Brain Tumor: Symptoms, Types & Treatment Options

What Is a Brain Tumor?

A brain tumor is an abnormal mass of cells growing in or near the brain. Brain tumors can be primary (originating in the brain) or secondary (metastases from cancer elsewhere in the body). Primary brain tumors are classified as benign (non-cancerous) or malignant (cancerous), though both types can cause serious symptoms and require treatment.

Brain tumors develop when cells in or around the brain begin to grow abnormally and uncontrollably. The term "brain tumor" encompasses a wide variety of growths that differ significantly in their behavior, treatment, and outlook. Understanding these differences is essential for patients and families navigating a brain tumor diagnosis.

The brain is enclosed within the rigid skull, which creates a unique challenge: even a slowly growing benign tumor can cause serious problems by compressing brain tissue or blocking the flow of cerebrospinal fluid. This is why even non-cancerous brain tumors often require treatment, unlike benign tumors in other parts of the body that may simply be monitored.

According to the World Health Organization, there are over 120 different types of brain tumors, classified based on the type of cell from which they originate and their genetic characteristics. The most common primary brain tumors in adults are gliomas (which arise from glial cells that support neurons) and meningiomas (which develop from the membranes covering the brain).

Primary vs. Secondary Brain Tumors

Primary brain tumors originate within the brain itself or in tissues closely related to it, such as the meninges (membranes covering the brain), cranial nerves, or pituitary gland. These tumors rarely spread to other parts of the body, though they can spread within the brain and spinal cord.

Secondary brain tumors, also called brain metastases or metastatic brain tumors, are cancers that have spread to the brain from another location in the body. Lung cancer, breast cancer, melanoma, kidney cancer, and colon cancer are the most common cancers that metastasize to the brain. Brain metastases are actually more common than primary brain tumors in adults.

Benign vs. Malignant Brain Tumors

Benign brain tumors are non-cancerous growths that typically have well-defined borders and grow slowly. They do not invade surrounding tissues or spread to other parts of the body. Common benign brain tumors include most meningiomas, schwannomas, and pituitary adenomas. However, the term "benign" can be misleading because these tumors can still cause serious symptoms, may be difficult to remove completely depending on their location, and can sometimes transform into malignant tumors over time.

Malignant brain tumors are cancerous and tend to grow more aggressively. They can invade surrounding brain tissue, making complete surgical removal difficult or impossible. Glioblastoma is the most common and aggressive malignant primary brain tumor in adults. Malignant brain tumors are graded from 1 to 4, with higher grades indicating more aggressive behavior.

What Are the Symptoms of a Brain Tumor?

Brain tumor symptoms vary depending on the tumor's size, location, and growth rate. Common symptoms include persistent headaches (often worse in the morning), seizures, vision or hearing changes, difficulty with balance or coordination, speech problems, personality changes, and progressive weakness in the arms or legs. Symptoms develop because the tumor either directly affects brain tissue or increases pressure within the skull.

Brain tumor symptoms can develop gradually over weeks to months, or they may appear suddenly in some cases. The specific symptoms depend primarily on which part of the brain is affected by the tumor, as different brain regions control different functions. A tumor in the area controlling speech will cause different symptoms than one affecting the vision centers or motor areas.

It's important to understand that many brain tumor symptoms are also caused by much more common conditions. Headaches, for example, are extremely common and are usually caused by tension, migraines, or other benign conditions. However, certain patterns of symptoms should prompt medical evaluation, particularly if they are new, persistent, or progressive.

The mechanism behind many brain tumor symptoms is increased intracranial pressure. The skull is a rigid container, so when a tumor grows inside it, pressure builds up. This can cause headaches, nausea, vomiting, and drowsiness. Additionally, tumors can directly damage brain tissue, disrupt electrical activity (causing seizures), or compress blood vessels and nerves.

