By Dr Neoh Yee Yik, Consultant Neurosurgeon, Hospital Seri Botani
Brain tumours are a significant public health concern in Malaysia. According to the World Health Organization’s GLOBOCAN 2012 database, brain tumours account for approximately 2% of all cancers in the country. Among Malaysians, brain tumours are ranked as the 11th most common cancer in males and the 13th in females. Despite these statistics, awareness about brain tumours remains relatively low among the general public, highlighting the urgent need for public education and advocacy.
The growing incidence of brain cancer can be attributed to multiple factors. Recent increases in environmental pollutants, occupational exposures, and industrial radioactive sources have contributed to this trend. Furthermore, improved access to advanced diagnostic facilities has led to more effective detection and reporting of brain tumours. These developments highlight the importance of ongoing public health initiatives to raise awareness about potential risk factors and the need for early detection.
Most brain tumours are diagnosed in adults, with the highest incidence observed in patients aged 51 to 60 years (26%). In contrast, developed countries such as the United Kingdom report the highest incidence in individuals over 65 years old. This disparity may be due to underdiagnosis among the elderly in Malaysia, as many opt for conservative management rather than surgery because of frailty, multiple health conditions, complex medication regimens, and insufficient social support. Without surgical intervention, histopathological confirmation is often lacking, even after imaging. This situation emphasises the urgent need to enhance public awareness and improve management strategies for brain tumours, particularly among the elderly population. Promoting early detection, accessible care, and robust support systems for older adults is crucial for better outcomes.
The management of brain tumours has been transformed by the integration of advanced surgical techniques such as Image-Guided Surgery (IGS) and Fluorescence-Guided Surgery (FGS). These techniques use neuronavigation and special fluorescent dyes to distinguish tumour cells from healthy brain tissue, allowing surgeons to visualise tumour margins more clearly. Moreover, intraoperative ultrasound is employed during surgery to detect changes in brain anatomy, guide the extent of tumour resection, and assess for any residual tumour tissue. Raising public awareness about these cutting-edge technologies is essential to encourage early consultation and improve patient outcomes.
Awake craniotomy is a specialised surgical procedure in which patients remain awake during certain stages of brain surgery. This technique is essential for procedures involving areas of the brain responsible for motor or speech functions, as it allows real-time mapping and monitoring to minimise neurological damage. Since brain tissue lacks pain receptors, patients can actively participate by performing speech or motor tasks in response to the surgical team’s instructions, ensuring critical brain functions are preserved. Most of the surgery is conducted under minimal to moderate sedation, with the patient remaining comfortable. Public education about awake craniotomy can help dispel misconceptions, reduce anxiety, and empower patients to make informed decisions about their treatment options.
References :
1.Global Burden of Disease Cancer Collaboration . Fitzmaurice C, Abate D, Abbasi N. Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 29 cancer groups, 1990 to 2017: a systematic analysis for the global burden of disease study. JAMA Oncol. 2019;5(12):1749–1768. doi:10.1001/jamaoncol.2019.2996.
2.Grech N, Dalli T, Mizzi S, Meilak L, Calleja N, Zrinzo A. Rising incidence of glioblastoma multiforme in a well-defined population. Cureus. 2020;12(05):e8195. doi: 10.7759/cureus.8195.
3.Heng YW, Tan KH, Yap NKB. Brain Tumor: A Review of Its Demographic in a Rural Hospital of Sibu in Sarawak, Malaysia. Asian J Neurosurg. 2023 Mar 27;18(1):1-4. doi: 10.1055/s-0043-1760855. PMID: 37056909; PMCID: PMC10089728.
4.Wan Hassan WM. The history of awake craniotomy in hospital universiti sains malaysia. Malays J Med Sci. 2013 Oct;20(5):67-9. PMID: 24643321; PMCID: PMC3957358.
