Brain tumor: symptoms, treatment and life expectancy

Brain tumor symptoms depend greatly on the location of the tumor in the brain. Brain tumor symptoms can be roughly divided into three groups: epilepsy, deficit symptoms and increase in pressure in the skull. The symptoms and complaints that occur with a brain tumor can vary greatly and depend not only on the location in the brain where the tumor is located, but also on the size of the tumor and its growth rate. A brain tumor is cell proliferation or abnormal cell growth in the brain. There are malignant and benign brain tumors. Brain tumors can originate in the brain itself, or elsewhere in the body, after which it has spread to the brain. After leukemia, brain tumors are the most common cause of cancer in children in the Netherlands. In the Netherlands there are more than a hundred new cases per year. The survival rate of patients with a malignant brain tumor has hardly improved over the years.

  • Brain tumor: key points
  • What is a brain tumor?
  • Types of brain tumors
  • Primary brain tumor
  • Gliomas
  • Meningiomas
  • Acoustic neuromas (Schwannoma)
  • Pituitary adenomas
  • Medulloblastomas
  • Germ cell tumors
  • craniopharyngioma
  • Secondary brain tumor
  • Types of brain tumors
  • Malignant brain tumor
  • Benign brain tumor
  • Preventing primary brain tumors
  • Brain tumor: tumor grades 1, 2, 3 and 4
  • Causes and risk factors
  • White skin color
  • Age
  • X-rays
  • Chemicals
  • Familial predisposition
  • Symptoms of a brain tumor
  • Headache due to brain tumor
  • Mental changes
  • Loss symptoms, speech and memory disorders
  • Epileptic attacks
  • Bleeding
  • Other symptoms of a brain tumor
  • Diagnosis and research
  • Interview and neurological examination
  • Imaging examination and biopsy
  • Treatment of a brain tumor
  • Neurosurgery (surgery)
  • Irradiation (radiotherapy)
  • Chemotherapy
  • Prognosis: life expectancy and survival rate of brain tumor

Radiotherapy (irradiation) for a brain tumor / Source: Adriaticfoto/Shutterstock.com

Brain tumor: key points

  • In the Netherlands, approximately 1,500 patients are diagnosed with a primary tumor of the nervous system every year. More than half of these are malignant.
  • A brain metastasis is diagnosed in approximately 7,000 patients per year. Brain metastases are metastases in the brain from cancer that originated elsewhere in the body.
  • Glioblastoma multiforme, GBM or glioblastoma for short, is one of the most aggressive neoplasms (new formation, tumor formation) in humans.
  • Surgery and radiotherapy occupy the most important place in the treatment of brain tumors.

What is a brain tumor?

A brain tumor is cell proliferation or abnormal cell growth in the brain . Keep in mind that there are several types of brain tumors that differ in symptoms, severity, growth rate, etc. Some brain tumors are benign and some brain tumors are malignant. Brain tumors can originate in the brain itself (primary brain tumors), or elsewhere in the body after which it has spread (metastasized) to the brain (brain metastases or secondary brain tumors).

Melanoma / Source: National Cancer Institute, Wikimedia Commons (Public domain)

Types of brain tumors

A distinction is made between a primary and a secondary brain tumor. A primary brain tumor is a growth that arises from the brain tissue itself. A secondary brain tumor is a metastasis of cancer elsewhere in the body to the brain. These are much more common than primary brain tumors.

Primary brain tumor

A primary brain tumor originates in the brain itself or in tissues of the brain, such as in the meninges, cranial nerves, pituitary gland or pineal gland. Tumors start as mutations in the DNA of a single cell; cancer occurs when mutations occur in genes involved in regulating cell division. In adults, primary brain tumors are much less common than secondary brain tumors, in which cancer starts elsewhere in the body and spreads to the brain. Many different types of primary brain tumors exist. Each gets its name from the type of cells involved. Examples are:

Gliomas

These tumors start in the brain or spinal cord and include astrocytomas, ependymomas, glioblastomas, oligoastrocytomas, and oligodendrogliomas.

Meningiomas

A meningioma is a tumor that originates from the meninges. It is therefore also called meningeal tumor. Most meningiomas are benign.

Acoustic neuromas (Schwannoma)

An acoustic neuroma or Schwannoma is a benign tumor that develops on the nerves that control balance and hearing, leading from the inner ear to the brain.

Pituitary gland / Source: Tefi/Shutterstock.com

Pituitary adenomas

These are usually benign tumors that develop in the pituitary gland, a gland in the center of the head, below the brain. These tumors can affect pituitary hormones, which can lead to effects throughout the body.

Medulloblastomas

These are the most common malignant brain tumors in children. A medulloblastoma is a brain tumor in the cerebellum and tends to spread through the cerebrospinal fluid. These tumors are less common in adult men and women.

Germ cell tumors

Germ cell tumors can develop during childhood where the testicles or ovaries will form. But sometimes germ cell tumors affect other parts of the body, such as the brain. It is a rare form of childhood cancer.

craniopharyngioma

A craniopharyngioma is a benign tumor in the pituitary gland, the gland that secretes hormones that regulate many bodily functions. As this tumor slowly grows larger, it can affect the pituitary gland and other structures near the brain.

