First detection of signs of inflammation in the brain of patients with chronic pain
Activation of certain brain cells has now been clearly observed, associated with pain, in humans.
A small human brain imaging study of people suffering from chronic back pain revealed for the first time the presence of elevated levels of a protein associated with inflammation in regions of the brain known to be involved in the transmission of pain. The results, which were published Monday in the journal Brain , may open the way to new treatments for chronic pain.
Marco Loggia and colleagues at Massachusetts General Hospital (MGH) have shown that the protein involved - translocator protein (TSPO ) - reaches high levels in structures of the brain that participate in pain transmission, and more precisely , in the glial cells of these structures.
Glial cells are cells present throughout the nervous system, but they are not neurons. They are responsible, among other things, for forming the myelin sheath that surrounds the fibers of the neurons, thus allowing the transmission of nerve impulses. And it is also known that they participate in inflammation processes that lead to pain. But, as the MGH explains in a statement, although it has been shown in animals that glial activation is linked to persistent pain, this mechanism "had never been documented in the brains of people with chronic pain."
TPSO, for it, is considered as a marker for the activation of glial cells in response to a trauma or pathology. Hence, scientists have decided to visualize protein levels in the human brain, in the presence and absence of pain.
PUB
"The fact that we have detected increased levels of TPSO in regions such as the thalamus - the portal of entry into the brain of sensory stimuli, including pain - is significant because we know that this protein is present at high levels in the glial cells when they are activated in response to a pathological event, "says Loggia, quoted in the same document.
To do the study, the scientists used a new drug that binds to TPSO. They were able to visualize - through magnetic resonance imaging and positron emission tomography (PET) - the levels of TPSO in the brains of ten people with chronic back pain and nine people who did not suffer from this type of pain.
As Loggia points out, the increase in TPSO levels in PET images was so marked in the ten chronic pain patients that the team was able to distinguish them from participants in the control group simply by looking at the images obtained. Statistical analysis of the results would confirm this correlation between TPSO levels and pain.
However, scientists found something they did not expect: among those with chronic pain, those with the highest levels of TPSO were also those who reported lower pain levels during the experiment. "While increasing TPSO levels is a marker for the activation of glial cells [in response to pain] - which is an inflammatory condition - animal studies have already suggested that what this protein actually does is limit the magnitude of the glial response, promoting a return to a pre-traumatic, painless state, "says Loggia.
"It means that what we are seeing may be the process of glial cells trying to 'calm down' after they have been activated by pain."
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NEUROSCIENCES
First detection of signs of inflammation in the brain of patients with chronic pain
Activation of certain brain cells has now been clearly observed, associated with pain, in humans.
A small human brain imaging study of people suffering from chronic back pain revealed for the first time the presence of elevated levels of a protein associated with inflammation in regions of the brain known to be involved in the transmission of pain. The results, which were published Monday in the journal Brain , may open the way to new treatments for chronic pain.
Marco Loggia and colleagues at Massachusetts General Hospital (MGH) have shown that the protein involved - translocator protein (TSPO ) - reaches high levels in structures of the brain that participate in pain transmission, and more precisely , in the glial cells of these structures.
Glial cells are cells present throughout the nervous system, but they are not neurons. They are responsible, among other things, for forming the myelin sheath that surrounds the fibers of the neurons, thus allowing the transmission of nerve impulses. And it is also known that they participate in inflammation processes that lead to pain. But, as the MGH explains in a statement, although it has been shown in animals that glial activation is linked to persistent pain, this mechanism "had never been documented in the brains of people with chronic pain."
TPSO, for it, is considered as a marker for the activation of glial cells in response to a trauma or pathology. Hence, scientists have decided to visualize protein levels in the human brain, in the presence and absence of pain.
PUB
"The fact that we have detected increased levels of TPSO in regions such as the thalamus - the portal of entry into the brain of sensory stimuli, including pain - is significant because we know that this protein is present at high levels in the glial cells when they are activated in response to a pathological event, "says Loggia, quoted in the same document.
To do the study, the scientists used a new drug that binds to TPSO. They were able to visualize - through magnetic resonance imaging and positron emission tomography (PET) - the levels of TPSO in the brains of ten people with chronic back pain and nine people who did not suffer from this type of pain.
As Loggia points out, the increase in TPSO levels in PET images was so marked in the ten chronic pain patients that the team was able to distinguish them from participants in the control group simply by looking at the images obtained. Statistical analysis of the results would confirm this correlation between TPSO levels and pain.
However, scientists found something they did not expect: among those with chronic pain, those with the highest levels of TPSO were also those who reported lower pain levels during the experiment. "While increasing TPSO levels is a marker for the activation of glial cells [in response to pain] - which is an inflammatory condition - animal studies have already suggested that what this protein actually does is limit the magnitude of the glial response, promoting a return to a pre-traumatic, painless state, "says Loggia.
"It means that what we are seeing may be the process of glial cells trying to 'calm down' after they have been activated by pain."
As for participants with pain, but with lower levels of TPSO, these "may present a more exaggerated neuroinflammatory response, which will eventually lead to more inflammation and more pain," adds Loggia.
He concludes: "More studies will be needed to support this interpretation of the results, but our work suggests that drugs that enhance TPSO's action may benefit patients by helping to limit glial activation."
Scientists discover ways to prevent metastasis
Movement of metastasis and ways to prevent the tumor from spreading throughout the body were research objects
German researchers at the Max Planck Institute and Goethe University have published in the scientific journal "Nature" an important study for the treatment of cancer. They found a way to prevent metastasis , which happens when some cells separate from the main tumor and enter the bloodstream, spreading rapidly through the body.
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For this to happen, metastasis takes advantage of specific molecules, called the "Death Receiver 6", which in turn receive a signal from the body cells to self-destruct. This is an action of the body already known by science and can occur in two ways: by apoptosis, which would be the imperceptible form, and by necroptosis, which causes inflammatory responses in the body, as well as the destruction of surrounding cells.
