A schwannoma is a type of benign nerve sheath tumor composed of Schwann cells, which normally produce the insulating myelin sheath covering peripheral nerves. Schwannomas are homogeneous tumors, consisting only of Schwann cells. The tumor cells always stay on the outside of the nerve, but the tumor itself may either push the nerve aside and/or up against a bony structure. Schwannomas are relatively slow-growing. For reasons not yet understood, schwannomas are mostly benign and less than 1% become malignant, degenerating into a form of cancer known as neurofibrosarcoma. These masses are generally contained within a capsule, so surgical removal is often successful.
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Symptoms of Schwannoma
Schwannomas grow slowly and may exist for years without any symptoms. As schwannomas can form in several different areas of your body, the symptoms vary greatly. Some people may have more symptoms than others, and they can range from mild to severe. Schwannoma symptoms can include:
- A visible lump that may feel tender when you put pressure on it.
- Numbness.
- Muscle weakness.
- Pins-and-needles feeling (paresthesia).
- Pain that’s aching, burning or sharp.
- Vestibular schwannomas can affect hearing and balance and/or cause ringing sensations (tinnitus).
- Tumors by your facial nerve can affect swallowing, eye movement and taste sensations or cause facial paralysis.
- Sciatic nerve schwannomas can mimic disk herniation with low back pain, with radiating pain down your leg.
Causes of Schwannoma
The cause of schwannomas isn’t known in most cases. Approximately 90% of cases occur sporadically (randomly). Genetic disorders such as Carney complex, neurofibromatosis 2 (NF2) and schwannomatosis can cause schwannomas. Genetic studies show that the NF2 gene on chromosome 22 plays an essential role in schwannoma development.
Diagnosis of Schwannoma
You may have a schwannoma for several years before getting diagnosed, as they grow slowly and often cause no symptoms at first. If you’re experiencing symptoms, your healthcare provider will likely order imaging tests. They may also find a schwannoma accidentally when reviewing imaging test results you had for another medical reason.
Imaging tests that can help diagnose a schwannoma include:
- Magnetic Resonance Imaging (MRI): MRI is a painless test that produces very clear images of the organs and structures within your body using a large magnet, radio waves and a computer to produce detailed images. This is the preferred imaging test for locating and diagnosing schwannomas.
- Computed Tomography (CT) scan: A CT scan uses X-rays and computers to produce images of the structures inside of your body.
- Ultrasound: Ultrasound uses high-frequency sound waves to create real-time pictures or videos of internal organs or other soft tissues. Healthcare providers can use ultrasound to detect schwannomas under your skin.
Your healthcare provider may also perform a biopsy to check if the tumor is schwannoma. This involves taking a small sample from the tumor with a needle. An expert called a pathologist will study cells from the sample under a microscope and run other tests to see what kind of tumor it is.
Treatment of Schwannoma
Treatment for schwannoma depends on where the tumor is in your body and how quickly it’s growing. Some treatment options include:
- Observation/Watch and Wait: If the tumor is benign, growing very slowly and you’re experiencing no or very mild symptoms, your healthcare provider may recommend closely monitoring it instead of treating it. If it eventually grows larger and/or causes symptoms, they’ll likely recommend medical treatment for it.
- Surgery: If the tumor is growing more quickly or causing other problems, your healthcare provider may recommend removing it with surgery. While the goal is usually to completely remove the tumor, the surgeon may only be able to remove part of it. As schwannomas form in the sheath surrounding the nerve, the surgery can often be completed without any damage to the nerve. However, surgery for vestibular schwannomas often leads to hearing loss.
- Radiation Therapy: Stereotactic radiosurgery (SRS) uses many precisely focused radiation beams to destroy tumors. Your healthcare provider may recommend SRS instead of surgery if the tumor is near vital blood vessels or nerves to prevent possible complications.
Malignant (cancerous) schwannomas may be treated with immunotherapy and chemotherapy medications as well.
Newer Treatment Options
- Immunotherapy: Breakthroughs in immunotherapy have led to the FDA approval of lifileucel (brand name Amtagvi), the first tumor-infiltrating lymphocyte (TIL) therapy for advanced melanoma. This personalized cellular immunotherapy represents a major advancement in the field.
- Experimental Treatment: New experimental treatments can stop the growth of schwannoma tumors. Researchers have shown that using a combination of patient-donor tumor cells from surgical resections and mouse models of schwannoma, the tumor growth can be strongly and significantly reduced. In addition, treatment with the Hippo pathway inhibitors (named VT1 and VT2 in the study) actually shrinks the size of the tumor.
Conclusion
Schwannoma is a rare type of tumor that develops from cells called Schwann cells. While it is usually benign, it can cause a range of symptoms depending on its location. Diagnosis involves imaging tests and biopsies, and treatment options include observation, surgery, and radiation therapy. Newer treatment options, such as immunotherapy and experimental treatments, offer promising alternatives. For those seeking alternative approaches, Welling Homeopathy’s Immuno-knife treatment provides a personalized and holistic method of managing schwannoma.