From Symptoms to Treatment: A Guide to Brain Tumours

This blog is dedicated to people who are either affected by a brain tumour or are simply seeking more information on the subject. It provides an overview of what a brain tumour is, its symptoms, how it is diagnosed, and the current treatments available.

While this blog does not delve into the specific types of brain tumours and their associated treatments, it offers a general discussion about the various treatment options for brain tumours.

What is a brain tumour?

A brain tumour is a group of cells in the brain that grows in an abnormal and uncontrollable way.¹ It’s worth noting that while all brain cancers are tumours, not all brain tumours are cancerous. Non-cancerous (benign) brain tumours grow slowly and are less likely to return after treatment. In contrast, brain cancers, or malignant brain tumours, grow more aggressively, are more likely to spread within the brain, and have a higher chance of returning after treatment.¹ It is important to mention that non-cancerous (benign) brain tumours can still be dangerous as they can press on critical areas of the brain, causing various symptoms and complications.²

There are different types of brain tumours depending on the kind of cells that make up the tumour. Some types include gliomas, meningiomas, or pineal tumours, each with its subtypes. For example, glioblastoma, a subtype of glioma, is the most common malignant brain tumour.³

What causes a brain tumour?

The cause of most brain tumours is unknown, but there are several risk factors that may increase the chances of developing a brain tumour.¹ These include:

• Age: Brain tumours can start at any age. However, the risk of getting a brain tumour increases with age, this risk being higher in patients older than 85. ^1,4
• Obesity. Excess body weight has been associated with a slightly higher risk of developing certain types of brain tumours, such as meningiomas..^{3, 4}
• Family history and genetic conditions. A higher risk of brain tumours may exist for individuals with a close relative (such as a parent or sibling) who has had a brain tumour. Certain genetic conditions that increase the likelihood of developing tumours, including neurofibromatosis, tuberous sclerosis, and Li-Fraumeni syndrome, are also associated with an increased risk.^2,4

What are the symptoms of a brain tumour?

The signs of a brain tumour depend on the brain tumour’s size, location and how fast the tumour is growing.³

Headaches are a common symptom of many conditions, and they’re also the most frequent symptom of brain tumours, affecting about half of those diagnosed. These headaches occur because a growing tumour in the brain can press on surrounding healthy tissue or cause swelling in the brain, which increases pressure inside the head. ^3,4 Headaches linked to brain tumours may be more intense in the morning, worsen with actions like coughing or straining, and sometimes come with vision problems, such as flashing lights or blind spots. They may also feel like tension headaches or migraines and tend to worsen gradually over weeks or months. ^3,4

Other brain tumour symptoms can include seizures, which can affect up to 80% of those with a brain tumour. Seizures may involve jerking or twitching of the hands, arms, or legs, or affect the whole body. ⁴ Some individuals may lose feeling in an arm or a leg, have extreme tiredness, have trouble with balance, or experience speech problems. Nausea or vomiting, confusion, memory problems or personality or behavioural changes may also occur. Dizziness or a sense that the world is spinning (vertigo), as well as increased hunger and weight gain, can also be signs of a brain tumour. ³

Diagnosis of a brain tumour

To diagnose a brain tumour, the doctor may start with a neurological exam. This test checks how well different parts of the brain are working by evaluating vision, hearing, balance, coordination, strength, and reflexes. While this exam doesn’t directly detect a brain tumour, it helps the doctor understand which part of the brain might be affected.⁵

A commonly used imaging test is a computed tomography (CT) scan, which uses X-rays to create detailed pictures of the brain. This scan can reveal abnormal areas that might suggest the presence of a tumour. If something suspicious is detected, the doctor may recommend a magnetic resonance imaging (MRI) scan. An MRI uses radio waves and strong magnetic fields to produce even more detailed images of the brain, providing a clearer view of any abnormalities. In some cases, a positron emission tomography scan, or PET, may also be performed. This test involves injecting a small amount of a radioactive substance into the bloodstream, which attaches to the tumour cells. The substance helps highlight any tumour cells in the brain, making them easier to see on the scan. ⁵

If these tests suggest the presence of a tumour, the doctor might recommend a biopsy. This involves taking a small sample of the tumour tissue to analyse if it’s cancerous or not and to determine the type of tumour. ⁵ The way the cells look under a microscope can determine how quicky the tumour cells are growing, which will determine the tumour’s severity grade. ⁵ A genetic test may identify what DNA changes are present in these cells, which may help to determine type of tumour, to predict how fast it will grow or suggest how it may respond to certain treatments. ^5,6

If you are interested in knowing more about genetic testing for brain cancer, please visit this blog.