Headaches, Nausea, and Increased Pressure

Headaches are one of the most common symptoms of brain tumors, occurring in about 50% of patients. However, it's important to note that headaches are very common in the general population, and the vast majority of headaches are not caused by brain tumors. Brain tumor headaches often have certain characteristics that distinguish them:

• Timing: Often worse in the morning upon waking or may wake you from sleep
• Pattern: May be more intense when lying down, coughing, or straining
• Progression: Tend to become more frequent and severe over time
• Character: May feel different from typical headaches you've experienced before
• Associated symptoms: Often accompanied by nausea, vomiting, or other neurological symptoms

Nausea and vomiting, especially when occurring with headaches in the morning, can indicate increased pressure within the skull. Dizziness and balance problems are also common complaints.

Seizures

Seizures are often the first noticeable symptom of a brain tumor, occurring in 20-40% of brain tumor patients. The tumor disrupts normal electrical activity in the brain, triggering abnormal electrical discharges. Seizures can vary widely in their presentation:

• Generalized seizures: Involve loss of consciousness and convulsions affecting the whole body
• Focal seizures: Affect only part of the body or cause unusual sensations, with or without loss of awareness
• Subtle signs: Some people experience strange sensations, feelings of déjà vu, unusual smells, or brief "spacing out" episodes

Any new-onset seizure in an adult should be thoroughly evaluated, as it may be the first sign of a brain tumor or other serious neurological condition.

Vision, Hearing, and Speech Changes

Tumors affecting the areas of the brain responsible for processing sensory information can cause various changes in vision, hearing, and speech:

Vision changes may include blurred vision, double vision (diplopia), loss of peripheral vision (tunnel vision), difficulty with visual tracking, or different pupil sizes. Some patients notice that colors appear different or that they have difficulty recognizing faces or objects.

Hearing changes can include hearing loss (often in one ear), tinnitus (ringing in the ears), or sounds seeming muffled or different than before. Vestibular schwannomas (acoustic neuromas) are a type of benign tumor that characteristically causes one-sided hearing loss and tinnitus.

Speech difficulties may manifest as difficulty finding words, trouble forming words clearly (slurred speech), problems understanding speech, or difficulty reading and writing. These symptoms can resemble a stroke, but in the case of a brain tumor, they typically develop more gradually.

Personality and Cognitive Changes

Brain tumors can cause changes in personality, mood, and thinking abilities that may be noticed by family members before the patient becomes aware of them. These changes can include:

• Difficulty concentrating or paying attention
• Memory problems, especially with short-term memory
• Confusion or disorientation
• Changes in judgment or decision-making
• Mood swings, depression, or anxiety
• Personality changes, such as becoming more irritable or passive
• Loss of initiative or motivation

These cognitive and personality changes can be particularly challenging for patients and families because they affect the very qualities that define a person. Tumors in the frontal lobes are particularly likely to cause personality and behavioral changes.

Motor Function and Coordination

Tumors affecting the brain's motor areas or the connections between different brain regions can cause problems with movement and coordination:

• Weakness: Gradual weakening of an arm, leg, or one side of the body
• Coordination problems: Difficulty with balance, walking, or fine motor tasks
• Numbness or tingling: Unusual sensations in parts of the body
• Difficulty swallowing: Problems with the complex coordination required for swallowing

These symptoms typically develop gradually, unlike the sudden onset seen in stroke. However, any new weakness or neurological symptom warrants prompt medical evaluation.

When Should You See a Doctor for Brain Tumor Symptoms?

Seek medical attention promptly if you experience new-onset seizures, persistent headaches that are different from your usual pattern (especially if worse in the morning), progressive vision or hearing changes, difficulty with speech or understanding language, personality changes noted by others, or gradually worsening weakness or coordination problems. Call emergency services immediately for sudden severe headache, sudden neurological changes, or prolonged seizures.

Many brain tumor symptoms can also be caused by much more common and less serious conditions. However, certain patterns of symptoms warrant prompt medical evaluation. The key is to pay attention to symptoms that are new, persistent, progressive, or significantly different from what you've experienced before.

