Brain Cancer (Brain Tumor)

A brain tumor is an abnormal mass of cells in or around your brain. It can form in your brain or other parts of your central nervous system, like your spine or cranial nerves.

Brain tumors can be cancerous (malignant) or noncancerous (benign). Benign tumors are well-contained and typically grow slowly. Malignant tumors (brain cancer) are much more aggressive and can spread into healthy brain and spinal tissue. Only about one-third of brain tumors are cancerous. But any brain tumor can impact your health if it grows large enough to press on surrounding tissue.

Tumors that develop in your brain are called primary tumors. Tumors that spread to your brain after forming in a different part of your body are called secondary tumors, or metastatic brain tumors.

Primary brain tumors are uncommon. Only about 5 per 100,000 people are diagnosed with one each year in the U.S. They can develop at any age, but more commonly affect adults.

Types of brain tumors

Researchers have identified more than 150 different brain tumors. Some types include:

• Meningiomas are the most common type of primary brain tumor. They typically develop slowly. They form in the layers of tissue that protect your brain and spinal cord. In rare cases, a meningioma can be malignant.
• Medulloblastoma is fast-growing and forms at the base of your skull. It’s the most common cancerous brain tumor in children.
• Schwannomas develop from Schwann cells, which help with nerve impulses. They’re common benign brain tumors in adults. Acoustic neuromas are the most common type of schwannoma.
• Gliomas form from glial cells. There are four subtypes. Most cases are malignant, but some are benign. Glioblastoma is the most aggressive type of glioma and the most common type of malignant brain tumor in adults.
• Pituitary adenomas form in your pituitary gland, which is at the base of your brain. They’re benign and may release excess hormones.
• Chordomas typically begin at the base of your skull and the bottom part of your spine. They’re slow-growing and mostly benign.
• Craniopharyngiomas arise from a portion of your pituitary gland. They’re difficult tumors to remove because of their location near critical structures deep in your brain.
• Gangliocytomas, gangliomas and anaplastic gangliogliomas are rare tumors that form in neurons (nerve cells).

Symptoms of brain tumors

Brain tumor symptoms vary depending on the tumor’s location, type, size and growth rate. Benign tumor symptoms are more likely to develop gradually, whereas symptoms from brain cancer may develop more quickly. If a tumor is small, you may have no symptoms.

Signs and symptoms can include:

• Headaches, which may be more severe in the morning or wake you up at night
• Seizures
• Difficulty thinking, speaking or understanding language
• Personality changes
• Weakness or paralysis in one part or one side of your body
• Balance problems or dizziness
• Vision or hearing issues
• Facial numbness or tingling
• Nausea or vomiting
• Confusion and disorientation

See a healthcare provider if you notice these changes.

Brain tumor headaches

Headaches are the most common symptom of brain tumors. About half of adults with brain tumors have them. Headaches are less common in kids with brain tumors.

Brain tumor-related headaches may:

• Come and go, and get worse over time
• Produce a pressing and tightening feeling or a pulsating feeling
• Be moderate to severe in pain
• Start in the early hours of the morning or be present when you wake up
• Get worse when you cough, strain or bend over
• Get better as the day goes on
• Happen along with vomiting, double vision or other neurologic symptoms

It’s important to remember that headaches are very common. Most cases of headaches aren’t due to brain tumors. But see a healthcare provider if you notice a change in your headache symptoms. It’s also a good idea to reach out if they happen suddenly and frequently. You know your body better than anyone.

Brain tumor causes

Researchers know that brain tumors develop when certain genes on the chromosomes of a cell are damaged and no longer function properly. But they aren’t sure why this happens.

The DNA in your chromosomes tells cells throughout your body what to do. It tells them when to grow, when to divide or multiply, and/or when to die.

When brain cell DNA changes, it gives your cells new instructions. Your body develops abnormal brain cells that grow and multiply faster than normal, and sometimes live longer than normal. When that happens, the ever-growing crowd of abnormal cells takes over space in your brain.

There’s nothing you can do to prevent brain tumors.

Risk factors

Most brain tumor cases happen randomly with no clear cause.

