Brain tumour in adults
A brain tumour occurs when a cluster of cells grow abnormally in the brain and this can affect people in different ways. A brain tumour may be benign (it’s not cancer) but may still grow to a size where it presses on important parts of the brain and causes symptoms as a result. Alternatively, it may have cancer cells in it that disrupt the normal functioning of an area of the brain (even if it is a small size) and this is called a malignant tumour. Brain tumours are more common in older people.
If a benign tumour remains small and slow-growing, it may not cause any symptoms at all. Almost 6,000 people in the UK are diagnosed with a benign brain tumour every year.
Malignant brain tumours usually grow faster than benign ones, and every year about 5,500 people in the UK are diagnosed with one. They’re more likely to come back after treatment than benign ones, as well as being more likely to spread to other parts of the brain.
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What are causes a brain tumour?
The cause is largely unknown but there are certain things that increase your risk. They’re more common as you get older. There’s a genetic component to it, so having a family history increases the risk as well as some neurological conditions like neurofibromatosis or Tuberous sclerosis. Exposure to any radiation from aeroplanes, CT scans, radiotherapy or repeated X-rays of the head, all increase your risk.
What are the symptoms?
Symptoms can vary depending on which particular structures in the brain are being pressed on or disrupted, and how big the tumour has grown. This is known as a space-occupying lesion, and can have causes other than a tumour. Symptoms can develop very slowly – even over years – if the tumour is very slow-growing, but if it is an aggressive type of malignant tumour they can occur quickly within days or weeks.
Commonly people suffer headaches, but this can have all manner of causes. Nausea and vomiting can be common, especially first thing in the morning. Anyone who has a seizure should be checked out immediately – brain tumour is one of a number of causes.
Progressive weakness on one side of the body and changes to your balance or co-ordination can occur. Problems with speech – either articulating or understanding it – may be a symptom and should be assessed.
Changes to your vision are quite common with a brain tumour, but your optician should be your first stop, as it’s much more common to need glasses (or stronger glasses) than have a brain tumour. The UK’s Brain Tumour Charity has a helpful page on visual changes to be concerned about:
https://www.thebraintumourcharity.org/brain-tumour-signs-symptoms/adult-brain-tumour-symptoms/changes-vision/
Mental and behavioural changes may be a subtle sign, but it’s significant if family, friends and work colleagues notice any changes.
When should I see my doctor?
Brain tumours can sometimes be the first thing people worry about if they have headaches and this worry can cause a great deal of stress. It’s worth remembering that headaches are one of the most common symptoms there are but brain tumours are comparatively rare. In addition, it’s unusual to have a brain tumour if headaches are your only symptom but if you start getting frequent headaches when you didn’t get them before, if they feel very different in nature to your usual headaches or they become very severe, these are all reasons to speak with your doctor as soon as possible.
A first seizure always needs thoroughly investigating, as do any unusual symptoms affecting your vision, speech, balance, co-ordination or strength. Similarly, you should discuss any changes with your behaviour or memory with a doctor.
Your doctor will ask about your symptoms and examine you, including checking the nerves in your head (cranial nerves) and the peripheral nerves to your arms and legs.
They may refer you for further investigations, such as a scan of your head, or they may refer you to a neurologist, a specialist that deals with the brain and spinal cord. Thye may also seek the opinion of a neurosurgeon - a surgeon that operates on the brain and spinal cord. If they are concerned about a brain tumour, they’ll refer you urgently.
How are brain tumours treated?
The treatment for brain tumours varies depending on several factors, such as whether the tumour is benign or malignant, the type of cancerous cells present, the location and impact of the tumour, other health conditions and your overall fitness. Surgery is usually the main treatment and aims to cut out the abnormal cells as completely as possible, with radiotherapy and chemotherapy being the other treatments. The surgical team may also consider reducing the size of the tumour – called ‘de-bulking’ – to relieve symptoms, especially if complete surgical removal is too risky to attempt. De-bulking usually refers to surgery, but oral steroids may also be used here to help reduce inflammation and the tumour size, which may then ease symptoms.
Radiotherapy treatment involves using high energy X-rays to destroy tumour cells, usually in a form called external beam radiotherapy. With a small brain tumour this may be targeted as a very high dose to one small area of the brain, called stereotactic radiotherapy.
Chemotherapy treatment uses anti-cancer drugs to destroy any cancer cells in the brain. This can be given on its own, or in addition with radiotherapy and you may be offered this after surgery to help prevent a tumour returning, or if your brain tumour comes back.
Depending on the symptoms you have, you may also require medication to manage symptoms such as anti-sickness medication for nausea and vomiting, painkillers for headaches and anti-seizure medication if you suffer seizures.
It’s tough to contemplate, but sometimes your treating team considers the best course is “watch and wait”, where they scan you regularly and keep an eye on any changes to the tumour size, surrounding brain structures and any symptoms you may develop.
With a malignant brain tumour, around 40% of people survive for a year or more and more than 10% survive for 5 years or longer.
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