If you're concerned about symptoms you're experiencing, it's always appropriate to consult with a healthcare provider. They can perform an evaluation and determine whether further testing is needed. Early detection of brain tumors can lead to more treatment options and potentially better outcomes.

What Causes Brain Tumors?

The exact cause of most brain tumors is unknown. Known risk factors include previous radiation exposure to the head and certain inherited genetic syndromes such as neurofibromatosis, Li-Fraumeni syndrome, and tuberous sclerosis. Age is also a factor, with most primary brain tumors occurring in older adults, though certain types are more common in children. There is no proven link between brain tumors and mobile phone use or other common environmental factors.

For the vast majority of brain tumors, no specific cause can be identified. Researchers have identified some factors that may increase risk, but most people with brain tumors have no known risk factors, and most people with known risk factors never develop brain tumors. This can be frustrating for patients and families seeking answers, but it's important to understand that developing a brain tumor is not something that can typically be attributed to any specific action or exposure.

Brain tumors occur when cells acquire genetic mutations that cause them to grow and divide uncontrollably. These mutations can be inherited (present from birth) or acquired during a person's lifetime. Advances in molecular biology and genetics are helping researchers better understand what drives brain tumor development, which is leading to new targeted treatment approaches.

Established Risk Factors

Ionizing radiation: Prior radiation therapy to the head, such as treatment for childhood leukemia or other head and neck cancers, increases the risk of developing a brain tumor years later. This is the only environmental exposure definitively linked to brain tumor risk. Diagnostic imaging (like CT scans) uses much lower doses of radiation and has not been shown to significantly increase brain tumor risk.

Genetic syndromes: Several inherited conditions increase brain tumor risk:

• Neurofibromatosis types 1 and 2: Cause benign tumors to develop on nerves
• Li-Fraumeni syndrome: Increases risk of many cancer types including brain tumors
• Tuberous sclerosis: Causes benign tumors in multiple organs including the brain
• Von Hippel-Lindau disease: Associated with hemangioblastomas and other tumors
• Cowden syndrome: May increase risk of certain brain tumors

Age: Brain tumors can occur at any age, but the risk of most types increases with age. Certain tumor types, however, are more common in children or young adults.

Factors That Do NOT Cause Brain Tumors

Despite persistent myths, there is no scientific evidence that the following cause brain tumors:

• Mobile phone use (extensively studied with no proven link)
• Living near power lines
• Artificial sweeteners
• Hair dye
• Head injuries (though they may sometimes lead to the discovery of a tumor)

How Are Brain Tumors Diagnosed?

Brain tumor diagnosis typically involves a neurological examination followed by imaging studies, with MRI being the most important imaging tool. CT scans provide rapid initial assessment. If a tumor is found, a biopsy is usually needed to determine the exact tumor type and guide treatment decisions. Additional tests may include PET scans, blood tests, and genetic/molecular analysis of tumor tissue.

The diagnostic process for a suspected brain tumor usually begins when a person presents with concerning symptoms. The path to diagnosis involves several steps, starting with a thorough medical history and neurological examination, followed by imaging studies, and often concluding with tissue sampling (biopsy) for definitive diagnosis.

If a doctor suspects a brain tumor, they will typically arrange for imaging studies to visualize the brain. If a tumor is found, a team of specialists including neurologists, neurosurgeons, neuro-oncologists, and radiation oncologists will review the case to develop a diagnostic and treatment plan. For standardized care pathways, patients may be evaluated through rapid diagnostic processes that expedite workup and treatment initiation.

Neurological Examination

A neurological examination tests various aspects of nervous system function to identify any abnormalities that might indicate where a tumor is located. The exam typically includes testing:

• Vision: Visual acuity, visual fields, pupil responses, eye movements
• Hearing: Ability to hear sounds and identify their source
• Reflexes: Various reflexes that can indicate nervous system problems
• Coordination and balance: Gait, finger-to-nose testing, heel-to-shin movements
• Strength: Muscle strength in arms and legs
• Sensation: Touch, pain, temperature, and vibration sensation
• Mental status: Memory, orientation, attention, language, and cognitive function

The doctor may also look at the back of your eye (funduscopic examination) using a special light, as swelling of the optic nerve (papilledema) can indicate increased pressure in the head.

