TRAVEL ADVISORY AND THE TOURISM INDUSTRY

A travel advisory is an official warning issued by government agencies, such as the Ministry of External Affairs, Government of India or the U.S. Department of State, informing their country’s travelers about safety risks and recommended precautions for specific destinations.

It aims to inform travelers about safety and security conditions in foreign destinations. For more localized travel advisories, one can refer to resources like the DHS Travel Advisory Map, which provides current travel status for specific counties. 

 

Purpose of Travel Advisories

Travel advisories are designed to help travelers make informed decisions about their travel plans. They provide essential information regarding potential risks, including:

• Crime and Terrorism: Advisories may highlight areas with high crime rates or threats of   terrorism.
• Natural Disasters: Information about regions prone to natural disasters, such as hurricanes or earthquakes, is included.
• Health Risks: Advisories may warn about disease outbreaks or health- related issues in certain areas.
• Civil Unrest: Travelers are informed about political instability or protests that could affect their  safety.

 

Levels of Travel Advisories

The travel advisories are categorized into four levels, depending upon the degree of risk associated with traveling to a particular country or region:

Level 1 - Exercise Normal Precautions: This is the lowest level of risk, advising travelers to   remain aware of their surroundings

Level 2 - Exercise Increased Caution: Travelers should be more vigilant due to heightened risks.

Level 3 - Reconsider Travel: There are significant risks, and travelers are advised to think very carefully about their plans.

Level 4 –  Do Not Travel: This indicates a high risk of life to the traveler  and they are strongly discouraged from going to the area

 

In the past few years, Government of India has issued travel advisories for Indians with respect to Venezuela, Iran, Nepal, Syria, Libya, Bangladesh, Israel, Cambordia (for employment}, Myanmar, Niger, Iraq, Yemen, Canada, and Pakistan.

Not all parts of a country are freely accessible for foreigners. Indians and Pakistanis are issued city specific visas, valid for only those mentioned cities and are not allowed to enter the cantonment areas of each other’s countries. Overseas guests in India are advised by their own government to avoid certain areas like Jammu & Kashmir, Indo-Pakistan land border, Manipur, Maoist hinterland in Central India and Arunachal Pradesh. At times Nagaland, and Tripura too are on their prohibition list.

Countries of the world often issue ‘country summary’ for various countries which their citizens would like to visit. Such advisories are often not very kind to these countries, but these countries do not like to risk the life of their citizens. While there are advisories for all countries, but the Level designated matters, because that decides the level of confidence travellers have about their safety. Countries like Australia, New Zealand, Switzwrland, France, Italy enjoy very high tourist confidence and so are filled with tourists throughout the year. India unfortunately is designated Level 2 by the U.S State Department. No wonder despie having such rich history and heritage, such varied geography and climate and such vibrant culture and customs, we fail to attract tourists less than Singapore.

The travel advisory country summary for India, issued by the U.S. government is particularly harsh. It says:

• Violent crime and terrorism occur in India.
• Rape is one of the fastest growing crimes in India.
• Violent crimes, including sexual assault, happen at tourist sites and other locations.
• Terrorists may attack with little or no warning. They target

o   tourist locations

o   transportation hubs

o   markets/shopping malls

o   government facilities

·   The U.S. government has limited ability to provide emergency services to U.S. citizens in rural areas. These areas stretch from eastern Maharashtra and northern Telangana through western West Bengal. Due to the risks, U.S. government employees working in India must obtain special authorization to travel to these areas.

·         If you decide to travel to India:

o   Do not bring a satellite phone or GPS device. Possessing a satellite phone or GPS device is illegal in India and may result in a penalty of $200,000 or jail time of up to three years.

o   Do not travel alone, especially if you are a woman. Read travel tips at Women Travelers .

o   Review your personal security plans and stay alert to your surroundings.

o   Enroll in the Smart Traveler Enrollment Program  (STEP ) to get alerts and make it easier for us to find you in an emergency.

o   Review the India Country Security Report  from the Overseas Security Advisory Council (OSAC)

o   Prepare a contingency plan for emergency situations. Review the Traveler’s Checklist .

o   Visit the CDC page for the latest Travel Health Information  related to your travel and return to the United States.

