makalah tumor otak

8/9/2019 Makalah tumor otak

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BRAIN TUMOURS: INCIDENCE,

SURVIVAL, AND AETIOLOGY

P A McKinney

The term !r"in t#m$#r%&& re'er% t$ " mi(e) *r$#+ $' ne$+"%m%

$ri*in"tin* 'r$m intr"cr"ni" ti%%#e% "n) the menin*e% -ith )e*ree% $' m"i*n"ncy

r"n*in* 'r$m !eni*n t$ "**re%%i.e/E"ch ty+e $' t#m$#r h"% it% $-n !i$$*y,

tre"tment, "n) +r$*n$%i% "n) e"ch i% i0ey t$ !e c"#%e) !y )i''erent ri%0 '"ct$r%/

E.en !eni*n&& t#m$#r% c"n !e eth" )#e t$ their %ite in the !r"in, their "!iity t$

in'itr"te $c"y, "n) their +r$+en%ity t$ tr"n%'$rm t$ m"i*n"ncy/ Thi% m"0e% the

c"%%i'ic"ti$n $' !r"in t#m$#r% " )i''ic#t %cience "n) cre"te% +r$!em% in

)e%cri!in* the e+i)emi$$*y $' the%e c$n)iti$n%/ P#!ic +erce+ti$n *ener"y '"i%

t$ )i%tin*#i%h !et-een )i''erent t#m$#r %#!ty+e% "n) "th$#*h tre"tment% "n)

+r$*n$%i% m"y ."ry, the '#ncti$n" ne#r$$*ic" c$n%e1#ence% "re 're1#enty

%imi"r/ Thi% "rtice -i *i.e "n $.er.ie- $' the !#r)en $' !r"in t#m$#r% in the

+$+#"ti$n, $$0in* "t the m"2$r %#!ty+e% -here +$%%i!e, in "))iti$n t$ *i.in* "

%#mm"ry $' c#rrent .ie-% $n +$%%i!e c"#%e%/

I/ INCIDENCE

The )e%cri+ti$n% in thi% +"+er '$c#% $n +rim"ry t#m$#r% $' the !r"in/ It

e(c#)e% )"t" $n %+in" c$r) t#m$#r%, met"%t"tic t#m$#r%, -h$%e $ri*in% "re

e(tern" t$ the centr" ner.$#% %y%tem, "n) +rim"ry !r"in ym+h$m"%, -hich "re

e%%enti"y h"em"t$$*ic" m"i*n"ncie%/

M"i*n"nt t#m$#r% $' the !r"in "re " r"re $cc#rrence "cc$#ntin* '$r

"++r$(im"tey 34 $' " c"ncer% in ")#t%/ A++r$(im"tey 5566 +e$+e "re ne-y)i"*n$%e) -ith " !r"in t#m$#r e"ch ye"r in the UK c$m+"re) t$ $.er 56 666

-$men -ith !re"%t c"ncer "n) "++r$(im"tey 37 666 men -ith +r$%t"te c"ncer/

8i*#re 9 %h$-% "))iti$n" c$m+"r"ti.e )"t" '$r )i''erent c"ncer%/ The $.er"

"nn#" inci)ence r"te $' " !r"in t#m$#r% i% +er 966 666 +$+#"ti$n/ UK )"t"

"re i%te) in t"!e 9/

The *re"te%t +r$+$rti$n $' ")#t t#m$#r% "re %#+r"tent$ri", "ri%in* in the

'r$nt", tem+$r" "n) +"riet" $!e%, "n) the m"2$rity ; "re *i$m"% -hich


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inc#)e "%tr$cyt$m"%, *i$!"%t$m"%, $i*$)en)r$!"%t$m"%, "n) #n%+eci'ie)

*i$m"%/

Three'$) )i''erence% in the inci)ence $' !r"in t#m$#r% h".e !een re+$rte)

!et-een c$#ntrie% -$r)-i)e "n) )i''erence% "re "%$ %een !et-een ethnic *r$#+%

-ithin the %"me c$#ntry/ De.e$+e) c$#ntrie% "++e"r t$ h".e the hi*he%t r"te% $'

!r"in t#m$#r% !#t thi% m"y !e " re%#t $' !etter re*i%tr"ti$n %y%tem% -hich inc#)e

