Editor
28-Jul-2020
Our brain is the best example of a supercomputer. It is the most complex of all organs, but the most organised centre in our body which controls each and every aspect of our bodily functions. Like any other organ, cancer can make its appearance in the brain too. Malignant growth arising from the brain substance itself is known as a primary brain tumour. Dr. Shradha Maheshwari, Neurosurgeon, HOD at Cooper Hospital explains what exactly brain tumour is and what symptoms to watch out for.
Cancers that spread from other organs to the brain are termed as metastatic or secondary brain tumours. There are around 120 types of brain tumours identified till date. Not all of them are cancerous, some are benign or non-malignant tumours as well. The biology and behaviour of each tumour is different and so is their presentation.
The symptoms of brain tumour could vague or very specific. The symptoms depend on the location of the tumour, its effects on the brain substance, and the resultant adjustments in the brain which happen to accommodate these tumours.
The five most common symptoms of brain tumour are
1.) Headache
We all know that "every head has a headache" (well so literally) but these normal looking headaches need extra attention in certain situations. Although common not usually the only symptom in patients with brain tumor, one should be aware of the red flags associated with headaches. If the headaches have shown a change in their behaviour in terms of frequency, character, site, or is associated with vomiting, visual disturbances, then a visit to a specialist becomes mandatory. Similarly, a new onset headache which fails to resolve even with medical treatment also calls for further evaluation. Headaches in patients with a brain tumor may be due to irritation of the meninges (the covering layer of the brain) and due to a rise in the intracranial pressure.
2.) Vomiting
As they say " Go with your gut feeling". So literally a feeling of persistent nausea, feeling of dizziness and bouts of vomiting which typically make you feel better are symptoms that may indicate a brain tumor. Again, not a stand-alone symptom and so other causes of vomiting should be ruled out. In children especially, persistent vomiting without nausea could be a stand-alone symptom of an intracranial pathology and if any other cause cannot found evaluation of brain tumour should be done.
3.) Weakness or sensory disturbances
"I don't do alcohol anymore but I get the same effect just standing up fast." If this is how you feel no matter the age, dig deeper. Noticeable difficulties in walking, talking, hearing, vision, and difficulties in doing any daily activities could suggest a brain tumor around the corner. Each area of the brain has specific functions, a tumour arising in these specific regions could cause specific symptoms. It could as small as an abnormal tingling sensation in limbs to difficulty in holding objects or wearing chapels to gross motor disturbances or paralysis. If the tumour is in the area controlling speech, there may be difficulties in naming objects, understanding, slurring of speech, or inability to speak. Similarly, a tumour affecting the vision may cause blurring of vision, seeing double, inability to see in a specific direction, or complete loss of vision. In brain tumour patients, most of these symptoms have subtle beginnings which slowly progress over a period of time and hence the appropriate and timely evaluation of these symptoms should be done.
4.) Changes in behaviour or personality
Personality changes can be a completely normal phenomenon of ageing. In some cases, it may be the presenting symptom in a patient with a brain tumor. Changes may start as small problems with logic, perception, reasoning, and memory usually noticed by family members and generally are ignored as a part of ageing. If mood swings or personality changes seem sudden, progressive, or severe, further evaluation is suggested. Another symptom is commonly seen in these patient's issues with the sleep-wake cycles. These patients may experience a reversal of their sleep wake cycle like excessive sleepiness during the day but inability to sleep at night or they may have difficulty in initiating or maintaining sleep, waking too early, waking up un-refreshed, etc. Brain tumors may cause neurocognitive dysfunction like alterations in consciousness and confusion regarding self-identity may also arise. For some patients, the development of neuropsychiatric symptoms may be the first manifestation of brain tumour. These patients along with treatment for the tumour also require neuropsychiatric evaluation and support throughout the treatment.
5.) Seizures
New onset seizures at any age may be the first presenting symptom of brain tumor. Seizures forms the first symptoms in almost fifty percent of patients with a brain tumor and in most patients if not the first symptom, it may occur during the course of treatment. The nature of the seizures depends on the site of brain tumor. The seizures may be miniscule episodes of going blank (absence seizures) to simple twitching of face/limbs (focal seizures) to extremely debilitating condition with full blown jerking movements of limbs followed by unconsciousness (generalised convulsion). Irritation of brain parenchyma by the tumor causes abnormal electrical activity in brain. This sudden upsurge of electrical activity leads to seizures and often leaves the patient extremely exhausted after the episode is over.
Besides the above common symptoms of brain tumor, other less common and vague symptoms may be seen in patients. Abnormal lactation from breasts, untimely growth spurts in feet or hands, skin discoloration, change in weight or appetite (pituitary tumors), inability to look upward (pineal gland tumors), hearing loss or ringing noise in the ears (acoustic schwanomma), etc. Not all brain tumors are cancerous, some may be benign tumors as well as other conditions or co-morbidities. Persistent symptoms in spite of the best medical management or worsening of symptoms should prompt the patient for an expert medical opinion. The goal of treatment for brain tumor patients is not just treating cancer but also appropriate relief from the symptoms.
