Can tumors like this develop in your nerves? Let's learn about 'Schwannoma'!

Have you ever heard the word 'Schwannoma'? This may be a new word for you. It is actually a type of tumor that forms in our nervous system. Don't worry, it is not always dangerous. Let's talk about it simply, in a way that you can understand.

What is a 'Schwannoma'?

Simply put, this 'Schwannoma' is a tumor that develops from 'Schwann cells' in our body. Now you're probably wondering what these 'Schwann cells' are, right? These are the cells of our 'peripheral nervous system' , that is, a type of cell that forms a sheath around the nerve fibers that extend from the brain and spinal cord. It's like the plastic covering around an electric wire. These cells protect our nerves and help nerve messages travel quickly. So these 'Schwann cells' are the ones that develop these tumors called 'Schwannomas'.

Most of the time, about 90% of the time, these 'Schwannomas' are benign . That means they don't spread throughout the body, they stay in one place. However, very rarely, they can become malignant . If that happens, you need to be a little more careful. These tumors usually grow very slowly .

These tumors can develop anywhere in the body, anywhere there are nerves. For example, they are most common in the nerves that run from our brain to our ears. This is also called a 'vestibular schwannoma' or 'acoustic neuroma' . Malignant schwannomas most commonly affect the 'sciatic nerve' in the leg, the 'brachial plexus' in the arm, and the 'sacral plexus' in the lower back.

Schwannomas are sometimes called neurilemmomas or neuromas. If they are cancerous, they may be called soft tissue sarcomas .

The best thing is, 90% of the time, this 'Schwannoma' is only present as a single tumor .

What is 'Vestibular Schwannoma'?

We've talked a little about vestibular schwannoma before. This is a type of schwannoma that starts in the nerves inside the ear that are responsible for our hearing and balance. This is also usually not cancerous, and it grows slowly.

However, as this tumor grows, it starts to press on the nerves related to hearing and balance. That's when:

• Hearing in the affected ear gradually begins to decrease .
• Tinnitus is a ringing (ringing...like sound) in the ears.
• Sometimes it feels like dizziness .

Is a 'schwannoma' a brain tumor?

Now you might be wondering if this 'schwannoma' is always a brain tumor. Actually, it's not. It can develop inside the brain or in the head, but it can also develop in a nerve anywhere else in the body. Because, as we said, these are formed from 'Schwann cells', and those cells are in our 'peripheral nervous system', that is, in the nerves that run from the brain to the rest of the body.

However, the most common type we talked about, called 'Vestibular Schwannoma', is considered a brain tumor .

Who gets Schwannoma?

These 'Schwannomas' tend to develop most often in people between the ages of 50 and 60. They are very rare in young children.

Schwannomas often develop randomly in healthy people. However, in some cases, schwannomas can also develop due to genetic conditions such as neurofibromatosis type 2 (NF2) , schwannomatosis , or Carney complex . People with these genetic conditions are more likely to have more than one schwannoma.

How common is Schwannoma?

Schwannoma is a very rare tumor . Just imagine, even in a country like America, less than two hundred thousand people are affected by this disease every year. Only 60% of non-cancerous (benign) Schwannomas are the 'vestibular Schwannoma' we mentioned earlier.

What are the symptoms of a Schwannoma?

Because these Schwannomas grow very slowly , they may not show any symptoms for years. Also, because these tumors can develop in different parts of the body, the symptoms can vary greatly from person to person . Some people may have several symptoms, and they may be very mild, while others may be severe.

Here are some common symptoms:

• A visible lump or tumor . This may feel a little painful when touched or pressed.
• Feeling numb .
• Muscle weakness .
• It feels like ants crawling or pins and needles (doctors also call this 'paresthesia').
• A sharp pain that feels like a burning, stinging, or stabbing pain .

Important: These symptoms can also be caused by other conditions, so if you have something like this, it's best to see a doctor for advice.

How symptoms vary depending on the location of the tumor

• As mentioned earlier, people with vestibular schwannoma may experience hearing and balance problems , and may also experience ringing in the ears (tinnitus).
• If these tumors form on your facial nerve , it can affect your ability to swallow, move your eyes, and taste . You may even lose the ability to use one side of your face (facial paralysis) .
• If a schwannoma develops on the sciatic nerve in the leg, it can cause back pain and pain that radiates down the leg, similar to a herniated disc .

What causes Schwannoma?

In fact, most of the time, the exact cause of Schwannoma is unknown . Only 90% of cases occur sporadically.

However, as mentioned earlier, Schwannomas can also develop due to genetic conditions such as Carney complex, Neurofibromatosis type 2 (NF2), and Schwannomatosis. Genetic studies have shown that the NF2 gene on our chromosome 22 is the main factor responsible for the development of Schwannomas.

How is Schwannoma diagnosed?

