Brain tumour

What is a brain tumour?

A brain tumour refers to an abnormal mass or growth of cells within or around the brain. Central nervous system (CNS) tumours are the collective term for both brain and spinal tumours.

Brain tumours can either be cancerous (malignant) or non-cancerous (benign), with different rates of growth. Approximately one-third of all brain tumours are malignant. However, regardless of their nature, they can disrupt normal brain function and overall health if they expand enough to compress the nearby tissues, nerves, and blood vessels.

Primary tumours develop in the brain, while secondary tumours, also referred to as metastatic brain tumours develop in different parts of the body and spread to the brain. This article, however, looks into primary brain tumours.

Benign brain tumours:

The types of brain tumours that are typically benign are:

• Chordomas: These are slow-growing and mostly benign tumours that usually originate from the base of the skull and the bottom of the spine.
• Craniopharyngiomas: These tumours normally arise from a section of the pituitary gland. This makes them difficult to remove due to their closeness to critical structures deep in the brain.
• Gangliocytomas, gangliomas and anaplastic gangliogliomas: These rare tumours develop in the neurons or nerve cells.
• Glomus jugulare: Located beneath the base of the skull just above the neck vein (jugular vein), these tumours are the most common types of glomus tumour.
• Meningiomas: These are typically slow-developing and the most common kind of primary brain tumours. They occur in the meninges, the brain and spinal protective tissue layers. Although rare, this condition may be malignant.
• Pineocytomas: These are slow-growing tumours that develop on the pineal gland situated deep in the brain, which secretes the hormone melatonin.
• Pituitary adenomas: These types of tumours occur in the pituitary gland located at the base of the brain, which produces and regulates hormones in the body. They normally grow slowly and can release excessive pituitary hormones.
• Schwannomas: These tumours, which originate from the Schwann cells within the peripheral nervous systems or cranial nerves, are common benign brain tumours among adults. Schwann cells support nerve impulse conduction, while acoustic neuromas are the most prevalent schwannoma. These tumours develop on the vestibular nerve or the nerve leading from the inner ear to the brain.

Malignant brain tumours:

Nearly 78% of malignant primary brain tumours are gliomas, which originate from the glial cells surrounding and supporting the nerve cells. The following are the kinds of gliomas:

• Astrocytoma: These are the most prevalent kinds of glioma, which occur in the star-shaped glial cells known as astrocytes. Though they mostly develop in the cerebrum, they can also form in various parts of the brain.
• Ependymomas: Occurring close to the ventricles in the brain, these tumours develop from the radial glial cells or ependymal cells.
• Glioblastoma (GBM): These are fast-growing astrocytomas that occur in the glial cells known as astrocytes.
• Oligodendroglioma: These are rare tumours that originate in the cells forming myelin, an insulation layer around the brain nerves.
• Medulloblastoma: These fast-growing tumours occur at the base of the skull and are the most common malignant brain tumours among children.

Who is more likely to develop a brain tumour?

Brain tumours can affect both minors and adults of any age. However, they are somewhat more common among individuals assigned male at birth (AMAB) compared to those assigned female at birth (AFAB).

Meningioma, a benign brain tumour, is the only type that is more common among women. On the other hand, as the general population ages, glioblastoma, the most dangerous kind, is increasingly becoming more prevalent.

How common are primary brain tumours?

Primary brain tumours, or those originating from the brain, are rare. In the US, only 5 out of 100,000 individuals develop the condition each year. Likewise, around 4,100 minors below 15 years get a brain or central nervous system tumour annually.

How serious can the brain tumour be?

A brain tumour, be it malignant or benign, can lead to severe problems due to the rigidity of the skull, which limits space for tumour expansion. Moreover, if the tumour occurs near the brain parts controlling vital functions, it could trigger symptoms like:

• Walking difficulty
• Body weakness
• Balance problems
• Partial or total vision loss
• Difficulty using or understanding language
• Memory problems

In addition, a brain tumour can lead to various problems if it:

• Directly attack and destroy the healthy brain tissue.
• Put pressure on the surrounding tissue.
• Rises pressure in the skull (intracranial pressure).
• Cause fluid build-up in the brain.
• Cause bleeding in the brain.
• Block the normal cerebrospinal fluid (CSF) flow through spaces in the brain, making them enlarge.

Nevertheless, some individuals have brain tumours that don't trigger any symptoms or enlarge further to compress nearby tissues.