Lung cancer / Source: Muratart/Shutterstock.com

Secondary brain tumor

In adults, secondary brain tumors are much more common than primary brain tumors. In principle, all forms of cancer can spread to the brain, but tumors that regularly lead to brain tumors are:

  • breast cancer
  • lung cancer;
  • colon cancer
  • kidney cancer
  • malignant skin cancer (melanoma)

Types of brain tumors

Malignant brain tumor

Secondary brain tumors are metastases from another part of the body and are by definition malignant. The most common type of primary malignant brain tumor arises from supporting cells of the brain tissue (glia cells), a so-called ‘glioma’. A characteristic of a glioma is that it almost never spreads. The malignant nature of a glioma lies in the fact that it grows diffusely in the surrounding brain tissue and that a glioma almost always returns. The most common benign brain tumor arises from the meninges and is called ‘meningioma’.

Benign brain tumor

A benign (non-cancerous) brain tumor is a mass of abnormal cells that grows relatively slowly in the brain. Benign brain tumors tend to stay in one place and do not spread. Cancer cells can eventually grow into surrounding tissue, but benign tumors do not, although they can suppress adjacent tissues and structures. A benign brain tumor usually does not come back if the entire tumor can be safely removed through surgery. They are usually not deeply rooted in the tissue, which means that surgical removal is often successful.

Preventing primary brain tumors

Unlike brain metastases, primary brain tumors are a rare phenomenon. In the Netherlands, approximately 1,000 people are diagnosed with a malignant primary brain tumor each year and approximately 7,000 people are
diagnosed with a brain metastasis.[1] About 500 people are diagnosed every year with a benign brain tumor.

Brain tumor: tumor grades 1, 2, 3 and 4

The World Health Organization (WHO) has classified the malignancy or aggressiveness of gliomas into four grades . Low-grade (grade 1 and 2) and high-grade (grade 3 and 4) gliomas are distinguished. Grade 4 (glioblastoma multiforme) accounts for 70% of all cases. High-grade gliomas are characterized by rapid and uncontrolled growth. Low-grade gliomas, on the other hand, grow slowly. Based on microscopic examination of a piece of tumor tissue, the pathologist determines the type and grade of the tumor. This is important for determining the treatment, the course of the disease and the prognosis.

Causes and risk factors

Nothing is known with certainty about the causes of a primary brain tumor. A number of risk factors can be distinguished:

White skin color

Brain tumors are more common in people with a white skin color, with the exception of meningioma (a tumor originating from the meninges), which occurs most often in people with a black skin color.

Age

The risk of a brain tumor increases as a person ages. Brain tumors are most common in older adults. Nevertheless, a brain tumor can occur at any age. And certain forms of brain tumors, such as medulloblastoma (a malignant brain tumor in the lower part of the brain stem), occur almost exclusively in children.

X-rays

Exposure of the brain to X-rays increases the risk of a brain tumor. Research shows that one should not expect an increased risk from low-frequency electromagnetic radiation (radiation from a mobile phone call or around high-voltage cables).

Chemicals

Exposure to chemicals at work. Nowadays, safety standards in the chemical industry and the environment in Western countries are such that exposure of workers to high doses of chemicals is limited.

Familial predisposition

A small proportion of brain tumors occur in people with a family history of brain tumors or a family history of genetic syndromes that increase the risk of brain tumors.

Brain tumor / Source: Bobjgalindo, Wikimedia Commons (GFDL)

Symptoms of a brain tumor

The symptoms and complaints that occur with a brain tumor can vary greatly and depend largely on the location in the brain where the tumor is located, but also on the size of the tumor and its growth rate. Brain tumors can cause the following complaints, among others:

  • headache: new headache or change in headache pattern
  • headaches that become more frequent and severe
  • unexplained nausea or vomiting
  • vision problems, such as blurred vision, double vision, or loss of peripheral vision
  • gradual loss of feeling or movement in an arm or leg
  • problems with balance
  • speech problems
  • confusion regarding everyday matters
  • personality or behavior changes
  • seizures, especially in someone who has no history of seizures
  • hearing problems

Headache due to brain tumor

Headache is often the first symptom of a brain tumor and occurs as a result of an increase in pressure in the brain. This headache mainly occurs during activities that also increase pressure, such as bending over, sneezing and straining. This may be accompanied by nausea and vomiting. Characteristic of a brain tumor is a headache in the morning. The focus is on a diffuse, throbbing headache. This is often accompanied by what is called ‘projectile vomiting’: violent vomiting without nausea.

Mental changes

Psychological changes, such as slowing down or psychological and verbal disinhibition. Confusion may also occur.

Loss symptoms, speech and memory disorders

Symptoms such as loss of strength or paralysis in the arm or leg, speech disorders and concentration and memory disorders.

Epileptic attacks

Epileptic seizures (in tumors in the temporal lobe of the brain), where the person in question suffers from a ‘strange bad smell and taste’.[2] For example, a sweet taste in the mouth or a salty taste in the mouth.