Treatment for brain tumours

Brain tumour treatment depends on whether the tumour is cancerous (malignant) or non-cancerous (benign). Treatment options also depend on the type, size, grade and location of the brain tumour. In some cases, immediate treatment might not be necessary if the brain tumour is small, benign, and does not cause any symptoms. In such cases, regular brain MRI scans may be used to monitor the tumour’s growth.⁵

Here are some of the treatment options available for brain tumours. Sometimes, a combination of these treatments may be used:

Steroids. Steroids are often prescribed to help reduce swelling around brain tumours. This can relieve symptoms caused by increased pressure inside the skull, such as headaches, and improve overall comfort. A commonly used steroid for this purpose is dexamethasone.⁷

Surgery. The goal of surgery is to remove as much of the brain tumour as can be safely done. Some tumours can be completely removed if they can be easily separated from the surrounding healthy tissue. However, if the tumour is too close to critical brain structures, complete removal may be risky, and the surgeon may opt to remove only part of the tumour to reduce symptoms or not to perform surgery at all. Surgery may carry risks, such as infection, bleeding, blood clots, and potential damage to brain tissue. Other risks may depend on the part of the brain where the tumour is located. ⁵

Radiation therapy. Radiation therapy uses powerful energy beams, such as X-rays or protons, to destroy tumour cells. This radiation can be directed to the specific area of the brain where the tumour is located, or it can be applied to the entire brain if there are many tumours. ⁵ In some cases, the radiation can be placed inside the body, which is called brachytherapy. In this method, seeds, ribbons or capsules that contain a radiation source are implanted within or immediately next to the tumour tissue, with the objective of limiting the exposure to this area.^{8, 9} Although the side effects depend on the type and dose of the radiation, common side effects include fatigue, headaches, memory loss, scalp irritation and hair loss. Some side effects may appear years later, such as memory and cognitive issues. ⁵

Radiosurgery. Radiosurgery, or stereotactic radiosurgery, is a highly precise form of radiation treatment for brain tumour in which there is no incision (no surgical cut). Instead, this technique uses 3D imaging to deliver high doses of radiation (gamma rays, X-rays, or protons) directly to the tumour, minimising damage to surrounding healthy tissue. ^{5 10 11} Side effects can include fatigue and skin changes on the scalp, such as dryness, itching, or hair loss. ⁵

Chemotherapy. Chemotherapy uses strong drugs to kill tumour cells. These drugs can be taken orally (in the form of a pill), intravenously (within a vein by injection), or placed directly into the brain during surgery. ⁵ A person may receive more than one chemotherapy drug as part of their treatment regimen. Temozolomide is the most used medicine, as it can be used to treat many types of brain cancer.¹² The side effects of this brain tumour treatment depend on the type and dose of the drugs and may include nausea, vomiting, fatigue, mouth sores, and hair thinning or patchy hair loss. ^{5, 10 14}

Targeted therapy. Targeted drug therapies are treatments that specifically attack tumour cells by focusing on unique parts that are different from normal, healthy cells. Unlike chemotherapy, targeted therapies spare more healthy tissue than traditional chemotherapy, so they generally have fewer, milder side effects. However, the side effects will depend on the type of targeted therapy used. ^{15 16} Some of these therapies include bevacizumab, everolimus, larotrectinib and entrectinib. ¹⁶ Although there are currently only a few targeted therapies available for brain tumours, doctors and researchers are working to find new and better options through ongoing research and clinical trials. ¹⁶

Tumour treating fields (TTF). Tumour Treating Fields (TTF) therapy involves applying adhesive patches to the shaved scalp. These patches are connected to a battery-powered device that transmits electrical pulses through the skin, aiming to interrupt the cell division process in rapidly dividing tumour cells while sparing normal cells. ^{15. 17} Some of the potential side effects related to the use of the device include muscle twitching, skin ulcers, and a general feeling of being unwell (malaise). When used in combination with chemotherapy, this brain tumour treatment can cause nausea, constipation, vomiting, tiredness, seizure, or depression.¹⁸ This technique is approved in the U.S for the treatment of a type of brain tumour called glioblastoma. Several clinical trials are currently investigating the use of TTF for other types or brain tumours or in combination with other standard treatments. ¹⁹

After brain tumour treatment, patients might need help to regain function in the areas of the brain that were affected by the tumour. Depending on individual needs, this may include physical therapy to regain lost motor skills or muscle strength, occupational therapy to help return to daily activities, speech therapy for those who have difficulty speaking, and tutoring for school-age children to help them cope with changes in their memory and thinking.⁵

Conclusions

A brain tumour is an abnormal and uncontrollable growth of cells within the brain. People with brain tumours may experience a variety of symptoms, including headaches, seizures, nausea, vomiting, vision problems or behaviour changes. The treatment plan will depend on whether the tumour is cancerous (malignant) or not (benign), as well as the type, size, grade and location. Common brain tumour treatments include steroids, surgery, radiation therapy and chemotherapy. Newer treatments include targeted therapy, which selectively attacks tumour cells, and tumour-treating fields, a technique that uses electric fields to disrupt the division of cancer cells. While some of these newer therapies are already approved for specific types of brain tumours in some countries, ongoing clinical trials continue to explore their safety and efficacy in different settings.

Are you affected by a brain tumour and want to explore clinical trial options with your physician?

At myTomorrows, we have a team of Patient Navigators who are medically trained, multi-lingual professionals, who help you and your physician explore your treatment options and support you through your journey.

You can book a call with a Patient Navigator to discuss your options and learn more about participating in clinical trials .