary brain tumours; this is because they’re not there as a result of another cancer in the body. Secondary cancers occur as a result of one part of the body to another part of the body and are called secondary tumours or metastases. (The information here is about primary brain tumours).

Cerebellum

The cerebellum is the region of the brain that is responsible for motor movement including, muscle tone balance and equilibrium. The cerebellum doesn’t initiate movement but contributes to the coordination, precision and timing.

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Hypothalamus

The hypothalamus is the part of the brain that maintains the body’s internal homeostasis (balance); it’s the link between the endocrine and nervous systems as it’s the section of the brain responsible for the production of the body’s essential hormones.

Optic Nerve

The optic nerve connects the eye to the brain and carries impulses formed by the retina, a nerve layer at the back of the eye that senses light and create impulses. It’s sometimes called the second cranial and is the second of several pairs of cranial nerves.

Pituitary Gland

This is a small gland found in the middle of the brain and its job is to make a lot of different hormones and controls many different functions of the body, such as; breast milk production, sperm production, growth, metabolism, production of natural steroids and menstruation/ ovulation in women.

Brain Stem

The brain stem is responsible for body functions such as; blood pressure, heartbeat, breathing and swallowing, which makes it extremely vital. It forms a connection between the brain and the spinal cord, located at the base of the brain.

Spinal Cord

The spinal cord is a long, fragile and important structure between the body and the brain. It consists of many nerves that carry information from the spinal cord to the rest of the body, and from the body back to the brain. It’s the centre for reflexes and is covered by layers of tissue called the meninges.

Pineal Gland

The pineal gland also called the pineal body, conarium or epiphysis cerebri is a small endocrine gland. The purpose of it is to produce a hormone called melatonin, which helps maintain circadian rhythm and regulate reproductive hormones. It also regulates wake and sleep patterns and photoperiodic functions.

Choroid Plexus

There are four Choroid plexus in the brain; they are responsible for producing cerebrospinal fluid in the ventricles of the brain. Its purpose is to ‘flush’ the brain to remove metabolic waste, foreign substances and excess neurotransmitters.

Cerebrum

Also known as the telencephalon, it’s the largest and most developed part of the brain, it’s a folded mass of nervous tissues and is responsible for multiple functions such as: planning, memory, thinking, perceiving, determining intelligence and personality, interpreting sensory impulses, motor function, and touch sensation.

Ventricles

The ventricles are a series of interconnecting cavities that are fluid-filled spaces in the brain. There are four ventricles and within each ventricle is a region of choroid plexus. The ventricles are filled with a cerebrospinal fluid (CSF) which bathes and cushions the brain and spinal cord.

Signs and symptoms

Symptoms with brain tumours and the central nervous systems can be physical and mental, depending on the part of the brain affected, if you experience one or more of common signs and symptoms plus some of the other symptoms, don’t hesitate seeing your doctor.

Common signs and symptoms:

  • – Headaches
  • – Seizures/ fits
  • – Nausea and sickness
  • – Problems with vision and eyes
  • – Drowsiness
  • – Dizziness/ vertigo

Other symptoms:

  • – Personality changes
  • – Fatigue (extreme tiredness)
  • – Weakness
  • – Stroke-like symptoms
  • – Memory becoming worst
  • – Forgetting words
  • – Fits associated with strange feelings, smells, déjà vu
  • – Difficulty with speaking and understanding
  • – Problems reading and writing
  • – Poor coordination/ problems with movement
  • – Uncontrolled movements of one or both eyes
  • – Stiffness of the neck
  • – Loss of control of bladder or bowel
  • – Seeing double/ changes to vision
  • – Difficulty speaking or swallowing
  • – Poor coordination/ problems with movement
  • – Uncontrolled movements of one or both eyes
  • – Loss of previously acquired milestones
  • – Neck or head tilting to one side
  • – Loss of previously acquired milestones

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Treatment and side-effects

The treatment you need would depend entirely on the:

  • – Position of brain tumour
  • – Your age
  • – Grade of tumour
  • – Size of tumour
  • – Type of tumour

Any treatment for a brain and CNS tumour is complex due to the areas in which they are. The brain and central nervous system are a huge nerves hub, therefore any damage to these nerves during treatment will likely cause long-term side effects.

