Brain Tumor: Symptoms, Types and Treatment

Primary vs secondary brain tumors

• Primary brain tumors start in the brain, its coverings (meninges), nerves or glands. About 1 in 3 is malignant. In the US, around 90,000 primary brain and spinal cord tumors are diagnosed each year.
• Secondary tumors (brain metastases) spread from cancers elsewhere, most often the lung, breast, melanoma, kidney and colon. They are more common than primary malignant tumors in adults.

"Benign" brain tumors are not always harmless: because the skull cannot expand, even a slow-growing tumor can press on vital areas.

Types of brain tumors

Gliomas, the tumors that grow from the brain's supporting cells, are grouped in the glioma family.

Brain tumor symptoms

General symptoms from pressure

• Headaches that are new, persistent and getting worse over weeks, often worse in the morning or when lying down, coughing or straining, sometimes with vomiting
• nausea and vomiting
• drowsiness
• blurred or double vision from swelling at the back of the eye

Most headaches are not caused by brain tumors. A tumor headache is usually accompanied by other neurological symptoms or a clear change in pattern.

Seizures

A seizure is the first sign in many people, especially with slow-growing tumors in the cerebral cortex. Any first seizure in an adult needs a brain scan.

Symptoms by location

Causes and risk factors

Most brain tumors have no identifiable cause. Known risk factors:

• previous radiation to the head
• inherited syndromes: neurofibromatosis types 1 and 2, tuberous sclerosis, Li-Fraumeni syndrome, von Hippel-Lindau disease
• weakened immune system (for CNS lymphoma)
• age: risk rises with age, though some types peak in childhood

Mobile phones, power lines and head injuries have not been shown to cause brain tumors.

Diagnosis

1. Neurological examination: strength, reflexes, coordination, vision, hearing, and mental function. An eye exam may show swelling of the optic nerve.
2. MRI with contrast: the key test. It shows the size, location and features of the tumor. Advanced MRI (perfusion, spectroscopy, functional MRI) helps plan surgery.
3. CT scan: often done first in emergencies.
4. Biopsy or surgery: tissue confirms the exact type, grade and molecular markers (such as IDH and MGMT) that guide treatment.
5. Other tests: a search for a primary cancer if metastases are suspected, hormone tests for pituitary tumors, hearing tests for acoustic neuroma.

Treatment

Treatment is planned by a multidisciplinary team (neurosurgeons, neuro-oncologists, radiation oncologists).

• Active monitoring: small, slow-growing benign tumors such as many meningiomas may be watched with regular MRI scans.
• Surgery: removes as much tumor as safely possible, relieves pressure and provides tissue for diagnosis. Awake surgery and brain mapping protect speech and movement areas.
• Radiation therapy: standard after surgery for malignant tumors. Stereotactic radiosurgery delivers precise high doses to small tumors and metastases.
• Chemotherapy: temozolomide for many gliomas; other drugs for lymphoma and childhood tumors.
• Targeted therapy: IDH inhibitors for some gliomas, BRAF and MEK inhibitors for tumors with BRAF changes, and drugs for specific metastases.
• Tumor-treating fields: a wearable device used with chemotherapy for glioblastoma.
• Medicines for symptoms: steroids (dexamethasone) to reduce swelling, anti-seizure drugs.
• Hormone-based treatment: for some pituitary tumors, such as prolactinomas, medicines alone may shrink them.

Rehabilitation with physical, occupational and speech therapy, along with psychological support and palliative care, is part of good treatment.

Outlook

Prognosis varies enormously. Most meningiomas, pituitary adenomas and acoustic neuromas are cured or controlled. Many childhood brain tumors are curable. Low-grade gliomas often allow many years of good life. Glioblastoma remains difficult to treat, with median survival of about 15 months to 2 years with standard treatment, though some people live much longer.

Frequently asked questions

What are the early signs of a brain tumor?

Early signs can include new headaches that steadily worsen, especially in the morning or with vomiting, a first seizure, changes in personality or memory, and gradual weakness, numbness, speech or vision problems. Most headaches are not caused by tumors.

What does a brain tumor headache feel like?

It is often a dull, persistent pressure that gets worse over weeks, is worse in the morning or when coughing, bending or lying down, and may come with nausea, vomiting or other neurological symptoms. A headache alone, without other signs, is rarely due to a tumor.

Are all brain tumors cancerous?

No. Many brain tumors, including most meningiomas, pituitary adenomas and acoustic neuromas, are benign. However, benign tumors can still cause serious problems by pressing on the brain and may need treatment.

How is a brain tumor diagnosed?

An MRI scan with contrast is the main test. If a tumor is found, a biopsy or surgery provides tissue to confirm the type and grade. Doctors also perform a neurological exam and may order other tests depending on the tumor's location.

Can a brain tumor be cured?

Many can. Benign tumors are often cured with surgery or radiosurgery, and many childhood tumors are curable. Some malignant tumors, especially glioblastoma, usually cannot be cured, but treatment can slow growth, relieve symptoms and extend life.