!eni*n t#m$#r%/ ?$-e.er, the m"*nit#)e $' the ."ri"ti$n i% e%% c$m+"re) t$

$ther c"ncer%@'$r e("m+e, #+ t$ 96'$) )i''erence% "re %een '$r !re"%t c"ncer/

Ge$*r"+hic" ."ri"ti$n h"% t$ !e c"#ti$#%y inter+rete) "%, #ni0e $ther c"ncer%,

the criteri" "n) re*i%tr"ti$n $' !r"in t#m$#r% i% n$t "-"y% c$n%i%tent/

The inci)ence $' !r"in t#m$#r% ri%e% -ith "*e 'r$m "++r$(im"tey 6

ye"r% $) $n-"r)%, in c$mm$n -ith .irt#"y " $ther ")#t c"ncer%/ 8i*#re 3

i#%tr"te% the "*e inci)ence c#r.e %h$-in* " )r$+ in inci)ence in th$%e $.er 7

ye"r%/ It i% th$#*ht thi% m"y -e !e "rte'"ct#" "n) $cc#rrin* "% " c$n%e1#ence $'

t#m$#r% $' the !r"in !ein* e%% i0ey t$ !e in.e%ti*"te) "n) )etecte) in the

e)ery/ Sym+t$m% in $)er +e$+e m"y !e e(+"ine) !y $ther c$m$r!i)

c$n)iti$n% %#ch "% %tr$0e% $r +hy%ici"n% m"y !e re#ct"nt t$ #n)ert"0e th$r$#*h

in.e%ti*"ti$n%/

M"e% "re m$re i0ey t$ !e )i"*n$%e) -ith !r"in t#m$#r% th"n 'em"e%,

-ith " m"e:'em"e r"ti$ $' 9/7:9/ ?$-e.er, thi% )i%*#i%e% the '"ct th"t -$men "re

m$re i0ey t$ )e.e$+ menin*i$m"% th"n men/

De%+ite it% re"ti.e r"rity the !#r)en $' the%e t#m$#r% i% c$n%i)er"!e '$r

the in)i.i)#"%, their '"miie%, "n) the he"th c"re %y%tem/ P$$r %#r.i." '$r m"ny

t#m$#r ty+e% re%#t% in " )i%+r$+$rti$n"te n#m!er $' ye"r% $' i'e $%t c$m+"re) t$

$ther c"ncer%/


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II/ TIME TRENDS

C$rre%+$n)ence t$:

Dr P"trici" A McKinney, P"e)i"tric E+i)emi$$*y Gr$#+, Unit $' E+i)emi$$*y

"n) ?e"th Ser.ice% Re%e"rch, Uni.er%ity $' Lee)%, 3 ?y)e Terr"ce, Lee)% LS3

LN, UK +/"/mc0inneyee)%/"c/#0

There h".e !een re+$rt% $' incre"%in* inci)ence $' +rim"ry !r"in t#m$#r%

in recent )ec")e% -hich nee) t$ !e inter+rete) -ith c"#ti$n/ Tren)% $.er time c"n

$ny !e c$n%i)ere) ."i) -hen !"%e) #+$n )"t" c$ecte) "cc$r)in* t$ the %"me

)e'initi$n% "n) re+$rtin* +r"ctice/ Inc$n%i%tencie% "n) ch"n*e% $.er time m"y !e

the e(+"n"ti$n '$r the $!%er.e) ri%e% -hich h".e !een "ttri!#te) t$ ."ri$#%

'"ct$r%/ Im+r$.e) )i"*n$%tic im"*in*, '$$-in* intr$)#cti$n $' r")i$ i%$t$+e

im"*in*,

c$m+#te) t$m$*r"+hy, "n) m"*netic re%$n"nce im"*in* in the 96% "n)

9


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%+eci'ic t#m$#r ty+e%@'$r e("m+e, "%tr$cyt$m"%@m"y merey !e "

c$n%e1#ence $' 'e-er n$n%+eci'ic )i"*n$%e% !ein* re*i%tere)/ In N$r-"y "n) the

USA %+eci'ic %t#)ie% in.e%ti*"tin* -hether time tren)% c"n !e "cc$#nte) !y the%e

'"ct$r% %#**e%t th"t the re+$rte) incre"%e in !r"in t#m$#r% i% i0ey t$ !e "n

"rte'"ct $' ch"n*in* )i"*n$%tic "n) re+$rtin* +r"ctice/ The e.ein* $'' $'

inci)ence in the 96% in the USA %#++$rt% thi% "%%erti$n/ Ste")y ri%e% in the r"te%

