Summary about Disease
Schwannomas are benign (non-cancerous) tumors that develop from Schwann cells, which are responsible for producing the myelin sheath that insulates nerve fibers. They most commonly occur on cranial nerves (especially the vestibulocochlear nerve, leading to acoustic neuromas) and peripheral nerves. While typically slow-growing, they can cause problems by compressing nerves or surrounding tissues.
Symptoms
Symptoms vary depending on the tumor's location and size. Common symptoms include:
Hearing loss: (Especially with acoustic neuromas)
Tinnitus: (Ringing in the ears)
Balance problems/Vertigo:
Numbness or weakness: in the face, arms, or legs, depending on the nerve affected.
Pain: can occur at the tumor site or along the affected nerve's path.
Headaches:
Swallowing difficulties: (Rare)
Hoarseness: (Rare)
Visible or palpable lump: If the tumor is near the skin surface.
Causes
The exact cause of most schwannomas is unknown. However, some cases are linked to:
Genetic factors: Neurofibromatosis type 2 (NF2) is a genetic disorder that significantly increases the risk of developing schwannomas, often multiple and bilateral acoustic neuromas.
Schwannomatosis: Another genetic disorder that predisposes individuals to developing multiple schwannomas, but typically not on the vestibulocochlear nerve.
Sporadic mutations: Most schwannomas occur sporadically, meaning they arise from a new, random mutation in a Schwann cell.
Medicine Used
There is no specific medicine to directly cure or shrink schwannomas. Medical management focuses on symptom control and may include:
Pain relievers: Over-the-counter or prescription pain medications to manage pain.
Steroids: To reduce swelling around the tumor and alleviate pressure on nerves.
Anti-nausea medication: if experiencing vertigo or balance problems.
Targeted Therapy: Some recent research is looking into therapies that target genetic pathways involved in tumor growth, but these are not yet standard treatments. Note: Treatment primarily involves surgery and/or radiation therapy (see "How is it diagnosed?" section for treatment plans).
Is Communicable
Schwannomas are not communicable. They are not caused by an infection and cannot be spread from person to person.
Precautions
There are no specific precautions to prevent the development of schwannomas, especially in sporadic cases. However, for individuals with NF2 or schwannomatosis:
Genetic counseling: is important for family planning.
Regular monitoring: and screening for tumor development are crucial for early detection and management.
How long does an outbreak last?
Schwannomas are not caused by an infection, and hence the term "outbreak" is not applicable. Schwannomas are a tumor. The symptoms related to a schwannoma can last indefinitely if the tumor is not treated, and can even develop or worsen over time.
How is it diagnosed?
Diagnosis typically involves:
Neurological examination: To assess nerve function.
Imaging studies:
MRI (Magnetic Resonance Imaging): The preferred imaging method to visualize the tumor, its size, and its location. Often with contrast dye.
CT scan (Computed Tomography): Can be used, but MRI is generally superior for soft tissue detail.
Audiometry: (For acoustic neuromas) To assess hearing function.
Biopsy: In rare cases, a biopsy may be performed to confirm the diagnosis, especially if the tumor is atypical.
Genetic testing: If NF2 or schwannomatosis is suspected. Treatment Options: Once diagnosed, the treatment plan is determined by the tumors location, size and symptoms.
Observation (Watchful Waiting): For small, slow-growing tumors that are not causing significant symptoms. Regular monitoring with imaging is necessary.
Surgery: To remove the tumor. The goal is to completely remove the tumor while preserving nerve function. This can be challenging, especially for tumors located near critical structures.
Radiation Therapy:
Stereotactic radiosurgery (e.g., Gamma Knife, CyberKnife): Delivers a high dose of radiation to the tumor in a single session.
Fractionated radiotherapy: Delivers radiation in smaller doses over several weeks. Used for larger tumors or those close to critical structures.
Timeline of Symptoms
The timeline of symptom development is highly variable.
Slow-growing tumors: may cause symptoms gradually over months or years. The initial symptoms may be subtle and easily overlooked.
Rapidly growing tumors: can cause symptoms to appear more quickly, over weeks or months.
Some tumors: may remain asymptomatic for a long time and are only discovered incidentally during imaging for another reason.
Important Considerations
Early diagnosis is crucial: for optimal management and preservation of nerve function.
Treatment decisions: should be made in consultation with a multidisciplinary team, including neurologists, neurosurgeons, otolaryngologists (ENT doctors), and radiation oncologists.
Hearing preservation: is a major concern for acoustic neuromas.
Facial nerve function: is a concern for tumors near the facial nerve.
Potential complications of surgery: include nerve damage, bleeding, infection, and cerebrospinal fluid leak.
Long-term monitoring: is essential after treatment to detect any recurrence or new tumor growth.
Quality of Life: Living with a schwannoma and its treatments can impact quality of life. Support groups and counseling can be beneficial.