Around 12,000 brain and other central nervous system (CNS) tumours are diagnosed in the UK every year, making them the ninth most common cancer. They can occur in children and adults of all genders and ages.
A brain tumour is a lesion or lump in the brain caused when certain sorts of brain cells divide and grow in an uncontrolled way. Brain tumours can be primary or secondary tumours. Primary brain tumours grow from the brain cells themselves while secondary tumours (metastases) spread to the brain from tumours elsewhere in the body.
Not all brain tumours are cancerous but even benign or noncancerous lumps can cause problems by exerting pressure on your brain which sits in your skull, a fixed bony structure.
Symptoms of brain tumours vary widely depending on which part of your brain is affected. However, common symptoms include headaches, seizures, dizziness, nausea, vomiting, changes to your taste or smell and tiredness.
You may also experience neurological problems that are similar to those seen in stroke patients, such as weakness affecting one side of your body, vision or speech problems, memory problems and/or personality changes.
Brain tumours in the wider population are rare but it is important to be able to recognise the signs of potential problems.
Not all brain tumours need surgery. Some brain tumours can be managed conservatively, closely monitored with surveillance imaging or treated non-surgically.
Some brain tumours can be treated using radiotherapy (ie X-rays, photons or protons), chemotherapy (ie anti-cancer drugs) and/or immunotherapy (ie stimulating your body’s own immune system to fight the cancer). A tissue sample (biopsy) of the tumour may need to be collected to determine which treatments are likely to be the most effective.
One of the main challenges with brain tumours and treatments that work via your blood (ie chemotherapy and immunotherapy) is the blood-brain barrier. This is a layer of cells that prevents certain substances in your blood from passing into your brain tissue. In some cases, therefore, surgery is needed to remove a brain tumour or manage the swelling or other reaction in the brain tissue.
Brain surgery to remove a tumour can be performed while you are asleep or awake. It usually involves a craniotomy ie removal of part of your skull to expose the brain tissue but can also be performed using less invasive approaches.
Depending on the location of your tumour, your surgeon may want you to be awake so that certain brain functions can be monitored and tested during your surgery. Numbing medication (analgesia) will be applied to your scalp so you won’t feel any pain — your brain tissue doesn’t have any pain receptors so it doesn’t generate any pain sensations when it is operated on.
Depending on what your brain surgery involves, and which part of your brain is affected, your stay in hospital could be as short as just the day of your surgery or extended for a period of rehabilitation. Your surgeon will discuss the expected course of treatment with you before you agree to any surgery.
After your surgery, it is common to feel tired for a while, sometimes for several months. The time it takes to fully recover will depend on several factors, including the extent of your surgery, the region of your brain affected and your general health.
If you have a craniotomy, you need to tell the DVLA and must not drive until informed by your medical team or the DVLA that it is safe to do so.
The effectiveness of surgery for brain tumours depends on several factors, including how much of the tumour and surrounding tissue (margin) your surgeon is able to remove to prevent abnormal cells being left behind, the molecular make-up of the tumour and how well the tumour responds to other treatments, such as chemotherapy or radiotherapy.
The type of brain tumour you have is also a major factor in the effectiveness of surgery. Brain tumours that originate in the lining of the skull can often be cured with complete removal during surgery. For aggressive brain tumours, surgery will likely not offer a cure but can help slow the progression of the cancer and may improve your quality of life in the meantime.
Brain surgery may be unsuitable if your tumour is located in a particularly important (eloquent) area of your brain or if you have multiple tumours that are too widespread within the brain.
In some of these cases, other treatments can still be given.
Increasingly, a type of highly-focused radiotherapy called stereotactic radiosurgery is used to treat brain tumours — this doesn’t require open surgery but uses highly targeted photons.
Regardless of your treatment plan, you will likely need follow-up appointments to image your brain and determine if any further treatments are needed. This is called surveillance imaging and usually involves MRI scans, or in some cases, CT scans or PET scans.
The diagnosis of a brain tumour for you or those close to you can be devastating. Taking aside the physical aspects of this diagnosis, it can affect a person’s identity and psychological and emotional wellbeing. There are many support services available for you and those close to you.
Mr Alex Leggate is a Consultant Neurosurgeon at Spire Nottingham Hospital and at Queen's Medical Centre, part of the Nottingham University Hospitals NHS Trust. He specialises in minimally invasive spinal surgery (neck and back) and neuro-oncology, and is also trained in all aspects of neurosurgery, spinal pathology and management, including spinal injections.