What has been discovered is that tumors activate the Death Receiver 6 out of the hour, leading to necroptosis and leaving the endothelial barrier weak and vulnerable to passing cancer cells to other parts of the body.
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In addition to understanding how the metastasis is transported, researchers have also done tests to prevent tumor movement. In genetically modified mice, they succeeded in disabling the Death Receptor 6 and, as a result, the mice had less necroptosis and metastasis.
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Although the results are promising, researchers still need to make sure that disabling Death Receiver 6 would not cause health damage, and the cancer has other ways of spreading through the body without using the bloodstream.
Brain tumors
Cancer - brain
Located inside the skull, the brain manages and coordinates most of our functions.
Located inside the skull, the brain manages and coordinates most of our functions.
internal functions of the body (heartbeat, blood circulation, muscle contractions or digestion),
the so-called higher functions (thought, emotions, personality, ability to communicate or to learn),
and finally, the five senses, which allow us to relate to the outside: sight, hearing, touch, smell and taste.
Thanks to advances in science, the functioning of the brain is better and better known. We know today that it works thanks to billions of neurons, connected to each other. We also know that it is organized in several zones, which manage each of the different functions.
This knowledge of the brain has made it possible to better understand the diseases that can be reached and to develop more and more precise and effective treatments.
What's going on inside the brain?
The brain functions as a central computer. He constantly receives a lot of information about what is happening inside and outside the body. This information comes from the spinal nerves, which run throughout the body, and cranial nerves, located inside the skull.
Each piece of information is classified, analyzed and processed by nerve cells, the neurons. Connected to each other, neurons are able to handle multiple pieces of information at a time. This allows us to see, talk, walk and breathe, all at the same time and without having to think about it.
These billions of neurons are surrounded and fed by other cells called glial cells. Glial cells are ten times more numerous than neurons. They represent 90% of the composition of the brain.
There are different types: astrocytes, oligodendrocytes, ependymocytes and microglial cells.
Just over half of brain tumors develop from these cells. This type of tumor is called glioma.
The different parts of the brain and their functions
The brain is very organized. It is composed of several parts that each have specific roles, while being complementary to each other.
In the strict sense of the term, the brain has two parts called the cerebral hemispheres. In common language, the brain (or brain) also includes structures close to the hemispheres: brainstem, cerebellum, hypothalamus, pituitary gland, etc.
The cerebral hemispheres:
The cerebral hemispheres form the largest parts of the brain. They are two: a right hemisphere and a left hemisphere. We often talk about right brain and left brain.
The hemispheres control all of our higher mental functions: voluntary movements, thought, learning, memory, etc.
Each hemisphere is itself divided into four zones called lobes, in which these different functions are managed: the frontal lobe, the parietal lobe, the temporal lobe and the occipital lobe.
The main functions of each lobe are:
The frontal lobes: speech and language, reasoning, memory, decision-making, personality, judgment, movements. The right frontal lobe manages the movements on the left side of the body, and conversely, the left frontal lobe manages the movements on the right side.
The parietal lobes: reading, location in space, sensitivity. Again, the right parietal lobe manages the sensitivity of the left side of the body and vice versa
Occipital lobes: vision
The temporal lobes: language, memory, emotions.
In general, the right hemisphere controls the left side of the body and vice versa. However, the distribution of functions inside the lobes is not completely fixed. Some functions are managed in different areas depending on the person. Thus, the language zone is generally located in the left temporal lobe in the right-handed ones, while it can be located on both sides in left-handed people.
The brainstem: connects the cerebral hemispheres to the spinal cord. It is he who controls the vital functions of the body: heartbeat, breathing, blood pressure. It also controls the mobility of the eyes, the movements of the face and swallowing.
The cerebellum: is located at the back of the brainstem, under the occipital lobes. It allows us to have reflexes, coordinate our movements and keep the balance.
The pituitary gland and the hypothalamus: are nerve structures located at the base of the brain, in the middle of the skull.
The size of a pea, the pituitary plays a fundamental role in the production of hormones. It controls many functions such as growth, breast milk production, puberty, fertility, etc.
The hypothalamus, located a little above the pituitary, is in contact with all other areas of the brain. It regulates feelings of hunger and thirst, body temperature, sleep, sexuality or heartbeat.
A well protected organ
As a command center for the entire body, the brain benefits from 3 protection systems:
the bones of the skull form a solid first shell around the brain. They protect it from shocks;
3 membranes, the meninges, envelop the brain and the spinal cord. They protect them from injuries and infections; little anatomy to understand the brain.
finally, inside the skull and along the spine, a liquid plays the role of insulator and damper against shocks.
This fluid is cerebrospinal fluid (abbreviated as CSF), also called cerebrospinal fluid (abbreviated as LCS). It is produced inside the brain, in cavities called ventricles. Renewed continuously, this liquid keeps a stable volume, which ensures a constant pressure inside the skull.
Brain tumors
Called tumor brain all tumors that develop inside the skull. They can develop in any area of the brain: the hemispheres, the cerebellum, the brainstem, the pituitary gland, etc.
There are dozens of different brain tumors, distinguished by 3 characteristics:
The location of the tumor
The type of tumor
The degree of aggressiveness of the tumor
The location of the tumor
The brain is organized into several areas, which manage each specific activity: language, body balance, heartbeat, blood circulation, memory, etc. A tumor can cause very different disorders depending on the area in which it develops.
The localization of the tumor is also an essential element for the choice of treatments. A tumor located at the surface of the brain, for example, is generally easier to extract a tumor located in the brain center.
The type of tumor
The brain is made up of different types of cells, each of which can cause different tumors.
Brain tumors are usually named after the cells from which they develop: gliomas develop from glial cells, which nourish and support neurons; meningiomas develop from the cells making up the meninges (envelopes of the brain), etc.