Bleeding

Bleeding in a tumor, which is sometimes difficult to distinguish from a normal cerebral hemorrhage.

Other symptoms of a brain tumor

Other common symptoms of a brain tumor include dizziness, loss of balance and coordination problems and tinnitus. As the pressure in the skull increases due to the growth of the tumor, nausea, vomiting, lethargy, drowsiness, recurrent bouts of fever and even coma may occur. Persistent hiccups also sometimes occur, as does tongue tingling. Blurred vision can also be one of the complaints.

ยป Keep in mind that this list of brain tumor symptoms is not exhaustive.

CT scan / Source: IStock.com/Pavel Losevsky

Diagnosis and research

Interview and neurological examination

The diagnosis of a brain tumor begins with a physical examination and consideration of your medical history. The physical examination consists of a very detailed neurological examination. The doctor will perform a test to see if the cranial nerves are intact. These are the nerves that originate in your brain. The doctor will also look into your eyes with an ophthalmoscope (eye mirror), an instrument used to examine the inside of the eye. This is a tool that allows a doctor to inspect the retina. It can also be examined whether there is swelling of the optic nerve. When pressure in the skull increases due to a tumor, changes in the optic nerve can occur. The doctor will also examine your muscle strength, balance, reflexes, coordination, memory, hearing and vision, skin sensitivity, hand strength, limb strength and mental agility.

MRI scan of the brain / Source: Triff/Shutterstock.com

Imaging examination and biopsy

Imaging techniques such as the CT scan and the MRI scan can be used to determine the size, location and suspected nature of a brain tumor. Complete certainty can be obtained through tissue diagnostics. This tissue diagnosis provides information about the type and grade of the tumor. Other research, such as an EEG in the case of epileptic seizures, is only performed if there is reason to do so.

Treatment of a brain tumor

The treatment of a brain tumor depends on the type of brain tumor, its size and location. Treatment of a brain tumor can include:

Neurosurgery (surgery)

In many cases it is desirable for the neurosurgeon to remove as much of the tumor as possible, preferably the entire tumor. This is not always possible, because the tumor is located near vital parts of the brain or is entangled with the surrounding healthy brain tissue. Tissue diagnosis then takes place, which helps determine the further treatment plan. Nowadays, people undergo surgery while awake if possible. During the operation you will be given language tests to assess whether an area to be excised can be removed without the risk of impairment of speech. A prerequisite for this method of surgery is that the tumor is present in non-vital parts of the brain tissue and is not too aggressive. This is the case for 200 of the 1,000 patients who present themselves annually in the Netherlands with this type of brain tumor, a so-called ‘low-grade glioma’.

Irradiation (radiotherapy)

Follow-up treatment with, for example, radiotherapy is often necessary, especially if the tumor cannot be completely removed surgically. Radiation can be combined with chemotherapy.

Chemotherapy / Source: Linda Bartlett, Wikimedia Commons (Public domain)

Chemotherapy

This concerns the administration of drugs that inhibit the growth of malignant cells. It turns out that in general brain tumors do not appear to be very sensitive to chemotherapy. In many cases, chemotherapy is only given as palliative treatment for tumor growth after neurosurgery and radiotherapy have previously taken place. Research has shown that it can be useful to use chemotherapy at an earlier stage in the treatment of patients with glioblastoma multiforme.[3]

Prognosis: life expectancy and survival rate of brain tumor

With a pilocytic astrocytoma (grade I glioma) – almost only in children – most patients are cured after a radical resection. In grade 2 low-grade gliomas in adults, approximately 50% of patients die within 10 years. Many patients suffer from epilepsy and cognitive problems. Glioblastoma multiforme (GBM) has a poor prognosis of less than 1 year. The prognosis of patients with a brain metastasis is almost always unfavorable. It appears that only in patients with a brain metastasis where there are no other metastases elsewhere in the body, surgical removal followed by radiotherapy provides long-term survival, i.e. they have a life expectancy of 11 months.[4]

In addition to the tumor grade, the patient’s condition and age are important prognostic factors. The chance of survival for brain tumors is small mainly because the tumors are often only discovered at a late stage and the growths are often difficult to treat.

Nuts

  1. Visser O.: What is cancer? Epidemiology of benign CNS tumors. In: Stalpers LJA, Dirven C, Boogerd W (eds.). Proceedings of the 66th oncology day on benign brain tumors. Amsterdam: The Netherlands Cancer Institute, 2008.
  2. Stalpers LJA, Dieleman EMT, van Westing BRH, Postma TJ, van Furth WR. Diagnosis and treatment of brain tumors. Ned Tijdschr Tandheelkd 2009;116:202-20.
  3. Ibid.

read more

  • Headache on the forehead, back of the head, behind the eyes, from the neck
  • Benign brain tumor: symptoms, cause and treatment
  • Epilepsy: symptoms and treatment epileptic seizure
  • Tinnitus (ringing in the ears or ringing in the ears): symptoms and causes
  • Vomiting (vomiting): causes of vomiting and nausea

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