$' !r"in t#m$#r% in chi)ren #n)er 95 ye"r% "n) the e)ery $.er 6 ye"r% "re m$%t

ce"ry )$c#mente)/ 8$r chi)ren thi% m"y !e e(+"ine) !y ch"n*e% in the

en.ir$nment, !#t the incre"%e $.er time in $)er +"tient% i% m$re i0ey "ttri!#te)

t$ ch"n*e% in the )ei.ery $' c"re "%%$ci"te) -ith " *re"ter i0eih$$) $' '#

e."#"ti$n "n) inter.enti$n/

III/ SURVIVAL

The en*th $' %#r.i." '$$-in* )i"*n$%i% $' " !r"in t#m$#r i% )e+en)ent

$n !$th the "*e $' the +"tient, hi%t$$*ic %#!ty+e "n) *r")e $' the t#m$#r, "n)

+re%entin* %ym+t$m%/ S#r.i." ch"nce% h".e im+r$.e) *r")#"y $.er the "%t 6

ye"r% !#t rem"in +$$r '$r " ")#t% )i"*n$%e) -ith " m"i*n"nt !r"in t#m$#r in

En*"n) "n) F"e% )#rin* 9


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6/15

rem"in #ne(+"ine)/ Le.e% $' %$ci" c"%% me"%#re) in )e+ri."ti$n c"te*$rie% "re

%een t$ in'#ence %#r.i.", -ith th$%e i.in* in m$re "''#ent "re"% *ener"y

h".in* im+r$.e) %#r.i." -ith the e''ect %een m$%t +r$minenty "t $ne ye"r

+$%t)i"*n$%i%/

Ge$*r"+hic" )i''erence% in %#r.i." e(i%t !et-een c$#ntrie%/ The 'i.e ye"r

%#r.i." $' +"tient% )i"*n$%e) -ith "ny ty+e $' !r"in t#m$#r in En*"n), F"e%,

"n) Sc$t"n) i% "++r$(im"tey 94 in men "n) 9=4 in -$men/ Acr$%% E#r$+e

e1#i."ent 'i*#re% "re 94 "n) 364 in men "n) -$men, re%+ecti.ey, "n)

*ener"y the UK 'i*#re% "re 964 !e$- the USA/ The )i%cre+"ncy i% +$tenti"y

e(+"ine) !y the '"ct th"t 'i*#re% 'r$m the USA inc#)e t#m$#r% c"%%i'ie)

"% !eni*n -hich -$#) n$t !e re*i%tere) in m"ny $' the UK c"ncer re*i%tr"ti$n

%cheme%/

The $.er" +$$r %#r.i." '$r thi% *r$#+ $' t#m$#r% m"%0% )i''erence% '$r

%#!ty+e%/ Menin*i$m"%, !$th !eni*n "n) m"i*n"nt, '$r e("m+e, h".e " m#ch

!etter +r$*n$%i% -here"% *i$!"%t$m" m#ti'$rme ;GBM> h"% the +$$re%t

%#r.i." in " "*e *r$#+%/

Other '"ct$r% "%%$ci"te) -ith %#r.i." ch"nce% inc#)e "*e, -ith y$#n*er

")#t% '"rin* !etter, !ein* 'em"e, -hich %i*hty im+r$.e% %#r.i.", "% -e "% the

$c"ti$n $' the t#m$#r "n) the e(tent $' t#m$#r re%ecti$n/ M$re recent %t#)ie%

h".e %h$-n th"t '#rther ch"r"cteri%"ti$n $' t#m$#r% !y m$ec#"r "n) *enetic

m"r0er% c"n +r$.i)e #%e'# +r$*n$%tic in)ic"t$r% "th$#*h there i% itte

in'$rm"ti$n in the iter"t#re "% m"r0er% "re n$t r$#tiney rec$r)e) '$r the m"2$rity

$' +"tient%/ ?$-e.er, -ith im+r$.e) "n) %y%tem"tic rec$r)in* $' the m$ec#"r

ch"r"cteri%tic% $' t#m$#r%, the re"ti$n t$ +r$*re%%i$n "n) +r$*n$%i% -i !e

c"ri'ie)/


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IV/ C?ILD?OOD BRAIN TUMOURS

Br"in t#m$#r% "re the %ec$n) m$%t c$mm$n c"ncer in chi)ren,

c$m+ri%in* 97 374 $' " +"e)i"tric m"i*n"ncie%, "n) they "re the m$%t c$mm$n

%$i) t#m$#r/ Di''erent

+r$+$rti$n% $' hi%t$$*ic" %#!ty+e% "re +re%ent in chi)ren c$m+"re) t$ ")#t%,

-ith *i$m"% ;"++r$(im"tey 564> "n) me)#$!"%t$m"% ;"++r$(im"tey 374>

m"iny "ri%in* in'r" tent$ri"y, -ith the rem"in)er, *erm ce t#m$#r% "n)