According to their type (the doctors speak of histological type), the tumors do not behave in the same way. Some develop faster than others or have an increased risk of recidivism, for example.
The degree of aggressiveness
The faster the tumor grows, the more aggressive it is. Brain tumors are classified into different grades according to their aggressiveness. Low grade is used for the less aggressive tumors and high grade for the tumors that are more aggressive. The grade can also be expressed by a Roman numeral from I to IV.
Grade I corresponds to non-cancerous tumors, these are the least aggressive. Grade IV is the most aggressive tumor. Knowing the grade of a tumor is crucial in the choice of treatments and in the prognosis. The lower the rank, the better the prognosis.
When a brain tumor is discovered, it is essential to determine its characteristics: its location, type and degree of aggressiveness. For this, several examinations must be carried out.
It is only after these different examinations that we know what type of tumor it is and that we can define the appropriate treatments.
Unlike other cancers, cancerous tumors of the brain do not cause metastases to the outside of the brain. They do not extend to other organs.
The different types of tumors
A small lexicon of the main types of brain tumors:
Pituitary adenoma : A benign tumor that develops in the pituitary gland. This tumor can cause hormonal disorders (stopping of the rules for example) or sometimes disturbances of the sight.
Astrocytoma : A tumor that develops from glial cells called astrocytes. They can appear in any area of the brain. Astrocytomas are classified into four grades, depending on their aggressiveness and the speed at which they develop. Grade 1 and 2 astrocytomas are considered benign and evolve slowly. Grade 3 astrocytomas are malignant, they evolve rapidly and tend to infiltrate several areas of the brain. Grade 4 astrocytomas, also known as glioblastomas, are the most aggressive tumors.
Ependymoma : Most often benign tumor , which develops in the ventricles of the brain or along the channels that carry the cerebrospinal fluid. It's a type of glioma. Ependymoma can be localized in the brain or spinal cord.
Glioblastoma : Tumor of the glioma family. Glioblastoma accounts for 20% of all brain tumors. It develops rapidly and spreads in several areas of the brain at the same time. After a complete treatment (surgery and radiotherapy), the progression of the tumor can be slowed down or stopped for several months.
Glioma : A category of brain tumors that develop from glial cells. There are several types of gliomas, some of which are cancerous and some non-cancerous. The majority of brain tumors are gliomas.
Meningioma : Tumor most often benign, which develops from the meninges. A meningioma can be located anywhere around the brain and spinal cord.
Neuroma : The most common benign tumor that develops from the cells surrounding the nerves (called Schwann cells). The most common neuroma develops in the brain, on the acoustic nerve (responsible for hearing), which connects the ear and the brain. It is also called schwannoma.
Neurofibroma : Tumor that develops from the nerves, most often the acoustic nerve responsible for hearing. Neurofibromas are benign tumors that can progress to malignant tumors, especially when they are linked to a genetic disorder called neurofibromatosis.
Oligodendroglioma : A tumor that develops from oligodendrocytes, a type of glial cell. An oligodendroglioma can be located in any area of the brain. There are two types: low-grade oligodendrogliomas, which evolve slowly and high-grade oligodendrogliomas, which are malignant and evolve more rapidly.
Metastases
Brain tumors should not be confused with brain metastases. Brain tumors are born directly inside the skull. We speak of "primitive" or "primary" tumor .
Brain metastases, for their part, are so-called "secondary" tumors, which develop from a cancer located in another part of the body: the breast, the lungs, etc.
The treatment of metastases depends on the treatments received for the first cancer.
Symptoms
The symptoms caused by a brain tumor are highly variable and do not appear systematically. They depend on the volume of the tumor , the speed at which it develops and especially its location.
The onset of symptoms may be sudden or very progressive depending on how quickly the tumor develops. Some tumors cause no symptoms, which usually means they develop slowly.
Three types of symptoms are possible:
headache (headache), associated with increased pressure inside the skull;
The development of a brain tumor sometimes causes headaches, which appear rather in the morning when waking up and are often accompanied by nausea or vomiting.
These headaches are caused by an increase in pressure inside the skull, called intracranial hypertension (abbreviated as HIC or HTIC).
This hypertension has three possible causes. It may be due:
swelling of the brain around the tumor , called cerebral edema;
to a compression of the brain by the tumor . By increasing the volume, the tumor presses on the brain, causing what doctors call a mass effect;
poor circulation of cerebrospinal fluid. This fluid is produced continuously in the ventricles of the brain and circulates around and inside the skull and spine. By its volume, the tumor can block this circulation. Instead of flowing normally, the cerebrospinal fluid accumulates in the ventricles which dilate and cause hypertension.
Most headaches are not a sign of a brain tumor . It is their unusual nature, duration, persistence or resistance to usual treatments, as well as their association with vomiting, which must alert and seek medical attention.
epileptic seizures, related to dysregulation of neuronal activity;
When the tumor develops on the surface of the brain, it can disrupt neuronal activity and trigger epileptic seizures.
Epileptic seizures are comparable to electrical shocks or short circuits between neurons. They are unpredictable and usually brief (1 to 2 minutes). But they can be impressive for loved ones.
There are different types of epileptic seizures. When they affect the whole brain, we talk about generalized crises. When they affect only part of the brain, they are partial seizures also called focal seizures.
Depending on the case, the symptoms vary. This may include:
loss of consciousness with falling, loss of urine, biting of the tongue or convulsions;
sudden and involuntary movements of arms and legs;
stiffness of the muscles;
strange or unusual sensations, of déjà vu or an unpleasant smell (of grilled for example) that the patient is the only one to feel;
sudden feeling of fear;
absences (the person stops his activity for a few moments, then resumes it as if nothing had happened).
These epileptic seizures sometimes lead to a loss of immediate memory: the patient has no memory of having had a seizure. He may even have trouble believing his relatives who describe the crisis.
