Schwannoma Treatment in Delhi, India

Schwannoma is a type of tumour that occurs in the nerve fibres. It is a rare form of tumour that grows in the cells known as Schwann cells, which cover, protect, and support the nerve cells. It is often a benign tumour, which rarely progresses into cancer.

Associated Anatomy of Schwannoma

Nerve cells

Alternate Name of Schwannoma 

Neurilemomas, neuromas, neurolemoms

Schwannoma Causes

• In most cases, the exact cause of schwannoma is not known.
• These tumours most often occur spontaneously.
• Genetic disorders such as neurofibromatosis 2 (NF2), schwannomatosis, and Carney complex can cause schwannomas.

Schwannoma Symptoms

The symptoms of schwannoma usually occur when the tumour is grown to a size that causes compression and puts pressure on the nerves surrounding it. Signs or symptoms will also depend on the location of the tumour. Sometimes patients do not have any symptoms. Some of the common symptoms are

• Numbness
• A noticeable lump
• Weakness of muscles
• Neck or back pain
• Prickling pain or feeling
• Burning and aching 
• Tumours around the ear can cause hearing, balancing, or tinnitus problems.
• Tumours around the facial nerve affect swallowing, taste, eye movements or facial paralysis, etc.

Diagnosis Schwannoma

Differential diagnosis of schwannoma include

• Fibroma (tumours of connective tissue)
• Neurosarcoma (a form of cancer of the connective tissue around the nerves)
• Neurofibroma (type of a nerve cell tumour that forms soft bumps on the skin)
• Lipoma (fatty tumour below the skin)
• Ganglion cyst (lumps around the wrist)
• Giant cell tumour of tendon sheath (benign lesion of soft tissues).

As the schwannomas grow slowly, these tumours are difficult to diagnose. And, also because the symptoms are often mild, non-specific, and similar to other conditions, they are often misdiagnosed. Doctors often use tests such as X Rays, MRIs, CT scans, ultrasounds, depending on the location, hearing or balance tests, etc. However, a biopsy is used to confirm the diagnosis.

Schwannoma Treatment

• Most commonly, schwannoma tumours are removed with surgery without damaging the nerve. The symptoms and the recovery time after surgery depend on the schwannoma tumour's location and size.
• If the size of the tumour is small, the doctors may decide to just monitor for any signs of changes in the tumour with regular scans.
• If the schwannoma tumour turns cancerous or becomes dangerous to perform surgery, then stereotactic radiosurgery is used to treat such tumours.
• In some situations, chemotherapy and immunotherapy are also used for the treatment of schwannoma.

Risk Associated with Schwannoma

• There are not any known risk factors for schwannoma.
• The tumours can form at any age or in any gender. 
• In some cases, women are slightly more prone to develop schwannoma due to neurofibromatosis 2
• If a parent has schwannoma, the chances that this disorder passes to their children are slightly higher. However, genetic risk factors are still being studied.

Schwannoma Prevention

Primary Prevention

• There is not much information available on the primary prevention of schwannoma. 
• Since they are hard to diagnose, it is important to always be aware of the symptoms.
• Early diagnosis is the key to preventing any serious consequences of schwannoma.
• If the patient has any family history of schwannoma, getting regular checkups and consulting a doctor in case of having any key symptoms will help.

Secondary Prevention

• There is no information available on secondary prevention of schwannomas.
• Depending on the size and the location, if the entire tumour is removed surgically, the recurrence of schwannoma does not happen.

Complication of Schwannoma

The severity of the complication of schwannoma depends on the location and size of the tumour. If the tumour is left untreated for a long time, it can result in permanent nerve damage. Surgery to remove the tumour (especially if the tumour is inside the head) can also cause unexpected complications such as headache, bleeding inside the head, hematomas, and in rare cases, death.

Epidemiology of schwannoma

• Schwannoma is the most common of all the nerve sheath related tumours, comprising around 89% of all cases.
• Schwannoma can occur at any age, most commonly seen in ages 50 to 60.
• These tumours do not show any preference for a certain gender.
• They can occur in any area in the body but are generally seen in the upper limbs most commonly, followed by the head, trunk, etc.

Expected Prognosis of Schwannoma

The signs, symptoms, and expected prognosis of schwannoma depend on the size and the location of the tumour. It also depends on whether the tumour is benign or spread to other areas of the body. As the tumour grows, the patients may experience symptoms gradually with increasing severity. Once the entire tumour is resected by surgery, it is unlikely to grow back or spread to other areas.

Natural Progression of Schwannoma

When cells of the tumour grow, it can result in damage to the nerves. However, the rate of growth of the tumour may vary. It sometimes can take years to develop, while others may progress and quickly cause symptoms and nerve damage.

Pathophysiology of Schwannoma

A few studies have shown that loss of function of a certain protein known as merlin, caused by genetic changes, results in the growth of tumours. The protein merlin has many functions within the nucleus and the cell membrane. Studies are being conducted to understand more deeply the mechanism by which the loss of the function of merlin is involved in schwannoma.