The Australian Scenario

Most Australian travellers are aware of their government’s Smart Traveller advice that sorts nations into the same four categories. Australia, in turn, cops a whole variety of advisory cautions. A positive common thread is that, as France puts it, “Australia is not a country with a significant security risk.” Still, every government says that terrorism is a real concern and that their citizens should be alert to petty crime, vehicle break-ins and drink spiking, all described as common. The US warns its citizens about Australia’s “narrow” roads that have just two lanes. Some additions are unexpected, such as Canada’s warning that “tour operators may not meet Canadian safety standards” or the United Kingdom’s that “some drinks served in bars in Australia can be stronger than those in the UK”. France advises against hitchhiking and tells visitors not to think of distances in European terms. Everyone warns, too, about the dangers of swimming, outback travel, mosquito-borne diseases such as dengue fever, and our fierce and poisonous wildlife. “The continent and its waters host animals that merit awe and respect in equal doses,” says the United States. The wildlife is “fascinating yet dangerous”, adds New Zealand. Bushfires, floods and extreme weather get extensive coverage. “Sudden storms and strong winds can make driving difficult,” adds the UK. Ireland and France are wary of sunburn.

You can detect national preoccupations and strengths. The UK, ironically, has a long section about our horrendous weather. The US is dismayed at highways only two lanes wide and “roads and streets … frequently narrower and less graded than US highways”. France complains about railways, which it describes as “little developed … and neither fast nor good value”.

Some governments give polite advice on social norms. China suggests visitors split restaurant bills, maintain a proper distance while queueing, bring beer to barbecues and avoid arguing. “Regardless of wealth or status, locals treat everyone equally and typically address people by their names, using ‘mate’ rather than honorifics,” China says. “They are generally open and direct, and enjoy a humorous and self-deprecating tone. ‘No worries’ is a common expression.”

Japan too, is struck by our “egalitarianism, known as mateship ... It is important to note that the Australian people have a strong sense of classlessness and social equality”. Japan is, however, agitated about theft, with a lengthy section of its travel advisory telling travellers to lock and chain their hotel doors and never leave bags unattended on beaches, golf courses and buses. “Avoid parking on the street whenever possible, even in places with parking meters” and use secure parking instead. “Australia is often thought of as a relatively safe country but, compared to Japan, there is a lot of general crime,” it sighs.

China in contrast devotes its longest travel advisory section to financial and internet scams including “romantic dating scams” that lure the lonely into handing over personal information or payment. The Chinese are also concerned about domestic violence, murder, robbery, sexual assault, illegal weapons, vehicle theft and “bar fights”.

The US concurs with China on most points, including the potential for “bar brawls” and the prevalence of “internet romance and financial scams”.

Ireland on the other hand, although it finds the risk of terrorism “probable”, calls crime levels “relatively low” except in certain (undefined) “party areas” of Brisbane, Melbourne, Sydney and Perth. Ireland finds its own citizens part of the problem: “A significant number of Irish nationals … come before the Australian courts each year,” it laments. It cites road accidents as the leading cause of death and injury for Irish visitors in Australia. 

Germany warns of potential assaults in Alice Springs, the Gold Coast, Cairns and Sydney’s Kings Cross but is otherwise pleasant, issuing only genteel warnings about snakes, credit-card fraud, “unusual emails” and theft from backpacker accommodation. 

Many countries have little concern. India offers no advice, saving its ire for places such as Iraq, Myanmar and Haiti, plus of late, Canada, because of Sikh separatists demanding Khalistan. 

And while you’d think super-safe Singapore might have Japanese anxiety levels about crime, its travel advice is short and laid back, with tut-tutting saved mainly for vehicle break-ins in Western Australia.

 

The Cricket playing countries have a lot of fan travel in between them despite these travel advisories, but reputation matters and Pakistan suffers maximally because of ongoing home grown terrorism and unstable democracy. South Africa too suffers because of crime, mugging, kidnapping and terrorism. Visitors are advised not to go out for a strol or use public transport for the fear of getting robbed.