"The first epileptic seizure I made was in the middle of the night. I do not remember anything but when I woke up, the firemen were there. It is from that that I made examinations and that the tumor was discovered ". Didier, 38 years old.
functional disorders, directly related to the location of the tumor and the functions managed in this area of the brain. It can be vision problems, changes in personality, difficulty coordinating movements or finding words ...
When a tumor develops inside the skull, it can damage the brain or interfere with its functioning. Depending on the area where it develops, it causes very different symptoms.
In general, a tumor located on the right side of the brain causes disorders in the left side of the body, and vice versa. A tumor in the right parietal lobe, for example, can cause numbness in the left side of the body.
Not all of these symptoms are synonymous with brain tumors . It is their duration and their persistence that must alert and have his doctor consulted.
The main possible symptoms are, depending on where the tumor is located:
Frontal lobes: change of personality, decrease of emotivity, confusion; difficulty acting, walking, talking, loss of smell.
Parietal lobes: Difficulty in choosing words, making sentences, reading or writing problems, orientation difficulties (finding one's way for example), feeling numb on one side of the body ...
Occipital lobes: disturbances of sight.
Temporal lobes: difficulty speaking, disturbed vision, memory, hearing, difficulty recognizing and naming something that we see for example.
Thalamus: pain, difficulty performing certain movements.
Region of the hypothalamus and pituitary: hormonal disorders (absence of rules for example), vision disorders.
Brainstem: gait disturbances, half-body numbness, lack of coordination of movements, paralysis of one side of the face, double vision, difficulty swallowing, loss of hearing.
Cerebellum: lack of coordination that can disrupt walking, gestures or speech, tremors during action.
Risk factors
The causes of brain tumors are poorly understood. It is not known why, at a given moment, the cells multiply uncontrollably until they form a tumor .
Numerous scientific studies have been conducted or are underway, to try to determine the factors that favor the appearance of a tumor in the brain. We talk about risk factors. Three types of risk factors are studied:
Risks related to the environment
Scientific studies have been looking for several years to determine the influence of the environment in the appearance of brain tumors. These studies focus on:
the influence of certain chemical substances, such as pesticides;
the consequences of exposure to electromagnetic fields, such as mobile phones, power lines or certain household appliances.
Chemical substances:
Several chemical substances are recognized as carcinogenic, that is to say that can promote the occurrence of a cancerous tumor of the brain.
These are chemicals used in various professional activities, such as the manufacture of synthetic rubber and certain drugs, the production of polyvinyl, crude oil and petroleum products, the nuclear industry and armaments, and finally the handling of pesticides.
These substances pose a risk to people exposed to them at high doses for a long time.
Electromagnetic fields:
The risk associated with regular exposure to electromagnetic fields is still being assessed. Experts have not made it clear whether this exposure can lead to brain tumors.
As for the use of mobile phones, a precautionary principle is necessary. The studies are not definitively decided, but they go in the direction of a possible risk especially in the child and the teenager.
As a precaution, it is advisable to limit the use of the mobile phone and not to keep it on oneself. During communications, the use of a headset is recommended.
Risks related to heredity
The vast majority of brain tumors have no hereditary link. It is not because a person has a brain tumor that other members of his family have an increased risk of developing the same type of tumor .
There is, however, a genetic risk for two types of brain tumors: neuroma and neurofibroma. These tumors account for less than 5% of all brain tumors.
These are benign tumors, which develop on the auditory nerve, connecting the brain and the ear. These tumors are often linked to a genetic disorder called neurofibromatosis.
Neurofibromatosis does not systematically result in a brain tumor .
If you are affected, specific exams can be offered to you and your family members. These tests will determine whether or not you have a risk of developing a tumor .
Risks related to viruses
According to current scientific studies, there is no link between viruses and the appearance of a brain tumor .
Only the AIDS virus (HIV), which weakens the body's defenses, can indirectly promote the development of a tumor called brain lymphoma.
A risk factor alone does not explain why a tumor has emerged. Indeed, for two people facing the same risk, one can develop a tumor and the other can not. Conversely, a person may have a tumor when it is not affected by any risk factor.
The diagnosis
Generally, it is the appearance of symptoms that makes it possible to suspect the presence of a brain tumor .
"I came back from vacation earlier because I had different headaches than usual. I immediately went to see my doctor. It was he who asked for the first scanner, where we saw that there was something. He then sent me to the neurological hospital to do further tests. " Josiane, 54 years old.
The attending physician plays an important role in the diagnosis because it is often he who is consulted first. In case of tumor suspicion , the intervention of several specialist doctors is then indispensable: neurologist, neurosurgeon, neuro-oncologist, radiologist, anatomopathologist (also called pathologist), etc.
The diagnosis of a brain tumor is done in several stages:
a complete clinical and neurological examination
The clinical and neurological examination is performed during a medical consultation, either by the attending physician or by a specialist brain doctor.
It consists in evaluating the general state of health on the one hand and the good functioning of the nervous system on the other hand.
The doctor asks questions about symptoms, medical, personal, family and surgical history, as well as general health.
It examines the whole body (blood pressure, heartbeat, etc.), then evaluates the functioning of the nervous system through various tests:
muscular exercises (walking, shaking hands, smiling to check the smooth functioning of the muscles of the face ...);
a test of reflexes;
a sensitivity test (feeling to the touch, reaction to hot and cold or a slight bite ...);
a balance and coordination of movements test;
an examination of the eyesight, the pupils, the movements of the eyes and the fundus of the eye;
a hearing test;
a test of language (ability to find the right word for example), reading, writing or drawing;
mental exercises (simple calculations), memory tests, comprehension, etc.
The clinical and neurological examination makes it possible to note any anomalies. To determine whether these abnormalities are due to a tumor or not, imaging tests are essential
imaging exams
The scanner
MRI
Imaging exams consist of making accurate images of the brain. They can detect a tumor , locate it accurately, measure its size and assess the consequences it has or may have on the brain.
For the diagnosis of a brain tumor , an MRI is essential. For practical reasons, MRI is often preceded by a scanner, for which it is easier to get an appointment quickly.