Imaging Studies

Magnetic Resonance Imaging (MRI) is the most important imaging test for brain tumors. MRI uses powerful magnets and radio waves to create detailed images of the brain without radiation exposure. MRI with contrast (gadolinium) enhancement is typically performed, as the contrast agent highlights areas where the blood-brain barrier is disrupted by tumor growth. MRI can show the tumor's size, location, and relationship to surrounding brain structures. Special MRI techniques can provide additional information:

• MR spectroscopy: Analyzes chemical composition of tumor tissue
• Functional MRI (fMRI): Maps brain function to plan surgery
• Perfusion MRI: Measures blood flow within the tumor
• Diffusion MRI: Assesses water molecule movement, helpful for tumor characterization

Computed Tomography (CT) uses X-rays to create images of the brain. CT is faster than MRI and widely available, making it useful for initial emergency evaluation. CT is particularly good at showing bone abnormalities and acute bleeding. However, MRI provides more detail for most brain tumor evaluations.

Positron Emission Tomography (PET) uses radioactive tracers to assess metabolic activity in the brain. PET scans can help distinguish between tumor tissue and treatment effects (like radiation necrosis), and can provide information about tumor grade and activity.

Biopsy and Tissue Diagnosis

A biopsy—obtaining a sample of tumor tissue for examination under a microscope—is almost always necessary for definitive brain tumor diagnosis. The tissue sample allows pathologists to determine the exact tumor type, grade, and molecular characteristics, which guide treatment decisions.

There are two main approaches to obtaining a biopsy:

Surgical biopsy during tumor removal: If the tumor is surgically accessible, the biopsy is obtained during the operation to remove the tumor. The pathologist examines the tissue and provides a preliminary diagnosis during surgery, with final results available within several days.

Stereotactic biopsy: For tumors that cannot be safely removed surgically, or when a diagnosis is needed before treatment planning, a stereotactic biopsy may be performed. This minimally invasive procedure uses imaging guidance (CT or MRI) to precisely target the tumor. A small hole is made in the skull, and a needle is inserted to obtain tissue samples. The procedure is usually performed under local anesthesia in adults, with patients able to go home the same day or the following day.

Molecular and Genetic Testing

Modern brain tumor diagnosis increasingly relies on molecular and genetic analysis of tumor tissue. The 2021 WHO Classification of CNS Tumors incorporates molecular characteristics into tumor classification, as these features often predict tumor behavior and response to treatment better than microscopic appearance alone.

Common molecular tests include:

• IDH mutations: Important prognostic markers in gliomas
• 1p/19q codeletion: Characteristic of oligodendrogliomas, predicts better response to treatment
• MGMT promoter methylation: Predicts response to temozolomide chemotherapy
• BRAF mutations: Important in certain tumor types, may be targetable with specific drugs

What Are the Treatment Options for Brain Tumors?

Brain tumor treatment options include surgery to remove as much of the tumor as safely possible, radiation therapy (including conventional radiation and stereotactic radiosurgery), chemotherapy (such as temozolomide for gliomas), targeted drug therapy, and immunotherapy. Treatment plans are individualized based on tumor type, grade, location, and patient factors. Many patients receive a combination of treatments. Supportive care to manage symptoms is also an important component of treatment.

Brain tumor treatment has advanced significantly in recent decades, with new surgical techniques, radiation technologies, and drug therapies improving outcomes for many patients. Treatment decisions are complex and are typically made by a multidisciplinary team of specialists who consider the specific characteristics of each patient's tumor and individual circumstances.

The goals of treatment may include curing the tumor (if possible), controlling tumor growth, relieving symptoms, and maintaining quality of life. For some tumors, particularly low-grade or benign tumors that are not causing symptoms, careful monitoring without immediate treatment (sometimes called "watchful waiting" or "active surveillance") may be recommended.