Sometimes treatments will not be used to cure the tumour but to prolong life and reduce the symptoms.

With children, long-term side effects are common; this is due to the nervous system still developing in children and if damage during surgery or radiotherapy, there’s a high chance of children not developing as well.

Surgery

There are various types of surgeries for brain tumour:

  • – Remove the entire tumour (benign and malignant)
  • – Remove most of the tumour (benign and malignant)
  • – Taking a biopsy of the tumour (benign and malignant)

Surgery is the most common option localised cancers, it’s not a suitable treatment option for advanced cancers or metastatic disease. With surgery to remove cancerous tissues, lymph nodes close to the cells are usually removed to prevent any possible spread of cancer.

Long- term side- effects can occur with surgery if nerves or surrounding healthy tissue and organs are damaged.

Side-effects (short-term)

Complications with any surgery can happen and a person’s health can put them at risk, Complications can be:

  • – Excess Bleeding
  • – Blood clots
  • – Wound Infections
  • – Death (Rare)

Long-term side effects

Long term effects depend on which area of the brain the tumour is at, the long effects can be:

  • – Weakness of part of the body
  • – Speech problems
  • – Personality changes
  • – Coordination changes

Long-term effects in children

  • – Physical problems (poor coordination, movement)
  • – Long-term seizures, headaches and migraines
  • – Lack of growth
  • – Fertility problems (late or early puberty)
  • – Educational and learning problems
  • – Memory problems
  • – Behavioural problems

Radiotherapy

Radiotherapy uses radiation to destroy cells; these high-energy rays target cells in order to kill cancer cells. It can be used as a stand-alone treatment or in conjunction with another treatment such as surgery or chemotherapy. In early lung cancer- radiotherapy can destroy the cancer all together but in advanced, it’s usually used to relieve symptoms and control cancer.

It works by focusing a beam of radiation, which passes through the body to destroy cancerous cells. Long-term side-effects occur as the radiation can harm healthy tissues when passing through the body.

There are two types of external beam radiotherapy; 3D-CRT (3-dimensional conformal radiotherapy) and IMRT (Intensity modulated radiotherapy.

Short-term side effects

  • Sore/ irritated skin that feels like sunburn
  • Fatigue (extreme tiredness)
  • Hair loss
  • Nausea / Vomiting
  • Loss of appetite
  • Diarrhoea
  • Hair loss
  • Fertility problems

Long-term effects

  • Headaches and migraines that come and go
  • Personality changes
  • Problems thinking clearly
  • Symptoms similar to ones you had before radiotherapy
  • Difficulty with simple tasks
  • Memory problems
  • Confusion
  • Coordination problems
  • Motor problems

Chemotherapy

Chemotherapy is done by using strong medication that can shrink a tumour or prevent cancer from returning. The medications used in chemotherapy attack cells that are dividing quickly, which is why they work well against cancer cells. Chemotherapy can be done as a stand-alone treatment or in conjunction with radiotherapy or surgery.

Chemotherapy can sometimes be difficult to treat brain and CNS tumours as the drugs can struggle to get from the bloodstream to the tumour.

Side-effects during treatment

  • – Hair Loss
  • – Mouth ulcers
  • – Nausea or vomiting
  • – Fatigue
  • – Increased chance of infections
  • – Bruising easily
  • – Changes in bowel habits

These side-effects usually stop once treatment is complete.

Long-term effects

  • – Confusion (chemo brain)
  • – Reoccurring cancer 

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Private Treatment : Proton Therapy

Proton therapy is a type of radiation therapy that uses photons at half the speed at light to destroy cancerous cells. It isn’t yet available on the NHS although there are current plans to build proton centres in the UK; however, the NHS may offer proton therapy for hard to treat cancers such as the brain or spinal area.

For brain and CNS tumours, proton therapy is ideal as it lets off a low ‘exit dose’ of radiation, this means the surrounding healthy tissue remains healthy and doesn’t damage the nerves, unlike radiotherapy.

Proton therapy has minimal long-term side-effects. The most common side-effects noticed are short-term and usually go away one the treatment has finished. These side-effects are usually a slight burn when the proton beam is targeted.

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