Brain Tumors

About

What is a brain tumor? 

There are many types of brain tumors and each can cause different symptoms, depending on their size and location in the brain. The most common symptoms are headaches, balance problems, vision disturbances and mental confusion. A brain tumor is an abnormal mass or growth of cells in the brain that can be cancerous (malignant) or noncancerous (benign). Primary brain tumors start in your brain. Secondary brain tumors are always cancerous and start in another part of the body, spread to the brain and form a new tumor(s). The rate at which the tumor grows and its location determine how it will affect your nervous system and the kind of symptoms it will cause. Treatment options include surgery, radiation and chemotherapy. The cause of brain tumors is unknown, but they may be caused by the environment, the patient’s genes, or both.

Causes

What causes brain tumors?

Brain tumors can develop when genes in a cell are damaged and no longer function correctly. These genes normally regulate the rate at which the cell divides, repair genes that fix defects in other genes, and cause the cell to self-destruct if damage is beyond repair. Some patients may be born with a partial defect in one or more of these genes. Environmental factors can be affected by the mutated gene and cause further damage that results in a tumor. Environmental factors are the only cause of tumor formation in other patients. Brain tumors can also be caused by cancer in another part of the body that spreads to brain tissue, and grows a new tumor(s). 

The body’s immune system would normally find the abnormal cell and kill it. However, the immune system may be defenseless because tumors can produce substances that block the immune response from being able to kill the abnormal cells. 

Are there different types of brain tumors?

There are more than 150 different types of brain tumors, and they are classified into two groups: primary and secondary (or metastatic). 

Primary brain tumors originate in the brain or in tissues close to it, such as the pituitary or pineal glands, or cranial nerves. When normal cells have mutations in their DNA (the cell’s instructions about what to do), the mutated cells can grow and divide rapidly, creating a mass of defective cells that form a tumor. 

Primary tumors can be cancerous or noncancerous. A cancerous (malignant) tumor is more dangerous because it can grow quickly, spreading to other parts of the brain and spinal cord. A noncancerous (benign) tumor can press on other parts of the brain and cause damage. Benign tumors don’t spread, but occasionally they become malignant.

Primary brain tumors include:

  • Gliomas begin in the brain or spinal cord, and are the most common type of adult brain tumor, accounting for 78% of malignant brain tumors. 
  • Meningiomas are tumors in the membranes that surround the brain and spinal cord (meninges). Most are not cancerous.
  • Acoustic neuromas (schwannomas) are benign tumors that develop on the nerves that control balance and hearing. The nerves lead from the inner ear to the brain.
  • Pituitary adenomas develop in the pituitary gland at the base of the brain, and can affect the pituitary hormones. This can cause symptoms throughout the body.
  • Medulloblastomas are cancerous and most common in children, although they occur at all ages. Starting in the lower back part of the brain, they spread through the spinal fluid.
  • Germ cell tumors are more common in children. 
  • Craniopharyngiomas are rare, and start near the pituitary gland, which secretes hormones that control many body functions. It can affect the pituitary gland and other structures near the brain.

Secondary brain tumors develop from cancer in another part of the body, usually through the bloodstream. They spread (metastasize) to the brain, where they form a new tumor(s). The most common types of cancer that spread to the brain are cancers of the breast, colon, kidney, lung and skin (melanoma). However, any cancer can metastasize to the brain. 

Secondary brain tumors are always cancerous. They are more likely to develop in people who have a history of cancer. Secondary brain tumors are much more likely to develop in an adult, while children are more likely to develop a primary tumor.

Secondary brain tumors affect 25% of cancer patients. About 40% of people with lung cancer will develop a secondary brain tumor. In the past, patients typically survived only a few weeks after diagnosis. With better diagnostic tools, and improved surgical and radiation treatment methods, survival rates have been extended to several years and greatly improved quality of life for patients. 

Who’s at risk for a brain tumor?

The cause of most primary brain tumors is unknown. However, certain factors can increase the risk, including exposure to ionizing radiation, which is the type of radiation caused by radiation therapy for cancer, or caused by atomic bombs. Risk is also increased if your family has a history of brain tumors.

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Symptoms

What are the symptoms of brain tumors?

Brain tumor symptoms vary according to the location, size and how fast it’s growing. Some patients have no symptoms. Tumors can cause local damage by putting pressure on crucial areas of the brain. If tumors block the flow of fluid around the brain, they can cause an increase of pressure inside the skull. Some types of tumors can spread through the spinal fluid to distant areas of the brain or spinal cord.  