The scanner
A CT scan is an examination that provides images of the brain in section, using a device that projects X-rays at the level of the skull.
The apparatus consists of an examination bed and a large ring. The patient is lying on the examination table and his head is placed inside the ring. An X-ray beam directed at the skull provides several hundred radiographs.
Radiographs are transmitted to a computer, which reconstructs images of the brain in all three dimensions. Generally, an iodine contrast agent is injected before or during the examination. This product helps to highlight certain aspects of the brain, including blood vessels and facilitates the interpretation of images. The exam lasts about 15 minutes. It is not painful.
The use of X-rays and the injection of iodine require some precautions for use, especially in cases of allergy to iodine, pregnancy, renal failure or metformin (a drug used to treat diabetes). It is important to tell the doctor if this is the case.
MRI
An MRI (Magnetic Resonance Imaging) is performed with a large cylinder-shaped device. This device is composed of a very powerful magnet (hence the term magnetic). It produces radio waves that are projected on the brain and allow to obtain images "in section".
The images are then assembled by a computer to obtain a very precise reproduction of the brain.
During the examination, a contrast product is injected into a vein of the arm. It helps to highlight certain aspects of the brain, such as blood vessels and facilitates the interpretation of images.
The examination usually lasts between 15 and 30 minutes. It is not painful, but noisy.
Due to the magnetic field, the patient must remove any metal objects before performing an MRI. Some metal implants are contraindications to the examination: pacemaker, hearing aid, mechanical heart valve, insulin pump ... It is necessary to report them to the doctor before the examination.
Unlike the scanner, the patient almost completely enters the inside of the device, lying down. An anti-anxiety medication can be prescribed to people suffering from claustrophobia.
For the youngest children, MRI is performed under general anesthesia to prevent them from moving during the examination.
An MRI does not use X-rays.
CT and MRI results are usually available immediately after the examination and sent to the specialist physician.
"My neurosurgeon showed me the MRI and told me it was a tumor . He immediately explained where she was located. Then you had to do other tests to see if she was cancerous or not. " Didier, 38 years old.
an anatomopathological examination
After the imaging examinations, the analysis of a sample of the tumor is essential to complete the diagnosis. This analysis is called pathological examination, often abbreviated by doctors in "anapath".
The objective of the pathological examination is to determine all the characteristics of the tumor : its exact nature, its composition, its degree of aggressiveness. It is only after this examination that the doctors can say especially if the tumor is cancerous or not and what is its grade.
Pathological examination requires the collection of a tumor sample . It can be realized:
before starting the treatments. In this case, doctors perform a specific surgical procedure called a biopsy, in which they take a tumor sample that is then analyzed.
just after surgery to remove the entire tumor . In this case, the doctors analyze one or more small pieces of the tumor that they have just removed. This intervention, called an open-air intervention, has a dual purpose. It allows both to complete the diagnosis and treat the tumor .
In very rare cases, especially in the elderly, the pathological examination can not be carried out because no removal is possible. Physicians can then, exceptionally, decide to directly treat the tumor by radiotherapy or chemotherapy.
The essential
MRI is the first test to be done to detect a brain tumor . For practical reasons, it is often preceded or completed by a scanner (for which we often get an appointment faster).
In all cases, the MRI must be completed by the collection and analysis of a sample of the tumor .
This sample is taken either during a biopsy or during surgery to remove the tumor . The tumor sample is analyzed by a specialist doctor, called an anatomopathologist. Once the results of the analysis are obtained, several doctors come together to determine the most appropriate treatments.
The choice of treatments
There are different treatment options that can be offered alone or in combination with each other: surgery, radiotherapy, chemotherapy. Depending on the case, they aim to eliminate the entire tumor ; to reduce the risk of reoffending; to contain the development of the tumor ; to relieve and prevent the symptoms caused by the tumor .
The choice and order of treatments depends on many factors:
the apparent gravity of the tumor ;
the type of tumor ;
its location and extent;
the age and general state of health of the patient.
Whenever possible, surgery is the first treatment to consider. The goal is to remove as much of the tumor as possible . After the procedure, the tumor is analyzed in an anatomopathology laboratory. This analysis makes it possible to refine the diagnosis and to decide on the continuation of the treatments.
Radiation and / or chemotherapy may be used to complete the surgery. These treatments are aimed at eliminating the remaining tumor cells and limiting the risk of recurrence.
In some cases, especially when the tumor is not evolving or does not present an immediate risk, doctors sometimes choose not to start treatments immediately, to monitor the evolution of the tumor . Indeed, as long as it does not evolve, it is sometimes less risky to leave the tumor than to intervene in the brain.
In contrast, treatments are proposed to relieve any symptoms caused by the tumor (headaches, epileptic seizures).
The multidisciplinary consultation meeting
The choice of treatments proposed for a brain tumor is based on a multidisciplinary team: several doctors of different specialties get together to determine the best treatment solutions in your situation. This collegial decision is a guarantee of quality for each patient.
This team includes a neurosurgeon, a neurologist, an oncologist (chemotherapist or radiotherapist), a radiologist and an anatomopathologist.
These specialists meet to discuss each patient and offer everyone the best treatment solution. These meetings are called Multidisciplinary Collaborative Meetings (RCP).
"Even if you only see one doctor, it's reassuring to know that decisions are not made by one person, but by several specialists. We saw only one doctor, but we knew that behind there was a whole team. Marc and Sylvie, parents of Clotilde.
The treatment possibilities are then presented to the patient by the doctor during a specific consultation, sometimes called an announcement consultation.
The doctor informs the patient about the treatment goals, their course, their benefits and their risks.
The patient is advised to be accompanied by one of his relatives during this consultation. He will hear the information given by the doctor; he will be able to discuss this with him again and this will help him feel less alone in the treatment.