Surgery

Surgery is often the first treatment for brain tumors, with the goal of removing as much of the tumor as safely possible. The extent of surgery depends on the tumor's location, size, and relationship to critical brain structures. Complete removal is the goal when possible, but even partial removal (debulking) can relieve symptoms and improve the effectiveness of subsequent treatments.

Modern neurosurgery uses many advanced techniques to maximize tumor removal while minimizing damage to normal brain tissue:

• Surgical navigation systems: Computer-guided systems that help surgeons see exactly where their instruments are in relation to the tumor and critical structures
• Intraoperative MRI: Imaging performed during surgery to assess the extent of tumor removal in real-time
• Fluorescence-guided surgery: Special dyes that make tumor tissue glow, helping surgeons identify and remove tumor cells
• Awake craniotomy: For tumors near speech or motor areas, the patient may be awakened during surgery to map brain function and minimize deficits
• Laser ablation: Minimally invasive technique using laser heat to destroy tumors

After surgery, most patients stay in the hospital for several days to a week. The specific recovery depends on the extent of surgery and the patient's overall condition. Rehabilitation may be needed to help recover functions affected by the tumor or surgery.

Radiation Therapy

Radiation therapy uses high-energy beams to kill tumor cells or slow their growth. It is commonly used after surgery to destroy remaining tumor cells, or as primary treatment for tumors that cannot be surgically removed. Radiation therapy has evolved significantly, with new techniques allowing more precise targeting while sparing normal brain tissue.

External beam radiation therapy is the most common type, delivering radiation from a machine outside the body. Modern techniques include:

• Intensity-modulated radiation therapy (IMRT): Shapes radiation beams to match tumor contours
• Image-guided radiation therapy (IGRT): Uses imaging to precisely target the tumor each session
• Proton therapy: Uses protons instead of X-rays, potentially reducing radiation to surrounding tissue

Stereotactic radiosurgery delivers a high, precisely focused dose of radiation in one or a few sessions. Despite the name, it does not involve actual surgery. Technologies include Gamma Knife, CyberKnife, and linear accelerator-based systems. Stereotactic radiosurgery is particularly useful for small tumors and brain metastases.

Radiation therapy can cause side effects including fatigue, headache, nausea, hair loss in the treatment area, and skin reactions. Later effects may include cognitive changes, particularly when large areas of the brain are treated. Children are especially sensitive to radiation effects on brain development.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells or stop them from dividing. The blood-brain barrier limits which drugs can reach brain tumors, so specific drugs known to cross this barrier are used. Chemotherapy may be given alone or in combination with radiation therapy.

Temozolomide (Temodar) is the most commonly used chemotherapy drug for brain tumors, particularly gliomas. It is taken orally (as a pill) and is often given with radiation therapy, then continued after radiation as maintenance therapy. The drug works by damaging tumor cell DNA, and its effectiveness can be predicted by a molecular marker called MGMT promoter methylation.

Other chemotherapy approaches include:

• Carmustine (BCNU): Can be given intravenously or as biodegradable wafers placed during surgery
• Lomustine (CCNU): Oral chemotherapy sometimes used for recurrent tumors
• PCV regimen: Combination of procarbazine, lomustine, and vincristine, used for certain tumor types

Chemotherapy side effects may include nausea, fatigue, decreased blood cell counts (increasing infection and bleeding risk), and other effects depending on the specific drugs used.

Targeted Therapy and Immunotherapy

Newer treatment approaches target specific molecular abnormalities in tumor cells or harness the immune system to fight cancer:

Targeted therapy drugs attack specific molecules involved in tumor growth. Examples include bevacizumab (Avastin), which blocks blood vessel formation that tumors need to grow, and drugs targeting specific mutations found in some brain tumors.

