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Neurosurgical Conditions

Brain Tumour

By May 11, 2021May 24th, 2021No Comments

A primary brain tumour is a group (mass) of abnormal cells that start in the brain. This article focuses on primary brain tumours in adults.

Causes, incidence, and risk factors

Primary brain tumours include any tumour that starts in the brain. Primary brain tumours can start from brain cells, the membranes around the brain (meninges), nerves or glands.

Tumours can directly destroy brain cells. They can also damage cells by producing inflammation, placing pressure on other parts of the brain, increasing pressure within the skull.

The cause of primary brain tumours is unknown. There are many possible risk factors that could play a role.

Radiation therapy to the brain, used to treat brain cancers, increase the risk for brain tumours up to 20 or 30 years afterwards.

Exposure to radiation at work or to power lines, as well as head injuries, smoking, and hormone replacement therapy have NOT been proven to be risk factors.

The risk of using cell phones is hotly debated. However, most recent studies have found that cell phones, cordless phones, and wireless devices are safe and do not increase the risk.

Some inherited conditions increase the risk of brain tumours.

Lymphomas that begin in the brain in people with a weakened immune system are sometimes linked to the Epstein-Barr virus.

Specific Tumour Types

Brain tumours are classified depending on:

  • The location of the tumour
  • The type of tissue involved
  • Whether they are noncancerous (benign) or cancerous (malignant)
  • Other factors
  • Sometimes, tumours that start out less aggressive can become more aggressive.
  • Tumours may occur at any age, but many types of tumours are most common in a certain age group. In adults, gliomas and mengingiomas are best common.

Gliomas come from glial cells such as astrocytes, oligodendrocytes, and ependymal cells.

The gliomas are divided into three types:

Astrocytic tumours include astrocytomas (can be noncancerous), anaplastic, astrocytomas, and glioblastomas.

  1. Oligodendroglial tumours. Some primary brain tumours are made up of both astrocytic and oligodendrocytic tumours. These are called mixed gliomas.
  2. Glioblastomas are the most aggressive type of primary brain tumour.
  3. Meningiomas and schwannomas are two other types of brain tumour. These tumours:

Occur most often between ages 40 and 70

Are usually noncancerous, but still may cause serious complications and death from their size or location. Some are cancerous and aggressive.

Meningiomas are much more common in women. Schwannomas affect both genders equally.

Other primary brain tumours in adults are rare. These include:

  • Ependymomas
  • Craniopharyngiomas
  • Pituitary tumours
  • Primary CNS lymphoma
  • Primary lymphoma of the brain
  • Pineal gland tumours
  • Primary germ cell tumours of the brain

Symptoms

Some tumours may not cause symptoms until they are very large. Then they can quickly damage a person’s health. Other tumours have symptoms that develop slowly.

The symptoms depend on the tumour’s size, location, how far it has spread, and whether there is swelling.

The most common symptoms are:

  • Changes in the person’s mental function
  • Headaches
  • Seizures (especially in older adults)
  • Weakness in one part of the body

Headaches caused by brain tumours may:

  • Be worse when the person wakes up in the morning, and clear up in a few hours
  • Occur during sleep
  • Occur with vomiting, confusion, double vision, weakness, or numbness
  • Get worse with coughing or exercise, or with a change in body position

Other symptoms may include:

  • Change in alertness (including sleepiness, unconsciousness, and coma)
  • Changes in hearing
  • Changes in taste or smell
  • Changes that affect touch and the ability to feel pain, pressure, different temperatures, or other stimuli
  • Clumsiness
  • Confusion or memory loss
  • Difficulty swallowing
  • Difficulty writing or reading
  • Dizziness or abnormal sensation of movement (vertigo)
  • Eye problems
  • Eyelid drooping
  • Pupils of different sizes
  • Uncontrollable movements
  • Hand tremor
  • Lack of control over the bladder or bowels
  • Loss of balance
  • Loss of coordination
  • Muscle weakness in the face, arm, or leg (usually on just one side)
  • Numbness or tingling on one side of the body
  • Personality, mood, behaviour, or emotional changes
  • Problems with eyesight, including decreased vision, double vision, or total loss of vision
  • Trouble speaking or understanding others when speaking
  • Trouble walking

Other symptoms that may occur with a pituitary tumour:

  • Abnormal nipple discharge
  • Absent menstruation (periods)
  • Breast development in men
  • Enlarged hands
  • Excessive body hair
  • Facial changes
  • Low blood pressure
  • Obesity
  • Sensitivity to heat or cold

Signs and tests

Most brain tumours increase pressure in the skull and press on brain tissue because of their size and weight.

The following tests may confirm the pressure of a brain tumour and find its location:

  • CT scan of the head
  • EEG
  • Examination of tissue removed from the tumour during surgery or CT-guided biopsy (may confirm the type of tumour)
  • Examination of the cerebral spinal fluid (CSF) (may show cancerous cells)
  • MRI of the head

Treatment

Treatment can involve surgery, radiation therapy, and chemotherapy. Brain tumours are best treated by a team that includes:

  • Neurosurgeon
  • Oncologist
  • Radiation oncologist
  • Other health care providers, such as physicians and social workers

Early treatment often improves the chance of a good outcome. How you are treated depends on the size and type of tumour and your general health. The goals of treatment may be to cure the tumour, relieve symptoms, and improve brain function or comfort.

Surgery is often needed primary brain tumours. Some tumours may be completely removed. Those that are deep inside the brain or that enter brain tissue may be debulked instead of removed. Debulking is a procedure to reduce the tumour’s size.

Tumours can be hard to remove completely by surgery alone, because the tumour invades surrounding brain tissues much like roots from a plant spread through soil. When the tumour cannot be removed, surgery may still help reduce pressure and relieve symptoms.

    • Radiation therapy is used for certain tumours.
    • Chemotherapy may be used with surgery or radiation treatment.
    • Other medications used to treat primary brain tumours in children may include:
    • Corticosteroids, such as dexamethasone, to reduce brain swelling
    • Medicines such as urea or mannitol to reduce brain swelling and pressure
    • Anticonvulsants, such as evetiracetam (Keppra), to reduce seizures
    • Pain medications
    • Antacids or histamine blockers to control stress ulcers

Complications

Brain herniation (often fatal)

  • Uncal herniation
  • Foramen magnum herniation
  • Loss of ability to interact or function
  • Permanent, worsening, and severe loss of brain function
  • Return of tumour growth
  • Side effects of medications, including chemotherapy
  • Side effects of radiation treatments