"My husband and I did not understand things the same way. Fortunately we were together, it allowed us to discuss again treatments and to be sure that we had understood well ". Maddy, 40 years old.
Once informed, the patient will have to agree before the treatment begins. The doctor will ask him to choose and appoint a trusted person to whom he can turn, especially if the patient can not give himself consent for treatment.
The personalized care program (PPS)
At the end of the consultation, the patient can be given a personalized care plan (PPS). This document contains all the treatments planned and their progress.
The personalized care program can evolve as treatments progress, depending on their results and how the patient supports them.
Questions to ask before starting treatments
Tuesday, July 06, 2010
It is recommended that the patient write down their questions in advance, to be sure that they are not forgotten during consultations with their doctor.
Here are some examples of questions:
Is the tumor cancerous or non-cancerous?
Do we know the causes of this tumor ?
Are several treatments possible?
When should the treatment start? Is it urgent?
How long will the treatment last?
How will treatments work?
Will there be any side effects?
Is there a risk of sequelae?
Will it be possible to drive again?
Is it possible to take the advice of another doctor?
In what type of institution to be hospitalized?
Is the proposed treatment part of a clinical trial?
The search for new treatments
Medical and scientific research has recently made it possible to develop new treatments called "targeted treatments" or "targeted therapies".
The principle of these treatments is to deprive the tumor of the elements it needs to develop: oxygen, nutrients, blood vessels ...
By better targeting the tumor , these drugs could improve the effectiveness of treatments for brain tumors, and reduce their toxicity.
These treatments are still under study. They may be offered as part of a clinical trial.
What is a clinical trial?
The goal of clinical trials is to study new treatments or combinations of treatments. The trials should show that there is an advantage to receiving the studied treatment compared to those that are usually used: better chances of healing, less side effects, improved quality of life.
Participating in a clinical trial is often a source of hope for patients for whom current treatments are not effective enough or poorly tolerated.
Each clinical trial is specific. The criteria for participating are therefore precise. To be accepted or not in an essay is not related to the severity of the tumor . It only means that the characteristics of the tumor or the general state of health of the patient match or do not match the research project.
Participate in a clinical trial
Before participating in a study, it is important to be aware of the risks and possible benefits. A treatment may be promising and prove, in the long run, less effective than others or have more side effects. However, accepting to participate in a clinical trial does not diminish the patient's chances of recovery. If he does not support the treatment under study or if his state of health worsens during the test, his participation will be interrupted to resume the usual treatment.
Here is a non-exhaustive list of questions to ask the doctor before participating in an essay:
What are the conditions to participate in this test?
What are the potential side effects of the new treatment?
Are there additional examinations (blood tests, imaging tests or other) as part of the new treatment?
How long is the treatment? How long and how fast is the follow up?
Does participation in the study involve travel to another health facility? If so, how often ?
Is it possible to be accompanied by a loved one during treatments?
What happens if the patient's condition worsens during the test?
If the patient agrees to participate in a clinical trial, the doctor in charge of the study will sign a form called informed consent. By signing it, he acknowledges having been informed of the practical details of the study and the risks that may be incurred.
His signature does not prevent him from leaving the study at any time if he wishes, without having to justify it.
Many people take a turmeric food supplement, believing that it brings them many benefits. Yet the way turmeric is used often makes it totally ineffective. Find out why and how to fix it.
Where are the promises of turmeric?
It has been about 6 years since the food supplements of turmeric snapped like hotcakes. And if we believe most of the websites of natural health, commercial or not, turmeric seems to have simply incredible effects: this spice could block the proliferation of cancer cells, cure osteoarthritis, multiple sclerosis, diseases cardiac disorders, neurodegenerative diseases such as Alzheimer's disease or inflammatory bowel diseases such as ulcerative colitis. And when looking for scientific studies on curcumin in a database of medical literature, we find that many studies seem to support these claims. Yet, over all these years, I have never received or read a message from a surfer announcing his recovery or the remission of his illness through turmeric. How to explain it? Would there be eel under rock? Marketing manipulation? This is what we will see.
Turmeric is a colorful spice rich in polyphenols: the curcuminoids. They are the ones who give the spice its yellow color. Among the curcuminoids, there are four substances: curcumin (which represents about 80% of all curcuminoids), demethoxycurcumin, bisdemethoxycurcumin and cyclocurcumin. Most of the virtues of turmeric seem to be related to the effects of curcumin, but not only: after ingestion curcumin undergoes chemical reactions in the liver which gives rise to four metabolites (or derivatives): tetrahydrocurcumin, hexahydrocurcumin, curcumin sulfate and curcumin glucuronide. It is tetrahydrocurcumin which is the main metabolite.
Curcumin in the industry
When you buy a product from the food industry and the list of ingredients mentions the "E100") it means that the product contains curcumin. This is generally used for its yellow coloring.
First problem: the analysis of different food supplements of curcumin revealed that a good part of them are developed with turmeric of first price which contains only very little curcumin, therefore very little active substance (1 ).
Second problem: the scientific studies in which researchers announce the virtues of turmeric in the face of cancers or chronic diseases are not the result of research on patients, but rather of in vitro studies, on cells, in the laboratory: we apply directly curcumin on cells or injected into animals.
Third problem: curcumin is very poorly absorbed by the digestive tract (2); when researchers gave different doses of turmeric in the form of a very popular and reputedly excellent dietary supplement to volunteers, they did not observe any passage of curcumin into the blood as long as doses were less than 10,000 mg, corresponding to 10 tablets of the product swallowed at one time (3). And by swallowing 10 or 12 tablets, only 2 in 24 people saw their blood curcumin levels increase, but at very low values (22 to 41 ng / mL).
This is finally why turmeric does not keep all its promises: whether as a food supplement or in the kitchen: it does not almost go into the blood and therefore can not have all the benefits attributed to it, because they come from laboratory experiments where conditions are very different from real life! Fortunately, there is a way to get around all these problems and get a highly absorbable and therefore highly effective turmeric.