Immunotherapy helps the immune system recognize and attack cancer cells. While immunotherapy has revolutionized treatment of some cancers, its role in brain tumors is still being established. Clinical trials are investigating various immunotherapy approaches for brain tumors.

Tumor treating fields (TTFields) is a treatment that uses electrical fields to disrupt cancer cell division. It involves wearing a device that delivers low-intensity electrical fields to the scalp, and has been approved for use with temozolomide for newly diagnosed glioblastoma.

Supportive Care

Managing symptoms and treatment side effects is an essential part of brain tumor care:

• Corticosteroids: Medications like dexamethasone reduce brain swelling (edema) caused by tumors, relieving headache and other symptoms
• Anti-seizure medications: Prescribed to prevent or control seizures
• Shunt surgery: If the tumor blocks cerebrospinal fluid flow causing hydrocephalus, a shunt may be placed to drain excess fluid
• Rehabilitation: Physical therapy, occupational therapy, and speech therapy help patients maintain or recover function
• Palliative care: Specialized care focused on relieving symptoms and improving quality of life at any stage of illness

What Happens After Brain Tumor Treatment?

After brain tumor treatment, patients require regular follow-up appointments and MRI scans to monitor for tumor recurrence or progression. The frequency of monitoring depends on tumor type and grade, but typically involves scans every few months initially, then less frequently if stable. Many patients need ongoing rehabilitation and support. Children who have had brain tumor treatment require lifelong monitoring for late effects.

Follow-up care after brain tumor treatment is essential for detecting any recurrence early, managing ongoing symptoms or treatment effects, and supporting patients' quality of life. The follow-up schedule and approach depend on the type of tumor and treatment received.

Monitoring for Recurrence

For malignant brain tumors, regular MRI scans are performed to check for tumor recurrence or growth. The schedule varies but often involves scans every 2-4 months initially, then every 4-6 months, and eventually annually if the patient remains stable. Benign tumors that have been completely removed may require less frequent monitoring, but some follow-up is usually recommended.

Long-term Effects and Rehabilitation

Brain tumors and their treatment can cause long-lasting effects on brain function. Many patients benefit from rehabilitation services including:

• Physical therapy for movement and balance problems
• Occupational therapy for daily living skills
• Speech therapy for communication and swallowing difficulties
• Cognitive rehabilitation for thinking and memory problems
• Psychological support for emotional adjustment

Children treated for brain tumors require particularly careful long-term follow-up, as treatment effects may become apparent years later as the brain develops. This includes monitoring for cognitive development, hormone function, growth, and second cancers. Specialized follow-up clinics for childhood cancer survivors provide comprehensive long-term care.

Quality of Life

Living with a brain tumor diagnosis affects many aspects of life beyond physical health. Patients may face changes in their ability to work, drive, or perform other activities. Emotional support, both professional and from family and friends, is important. Many patients find support groups helpful for connecting with others who understand their experience.

What Is the Outlook for Someone With a Brain Tumor?

Brain tumor prognosis varies enormously depending on tumor type, grade, location, and how well it responds to treatment. Benign tumors that can be completely removed often have excellent outcomes. Low-grade gliomas may allow patients to live for many years. High-grade malignant tumors like glioblastoma have more challenging prognoses, though treatments are improving. Many factors influence individual prognosis, and survival statistics represent averages that may not apply to any individual patient.

It's important to understand that prognosis statistics are based on large groups of patients and represent averages. Every patient is unique, and many people live significantly longer than statistics might suggest. Advances in treatment are continually improving outcomes, so statistics from even a few years ago may not reflect current expectations.

Factors that generally indicate a more favorable prognosis include:

• Lower tumor grade
• Ability to completely remove the tumor surgically
• Younger age
• Good overall health and functional status
• Favorable molecular markers (like IDH mutation in gliomas)
• Good response to treatment

Many people with brain tumors live full, productive lives for years after diagnosis. Even for those with more aggressive tumors, effective symptom management and supportive care can help maintain quality of life. Ongoing research continues to develop new treatments that may improve outcomes for all brain tumor patients.