Israeli and U.S. citizens are advised to travel with extreme caution in Muslim countries. Canada warns its LGBTQ travellers to be cautious while visiting certain cities in the U.S. The war zones in the Gulf and Europe are a tinder box, avoided by all travellers.

For tourism to prosper the safety of the tourists is paramount, and travel advisories are all about keeping the tourists safe. A country has to be friendly, safe, and welcoming for its tourism industry to boom. Countries inflicted by social unrest and terrorism are losing out big time.

SOME MORE ENGLISH IDIOMS AND THEIR STORIES OF ORIGINS

Idioms and Phrases are an integral part of the English language and are commonly used to make sentences fascinating. Idioms are often used in stories, poems and even in spoken words. The origins of these idioms are not always known, but they are said to originate from stories and creative writing and are modified over time. Phrases are unlike idioms, they are actually direct and to the point. They do not have figurative meanings; the expression means what the words indicate.

I have in 5 previous blogs discussed about similar English idioms and how they originated. You can re-visit them by clicking on these hyperlinks:

https://surajitbrainwaves.blogspot.com/2022/07/the-story-behind-english-idioms.html

https://surajitbrainwaves.blogspot.com/2021/05/the-origin-of-common-english-idioms.html

https://surajitbrainwaves.blogspot.com/2021/06/the-origin-of-common-english-idioms-2.html

https://surajitbrainwaves.blogspot.com/2023/05/the-history-behind-some-english-idioms.html

https://surajitbrainwaves.blogspot.com/2024/06/stories-behind-few-english-idioms.html

These are a fresh set of idioms.

"A baker's dozen" 

What does it mean? Thirteen items.

Back in 13th-century Britain, there was a law called the As size of Bread and Ale. It stated that if bakers were caught selling low-quality bread or undersized portions, they could have their hands chopped off. That's why a group or set of 13 is referred to as a baker's dozen - it was a sure-fire way of them keeping their hands! 

"Bite the bullet"

What does it mean? Accepting something difficult or unpleasant.

Where does it come from? Before, during the war, there was no time to administer anesthesia before emergency surgery. Instead, the surgeon made patients bite down on a bullet in an attempt to distract them from the pain. 

"Blood is thicker than Water"

What does it mean? Family comes over and above everything else.

In ancient Middle Eastern culture, blood rituals were performed between men to symbolize a bond that was far greater than those of family. It was believed that blood brother warriors who symbolically shared the blood they shed in battle together were said to have a stronger bond than biological brothers.   

"Break the Ice"

What does it mean? To initiate a friendship or to start a project.

Prior to trains or cars, port cities that thrived on trade suffered during the winter because frozen rivers prevent commercial ships from entering the city. To solve this issues, small ships known as 'icebreakers' would then rescue the icebound ships by breaking the ice and creating a path for them to follow. Today it has quite a different meaning - before any type of business arrangement today, it is now customary to break the ice before beginning a project. 

"Cat Got Your Tongue?"

What does it mean? This saying is said when a person is at a loss for words. 

This common saying has two possible sources. The first refers to the cat-o'-nine tails - a whip used by the English Navy for flogging. The whip had caused so much pain, the victims were left speechless. The second refers to the practice of cutting out the tongues of liars and feeding them to cats. 

"Caught Red-Handed"

What does it mean? Caught doing something wrong.

This saying originated because of law. Some time ago, if someone butchered an animal that didn't belong to him, and was caught with the animal's blood on his hands, he had to be convicted. But being caught with freshly cut meat did not make the person guilty.

"Throw the Baby Out with the Bathwater"

What does it mean? Hang on to valuable things when getting rid of unnecessary things. 

In the 1500s, most people would bathe once a year and when they did bathe the entire family would use the same tubful of water. The man of the house would bathe first, then the females and finally, the babies. By the time the babies came to wash, the water would be thick and cloudy. Consequently, the infants' mothers had to take care not to throw them out with the bathwater when they emptied the tub. 

"Eat Humble Pie"

What does it mean? To make an apology and suffer humiliation with it.

During the Middle Ages, the lord of a manor would hold a feast after hunting. Yet, while he would feast on the finest cut of meat at dinner, those of a lower standing were served a pie filled with entrails and innards, which were then known as 'umbles'. So, receiving an 'umble pie' was considered humiliating because it signified the guest's lower status. 

