Brain tumour symptoms: know the signs

The thought of having a brain tumour can be very worrying, but ignoring warning signs is never a good idea.

10 early signs of cancer

It is important to be aware of the symptoms of brain tumours, so that you can recognize the signs, and see your GP.

However it’s also useful to know that brain tumours are fairly rare. Approximately 12,100 people in the UK are diagnosed with a brain tumour and intracranial brain tumours each year. This compares with more than 42,000 people in the UK diagnosed with bowel cancer each year.

Brain tumour symptoms vary. This can depend on the type of tumour and in which part of the brain the tumour is growing.  Similar symptoms can result from malignant (cancerous) and benign (non-cancerous) tumours. They can also vary from person to person. Brain tumours can also grow at different rates – slowly or quickly – depending on the type of tumour.

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Brain tumour symptoms

Headaches

Headaches are among the most common symptoms. Those caused by a tumour tend to be severe, to last a long time, and may be throbbing headaches. They may also feel worse if you cough. Brain tumour-related headaches may not improve after taking painkillers, but you may find that they feel less painful when you stand up.

Waking in the night with a headache, or having worse headaches in the morning, particularly if you also feel sick, may be signs of a brain tumour. If your headaches fit this pattern, particularly if they are making you feel sick, you should see your GP.

12 types of headaches and what they mean

Feeling sick

Your doctor may also describe this as nausea. This symptom can be more extreme in the morning, or if you suddenly change from sitting down to standing up.

If you have a headache, confusion, nausea and vomiting these can be signs that you have increased pressure in your head. In medical terms this is known as raised intracranial pressure. This increased pressure can be caused by a brain tumour.

Vision problems

These can include blurred eyesight, making it difficult to see clearly. You may also have moments where you lose vision – known as ‘greying out’ – when you change posture or stand up quickly, for instance. Persistent or recurrent headache is another possible symptom.

Seizures or fits

These are a common symptom of brain tumours, and can often be the reason why people visit their doctor about this condition. According to The Brain Tumour Charity, one quarter of those who are diagnosed with a brain tumour see their GP about their symptoms for the first time following a seizure.

Seizures can vary in strength. Subtle seizures, which are more common than severe seizures, don’t make you lose consciousness. They can cause twitching in an arm or leg, as your muscles relax and then tighten again.

Some seizures can cause short periods of ‘absence’, which can make it seem as though you have switched off for a while, but you may still have your eyes open. They can also affect your senses of taste and smell. It can take a little while to recover after a seizure, so don’t try to get up and move too quickly.

Personality changes

Brain tumours can cause personality changes, either directly, because of their location, or because of swelling in the brain following treatment. Sometimes the emotional toll of having a brain tumour and everything that follows from that, such as the treatment that’s involved, and becoming more dependent on others, can bring on a change in personality.

Being aggressive or irritable, feeling confused, depressed and having mood swings, are all common symptoms of personality changes. Someone with a brain tumour may also lose their inhibitions, and shout and swear, or behave inappropriately in public.

Feeling drowsy

This symptom usually develops later on in the course of this condition. As the tumour become larger, and exerts more pressure on your brain, it can affect your sleeping pattern. This can mean that you sleep during the day, as well as sleeping more at night.

Other factors affecting brain tumour symptoms

• The size of the tumour can make a difference because tumours can cause pressure in your skull. The pressure will increase as the tumour grows. The symptoms most likely to be caused by extra pressure include sickness, headaches, vomiting and confusion.
• The location of the tumour can also make a difference, because it can affect how well different parts of the brain work.
• Tumours located in the cerebrum can cause weakness or numb feelings, and may affect your speech.
• Tumours that develop in the cerebellum and brain stem can cause problems with your movement, balance and physical coordination. This can also cause dizziness and a stiff neck.

A quick guide to the brain

There are three main parts to the human brain:

1. The cerebrum iis the biggest section of the brain. It is split into two halves, with the right half controlling the left side of the body, and the left side controlling the right side of the body. These halves both divide into four lobes that have control over a range of functions. These include thinking and feeling, memory, personality, language, sight, touch and behaviour, and other functions. For example, a tumour in your frontal lobe (part of the cerebrum) can cause weakness on one side of your body.

2. The cerebellum is at the back of your brain and looks after co-ordination, posture and balance. Tumours in the cerebellum and the brain stem can also cause difficulties with coordination, and can make you unsteady and dizzy, and can affect your ability to walk.

3. The brain stem joins the brain to the spinal cord. It looks after the body functions that keep us alive, including breathing, heart rate, blood pressure, heartbeat, swallowing and digestion.

4.The pituitary gland, in the centre of the brain, looks after energy, weight gain, growth, mood swings and blood pressure. The symptoms of a tumour can include headaches, and loss of vision.