cr"ni$+h"ryn*i$m"%, $cc#rrin* in the mi)ine/ There i% " %m" +e"0 in inci)ence

in e"ry chi)h$$) "cc$#nte) '$r !y me)#$!"%t$m"%/ St#)ie% in the USA,

S-e)en, "n) the UK h".e re+$rte) -h"t "++e"r t$ !e tr#e ri%e% in inci)ence $.er

the "%t three )ec")e% -hich "re #ne(+"ine) !y ch"n*e% in )i"*n$%tic +r"ctice,

tre"tment, $r c"%%i'ic"ti$n/ The 1#e%ti$n $' -hether thi% i% " re" "n) c$ntin#in*


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e''ect c"n $ny !e "n%-ere) !y '#t#re %#r.ei"nce #%in* "cc#r"te "n) c$m+ete

+$+#"ti$n !"%e) re*i%ter%/

S#r.i." '$r chi)ren -ith !r"in t#m$#r% h"% im+r$.e) !y 9=4 %ince 99

in En*"n) "n) F"e%/ The +r$*n$%i% in chi)ren i% %#+eri$r t$ th"t $' ")#t% -ith

"n $.er" +r$!"!iity $' %#r.i.in* t$ 'i.e ye"r% $' 74 in En*"n) "n) F"e% '$r

th$%e )i"*n$%e) 9 %i*n"% -hich '" -ithin the micr$-".e re*i$n $'

the eectr$m"*netic %+ectr#m "re emitte) "n) recei.e) !y m$!ie +h$ne h"n)%et%/

The ener*y e.e% $' the%e -".e% "re in%#''icient t$ )"m"*e $r )i%r#+t ce#"r

DNA/ ?$-e.er, +#!ic c$ncern $.er the +$%%i!e )etriment" he"th e''ect% $'

#%in* m$!ie +h$ne% h".e re%#te) in " n#m!er $' in.e%ti*"ti$n% $' +$%%i!e in0%

-ith !r"in t#m$#r%/ Fhen "%%e%%in* the iter"t#re $n thi% t$+ic inter+ret"ti$n $' " %m" n#m!er

$' e"ry %t#)ie% 'r$m the USA "n) S-e)en m#%t !e c"#ti$#%/ They -ere

c$n)#cte) $n re"ti.ey %m" +$+#"ti$n%, re"tin* t$ " time -hen "n"$*#e

+h$ne% +re)$min"te), they h") re"ti.ey %h$rt '$$- #+ +eri$)%, $r they %#''ere)

'r$m meth$)$$*ic" %h$rtc$min*%/ T$ )"te 'i.e '#rther re+$rt% 'r$m %#!%t"nti"

-e c$n)#cte) %t#)ie% in the USA, 8in"n), "n) Denm"r0 #%in* )i''erent e+i)e


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mi$$*ic" meth$)% h".e $!%er.e) the %"me $#tc$me/ They '$#n) n$ incre"%e)

ri%0 $' !r"in c"ncer% $r "ny %#!ty+e $' !r"in t#m$#r "%%$ci"te) -ith e(+$%#re t$

m$!ie +h$ne% #%in* me"%#re% $' the ty+e $' +h$ne, )#r"ti$n "n) 're1#ency $'

#%e, "n) c#m#"ti.e h$#r% $' #%e/ Th#%, %$ '"r the c$n%en%#% $' e.i)ence i% th"t

m$!ie +h$ne #%e )$e% n$t incre"%e the ri%0 $' )e.e$+in* " !r"in t#m$#r/

?$-e.er, -ith the e(+$nenti" incre"%e in the $-ner%hi+ "n) )#r"ti$n $' #%e $'

the%e h"n) he) )e.ice% it -i !e im+$rt"nt t$ c$ntin#e in.e%ti*"ti$n% -ith re%+ect

t$ )i*it" +h$ne%, "$-in* '$r " "tent +eri$) $' %e.er" )ec")e% in the

)e.e$+ment $' " t#m$#r/

VII/ RISK 8ACTORS

C#rrent thin0in* %#**e%t% th"t !r"in t#m$#r% )e.e$+ "% " c$n%e1#ence $'