The two known risk factors include radiation exposure from previous cancer treatment and having certain rare genetic syndromes, including:

• Gorlin syndrome
• Li-Fraumeni syndrome
• Lynch syndrome
• Neurofibromatosis type 1 and type 2
• Tuberous sclerosis
• Turcot syndrome
• von Hippel-Lindau syndrome

If your biological sibling or parent is diagnosed with one of these conditions, you may want to get genetic counseling to test for it.

Complications

Brain tumors — whether cancerous or not — can cause serious problems. This is because your skull is rigid and doesn’t provide room for the tumor to expand.

They can lead to:

• Damage or destruction of healthy brain tissue
• Increasing pressure within your skull (intracranial pressure)
• Blockage of the flow of cerebrospinal fluid (CSF), causing hydrocephalus
• Bleeding in your brain

How doctors diagnose this condition

If you have symptoms, a healthcare provider will ask about your medical history and do a neurological exam. If they suspect you may have a brain tumor, an imaging test is usually the next step.

In some cases, providers may discover a brain tumor when doing imaging tests for another reason.

Tests that help confirm a brain tumor diagnosis include:

• MRI or CT scan: Magnetic resonance imaging (MRI) is the best imaging test for identifying brain tumors. Computed tomography (CT) is a good alternative if you’re unable to undergo an MRI.
• Biopsy: Providers usually need to get a sample of the tumor for examination under a microscope. This may happen during surgery to remove the tumor or as a separate procedure.
• Biopsy sample testing: Tests can show whether the cells are cancerous and how quickly they’re growing. Other tests can look for DNA changes in the cells. All this information helps determine the best treatment.

Grades

Unlike other cancers, primary brain tumors don’t have a staging system. Instead, healthcare providers assign a grade to them based on what they look like under a microscope. The grades include:

• Grade 1: The cells look nearly normal and grow slowly. Grade 1 brain tumors are often benign.
• Grade 2: The cells are slow-growing and look less like normal cells. The tumor may infiltrate surrounding tissues.
• Grade 3: The cells look distinctly abnormal. It’s a cancerous tumor that’s aggressive and may spread in your brain or spinal cord.
• Grade 4: The cells appear highly abnormal. These cancerous tumors are the most aggressive and fastest growing.

How is it treated?

Brain tumor treatment depends on several factors, like the tumor’s location, size and type. Your age and overall health play roles, too.

If the tumor is very small, benign (grade 1) and you don’t have symptoms, your healthcare provider may recommend monitoring it with regular imaging.

Providers often use a combination of therapies to treat a tumor, especially cancerous ones. Your treatment options might include:

• Brain surgery (craniotomy): When possible, neurosurgeons remove as much of the tumor as possible. This is the go-to treatment.
• Radiation therapy: High doses of X-rays destroy tumor cells or shrink the tumor. Radiosurgery, proton beam therapy and brachytherapy are types of radiation therapy.
• Chemotherapy: Drugs kill cancer cells in your brain and throughout your body.
• Immunotherapy: Drugs use your body’s immune system to fight cancer.
• Targeted therapy: Drugs target specific features in cancer cells without harming healthy cells.
• Clinical trials: You try experimental treatments for the type of tumor you have.
• Palliative care: This is an extra layer of support on top of the cancer care you already receive. It provides symptom relief and emotional support. Caregivers can get this support, as well.

What can I expect if I have this condition?

The prognosis (outlook) for people with primary brain tumors varies greatly. Factors that affect the prognosis include:

• The tumor’s type, grade and location
• Whether surgery removes the whole tumor
• Your age and overall health

In many cases, healthcare providers can successfully treat a brain tumor. For some people, brain tumors can recur (return) after treatment.

Your healthcare team is the best resource for more detailed information on your unique case. If you’ve been diagnosed with a brain tumor, it may be helpful to ask your team the following questions:

• Is the tumor malignant or benign?
• What kind of tumor do I have?
• What type of treatment is best for me?
• Will my treatment cause side effects?
• What type of specialists will be part of my care?
• What’s my prognosis?
• Are my family members at risk of developing a brain tumor?
• Do you know of any online or in-person support groups for people with brain tumors?