A brain tumour is a mass of abnormal cells that grow in the brain. These cells grow rapidly and invade the healthy areas of the brain. There are different types of brain tumours, some tumours can be non-cancerous (benign) and some may be cancerous (malignant). Brain tumours can either begin in the brain (primary brain tumours) or may migrate from distant parts of the body to the brain (secondary or metastatic brain tumours).
Though the exact cause of brain tumour is unknown, researchers believe that primary brain tumours occur when the normal cells in the brain undergo sudden mutation (cellular changes) and grow at an uncontrollable rate. The tumour can grow in any part of the brain and spinal cord affecting the vital functions.
Warning signs of a brain tumour
In most cases, brain tumours are asymptomatic. However, when the tumour begins to grow, exerting pressure on the brain tissue, then the person might experience some noticeable symptoms.
Because most of the symptoms lack specificity, they are often recognised in retrospect by the patient or the treating clinician.
Depending on the size and location of the brain tumour here are the five warning signs which should not be ignored and a physician evaluation is recommended.
“Two in three people diagnosed with a brain tumour will experience at least one seizure”
Seizures are the most common symptom in patients with a malignant brain tumour. These are the sudden involuntary, repeated muscle movements caused by a burst of electrical impulses in the brain. A brain tumour may trigger seizures by restricting the normal electrical activity of the brain. Experiencing seizures for a short period may indicate:
- A slow-growing, low-grade tumour
- Tumour in one of the lobes of the cerebrum (anterior part of the brain) or the meninges (the membranes that cover and protect the brain and spinal cord).
“According to the American Brain Tumour Association, about 50% of people with a brain tumour experience headaches”
Increased intracranial pressure (ICP) can arise either from a large mass or from restriction of cerebrospinal fluid (CSF) outflow causing hydrocephalus. Symptoms may be subtle or consist of the triad of headache, nausea, and papilledema. A tumour in the brain can put pressure on sensitive nerves and blood vessels which may cause a headache. Most headaches do not indicate a brain tumour. But, if the pain lasts longer or recurs in a different pattern, then it can be a warning sign of brain tumour.
Headache associated with brain tumours is:
- Worse or intense in the morning
- Aggravates with a change in position, coughing, shouting or bending over
- Accompanied by nausea or vomiting
- Not managed by painkillers
Focal deficits — Focal signs and symptoms of brain tumours vary based on tumour location. Symptoms may be caused by local tissue disruption, mass effect on nearby structures, or vasogenic edema.
Weakness – Muscle weakness is a common complaint in patients with brain tumours.
The manifestations may be subtle, particularly in the early stages. For upper motor neuron lesions, weakness is generally more pronounced in the flexors of the lower extremities than in the extensors, and more pronounced in the extensors than the flexors in the upper extremities.
Sensory loss and visual-spatial dysfunction
Uncoordinated limb movements or altered body balance
Having trouble with your mobility, performing tasks or maintaining balance might be connected to a brain tumour. Tumour in certain areas of the brain like cerebellum may cause difficulty in walking, loss of balance and coordination. This usually affects only one side of the body.
Brain tumours can disrupt brain function and may affect the personality and behaviour of a person. Behavioural changes are seen when the tumour affects either the frontal lobe, the temporal lobe, or some parts of the cerebrum. Cognitive dysfunction, which includes memory problems and mood or personality change, is common among patients with primary and metastatic brain tumours.
Behavioural changes that may indicate brain tumour are:
- Difficulty in concentrating
- Short-term memory loss
- Difficulty in thinking, speaking or articulating
- Mood swings
“One in three patients with a brain tumour report a problem with their vision.”
A tumour in the temporal lobe, occipital lobe or brain stem can cause vision changes, especially blurred or double vision. A growing tumour may squeeze the healthy brain tissue, thus it increases pressure on the optic nerve and affects the vision.
A person with a brain tumour may experience the following vision changes:
- Partial or complete loss of vision
- Blurred vision
- Sensitivity to light
- Rapid eye movements
- Dry eyes
In addition to the above-mentioned warning signs, a person with a brain tumour might also experience the following:
- Unexplained nausea or vomiting
- Hearing problems
- Stiffness or tingling sensation on one side of the body
- Anxiety or depression
These signs always don’t indicate a brain tumour. Some other reasons like vitamin deficiencies, dehydration, certain medications, lack of sleep and mental disorders may also cause these symptoms.