"cc#m#"te) *enetic "ter"ti$n% th"t +ermit ce% t$ e.")e n$rm" re*#"t$ry

mech"ni%m% "n) )e%tr#cti$n !y the imm#ne %y%tem/ The%e "ter"ti$n% m"y !e in

+"rt $r -h$y inherite) !#t "ny "*ent%@chemic", +hy%ic" $r !i$$*ic"@th"t

)"m"*e DNA "re +$%%i!e ne#r$c"rcin$*en%/ In.e%ti*"ti$n% $' the c"#%e% $' !r"in

t#m$#r% %h$#) i)e"y "))re%% the %im#t"ne$#% in'#ence $' !$th *enetic '"ct$r%

"n) en.ir$nment" e(+$%#re%/ T"!e 3 i%t% the en.ir$nment" '"ct$r% -hich h".e

recei.e) "ttenti$n "% +$%%i!e c"#%e% $' !r"in t#m$#r%/

VIII/ GENETICS

Genetic +re)i%+$%iti$n t$ )e.e$+in* !r"in t#m$#r% i% "%%$ci"te) -ith cert"in

inherite) %yn)r$me% %#ch "% t#!er$#% %cer$%i%, ne#r$'i!r$m"t$%i% ty+e% 9 "n) 3,

ne.$i) !"%" ce c"rcin$m" %yn)r$me, "n) %yn)r$me% in.$.in* ")en$m"t$#%

+$y+%/ The%e %yn)r$me% "cc$#nt '$r 934 $' " t#m$#r%/ The Li8r"#menic"ncer '"miy %yn)r$me i% "%$ "%%$ci"te) -ith " +re)i%+$%iti$n t$ !r"in t#m$#r%

"n) %+eci'ic"y -ith m#t"ti$n% in the TP7 *ene/ M#t"ti$n% in c$n%tit#ti$n"

;th"t i%, n$nt#m$#r ti%%#e> TP7 h".e !een in0e) t$ +"tient% -ith *i$m"%/

8#t#re -$r0 $n c"#%"ity %h$#) !e "!e t$ "cc$#nt '$r +$%%i!e inter"cti$n%

!et-een 0n$-n *enetic +re)i%+$%iti$n in the in.e%ti*"ti$n $' en.ir$nment"

ri%0 '"ct$r%/


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8"mii" "**re*"ti$n% $' !r"in t#m$#r% $cc#rrin* in )i''erent *ener"ti$n%

"n) %i!%hi+% $cc#r .ery r"rey "n) the +"ttern% $' inherit"nce "re inc$n%i%tent/ In

the%e %it#"ti$n% c$mm$n en.ir$nment" e(+$%#re% c"nn$t !e e(c#)e) "% "n

e(+"n"ti$n/ O.er", it "++e"r% th"t $ny " .ery %m" +r$+$rti$n $' !r"in t#m$#r%

c"n !e "ttri!#te) t$ the e''ect $' inherite) +re)i%+$%iti$n/

C$mm$n ."ri"ti$n% in the %tr#ct#re $' %+eci'ic *ene% "re 0n$-n t$ !e

"%%$ci"te) -ith !"%ic ce#"r met"!$ic +r$ce%%e% %#ch "% $(i)"ti$n,

)et$(i'ic"ti$n, DNA %t"!iity "n) re+"ir, "n) imm#ne '#ncti$nin*/ S#ch *enetic

+$ym$r+hi%m% m"y -e !e "%%$ci"te) -ith the )e.e$+ment $' !r"in t#m$#r% in

the +re%ence $r "!%ence $' en.ir$nment" c"rcin$*en%/ ?$-e.er, the imite)

'in)in*% "."i"!e %$ '"r h".e '"ie) t$ c$n%i%tenty i)enti'y "ny %+eci'ic

+$ym$r+hi%m%, !#t thi% rem"in% " +$tenti"y 'r#it'# ine $' re%e"rch "n) '#t#re

"r*e %"m+e %t#)ie% "re nee)e)/

IH/ EHTREMELY LOF 8REUENCY MAGNETIC 8IELDS

P$-er 're1#ency e(tremey $- 're1#ency m"*netic 'ie)% ;EL8M8> $'

76=6 ?J "re #%e) in )$me%tic "n) in)#%tri" eectricity %#++ie% +re%entin* "