Diagnosing brain tumours

Brain tumours aren’t always easy to diagnose in the early stages, because the symptoms they cause aren’t always clear.

There are a number of symptoms that can appear early on, including;

• Early morning headaches that are more painful than your headaches usually are, and headaches that wake you at night. These don’t feel the same as normal headaches, and get steadily worse as time goes on. You may also feel nauseous, and you may throw up.
• You may have seizures, caused by abnormal electrical impulses in your brain. According to the brain cancer charity, brainstrust, if your first seizure happens when you are an adult, your doctor will very probably want to refer you on to a specialist, to have it investigated.
• If you have disturbed vision, such as only being able to see out of one eye, or double vision, this could mean that a brain tumour is affecting your optic nerve, or that the pressure inside your skull is higher than normal.

If you have unusual symptoms, particularly any that you haven’t had before, and they continue happening, you should see your GP. Don’t put this off. You may not have any serious health issues, but it is very important to have these symptoms checked. If your GP feels that your symptoms may indicate that you have a tumour, it is far better to have them diagnosed, and treated as quickly as possible, than to risk delaying treatment.

In some cases symptoms – including drowsiness, a very bad headache or a seizure – can come on very suddenly. If this happens to you, or someone you’re with, go to A&E immediately.

John Newlands, Senior Cancer Information Nurse at Macmillan Cancer Support, says:

“Some brain tumour symptoms, like headaches, can be caused by much more common and less serious conditions. But even though it’s unlikely to be a brain tumour, it is always worth seeing your GP to get your symptoms checked out, especially if they are persistent.

“If you have been diagnosed with cancer, don’t put off getting treatment – it’s best to start as soon as you can. Practical help, information and emotional support is available free from the Macmillan Cancer Support line on 0808 808 00 00 - or by visiting www.macmillan.org.uk”

If your doctor feels that your symptoms indicate that you may have a brain tumour, they will refer you to a specialist, for instance, a neurosurgeon, or possibly a neurologist. Your specialist will carry out a neurological examination. This will involve asking you about different aspects of your health, and they will want to know about any existing health conditions you have.

Your specialist will also carry out a physical examination, and check for any problems with your nervous system. It’s important that everything possible is taken into account, so that they have as much information about your health as possible.

The examinations will include checking your muscle strength, reflexes and co-ordination, to see if they are all working as they should. Another test they may carry out is to look at the back of your eyes. This will show if your optic disc has swollen. If it has, this may indicate that you have increased blood pressure in your skull. This may be a sign of a brain tumour.

More tests are likely to follow. These will probably include a Magnetic Resonance Imaging (MRI) scan or a computerized tomography (CT) scan. These can show whether you have a brain tumour. They are also used to help your surgeon remove a very small part of the tumour during a biopsy.

‘Awareness of brain tumours and these symptoms amongst people over 50 is important because it is the age group where the incidence of having a brain tumour is increasing the most,’ says Helen Bulbeck, Director of Services, brainstrust. ‘There should be equality of treatment across all age groups, particularly with people living longer and more active lives.’

What happens during a biopsy for a brain tumour?

You will probably need to have a biopsy carried out so that your medical team can find out what type of tumour you have. During a biopsy your surgeon takes a sample of your tumour. They do this by making a small hole in your skull. Your surgeon takes a sample using a very narrow needle to reach down and into the tumour to remove a small piece of it for examination.

A neuropathologist (a doctor who is an expert in body cells, especially in diagnosing diseases of the nervous system and the brain) will then examine the sample, and pass information about your particular type of tumour to the rest of the team caring for you. This means that they know what type of tumour you have, and how best to treat it.

Classifying brain tumours into grades

Brain tumours aren’t all the same. They are graded – or put into groups - from 1 to 4 - depending on how fast they will probably grow. A pathologist – an expert on disease and what causes it - examines cells from tumours on a microscope, looking to see if the sample is healthy, or if there are any abnormalities. They then classify them into the relevant grade, 1 being the slowest-growing and 4 being the fastest. (Pathologists also work on research on the positive side of medicine, helping to develop treatments for a wide range of conditions.)

Grades 1 and 2 are regarded as being benign. These tumours are low grade, grow more slowly than malignant tumours, and are less likely to spread to other parts of your body. (See below for more on benign brain tumours.)

Grades 3 and 4 are regarded as being high grade, faster growing, and malignant. Some tumours go through what is known as malignant transformation. This means that tumours can change, and become more malignant. So grade 2 tumours can go up the scale to become a grade 3 tumour, and a grade 3 could become a grade 4, the top of the scale.