Some of the more general brain tumor symptoms include:

  • Headaches, especially a change in your pattern of headaches, more frequent headaches, or developing severe headaches for the first time; they may be more severe in the morning
  • Nausea and vomiting, or swallowing difficulties
  • Vision problems like double vision, blurriness, or loss of peripheral (side) vision
  • Hearing and/or speech problems
  • Extreme fatigue
  • Difficulty with balance, dizziness
  • Personality or behavior changes
  • Mental confusion about everyday things, difficulty making decisions, inability to follow simple directions, feeling disoriented
  • Gradual loss of feeling or movement in an arm or leg, or on one side of the body
  • Tingling or numbness in the face
  • Seizures or convulsionsli>

Diagnosis

How is a brain tumor diagnosed?

If your doctor suspects a brain tumor, he or she may recommend these tests to confirm the diagnosis:

  • Neurological exam to check vision, hearing, balance, coordination and reflexes. It can help determine the tumor’s location.
  • Imaging tests can include an MRI, done with an injected dye to find the tumor and plan treatment. A PET scan or CT scan may also be used.
  • Biopsy may be done to collect a sample of the abnormal tissue for analysis.

Treatment

What are the treatment options for brain tumors?

Brain tumor treatment depends on the type, size and location of the tumor, and the patient’s overall health. Treatment can include surgery, radiation, radiosurgery, chemotherapy, and targeted drug therapy. Currently, there is no data to determine if one of these methods is better than another in terms of outcome. Each has advantages and disadvantages and treatment should be individualized for each patient. 

  • Surgery can be done if the tumor is located where it can be removed. Small tumors can easily be separated from surrounding brain tissue and be completely removed. Other tumors or large tumors cannot be safely separated from brain tissue if they’re near sensitive areas of the brain. Because these tumor surgeries carry significant risk, your surgeon will only take out that part of the tumor that can be removed safely. Removal of only a part of the tumor can improve symptoms. Surgery carries risks such as infection and bleeding. 
  • Radiation therapy uses high-energy radiation beams such as X-rays or proton beams to kill tumor cells. Most radiation treatment is done with the machine outside your body. Very rarely, the radiation source is placed inside your body next to the tumor (brachytherapy). Radiation can be focused just on the tumor, or on the whole brain to treat cancer that has metastasized from another part of the body and formed multiple brain tumors. Radiation therapy is also used to shrink tumors. It is used when the tumor cannot be completely removed with surgery. Side effects of radiation therapy can include fatigue, headaches, memory loss, and hair loss.
  • Stereotactic radiosurgery uses multiple radiation beams to provide highly focused radiation that can kill tumor cells in a very small area. The tumor gets a very large dose of radiation at the point where all the beams meet. Gamma knife and linear accelerator are two types of radiosurgeries. It is usually done in one treatment and the patient can go home the same day. This treatment tends to incur less damage to tissues adjacent to the tumor. 
  • Chemotherapy uses medications to kill tumor cells. The drugs can be taken by mouth or injected into a vein (intravenously). Side effects depend on the type and dosage of drugs, and can include nausea, vomiting and hair loss. 
  • Targeted drug therapy focuses on specific abnormalities within cancer cells. Medications are given to block these abnormalities, causing the cancer cells to die. 
  • Laser interstitial thermal therapy (LITT) is a newer technique for smaller tumors that are hard to remove with traditional brain surgery. A laser is used to remove the lesion with heat. Long-term effectiveness of this treatment has not been established.
  • Post-treatment rehabilitation may be needed if the tumor was in a part of the brain that controls speech, vision and thinking. Physical therapy can help regain lost motor skills or muscle strength. Speech therapy may be needed if there are problems with speaking. Occupational therapy helps restore the ability to do normal daily activities and resume working.

References

Mayo Clinic. (Aug. 2021). Brain tumor. Retrieved 10-28-21, {https://www.mayoclinic.org/diseases-conditions/brain-tumor/symptoms-causes/syc-2035008}
Mayo Clinic. (Aug. 2021). Brain tumor Diagnosis and Treatment. Retrieved 10-28-21, {https://www.mayoclinic.org/diseases-conditions/brain-tumor/diagnosis-treatment/drc-20350088}
American Association of Neurological Surgeons (N.d.). Brain Tumors. Retrieved 10-28-21, {https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Brain-Tumors}
Johns Hopkins Medicine. (N.d.). Basics of Brain Tumors. Retrieved 10-28-21, {https://www.hopkinsmedicine.org/health/conditions-and-diseases/basics-of-brain-tumors}

Information

Medically reviewed by:

Dr. Desiree Levyim

Dr. Desiree Levyim is a board eligible neurologist in practice since 2020. She joins TeleMed2U in our mission to provide increased access to healthcare.

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