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Signs and Symptoms of Brain tumours

A brain tumour can sometimes cause no symptoms, particularly when it's still small. However, when they occur, they can vary based on the type of tumour, the size, and location. These signs and symptoms include:

• Headaches, which might be more intense in the morning or disrupt your sleep at night
• Difficulty talking, understanding language, or thinking
• Weakness or paralysis affecting one part or side of the body
• Seizures
• Changes in personality
• Balancing problems or dizziness
• Hearing problems
• Vision problems
• Nausea or vomiting
• Facial numbness or tingling
• Confusion or disorientation

Consult your medical provider if you experience any of these signs and symptoms.

Causes of brain tumours

According to researchers, brain tumours occur when particular genes on the cell chromosomes become damaged and fail to function correctly. However, the exact reasons for these occurrences remain unclear. The DNA in the chromosomes instructs cells in the body, telling them when to grow, divide, and die.

When changes occur in the brain cell DNA, it prompts new instructions. The body creates abnormal brain cells, which grow and proliferate faster than usual and can even survive longer. As a result, the constantly growing abnormal cells crowd take hold of the space within the brain.

In other cases, an individual can be born with alterations in a single or more genes. Moreover, environmental aspects like too much radiation exposure from X-rays or prior cancer treatment could aggravate the damage. Environmental harm to the genes might also be the sole cause in some instances.

These are the uncommon inherited genetic syndromes linked to brain tumours:

• Neurofibromatosis type 1 (NF1 gene)
• Neurofibromatosis type 2 (NF2 gene)
• Turcot syndrome (APC gene)
• Gorlin syndrome (PTCH gene)
• Tuberous sclerosis complex (TSC1 and TSC2 genes)
• Li-Fraumeni syndrome (TP53 gene)

Diagnosing Brain tumours

Brain tumour diagnosis involves an intricate process that may require the expertise of various specialists. However, in some instances, medical practitioners can detect a brain tumour while conducting an imaging examination for a different medical condition.

In addition to performing a physical examination to diagnose a brain tumour, your healthcare provider will also ask questions concerning:

• Symptoms
• Past and present health conditions
• Current medications
• Surgeries or other medical treatments
• Family history

Neurological examination is another diagnostic procedure that may also be performed to search for changes in neurological functions, including balancing and coordination, hearing, mental status, reflexes, and vision. These changes can provide useful insights into the specific part of the brain that could be affected by the tumour.

In case the practitioner suspects the presence of a brain tumour, the next step will typically be a brain scan, most likely an MRI.

Brain tumour diagnostic tests

Healthcare providers often employ the following tests when diagnosing a brain tumour:

• Magnetic resonance imaging (MRI) or Computed tomography (CT) scan: Brain MRI is thepreferred imaging test for diagnosing brain tumours. CT scan, on the other hand, serves as an alternative, especially when one is unable to tolerate MRI. Prior to these tests, a contrast agent is administered through one of the veins in order to enhance the visibility of the tumour. These scans can also provide precise information on the size and location of the tumour. Moreover, healthcare providers can examine other body parts like the lungs, breasts or colon using these procedures to determine if the tumour has metastasized.
• Biopsy: Typically, a biopsy, which involves removing a sample of the tumour for microscopic examination, is required to determine the type of brain tumour and whether it is malignant. During the surgical procedure, to remove all or a section of the tumour, a neurosurgeon can do a biopsy. However, if the tumour location isn't easily accessible, a stereotactic biopsy involving making a tiny hole in the skull with a needle to obtain a tissue sample from the tumour may be performed.
• Lumbar puncture or spinal tap: During this procedure, the medical practitioner uses a tiny needle to collect cerebrospinal fluid (CSF) from the spine. The obtained fluid is then examined in the laboratory to detect the cancerous cells. A lumbar puncture can also be performed if the tumour is suspected of having spread out to the meninges, the tissue layers covering the brain.
• Specialized tests: Sometimes, additional tests may be ordered to aid in brain tumour diagnosis. For instance, the healthcare provider might perform tests to check the CSF and blood for tumour markers, the substances released by some tumours. Additionally, they can look for gene anomalies typical of particular types of tumours.

Brain tumour Treatment

The treatment for brain tumour is based on some factors such as:

• The type, location, and size of the brain tumour
• The number of tumours
• Age
• Overall health

Normally, non-cancerous brain tumours can be successfully removed through surgery with no chance of recurrence. However, the success of the surgical procedure typically depends on the neurosurgeon's ability to take out the entire tumour safely.

Certain treatments, like radiotherapy, that the adult brain can tolerate well, might prevent the brain of minors from developing normally. This is especially true if the child is below the age of 5.