Dealing with malignant tumours is usually more difficult, because even if they are totally removed by surgery they can still grow back. They can also spread from their initial site to different parts of your brain, and to different parts of your body.

Unfortunately, malignant brain tumours tend to be harder to treat. And they can cause a lot of damage, and may be life-threatening, depending on their location in your brain and the type of tumour you have. Benign tumours may also cause problems in the brain, see the section on benign brain tumours below for more detail.

Treatment for brain tumours

When it comes to deciding what treatment you need to have for your brain tumour, you will have a team of experts working together. This is a recommendation from NICE (National Institute for Health and Care Excellence), to ensure that you have the best care and treatment possible, and that this is tailored to your situation. The team is known as your MDT, (short for Multidisciplinary Team).

It would be impractical for you to meet every member of your MDT each time you have an appointment, so there will be a specific member of the team who will keep in contact with you.

Your treatment will depend on your situation – what type of brain tumour you have, where it is situated in your brain, and whether it is benign (not cancerous) or malignant (cancerous). Some cancers start off elsewhere in the body – your lung, breast, prostate or stomach, for example – and if they are malignant, may travel to other parts of your body. These are then known as secondary cancers.

Treatment for malignant cancers

Your treatment will depend on where your cancer is, how quickly it is growing, and whether it has already spread from the point at which it developed, to other parts of your body. Unfortunately, malignant brain tumours do tend to be harder to tackle because even if they are completely removed in an operation, they can come back. They tend to be faster growing than benign brain tumours, and can spread throughout your brain and to the spinal cord.

Your treatment for malignant brain cancer will probably involve radiotherapy or chemotherapy. This may help prevent the cancer returning, and may help to control your symptoms.

Benign brain tumours

If a benign tumour is totally removed from your body, it is less likely to return. Having a benign tumour means that your chances of needing to have radiotherapy or chemotherapy after the tumour is removed, tend to be fairly low. And if your surgeon is able to completely remove the tumour, it is much less likely to regrow.

Benign tumours usually grow more slowly than malignant tumours, and don’t spread to other parts of your brain. However, you may have more than one benign tumour, and any tumour you have will take up space in your skull and so may affect your brain. With modern equipment, for instance MRI and CT scans, medical specialists can see how large the tumour is, and which part of the brain may be affected.

Your surgeon may be able to remove all or most of the tumour in an operation that is known as a craniotomy. If the location of the tumour makes it hard to take all of it out, your specialists may suggest having further treatment, using radiotherapy, or taking anti-cancer drugs.

While benign tumours are lower on the grading system, they can still affect your brain. Ask your medical team to explain the best options for your treatment, and the most likely outcome in your case.

Main types of brain tumours in adults

There are many different types of brain tumour. They fall into different groups, depending on how they develop and behave, and whether they are cancerous – in medical terms malignant – or non cancerous – in medical terms these are classed as benign, although they can still cause problems. These can include memory loss, impaired mobility and personality changes, and will also involve treatment, and a quite intensive follow-up regime.

Types of brain tumours

Benign brain tumours are those that are not cancerous. Brain tumours that are cancerous are known as malignant. These tumours are usually the most dangerous.

The chances of being able to remove a brain tumour successfully tend to depend on what type it is, and where in the brain it is located.

Benign brain tumours

These include Meningiomas, which are quite common. This type of tumour is usually slow growing and benign. They tend to start growing in the meninges, the tissue covering your brain and spinal cord.

Acoustic neuroma is a benign (non-cancerous) tumour of the hearing nerve, and is quite rare – only five percent of brain tumours are acoustic neuromas.

Haemangioblastomas are benign tumours that originate in the cells lining our blood vessels. They can usually be removed with surgery.

Pituitary adenoma tend to grow in the pituitary gland, and are usually treated with drugs or surgery. Most of these tumours are non-cancerous.

Malignant brain tumours

Glioma tumours can be either malignant or benign, and develop from glial cells, found in the brain. This term covers a range of different brain tumours. Glioblastoma are the commonest form of cancerous brain tumours

Astrocytoma usually develop in the cerebrum. These are the commonest form of glioma. They are sometimes called anaplastic astrocytoma when they reach grade 3. Once they reach grade 4 they are also known as a glioblastoma multiforme, or GBM4. These tumours often develop in the cerebral hemisphere of the brain and spread outwards from there. 

Anaplastic oligodendroglioma tumours tend to be found in middle-aged adults. They don’t respond very well to radiation, but chemotherapy may be more effective.

Lymphoma tend to appear in people who have a damaged immune system. They are most likely to be treated with radiation and chemotherapy. Lymphoma are similar to gliomas.

For more information about all types of brain tumours, visit Macmillan's website or the braintrust

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