Brain tumours

What is a brain tumour?

A brain tumour is an abnormal mass of cells that have grown and multiplied without control. There are two groups:

• Primary: it starts in the brain itself or in the tissues around it. A meningioma is an example of a primary tumour, and it is the most common benign tumour inside the skull.
• Metastatic (secondary): it has reached the brain from somewhere else in the body, such as the breast or lung.

Doctors give tumours a grade. Grades 1 and 2 are usually benign and slow growing, and are less likely to come back. Grades 3 and 4 are malignant and grow faster. The grade is set after a sample has been examined, not from an image alone.

Symptoms

Symptoms depend on where the tumour is. These are common:

• headache, especially one that is different from your usual headaches, is getting worse, or wakes you at night and is worse in the morning
• seizures (fits)
• ongoing nausea and vomiting, or drowsiness
• changes in behaviour or personality, trouble thinking, concentrating or remembering
• gradual weakness or paralysis on one side of the body
• problems with vision, hearing or speech
• dizziness or poor balance

These symptoms also occur in other conditions. Having them does not mean you have a tumour, but they should be checked. Some people have no symptoms at first, or symptoms come on very slowly.

Who is this page for?

This page is written for:

• people whose MRI or CT report mentions a “mass” or “tumour”
• people who have the symptoms above and want to know what path lies ahead
• the patient’s family

Diagnosis

• CT and MRI show the tumour. Special types of MRI can also map the paths of important nerves in the brain so that surgery can be better planned.
• Biopsy (taking a sample). Sometimes this is the only way to be sure. The surgeon takes a sample, and a pathologist decides whether it is benign or malignant and what grade it is.

It may be necessary to wait to learn the type of tumour, and this waiting is hard for families. We talk about it in the article “A family guide after a brain tumour diagnosis”.

Treatments

A brain tumour is usually treated with surgery, radiotherapy or chemotherapy, alone or together. The choice is made for each patient separately, and each method has its own risks and side effects. These factors affect the decision: the type and place of the tumour, its size and how far it has spread, and the patient’s general health and strength.

• Watching and monitoring. Slow-growing benign tumours are sometimes not treated straight away and are only checked and scanned regularly.
• Surgery. The aim is to remove as much of the tumour as possible without harming the brain tissue that controls speech and walking. To reach the tumour, the surgeon temporarily removes part of the skull and puts it back afterwards (a craniotomy). Sometimes only a biopsy is done, or extra fluid is drained. Tumours in the area of speech may be planned with speech mapping during the operation.
• Radiotherapy. High-energy radiation destroys tumour cells. It is used after surgery or when surgery is not possible.
• Chemotherapy. Treatment with drugs; it may be used after surgery, together with radiotherapy, or when a tumour returns.
• Medicines to control symptoms. Such as anti-seizure medicine, painkillers for headache, and sometimes a steroid to reduce swelling around the tumour.

A specialist team works with you on the treatment plan and explains the side effects and benefits of each method. This page does not say which methods are available in a particular clinic or hospital.

Recovery

Recovery is different for every patient. For benign tumours, treatment is often successful but may take time. Effects that may remain after treatment or appear later include:

• a lot of tiredness
• trouble concentrating or remembering
• changes in speech, vision or movement
• changes in mood or personality

Help includes physiotherapy, speech therapy, occupational therapy and psychological counselling. Ask the treatment team about driving; in some countries the patient must tell the licensing authority, and may not be allowed to drive until after treatment.

See also the guide page “The first days after brain surgery”.

Risks

Every treatment for a brain tumour carries risks, and the surgeon talks to you about them before starting. These are the main ones:

• Surgery: possible damage to brain tissue that does an important job. If a tube (a shunt) is used to ease fluid pressure, the tube can become blocked and earlier symptoms such as headache, vomiting, trouble with vision or confusion can return.
• Radiotherapy: with modern methods the risk of long-term damage is very low. In children, especially under five, radiation can affect normal brain development.
• Chemotherapy: including the risk of nausea, a weakened defence against infection and, with some drugs, scarring of the lungs (fibrosis).

After any surgery there is also a risk of wound infection and of a blood clot in the leg. This page gives no percentages or success figures, because they depend on the type of tumour and on each patient.

When to call

Call 115 now or go to an emergency department (115 is Iran’s emergency number) if:

• you have a sudden, very severe headache
• it is the first seizure of your life, a seizure lasts longer than is usual for you, or it lasts more than 5 minutes and you do not know how long your seizures usually last
• you were seriously hurt in a seizure
• you have passed out and are not waking up, or breathing is hard
• you suddenly have weakness on one side of the body, a drooping face or trouble speaking
• after brain surgery: new or worse weakness in an arm or leg, new trouble speaking, a seizure or fainting (if you have not had one before), or marked drowsiness

Contact a doctor the same day if:

• headaches come back, make you feel sick or do not ease with painkillers
• your vision changes, for example spots, flashing lights or blurring
• you have been vomiting for more than two days
• after surgery: a worsening headache, a painful or stiff neck, a fever or discharge from the wound. If you cannot reach the surgical team, call 115

The full list is in “When should I call urgently?” in the guide section. Every patient’s treatment plan is different; ask your doctor about your own situation.