Because these tumors grow slowly, they can be present for years before you have any symptoms. So it can take a while to get a diagnosis . If you have symptoms, your doctor will likely order some tests. Sometimes, a tumor is found incidentally during a scan done for another reason.

Imaging tests that can help detect a schwannoma are:

• MRI (Magnetic Resonance Imaging) scan : This is a painless test. It uses a large magnet, radio waves, and a computer to make very clear pictures of organs and structures inside the body. This is the best test to find and diagnose Schwannoma.
• CT (Computed Tomography) scan : This uses X-rays and a computer to take pictures of structures inside the body.
• Ultrasound scan : This uses high-frequency sound waves to take live pictures or videos of organs or soft tissues inside the body. Doctors use this to find schwannomas under the skin.

Your doctor may also do a biopsy to make sure it's really a schwannoma or cancerous. This involves taking a small sample of the tumor using a needle. A pathologist , a doctor who specializes in examining tissue samples, will look at the cells in the sample under a microscope and do further tests to determine exactly what type of tumor it is.

How are Schwannomas treated?

The treatment for a schwannoma depends on factors such as where the tumor is located, how quickly it is growing, and the symptoms you are experiencing .

There are several treatment options:

• Observation/watch and wait : If the tumor is not cancerous (benign), is growing very slowly, and you have no symptoms or very little, your doctor may recommend close observation instead of treatment. This means that they will scan you frequently to see if the tumor is getting bigger or if new symptoms appear. However, if it gets bigger or if you have symptoms later, they may recommend treatment.
• Surgery : If the tumor is growing too quickly, if it is bothering you with symptoms, or if it is causing other problems, your doctor may recommend surgery to remove it. Usually, the entire tumor is removed, but sometimes, depending on the location of the tumor, the surgeon may be able to remove only part of the tumor. Schwannomas form in the sheath around the nerve, so surgery can often be done without damaging the nerve . However, there is a higher risk of hearing loss after surgery for vestibular schwannomas.
• Radiation therapy : This uses special techniques, such as stereotactic radiosurgery (SRS) , to destroy the tumor by sending very precisely focused beams of radiation. If the tumor is near important blood vessels or nerves , your doctor may recommend this type of radiation therapy to avoid complications that can occur with surgery.

In addition to this , immunotherapy and chemotherapy drugs are also used for malignant schwannoma.

Can Schwannoma be prevented?

Unfortunately, there is currently no way to prevent these 'schwannomas'. Most of the time, they develop randomly, with no known cause. About 10% of cases are linked to certain genetic conditions, making people more likely to develop these tumors.

If someone in your family has been diagnosed with neurofibromatosis type 2 (NF2), schwannomatosis, or Carney complex, talk to your doctor . He or she may recommend genetic counseling to see if you also have the condition.

What is the outlook for Schwannoma disease?

The prognosis of Schwannoma, that is, how the disease will affect you in the long term, depends on several factors:

• Where the tumor is located on the body.
• How big the tumor is.
• If surgery was performed, how much of the tumor was removed .
• Whether the tumor is cancerous (malignant) or benign (benign) .

Generally, the outlook for a schwannoma is good . In most cases, if the tumor is completely removed, it will not grow back .

Most of the complications that can occur due to this 'Schwannoma' occur after the surgery to remove the tumor . The following are especially likely to cause complications after surgery:

• If the tumor is very large .
• If the tumor is deep in the body.
• If the tumor started in the ulnar nerve, one of the three main nerves in your hand.

When should you see a doctor about Schwannoma?

If you have been diagnosed with a schwannoma, it is important to see your doctor immediately for advice on how to manage your schwannoma , whether you develop new symptoms or if your existing symptoms worsen .

If your doctor has recommended that you observe the tumor without treatment, you should see him or her at least once a year for checkups . He or she can then perform imaging tests (such as MRI) to monitor the growth and condition of the tumor.

It's normal to feel scared when you find out you have a tumor. But the good news is that a schwannoma is a type of tumor that is usually not cancerous and grows slowly . Your medical team will help you decide on the best treatment plan for you. It could be just observation of the tumor, surgical removal, or something else. Don't be afraid to ask questions, no matter what . Your doctor is always here to help you.

Take-Home Message

Okay, so now you have a good idea about what we've been talking about, Schwannoma. Here are some important things to remember:

• A schwannoma is a tumor that develops from Schwann cells that surround nerves. Most of the time, these are not cancerous .
• These grow very slowly , so it can sometimes take years to show symptoms.
• Symptoms vary greatly depending on where the tumor is located in the body . For example, there may be hearing loss, ringing in the ears, numbness, pain, and muscle weakness.
• The exact cause of these conditions is often unknown , but they may be linked to certain genetic conditions .
• MRI scan is the main and best way to detect these.
• Treatment may include observation of the tumor, surgical removal, or radiation therapy . Treatment depends on the type and location of the tumor.
• Don't worry , Schwannoma is often a well-managed, curable condition. If you have any concerns or questions, be sure to talk to your doctor.

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