indiacancer.org - Tumors Of The Pituitary

Tumors Of The Pituitary

		What is the Pituitary Gland?
		What are Pituitary Tumors?
		How do Pituitary Tumors present?
		How are Pituitary Tumors detected?
		What are staging and grading?
		What are the types of Pituitary Tumors?
		How are Pituitary Tumors treated?
		What are the side effects of treatment for Pituitary Tumors?
		What is the importance of follow up?

What is the Pituitary Gland?

This is a small gland nestling in the base of the skull, about the size of a pea, located almost near the the center of the brain just behind the nose.

The function of the pituitary is to make hormones, that affect the growth and functions of other organs in the body. Thus, it is an extremely vital organ.

What are Pituitary Tumors?

These are tumors arising from the pituitary gland. Most of these are benign.

There are several varieties of pituitary tumors. The chief problem with pituitary tumors is that they are often functional tumors, that is, they over produce hormones, leading to functional disturbances, often severe, in various organs of the body.

How do Pituitary Tumors present?

	The following are a few common ways in which these tumors present:
		Cushing's disease is a condition in which certain steroid hormones called glucocorticoids are over produced. This leads to a fat build up on the face, chest and back (a 'buffalo hump') and very thin arms and legs (a 'lemon on sticks'). The patient also develops diabetes, weak muscles and bones, and has a perpetually flushed face and high blood pressure.
		Acromegaly is a condition produced by other pituitary hormone over production, in which the hands, feet and face are larger than normal, and if the condition occurs in young age, it may produce giants.
		Prolactin secreting tumors may produce a pseudopregnancy, that is, even though a female is not pregnant, there is production of milk and the periods stop.

How are Pituitary Tumors detected?

Besides the significant and obvious history given by the patient, the doctor may also perform a series of investigations:

A series of blood and urine tests which detect the high levels of hormones in circulation. This not only gives us proof of the presence of a pituitary tumor, but also gives us a clue to the specific type of tumor.

MRI (Magnetic Resonance Imaging) uses a powerful magnet linked to a computer. This large machine has space for the patient to lie in a tunnel inside the magnet. The machine measures the body's response to the magnetic field. The computer uses this information to create detailed, three dimensional pictures of areas inside the body.

What are staging and grading?

These are terms with which you must become familiar, if you are dealing with any form of cancer.

When we stage a cancer, we try to establish carefully degree of spread of the cancer and if indeed there is spread, to what extent and involving which organs.

The grading of a cancer is a microscopic issue, in which the pathologist lets you know how aggressive this particular type of cancer is ; well differentiated means less aggressive, moderately differentiated intermediately aggressive and poorly differentiated more aggressive.

Both grading and staging help your clinician to establish the prognosis or how serious your disease is and what is going to be the likely outcome.

Staging may require additional imaging tests such as CT Scan, MRI, Sonography of the abdomen, IVU, Bone scan or chest X-ray.

What are the types of Pituitary Tumors?

		Non functioning tumors There is no hormone production.
		Functioning tumors There is over production of hormones.
		ACTH producing tumors Produce a hormone called ACTH(Adrenocorticotropic hormone), which is a stimulator of the suprarenal glands, located just above the kidneys. This leads to the over production of glucocorticoids and Cushing's disease.
		Prolactin producing tumors They over produce prolactin, and lead to pseudopregnancy in females and impotence in males.
		Growth hormone producing tumors Over produce growth hormone, which leads to acromegaly and gigantism.

How are Pituitary Tumors treated?

	A lot depends on the patient's constitution, the grade of his disease and its staging. Patients are usually treated by a team of specialists which utilizes a multipronged approach. This includes an oncosurgeon, a radiotherapist, and an endocrinologist( a clinician who treats hormone disturbances). The plan of treatment is tailored to fit a patient's requirements. Treatment strategies: The bastion of treatment is surgery. Surgery employs two approaches to tackle pituitary tumors:
		A cut through the nasal passage is taken and the tumor is removed form here. This procedure is known as Trans sphenoidal hypophysectomy.
		The skull is opened and the tumor is removed from above. This procedure is called a craniotomy.
	The alternative local therapy to surgery is radiation therapy. This involves the use of high energy, penetrative rays to destroy cancer cells. It affects cancer cells only in the zone treated. Radiation therapy is also employed for palliation i.e. control of symptoms alone in an advanced cancer. Radiation therapy can also be used in adjunct to surgery or chemotherapy, either before or after. Teletherapy or external radiation is given via a machine remote from the body while brachytherapy or internal radiation is given by implanting a radioactive source within the involved tissues. Patients may or may not require both modalities of radiation. Radiotherapy, after initial planning, usually takes just 5 to 10 minutes per day, 5 days a week for about 6 weeks. This time period is flexible depending upon the modality of radiation used. Certain drugs can also block the over production of hormones by the pituitary. For ACTH producing tumors, one of the following options may be entertained:
		Surgery.
		Radiation.
		Surgery with radiation.
		Radiation with drugs for hormone over production.
	For prolactin producing tumors, one of the following options may be entertained:
		Surgery.
		Radiation.
		Surgery, radiation and drugs.
		Drugs alone to control hormone over production.
	For growth hormone producing tumors, one of the following options may be entertained:
		Surgery.
		Radiation.
		Drugs alone to control hormone over production.
	For non functioning tumors, one of the following options may be entertained:
		Surgery.
		Radiation.
		Surgery with radiation.

What are the side effects of treatment for Pituitary Tumors?

Surgery for pituitary tumor should be undertaken only in institutes which are experienced in this kind of surgery. The surgery can be very morbid in the wrong hands and it is one of the technically more difficult surgeries to perform. Often the result of surgery may also not be favorable if done by inexperienced hands.

Unfortunately treatment for cancer does cause damage to the healthy tissues.

Please ask the clinician about any possible side effects before any form of treatment commences.

The effects of radiation depend upon the dose of radiation, the size of the area radiated, and the number and size of each fraction.

The commonest side effect is extreme fatigue. Although bed rest is good, most radiotherapists advise the patient to be as mobile as possible.

Another common problem is that of radiation dermatitis in which the skin covering the radiated area becomes red, dry, itchy, and may show signs of scaling off. This will slowly settle down after radiation ceases, but there may be a permanent 'bronzing' of the skin. It is important to note here that this skin problem is associated only with teletherapy or external radiation therapy.

Radiation also may cause nausea and vomiting, diarrhea, urinary discomfort.

There may also be a fall in the white blood cells, which are needed by humans to fight infection.

Usually the radiotherapist can suggest the drugs and diet necessary to alleviate such problems.

What is the importance of follow up?

The importance of follow-up cannot be overemphasized. It is a fatal fallacy to assume on the patient's part that once the primary or the first phase of treatment is over, then he or she is cured. It must be stressed here that cancer has a notorious proclivity of coming back again and again. The only way to fight this is to pick up any problem when it is still early, so that it can be nipped in the bud. And the only way to do this is to follow up when the doctor calls you for the next visit. Each such visit will include a detailed history, a physical examination (including an internal i.e. a rectal or vaginal examination), a chest x-ray, an ultrasonography or a CT scan, a repeat MRI and various other blood studies as indicated.