.irt#"y #!i1#it$#% e(+$%#re t$ the +$+#"ti$n, "th$#*h e.e% $' e(+$%#re )$

."ry/ The +$%%i!iity $' ").er%e he"th e''ect% h"% *ener"te) c$n%i)er"!e +#!ic

c$ncern, )e%+ite %c"nt e+i)emi$$*ic" "n) !i$$*ic" %#++$rt in the re%e"rch

iter"t#re/ The !i$$*ic" !"%i% '$r EL8M8 !ein* in.$.e) in m"i*n"nt

tr"n%'$rm"ti$n i% n$t %tr$n* "% there i% n$ c$n%i%tent re%e"rch -hich %h$-%

thi% $- ener*y e(+$%#re h"% "ny )irect e''ect% $n )i%r#+tin* ce#"r DNA $r

met"!$ic +"th-"y%/

St#)ie% $' $cc#+"ti$n" e(+$%#re t$ hi*h e.e% $' EL8M8 "n) the ri%0 $'!r"in t#m$#r% h".e mi(e) 'in)in*%/ V"ri"ti$n in re%#t% c"n !e e(+"ine) !y

)i''erin* %t#)y meth$)$$*ie% "n) %"m+e %iJe, the "tter "''ectin* the +$-er t$

)etect incre"%e) ri%0/ One %#!%t"nti" )i''erence i% the meth$) #%e) t$ "%%e%% EL8

M8 e(+$%#re thi% ."rie% 'r$m the #%e $' +r$(ie% %#ch "% -irin* c$n'i*#r"ti$n

c$)e%, )i%t"nce 'r$m )i%tri!#ti$n e1#i+ment, "n) hi%t$ric $") )"t" t$ )irect


11/15

me"%#re% $' e(+$%#re/ The "c0 $' c$n%i%tency !et-een in)e+en)ent re%e"rch

+r$2ect% "n) the )i''ic#tie% -ith me"%#rin* the e("ct e(+$%#re e.e% $' the

in)i.i)#"% "t -$r0 m"0e% inter+ret"ti$n +r$!em"tic/

8$r m$ther% e(+$%e) "t -$r0 )#rin* their +re*n"ncy there )$e% n$t "++e"r

t$ !e "ny incre"%e) ri%0 $' their chi) %#!%e1#enty )e.e$+in* " !r"in t#m$#r/

O.erhe") +$-er c"!e% "n) -irin* c$n'i*#r"ti$n% in h$#%e% "''ect the

e.e% $' e(+$%#re t$ EL8M8 in " )$me%tic re%i)ence/ E"ry re+$rt% in the "te

9


12/15

e+i)emi$$*ic" -$r0 $n " %erie% $' chi)ren 'r$m the n$rth -e%t $' En*"n)

)i"*n$%e) -ith !r"in t#m$#r% h"% %h$-n *e$*r"+hic" )i%tri!#ti$n% -hich "re

%#**e%ti.e $' "n in'ecti$#% "eti$$*y '$r %$me $' the t#m$#r ty+e%/ C#%terin* in

time "n) %+"ce "n) %e"%$n"ity $' )i"*n$%i% in)ic"te in'ecti$n% m"y !e ri%0

'"ct$r%/

The in.$.ement $' in'ecti$n% "n) imm#ne re%+$n%e% in !r"in t#m$#r

"eti$$*y i% "n "re" $' re%e"rch th"t ce"ry -"rr"nt% '#rther "ttenti$n/ P$tenti"y

+r$tecti.e e''ect $' c$n%#min* "nti$(i)"nt%/ The %$#rce% $' "nti$(i)"nt% inc#)e

're%h 'r#it "n) .e*et"!e%, %#++ement%, "n) en)$*en$#% met"!$ic +"th-"y%/

Attri!#tin* the c"#%e $' !r"in t#m$#r% t$ the%e c$m+$#n)% $r $ther )iet"ry '"ct$r%

%#ch "% .it"min %#++ement% h"% recei.e) mi(e) %#++$rt in the +#!i%he)

iter"t#re/ Diet"ry "%%e%%ment i% 'r"#*ht -ith +r$!em% "n) it m"y !e th"t the

in*e%ti$n $' +$tenti"y t$(ic c$m+$#n)% i% $''%et !y the in*e%ti$n $' "nti$(i)"nt%

-hich +r$m$te DNA re+"ir/ Nitr"te e.e% in )rin0in* -"ter h".e "%$ !een

in.e%ti*"te) !#t n$ c$n%i%tent "%%$ci"ti$n% '$#n)/

The $- c"$rie %-eetener "%+"rt"me h"% !een c$mm$ny #%e) in "

n#m!er $' '$$) +r$)#ct% '$r $.er 97 ye"r%/ It h"% !een %#**e%te) t$ !e in.$.e) in