The state of research on the absorption of turmeric
Some laboratories, a little more preoccupied than others to sell quality products, know this problem. There are many dietary supplements of curcumin mixed with black pepper on the market. Indeed, one study has shown that the addition of 20 mg of piperine (an extract of black pepper) to 2000 mg of curcumin multiplies the absorption of curcumin (4)! The mixture of curcumin and black pepper therefore seems particularly interesting since a dose of 2000 mg of this mixture would be equivalent to a dose of 40 gr of simple turmeric. But unfortunately this solution also poses two problems:
Manufacturers never put more than 5 mg of piperine per 1000 mg of turmeric, which is half the effective dose in scientific studies.
Many studies have shown that black pepper increases the absorption of turmeric (or other substances) because it increases the intestinal permeability and thus the passage into the blood of the outer molecules (5). And unfortunately the researchers also explain that this effect promotes the development of intolerance and food allergies (6). Moreover, it is also known that anything that increases the permeability of the intestine promotes the appearance of autoimmune diseases .
Finally, dietary supplements of turmeric combined with black pepper, although promising, can not be recommended to preserve or optimize its health. But other types of turmeric even more effective have been developed.
Nanoparticles and phospholipids of turmeric
Turmeric is a fat-soluble substance, but it is also soluble in water, like most polyphenols. Two techniques have therefore been developed to increase its absorption: nanoemulsions of turmeric, to greatly increase its solubility in water and therefore its absorption in the intestine and phospholipids turmeric, to greatly increase its solubility in the fats, for the same purpose.
The nanoemulsion process gives rise to turmeric nanoparticles whose absorption has been evaluated in several clinical studies. Compared to simple turmeric, the absorption of curcumin is multiplied by about 10 (7, 8). Another advantage of this formulation: while classical turmeric quickly disappears from the bloodstream, nanoparticles have a half-life of about 13 hours, which means that taking one capsule three times a day is enough to maintain levels. high levels of curcumin in the blood, capable of having a real impact on health, and in particular on inflammation. For several teams of researchers, turmeric nanoparticles are indeed a potential agent for natural cancer chemotherapy (9).
The second formulation, turmeric phospholipids, also known as turmeric phytosomes, is able to multiply the absorption of turmeric by 29. More precisely, the absorption of curcuminoids is accentuated as follows: curcumin absorption increased by 19, uptake of demethoxycurcumin increased by 68 and bisdemethoxycurcumin by 56 (10). This new turmeric has been tested in several clinical studies, and unlike simple turmeric, it seems as effective as the miraculous studies done in the laboratory would have predicted! That's why Nutriting now sells turmeric ( available here ) as phospholipids on my advice.
turmeric
Concentration of curcuminoids in the blood as a function of time
How to use turmeric phospholipids
To treat pain: Turmeric in the form of phospholipids is effective on any type of pain (osteoarthritis, shock, etc.) with the exception of neuropathic pain (diabetes, fibromyalgia, multiple sclerosis, etc.). Its efficacy is superior to that of paracetamol and comparable to that of nonsteroidal anti-inflammatory drugs (ibuprofen, etc.). In case of acute pain, you can take 4 tablets that will relieve pain without side effects (the maximum effect is felt after 1h to 1h30) while providing other health benefits (decreased inflammation, better health of the blood vessels and probably decrease the risk of cancer). In case of chronic pain it is possible to reduce the dose to 3 tablets per day (11).
To treat osteoarthritis: in 2010 Italian researchers recruited 50 patients with osteoarthritis who were assigned either to receive 2 capsules of phospholipidic turmeric morning and evening or a placebo. All were taking concomitant conventional treatment (nonsteroidal anti-inflammatory drugs). Result: inflammatory markers (CRP) and pain were significantly reduced. The ability to walk pain-free has increased by 245% in three months and the use of turmeric has helped patients save money as 62% of them have stopped their traditional medicines. In addition, turmeric had no side effects (while anti-inflammatory drugs often give a stomach ache when they do not increase the risk of heart attack) (12).
Decrease the side effects of radio and chemotherapy: in a recent study researchers gave phospholipidic turmeric (one capsule morning, noon and evening) or placebo to 160 cancer patients (cancers of the colon, rectum, liver , kidneys, stomach, lungs, ovaries or blood) that followed conventional treatments: chemotherapy or radiotherapy. They observed whether turmeric had an effect on the incidence of side effects. Results: when taking turmeric, patients had almost twice as many side effects (nausea, vomiting, diarrhea, constipation, weight loss, infections, collapse of the immune system or blood). Same observation with radiotherapy (13).
To block the proliferation of cancer: two studies have tested the effects of turmeric in humans in an attempt to limit the proliferation of precancerous cells, for example following the removal of a tumor. 25 men with various precancerous lesions took 8 grams of simple turmeric for 3 months. The results of this study were modest: 50% of the patients who received turmeric improved their condition and 50% saw their condition worsen. But the researchers could not test the effects of the doses higher than 8 gr because they became too difficult to swallow. It can be assumed that the results would be much higher with phospholipidic turmeric (14, 15).
To improve the treatment of pancreatic cancer: pancreatic cancer is a serious cancer that evolves quickly and is almost always fatal. Two studies have therefore tried turmeric powder at a dose of 8 grams per day. The results seem very variable, but following the taking of turmeric a patient saw his tumor suddenly fall by 73% (16). In the case of patients who have become resistant to chemotherapy treatments, turmeric has survived for over a year in 19% of cases (17).
To improve the treatment of colon cancer: Two studies have tested turmeric powder in patients with precancerous or cancerous lesions of the colon. In both cases turmeric proved effective when used in conjunction with conventional treatments, from 4 gr per day. Again, researchers have not tried turmeric as phospholipids, which is probably more effective (18, 19).