"the Cold Shoulder"

What does it mean? This is considered to be a rude way of telling someone that he isn't welcome. 

 Today, giving the cold shoulder is considered rude. But it was actually regarded as a polite gesture during medieval England. At the end of a feast, the host would let his guests know it was time to leave by giving them a cold piece of meat from the shoulder of beef, mutton or pork. 

"Go Cold Turkey"

What does it mean? To quit something all of a sudden.

It was believed that during withdrawal, the skin of drug addicts would become translucent, hard to touch and covered with bumps and would resemble the skin of a plucked turkey. 

"Go the Whole 9 Yards"

What does it mean? To try your best.

During the Second World War, fighter pilots received a 9-yard chain of ammunition. The saying came about when a pilot used all of his ammunition on one target, he gave it 'the whole 9 yards.'

"Highway robbery" 

What does it mean? Charging too much.

These days, most people would refer to being charged Rs. 250 for a cup of coffee as a highway robbery. With that being said, its original definition meant literally robbing travelers on or near a highway. It's thought that the phrase was first used way back in 1611. 

"Jaywalker"

What does it mean? Someone who crosses the street in a reckless or illegal manner. 

 The term comes from jay birds who traveled outside of the forest into urban areas became confused and unaware of the potential dangers in the city - such as traffic. Fascinated by their erratic behavior people began using the term 'jaywalker' to describe someone who crossed the street irresponsibly. 

"Kick the Bucket"

What does it mean? Simply put, it means to die!

When a cow was killed at a slaughterhouse a bucket was placed under it while it was positioned on a pulley. There were times when the animal's legs would kick during the adjustment of the rope and it would kick the bucket before being killed. 

"Let Your Hair Down"

What does it mean? To relax or to be at ease.

Parisian nobles risked being condemned by their peers if they appeared in public without an elaborate hairdo. As some of the more intricate styles required hours of work, it would always be a relaxing moment to come home at the end of a long day and let their hair down. 

"Letting the cat out of the bag" 

What does that mean? To reveal a secret, often unintentionally.

Nowadays, letting the cat out of the bag means spilling someone's secret, however, the phrase used to mean something completely different back in Medieval times. Back then, farmers would purchase piglets from markets, which would usually be handed over in bags. The thing is that unscrupulous dealers would swap out the pigs they were supposed to be selling for much less expensive cats. This theory is quite hotly disputed. 

"Meeting a deadline" 

What does this mean? Completing a task in time or before time

Meeting a deadline had a very different meaning during the American Civil War than it does today. A deadline was a line inside the area where Federal prisoners were kept. If any of them attempted to cross the line, they would be shot and killed.  

"More Than You Can Shake a Stick At"

What does it mean? To have more of something than you actually need. 

Farmers controlled their sheep by shaking their staffs to show animals where they had to go. But when farmers had more sheep than they could control, it was said they had 'more than you can shake a stick at.'

"No Spring Chicken"

What does it mean? Someone who is no longer in their prime.

In New England, chicken farmers generally sold their chickens during the spring because chickens born at that time of year yielded better earnings than the chickens that survived the winter. Sometimes, farmers would try to sell old birds for the price of a new spring chicken. As buyers who were aware of this complained that the fowl was 'no spring chicken' the term then came to represent anyone past their prime. 

"Paint the town red" 

What does it mean? It is often associated with getting glammed up before heading out for a night of drinking and dancing. 

But that's not what it meant back in 1837. As the story goes, the Marquis of Waterford went out for a night of drinking with some friends. They all proceeded to become quite severely intoxicated, and set about destroying property in the small English town. Things got really crazy when they stumbled upon some red paint, and literally began painting the town red. Doors, a tollgate, and a swan statue were among the victims... 

"Paying through the nose" 

What does it mean? It means paying far too much than the actual worth.

Paying through the nose for something is never a pleasant experience, but at least your face remains intact throughout. The Vikings took paying through the nose quite literally - they used to slit someone's nose from tip to eyebrow if they refused to pay tax. 

"Pleased as Punch"

What does it mean? To be very happy.