In most of the cases, people tend to ignore these warning signs considering them as normal, which results in delayed diagnosis. For conditions like brain tumours, early diagnosis and treatment confers a better outcome and survival. So, if a person is having one or more of these signs, it is important to consult a specialist immediately to get a proper diagnosis and timely treatment.
Diagnosis of brain tumour
Once after reviewing the symptoms, patient history, and overall health ,the doctor may advise a neurological examination if a brain tumour is suspected. A neurological examination is done to check the vision, hearing, balance and coordination.
Additionally, the patient may need to undergo the following tests:
- A CT scan or an MRI is done to determine the specific location of the tumour.
- Biopsy: The procedure involves removing and examining a small sample of the tumour. A biopsy may be done as a procedure on its own, or as a part of surgery to treat the tumour.
Grades of brain tumour
Grading of brain tumour is done in accordance with the appearance of the cancer cells when compared with the normal brain cells. This provides information about the growth of brain tumour and likelihood of its spread to other parts of the body.
There are 4 grades of brain tumour, they are:
Grade I: These are the least malignant, non-cancerous tumours, slow growing , non infiltrative Grade I tumours can be safely removed by surgery.
Grade II: They are low-grade tumours, and relatively slow growing, somewhat infiltrative may recur later as high grade.·
Grade III: These are malignant (cancerous) tumours and are infiltrative. They actively divide and spread into nearby tissues. Once removed, these tumours tend to recur, often as a higher-grade tumour.
Grade IV: They are highly malignant tumours. Rapid growth and aggressive, widely infiltrative. The tumour grows and spreads very quickly into other areas of the brain.
Treatment of brain tumour
Treatment for a brain tumour depends on the size, grade, and the type of tumour. Treatment options include surgery, radiation therapy, chemotherapy, targeted therapy, and immunotherapy.
Surgery is usually the first treatment used for a brain tumour and is often the only treatment needed for a low-grade brain tumour. It is done to remove the tumour in the brain and some surrounding healthy tissues. In most cases, the surgeon tries to remove the entire tumour without harming the brain tissues. But, if the surgeon believes the tumour cannot be removed completely without damaging brain tissue then the surgeon will remove the tumour partially to ease symptoms. Removing the tumour can improve neurological symptoms, provide tissue for diagnosis and help in decision with further other treatments that would be required.
Radiation therapy uses high energy beams to shrink and destroy tumours. X-rays, gamma rays, electron beams, and photon beam therapy are common energy beams used in radiation therapy.
Radiation therapy may be delivered either externally or internally. In external radiation therapy, high-intensity beams are delivered at the site of the tumour through an external source. In internal therapy or brachytherapy, the radiation source is placed inside the body near the tumour to deliver a high dose of rays without damaging the surrounding cells. Common side effects of radiation therapy include fatigue, headaches, memory loss and scalp irritation.
Chemotherapy is the use of drugs to destroy tumour cells, usually by keeping the tumour cells from growing, dividing, and making more cells.These drugs interfere with the process of cell division and promote cancer cell death. Chemotherapy to treat a brain tumour is typically given after surgery and possibly with or after radiation therapy, particularly if the tumour has come back after initial treatment. Common side effects of chemotherapy include nausea, vomiting and hair loss.
Immunotherapy is a treatment option that enhances a person’s own immunity to fight against cancer. It is recommended to treat brain metastases from lung or skin cancer.
Although there is no way to prevent brain tumour, early diagnosis and proper treatment may reduce the risk of metastatic brain tumours.
In addition to standard chemotherapy, targeted therapy is a treatment that targets the tumour’s specific genes, proteins, or the tissue environment that contributes to a tumour’s growth and survival. This type of treatment blocks the growth and spread of tumour cells while limiting the damage to healthy cells.
Not all tumours have the same targets, and some tumours may have more than one target. To find the most effective treatment, tests to identify the genes, proteins, and other factors in the tumour are required.