the "eti$$*y $' %$me !r"in t#m$#r% !"%e) +rinci+"y $n the re%#t% $' "!$r"t$ry

e(+eriment%/ The !i$$*ic" !"%i% '$r "ny in'#ence -hich "%+"rt"me c$#) h".e

$n the ri%0 $' )e.e$+in* " !r"in t#m$#r i% #nce"r/

T$!"cc$ %m$0e i% c"rcin$*enic !#t m"ny c$n%tit#ent% )$ n$t +"%% the

!$$)!r"in !"rrier/ Sm$0in* )$e% n$t "++e"r t$ !e %tr$n*y in0e) t$ !r"in

t#m$#r% either in ")#t% -h$ %m$0e them%e.e% $r .i" m"tern" %m$0in* in

+re*n"ncy/ A %imi"r "c0 $' "%%$ci"ti$n i% %een '$r "c$h$ c$n%#m+ti$n/

V"ri$#% $ther chemic"% h".e recei.e) "ttenti$n/ ?"ir )ye% "n) h"ir %+r"y%-ere im+ic"te) "% ri%0 '"ct$r% '$r !r"in t#m$#r% in %$me e"ry e+i)emi$$*ic"

%t#)ie% !#t the $!%er."ti$n% rem"in #nc$n'irme)/ 8#rther inc$n%i%tent re+$rt%

h".e in0e) chi)h$$) !r"in t#m$#r% t$ +e%tici)e e(+$%#re, tr"''ic +$#ti$n, "n)

+"rent" $cc#+"ti$n%/ The +$%%i!iity $' '"ther%& %+erm !ein* )"m"*e) "n) the

)e.e$+in* 'et#% !ein* "''ecte) !y +"rent" $cc#+"ti$n "n) the )e.e$+ment $'

chi)h$$) !r"in t#m$#r% h"% !een e(ten%i.ey %t#)ie), !#t 'e- c$nc#%i$n% h".e

!een )r"-n/ A recent "r*e %c"e c"%ec$ntr$ %t#)y $' chi)h$$) c"ncer% in the


13/15

UK '"ie) t$ %h$- "ny %i*ni'ic"nt "%%$ci"ti$n% !et-een !r"in t#m$#r% "n) the

$cc#+"ti$n% $' either m$ther% )#rin* +re*n"ncy $r '"ther% "r$#n) the time $'

c$nce+ti$n/

In the -$r0in* +$+#"ti$n m"ny 2$!% in ."ri$#% in)#%trie% in.$.e

e(+$%#re t$ c"rcin$*enic $r ne#r$t$(ic c$m+$#n)% inc#)in* $r*"nic %$.ent%,

+$ycycic "r$m"tic hy)r$c"r!$n%, #!ric"tin* $i%, "n) +hen$% "n) the 1#e%ti$n

h"% !een 're1#enty "%0e) "% t$ -hether %#ch e(+$%#re i% re"te) t$ !r"in t#m$#r%/

De%+ite n#mer$#% %t#)ie% n$ c$n%i%tent ri%0% h".e !een i%$"te) '$r "ny chemic"

$r *r$#+ $' -$r0er% "+"rt 'r$m th$%e in the +etr$chemic" "n) $i in)#%try/ In

the%e circ#m%t"nce% n$ %+eci'ic chemic" h"% !een i)enti'ie) "n) the +$%%i!iity $'

m#ti+e e(+$%#re% h"% t$ !e c$n%i)ere)/

HI/ ?EAD TRAUMA AND INURY

P"tient% -ith !r"in t#m$#r% ine.it"!y rec" $cc#rrence% $' tr"#m" $r in2#ry t$

the he") -ith *re"ter 're1#ency th"n the *ener" +$+#"ti$n, "n) %t#)ie% $'

+"tient%& re+$rt% "re there'$re %#!2ect t$ rec" !i"%&&/ S$me e+i)emi$$*ic"

in.e%ti*"ti$n% $' the re"ti$n !et-een he") tr"#m"in2#ry "n) the %#!%e1#ent

)e.e$+ment $' " t#m$#r h".e "ttem+te) t$ $.erc$me thi% !y e("minin* me)ic"

rec$r)%, !#t the%e m"iny '"i t$ )em$n%tr"te "ny re"ti$n/ The ine.it"!e +it'" $'

rec" !i"% "% "n e(+"n"ti$n $' " r"i%e) ri%0 ren)er% m$%t -$r0 in thi% "re"