Medical professionals usually treat brain tumours using a combination of therapies. These treatments may include the following:

• Brain surgery (craniotomy): Neurosurgeons strive to remove the brain tumour whenever possible. They usually operate cautiously to reduce the risks of damaging the functional parts of the brain. In some cases, they can perform the surgery while you are wide awake but can't feel any pain to avoid damage.
• Radiation therapy: This kind of treatment uses high doses of X-rays to kill the cells or reduce the tumour.
• Radiosurgery: This form of radiation therapy employs highly focused radiation beams, such as proton beams or gamma rays, to kill the tumour. Since there is not incision or cutting involved, this treatment procedure isn't considered surgery.
• Brachytherapy: This type of radiation therapy involves the surgical placement of radioactive seeds, capsules, or other implants straight into the malignant tumour or near it.
• Chemotherapy: This treatment uses anticancer medications that destroy the cancerous cells in the brain and all over the body. Chemotherapy can be administered through intravenous injection or oral tablet. The physician can also recommend this type of therapy after surgery to help eliminate any remaining cancer cells or stop them from growing back.
• Immunotherapy: Also known as biological therapy, this form of treatment uses the immune system of the body to attack cancer. Immunotherapy mainly involves immune system stimulation so that it can function more effectively.
• Targeted therapy: This treatment involves using drugs that specifically target certain features present in cancer cells while sparing the healthy cells from damage. Targeted therapy may be recommended if you experience difficulty tolerating chemotherapy side effects, including nausea and fatigue.
• Active surveillance: In cases where the brain tumour is small and asymptomatic, the healthcare provider can suggest close surveillance of the tumour for any signs of progression through regular tests.

Additional therapies aimed at managing the symptoms linked to brain tumour are:

• Shunts: In cases where the brain tumour leads to increased pressure in the skull, surgical placement of a shunt, a thin tube, is necessary to facilitate drainage of excessive CSF from the brain.
• Medications: Mannitol and corticosteroids drugs can help lower the pressure in the skull by reducing swelling near the tumour.
• Palliative care: This specialized type of care focuses on providing relief from symptoms, improved support, and giving support to persons living with diseases like brain tumour. Additionally, palliative care extends support to the caregivers and people affected by the patient's condition.

Preventing Brain tumours

Brain tumours, unfortunately, cannot be entirely prevented. However, it is possible to lower the risks of developing the condition by minimizing environmental dangers like smoking and too much exposure to radiation.

Furthermore, if you have a family member or a close relative with a brain tumour, then it's essential to inform your medical provider. In such situations, they may suggest genetic counselling to determine whether you carry any inherited genetic syndrome linked to the condition.

Prognosis/Outlook for Brain tumours

The prognosis for persons with brain tumours significantly varies. It, however, depends on factors such as the type, location, and grade of the tumour, whether the entire tumour has been surgically taken out, age, and general health.

In most instances, brain tumours can be successfully treated, and some people can lead full, active lives with tumours that are asymptomatic. For others, the tumour may recur following treatment, and they may have to continue with therapies like chemotherapy and radiotherapy to prevent further growth.

Brain tumour survival rate

Each kind of brain tumour has a different survival rate, which vary depending on your age, overall health, and race. The five-year rate of survival indicates the percentage of persons who survive at least 5 years after brain tumour diagnosis.

For meningioma, the most prevalent benign primary brain tumour, the five-year survival rates are as follows:

• Over 96% in children aged 14 and below
• 97% in persons aged 15 to 39
• Over 87% in adults aged 40 and above

It is important to note that survival rates vary extensively and depend on some factors. Therefore, discussing your diagnosis with your healthcare provider can provide more insights on what to expect.

When to Visit Your Healthcare Provider

After being diagnosed with a brain tumour, you will need to make regular visits to your healthcare provider to get treatment and closely monitor the symptoms. Also, you should seek medical care if your symptoms worsen or you develop new ones.

Additionally, regular check-ups with your doctor, even after undergoing treatment,are very important. 

Questions to ask your healthcare provider about brain tumour diagnosis

Asking your doctor the following question about brain tumour could be beneficial if you have been diagnosedwith the disease:

• Is the tumour cancerous or non-cancerous?
• Which specific type of tumour do I have?
• What treatment/therapy options are best for my condition?
• What potential side effects can I expect from my recommended treatment?
• Which specialists will be involved in my treatment?
• What is my prognosis/outlook?
• Are any members of my family at risk of developing a brain tumour?
• Can you provide information about support groups available for persons with brain tumours?