During the 17th century, a puppet show for children called Punch and Judy featured a puppet named Punch who killed people. Punch felt pleased with himself after the act of killing as it brought him so much pleasure.

"Pulling your leg" 

What does it mean? A light hearted banter. Deceive or joke in a harmless way.

You'd probably think that pulling someone's leg is just a bit of light-hearted fun, but it meant something much more sinister back in 18th and 19th-century London. Thieves would drag their victims to the ground by their legs so that they were easier to steal from. 

"Read me the riot act" 

What does it mean? To give someone a severe reprimand or warning.

If you were ever read the riot act as a child or teenager, it might have meant being confined to your room for a few weeks without being able to watch television. In 18th-century England, however, it meant that you could face time behind bars. The Riot Act of 1715 stated that groups of 12 or more people gathered on the streets could be deemed a threat to public safety, and therefore ordered to be broken up. Refusal to disperse could also have led to arrests and forcible removals. 

"Riding shotgun"

What does it mean? Sitting in the front seat, just next to the driver

Although it might be the ideal place to ride during a road trip, riding shotgun in the Old West was a much more serious matter. Stagecoach passengers literally rode with a shotgun in their hands in order to scare off robbers to ward off would-be attackers. 

Idioms can convey complex ideas succinctly and memorably. For example, “break the ice” means to initiate conversation in a social setting. They often reflect cultural values and traditions, providing insight into a society's way of thinking. For example, “the early bird catches the worm” emphasizes the value of being protective.They can often paint vivid pictures in the listener's mind. “Bite the Bullet” creates a visual of someone enduring a painful experience bravely. Phrases too can effectively convey feelings and attitudes. “Over the moon” expresses extreme happiness.

REMEMBERING PROF. D.K. CHABRA BY HIS LECTURE ON BRAIN CANCER

 

 

Dr. D.K. Chabra was a Reader in the Department of Neurosurgery when we were doing our M.S. and was always present in the Neurosurgery department either attending to his patients, or operating, or addressing some administrative problems or attending to the maintenance of some surgical equipment. You could never find him sitting idle, work was his way of relaxation. I have, in the past, written about Prof. Chabra in one of my blogs, and if you have missed it, please click: https://surajitbrainwaves.blogspot.com/2020/06/remembering-prof-d-k-chabra-today.html

He married very late in life and in his bachelor days was truly married to neurosurgery, and so had no time for family. We, residents and students were his family and to us he was a huge inspiration. I did my first carotid angiography, my first cranial burr hole, my first craniotomy and my first drainage of subdural haematoma with him breathing down my neck! He was a strict stickler of S.O.Ps and these got ingrained in our DNA. Training with him was always hands-on. 

When Sanjay Gandhi Post Graduate Institute of Medical Sciences was established, he was hand-picked by the Director to build the Department of Neurosurgery from scratch. It was a huge loss to our Institution, but the Neurosurgery department in S.G.P.G.I. flourished under his care. His influence in the new Institute was far beyond his own speciality, and his contribution in the building of his new Institute and its work culture was profound.

When we were doing our M.S in General Surgery, we the residents of Surgery, who were about to appear in the M.S. examination, would request particular teachers to teach us particular subjects, of which they were true domain expert. Thus we would request Prof. A.K. Wakhlu to revise Ano-rectal malformations with us, Dr. G.K. Singh to teach us Bone Tumours, and Prof. S.K. Bhatnagar to teach us Cleft Lip & Palate and Hypospadias. These classes would occur in the evening and no teacher ever said no to our request. One day we approached Dr. D.K. Chabra and requested him to teach us Brain Cancers. In his customary style Dr. Chabra said “give me 3 days to collect some teaching material and we will do this at 7PM next Friday. So, this is what I could recover from my notes of that evening’s class. 

Brain cancer refers to a growth of abnormal cells in the brain. These tumors can start in the brain (primary brain tumors) or spread to the brain from cancers elsewhere in the body (metastatic tumors).

Some brain tumours are non-cancerous (benign) while others are malignant “brain cancers” that grow quickly and invade tissue. Even benign tumors can cause serious symptoms by pressing on brain structures.

 

Types of Brain Cancer

Brain tumours are classified by the cells they originate from.