.irt#"y im+$%%i!e t$ inter+ret/

HII/ C?EMICALS

Nnitr$%$ c$m+$#n)% "re '$#n) in the en.ir$nment !#t the m$%t c$mm$n %$#rce

$' h#m"n e(+$%#re i% thr$#*h '$$)%, -ith .e*et"!e% "n) c#re) me"t% !ein* m"2$r%$#rce%/ Cert"in "0y"tin* "*ent%, %#ch "% ethy "n) methy nitr$%#re", "re 0n$-n

tr"n%+"cent" c"rcin$*en%, +"rtic#"ry '$r !r"in t#m$#r% in r"t%/ Their "!iity t$

cr$%% the !$$)!r"in !"rrier "n) their m#t"*enic +$tenti" m"0e% them i)e"

c"n)i)"te% "% initi"t$r% in the c"rcin$*enic +r$ce%%/


14/15

HIII/ SUMMARY

Br"in t#m$#r% in ")#t% "re " r"re )i%e"%e 'r$m -hich %#r.i." i% *ener"y +$$r

c$m+"re) t$ m"ny $ther c"ncer%/ Re+$rt% $' ri%in* tren)% nee) t$ !e c"#ti$#%y

inter+rete) "% they m"y -e !e e(+"ine) !y ch"n*e% in )i"*n$%tic "n) cinic"

+r"ctice/ In chi)h$$) " )i''erent +r$'ie $' t#m$#r ty+e% i% +re%ent "n) %#r.i."

h"% im+r$.e) $.er recent ye"r% "n) i% hi*her th"n in ")#t%/ A+"rt 'r$m *enetic

+re)i%+$%iti$n, the m$%t -e e%t"!i%he) en.ir$nment" ri%0 '"ct$r '$r !r"in

t#m$#r% i% e(+$%#re t$ hi*h )$%e% $' i$ni%in* r")i"ti$n/ Re%e"rch int$ in'ecti$n%

"n) imm#ne '"ct$r% m"y +r$.e " 'r#it'# ".en#e $' in.e%ti*"ti$n/

The UK

C"ncer Re%e"rch UK ;---/c"ncerre%e"rchUK/$r* >

UK A%%$ci"ti$n $' C"ncer Re*i%trie% ;UKACR> ;---/UKACR/$r*/#0>

En*"n): N"ti$n" C"ncer Intei*ence Centre, O''ice '$r N"ti$n" St"ti%tic%

;---/%t"ti%tic%/*$./#0>

F"e%: Fe%h C"ncer Intei*ence "n) S#r.ei"nce Unit ;---/.ein)re

tr/-"e%/nh%/#0>

Sc$t"n): In'$rm"ti$n "n) St"ti%tic% Di.i%i$n, N?S in Sc$t"n)

;---/%h$-/%c$t/nh%/#0i%)>

N$rthern Ire"n): N$rthern Ire"n) C"ncer Re*i%try

;---/1#!/"c/#0nicrintr$/htm>

SOURCES O8 IN8ORMATION

Intern"ti$n"

The Intern"ti$n" A*ency '$r Re%e"rch $n C"ncer ;---/i"rc/'r>Centr" Br"in T#m$#r Re*i%try $' the Unite) St"te% ;CBTRUS>

;---/c!tr#%/$r*>


15/15

RE8ERENCES

9/ C$em"n MP, B"!! P, D"miec0i D, et "/ C"ncer %#r.i." tren)% in

En*"n) "n) F"e%, 9997: )e+ri."ti$n "n) N?S re*i$n/ St#)ie% in

me)ic" "n) +$+#"ti$n %#!2ect% n$/ =9/ L$n)$n: St"ti$nery O''ice, 9/

3/ D".i% 8G, McC"rthy B/ C#rrent e+i)emi$$*ic" tren)% "n) %#r.ei"nce

i%%#e% in !r"in t#m$#r%/ E(+ert Re. Antic"ncer Ther 36699:7569/

/ Litte / E+i)emi$$*y $' chi)h$$) c"ncer/ IARC Scienti'ic P#!ic"ti$n

n$/95/ Ly$n, 8r"nce: Intern"ti$n" A*ency '$r Re%e"rch $n C"ncer, 9/

5/ McKinney PA, 8e"r NT, St$c0t$n D, $n !eh"' $' the UK Chi)h$$)

C"ncer St#)y In.e%ti*"t$r%/ P"rent" $cc#+"ti$n "t +eric$nce+ti$n:

'in)in*% 'r$m the Unite) Kin*)$m chi)h$$) c"ncer %t#)y/ Occ#+ En.ir$n

Me) 366=6:69/7/ Fren%ch M, Minn Y, Che- T, et "/ E+i)emi$$*y $' +rim"ry !r"in

t#m$#r%: c#rrent c$nce+t% "n) re.ie- $' the iter"t#re/ Ne#r$$nc$$*y

36635:3

makalah tumor otak

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