To treat uveitis: ophthalmology researchers have tested the efficacy of phospholipid turmeric in people suffering from uveitis, an inflammation of the uvea, a pigmentary part of the eye, whether autoimmune or the consequence of another disease. The 106 study participants took 1 capsule of turmeric morning and evening for 12 months in addition to conventional treatment and the researchers noted a marked decrease in inflammation which resulted in a decreased risk of relapse of 80% (20).
To treat diabetic retinopathy and microangiopathy: in one study, 38 people with diabetes for at least 5 years received 2 tablets a day of phospholipidic turmeric in addition to the standard treatment and 39 received a placebo. At the end of a month only the blood circulation in the vessels of the eye had improved. In addition, participants' visual acuity increased with no change in the placebo group (21).
You will find quality turmeric on the Nutriting website .
Given the ridiculous price of baking soda, it should not be expected that official medicine welcomes this innovation with enthusiasm. It's been years now that we're talking about Dr. Tullio Simoncini's method, but the only title of his book, cancer is a mushroom , has robbed me from the start. What also made me wary is that I did not hear that this "derangeur" emancipated from the "medically correct" had some trouble with the Institution. I learned that since then he has been banned from practicing in Italy, which is reassuring.
On the other hand, I always assume that a lot of phenomena work perfectly from false theories, or even without any explanation.
For Dr. Simoncini, the cancer would be the consequence of an infection from Candida albicans (fungus) . According to statistics going back ten years, there would be about 70% of Americans unknowingly suffering from candidiasis. The spores of this fungus settle and proliferate in the body, following the food imbalance and chemical pollution of modern life, which have created an acidic ground. Although one can live for a long time with the many painful disorders known, when this invasion maintained by the acidosis exceeds a certain threshold, the situation becomes unmanageable for the organism. It is at this moment that, in a survival program, this one creates tumors-trash to try to limit the problem geographically.
Dr. Simoncini believes that the best way to try to eliminate a tumor is to put it in contact with sodium bicarbonate, as close as possible, using oral administration for the digestive tract, enemas for rectum, vaginal douche for the vagina and uterus, and inhalation (?) for the upper parts of the airways.
The breasts, the lymph nodes, can be treated with local subcutaneous infusions.
For the lungs and the brain, it uses the intravenous injection route (there, it is no longer soft medicine). The internal organs can be treated with sodium bicarbonate by locating the appropriate catheters in the arteries (liver, pancreas, prostate and limbs) or in the cavities (pleura or peritoneum). Simoncini says that sodium bicarbonate destroys fungal colonies in the heart of cancerous tumors.
What cure rate for cancer?
Dr. Simoncini gives the following statistics:
"If fungi are sensitive to sodium bicarbonate solutions, and if the tumor size is less than 3 cm, the percentage [cure] will be in the order of 90%. the terminal phases where the patient is in good enough condition, it is 50%. "
The doctor states, "My methods have cured people for twenty years, many of my patients have recovered completely from cancer, even in cases where the official oncology had given up."
In addition to his training as an oncologist, Dr. Simoncini is a very human person and sensitive to the problems of others. It is always possible to reach him by email or telephone (+39.335.294480) for further information.
For other non-directly accessible types of cancer, bicarbonate is administered by arteriography (injection into a catheterized artery).
It not only brings an alkaline shock wave to cancer cells, but also oxygen that breaks the hypoxia associated with cancerous tissue. In addition, it has the property of absorbing some heavy metals, dioxins and furans.
Personally, I consider that in the face of chemo, this technique involves no risk.
https://www.zamnesia.com/de/blog-cannabis-bekampft-nachweislich-die-aggressivste-form-von-hirntumoren-n447
References : (1) Zhou H1, CS Beevers, Huang S. The targets of curcumin. Curr Drug Targets. 2011 Mar 1; 12 (3): 332-47.
(2) Anand P1, Kunnumakkara AB, Newman RA, Aggarwal BB. Bioavailability of curcumin: problems and promises. Mol Pharm. Nov-Dec; 4 (6): 807-18.
(3) Lao CD1, Ruffin MT 4th, Normolle D, DD Heath, Murray SI, Bailey JM, ME Boggs, Crowell J, CL Rock, Brenner DE. Dose escalation of a curcuminoid formulation. BMC Complement Altern Med. 2006 Mar 17; 6: 10.
(4) Shoba G1, Joy D, Joseph T, Majeed M, Rajendran R, Srinivas PS. Influence of piperine on the pharmacokinetics of curcumin in animals and human volunteers. Planta Med. 1998 May; 64 (4): 353-6.
(5) Khajuria A1, Thusu N, Zutshi U. Piperine modulates the permeability of membrane dynamics, the influence of membrane dynamics, ultrastructure and enzyme kinetics. Phytomedicine. 2002 Apr; 9 (3): 224-31.
(6) Erika Jensen-Jarolim, Leszek Gajdzik, Ines Haberl, Dietrich Kraft, Otto Scheiner, Jürg Graf. Hot Spices Influence Permeability of Human Intestinal Epithelial Monolayers. J. Nutr. 1998 128: 3 577-581.
(7) Yu H1, Huang Q. Improving the oral bioavailability of curcumin using novel organogel-based nanoemulsions. J Agric Food Chem. 2012 May 30; 60 (21): 5373-9.
(8) Sasaki H1, Sunagawa Y, Takahashi K, Imaizumi A, Fukuda H, Hashimoto T, Wada H, Katanasaka Y, Kakeya H, Fujita M, Hasegawa K, Morimoto T. Innovative preparation of curcumin for improved oral bioavailability. Biol Pharm Bull. 2011; 34 (5): 660-5.
(9) Kanai M1, Imaizumi A, Otsuka Y, Sasaki H, M Hashiguchi, Tsujiko K, Matsumoto S, Ishiguro H, Chiba T. Dose-escalation and pharmacokinetic study of nanoparticle curcumin, a potential anticancer agent with improved bioavailability, in healthy human volunteers. Cancer Chemother Pharmacol. 2012 Jan; 69 (1): 65-70.
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