Glioblastoma (GBM):

This is an aggressive cancer arising from glial (supportive brain) cells, and the most common malignant brain tumor in adults. GBM accounts for about 16% of adult primary brain tumors. It grows rapidly and is difficult to cure; five-year survival rates are very low (around 6–9% for patients in their mid-40s to mid-50s). GBM often affects adults over 45 and can cause headaches, personality changes, or seizures as it progresses.

 

Meningioma:

This is a tumor of the meninges, the membranes covering the brain and spinal cord. Meningiomas are usually benign (non-cancerous) and slow-growing. They are the single most common brain tumor type, making up roughly 46% of adult brain tumors. Meningiomas often occur in people over 60 and more frequently in women, and can grow for years before causing symptoms like headaches or focal neurological deficits. Because they are often treatable (usually with surgery and/or radiation), survival rates are high – about 79% five-year survival for patients in their late 40s and 50s.

 

Astrocytoma:

This is a tumor originating from astrocytes, the star-shaped glial cells. This category includes a range of gliomas from lower-grade (grade II) astrocytomas to grade III (anaplastic) astrocytomas. These tumors tend to grow slower than GBM (which is actually considered a grade IV astrocytoma) and often affect middle-aged adults. While they are malignant, they generally have better outcomes than GBM; for example, a diffuse low-grade astrocytoma has around a 46% five-year survival in people age 45–54. Astrocytomas can cause seizures, cognitive changes, or weakness, and sometimes progress into more aggressive forms over time.

 

Metastatic Brain Tumors:

These are cancer that has spread to the brain from another organ (such as the lung, breast, colon, or skin). Metastatic tumors (also called secondary brain tumors) are actually more several times more common than primary brain cancers. Virtually any cancer can spread to the brain, but lung cancer, breast cancer, melanoma, and kidney cancer are among the most likely to do so. These tumors often present with symptoms similar to primary brain tumors. Treatment typically focuses on controlling the spread by radiation or surgery and managing symptoms.

 

Early Symptoms and Warning Signs

Brain tumors can produce a wide range of symptoms. In adults over 45, it’s especially important to recognize new or unusual symptoms and not simply attribute them to “normal aging.” Early detection of a brain tumor can greatly improve outcomes. Common early signs include:

1.      Frequent headaches: Especially headaches that are new, persistent, and worse in the morning or wake one from sleep. These may be accompanied by nausea or vomiting. While many adults get headaches, a pattern of headaches that steadily worsens over time or is coupled with other neurological symptoms should be evaluated carefully.

2.      Seizures: A seizure in someone with no prior history of epilepsy is a red flag for a brain tumour until proven otherwise. About one-third of brain tumour patients experience seizures as an initial symptom. Any sudden convulsion, unusual spell of confusion, or loss of consciousness warrants prompt medical attention.

3.      Cognitive or personality changes: Brain tumours can subtly affect memory, thinking, and mood. Family members might notice the person becoming more confused, forgetful, or having trouble following conversations and simple commands. Some tumors cause personality changes – for example, a formerly calm person may become easily irritable or apathetic. Such changes, especially if they worsen over weeks or months, should be investigated.

4.      Weakness or balance problems: Unexplained weakness or numbness in an arm or leg, or clumsiness and balance difficulty (stumbling, swaying while walking), can indicate a tumor affecting the motor areas or cerebellum. Sometimes this is mistaken for stroke; unlike a stroke, which develops suddenly, tumor symptoms often develop gradually. If you notice progressive loss of coordination or one-sided weakness, investigate for brain tumour.

5.      Vision or speech disturbances: Tumours in certain brain regions can cause blurred or double vision, loss of peripheral vision, or other visual changes. Likewise, a growth affecting language centers may lead to speech problems – difficulty finding words, slurred speech, or trouble understanding others. These symptoms, particularly if they are new and getting worse, should be promptly evaluated. What is to be appreciated is that the symptoms depend on the tumor’s location and growth rate. A slow-growing meningioma might cause very subtle issues for years, whereas an aggressive glioblastoma can produce symptoms that escalate over a short time. In any case, new neurological symptoms in midlife or later age should not be ignored.

 

 

How Brain Cancer is diagnosed?

If a brain tumour is suspected, you will have to perform a series of evaluations and tests to confirm the diagnosis and identify the tumor type. The typical steps include:

Neurological exam: The first step is usually a thorough exam of the nervous system. Check for  reflexes, muscle strength, vision, hearing, balance, coordination, and cognitive function. Specific deficits (for example, weakness in the left arm or trouble with peripheral vision) can provide clues about where in the brain a tumor might be located.

 

Imaging tests: If exam findings suggest a possible brain issue, imaging is done to look inside the skull. A Carotid Angiogram is a quick X-ray based scan that may be done initially, especially in emergency situations or to diagnose a space occupying lesion and rule out other problems. However, the preferred imaging for brain tumors is CT Scan. Even these have limitations as it is difficult to distinguish tumor tissue from normal brain or scar tissue and assess how active or aggressive the tumor might be.

 

Biopsy: Imaging alone can strongly suggest a tumor, but the definitive diagnosis comes from examining tumor cells under a microscope. To obtain cells, a biopsy is performed. In many cases, if the tumor is accessible and operable, a neurosurgeon will remove as much of it as safe during surgery and send samples to the lab. If the tumor is in a tricky location not easily removable, a smaller stereotactic needle biopsy can be done. A pathologist then analyzes the tissue to determine the tumor type and its grade.

 

Additional tests: These may include blood investigations and a spinal fluid exam in certain cases, but the neurological exam, imaging, and biopsy are the cornerstone of diagnosis.

 

Age distribution:

The risk of brain tumors increases with age. The median age at diagnosis is around 60 years. Brain and other central nervous system cancers are most frequently diagnosed in people between 65 and 74. Over two-thirds of brain tumor cases occur in those above 40. In older adults, brain tumors rank among the more common cancers – they are the seventh most common type of tumor and the sixth leading cause of cancer-related death in people over 40.

 

Survival rates:

Thanks to advances in treatment, many patients live with brain tumors for years. Overall, considering all primary brain tumors (including benign), the five-year survival rate for adults is around 72%. For malignant brain tumors in older adults, survival is much lower. Among adults aged 40 and over, only about 21% survive five years. Glioblastoma has especially poor outcomes – around 9% for ages 45–54, and around 6% for ages 55–64. For benign tumors, survival is much better: about 90% in those over 40. For example, meningioma patients typically see five-year survival rates of 80% or higher. Grade II/III astrocytomas fall in between, with survival rates from 29% to 46% in middle-aged adults, depending on grade.

It’s important to remember that survival statistics are averages. Individual outcomes vary based on tumor type, location, genetics, treatment options, and overall health.

 

Risk Factors for Brain Cancer in Older Adults

Most brain cancers do not have a clear cause, but certain factors can increase the risk:

1.      Advancing age is one of the strongest risk factors. Risk increases significantly after age 45 and peaks in the elderly.

2.      Sex: Women are more likely to develop benign brain tumors, while men are more likely to develop malignant ones like glioblastoma.

3.      Radiation exposure: High-dose ionizing radiation to the head increases the risk, especially when received for previous cancer treatments.

4.      Genetic conditions: Rare syndromes like NF1, NF2, Li-Fraumeni syndrome, and tuberous sclerosis can increase risk, though they are uncommon.

5.      Metastasis from other cancers: Lung, breast, kidney, and skin cancers are most likely to spread to the brain.

 

Thus ended Dr. Chabra’s class on Brain Cancers. He had brought a bunch of Carotid Angiograms of patients with Brain Cancers and he demonstrated Meningiomas, Secondary deposits and other intra-cranial space occupying lesions. He also projected some histopathology slides of different brain tumours to revise the types of tumours. Our institution did not have a CT Scan and MRI then and Carotid Angiogram was our only radiological investigation for diagnosing these tumours. Dr. Chabra then left with his two residents to complete his ward rounds.

Remember, this was Brain Cancer before the advent of MRI and fancy genomic profiling, targetted treatment, IDO1 inhibitors, Focoused Ultrasound, Motor Protein inhibitors, Immunotherapy, and Gamma knife.