Brain tumor

The symptoms of a brain tumors are often very diverse and atypical. Most people do not immediately associate the first signs of a brain tumor with a malignant growth in the brain. The symptoms depend on the region of the brain in which the tumor formed, how fast it is growing, and how big it is.

Benign brain tumors often grow slowly over months or years and cause no symptoms for a long time. Malignant tumors in the brain, on the other hand, are often aggressive , develop quickly and make themselves noticeable more quickly.

A tumor in the brain increases intracranial pressure and gradually displaces or damages healthy tissue - this applies equally to benign and malignant tumors. These two factors can also explain the symptoms that arise. A possible brain tumor can be recognized by the following warning signals:

• New headaches , especially at night or early in the morning, get better during the day.
• Headaches that intensify continuously over a period of days or weeks and cannot counteract "normal" headache medication.
• Epileptic seizures (convulsions): Especially adults who suffer from epilepsy for the first time should see a doctor.
• Nausea and vomiting
• Disturbances in consciousness : drowsiness up to coma
• Visual impairment : Affected people have blurred vision or experience visual field failures
• Speech disorder
• Hearing loss
• Swallowing disorders
• dizziness
• Hormonal disorders , such as delayed onset of puberty and stunted growth, can be symptoms of a brain tumor in children and adolescents.
• Numbness and paralysis (e.g. facial muscles)
• Disorders of sensitivity to heat, cold, pressure or touch
• Impaired coordination of movements , clumsiness
• Changes in personality and character : irritability, forgetfulness, listlessness, increased distractibility, difficulty concentrating, disorientation, fears, depression

These symptoms of a brain tumor can occur in both children and adolescents and adults. An earlier study by British researchers found that parents were particularly likely to have vomited and headaches without a gastrointestinal infection in their child before the diagnosis of the brain tumor. Less often they noticed unsteady gait with no apparent cause, visual disturbances and weight loss in their child .

Always consult your doctor promptly yourself or with your child if you or your child notice such symptoms. It may or may not be due to a brain tumor. Most people with a headache do not have a brain tumor, but there are other harmless reasons for it.

Brain tumor: definition and frequency

By definition, a brain tumor is a growth in the brain that can be either benign or malignant. There are very many type of brain tumor that can form in different places, are differently malignant and aggressive and have their origin in different tissues and cell types in the brain. For example, they can arise from the supporting cells (gliomas), the membranes of the brain and spinal cord (meningiomas) or the cranial nerves (neurinomas).

Compared to other types of cancer such as breast cancer , prostate cancer , colon cancer or lung cancer , malignant brain tumors are rather rare . They only make up around two percent of all cancers. In Germany, a good 7,000 people contracted it in 2013 - men slightly more often than women. Central nervous system (CNS) tumors form more often in the brain than in the spinal cord.

A brain tumor can in principle occur at any age . An adult can develop a brain tumor just as much as a child. Doctors find tumors in the brain more common between the ages of 50 and 70. But a peak in frequency can also be identified in childhood. In children, brain tumors are the seconds most common types of cancer after blood cancer - leukemia . The reasons for the increased occurrence are still unknown.

Types of brain tumors

There are many different types of brain tumors that originate from different cells in the brain: up to 150 different variants are known in the specialist literature. Sometimes the brain tumor is benign, sometimes malignant. What they all have in, however, is that a brain tumor that increases in size can displace or damage healthy brain tissue - and can thus cause a wide variety of, often very serious, complaints. Some brain tumors are particularly aggressive, grow quickly, and have an unfavorable prognosis.

Benign or Malignant? Classification of brain tumors

The World Health Organization (WHO) classify brain tumors into four grades - depending on their aggressiveness, growth rate and course:

• Grade 1 : The brain tumor is benign and grows slowly.
• Grade 2 : the brain tumor is still benign, but tends to recur (relapse, relapse); the transition to a malignant tumor is possible.
• Grade 3 : The brain tumor is already malignant, but it grows slowly.
• Grade 4 : The brain tumor is very malignant and aggressive, it grows quickly.

This WHO classification is very important for the choice of treatment, therapeutic success, course and prognosis of brain tumors.

Types of brain tumors by cell type

The cell type from which the brain tumor developed also plays an important role. An overview of the most common types of brain tumors .

Many brain tumors start from the supporting cells in the central nervous system, the so-called glial cells. The umbrella term for these brain tumors is gliomas . They make up about 40 percent of all brain tumors. These types of brain tumors include, for example:

• Glioblastomas are particularly malignant and aggressive and therefore correspond to WHO grade 4. At around 50 percent, glioblastomas are the most common gliomas.
• Astrocytomas : Like glioblastomas, they arise from altered cells, the so-called astrocytes. Doctors differentiate between a diffuse astrocytoma, anaplastic astrocytoma or pilycystic astrocytoma. About 30 percent of all gliomas are astrocytomas.
• Oligodendrogliomas develop from so-called oligodendrocytes and come in different WHO grades. At around eight percent, they are less common.
• Ependymomas : They develop from the wall (the covering tissue) of the brain chamber. Different WHO grades are possible. About six percent of gliomas are ependymomas.

Doctors also differentiate between the following types of brain tumors:

• Meningiomas : These include tumors of the meninges of the brain and spinal cord (meninges). This type of brain tumor is usually benign (WHO grade 1) and grows slowly. But WHO grades 2 and 3 also occur. Doctors often find meningiomas by chance during another exam.
• Embryonic tumors such as medulloblastoma: It is particularly common in children and affects the cerebellum. It originates from immature cells in the children's brain. Boys are affected slightly more often than girls. The medulloblastoma is malignant (grade 4).
• Tumors of the cranial nerves : These include, for example, schwannomas (= neurinomas, benign tumors, mostly WHO grade 1) and neurofibromas. Brain tumors that originate in the blood vessels in the brain are less common.

There are also some types of brain tumors that do not belong to these in the strict sense:

• Adenomas : Brain tumors can also start from the glands in the brain. They are often benign, such as pituitary adenoma. Still, they can cause severe symptoms and are often difficult to treat.
• CNS lymphomas and CNS sarcomas : By these, doctors understand special forms of lymphoma and soft tissue cancer (sarcoma). They can occur anywhere in the body - including the central nervous system.

Brain metastases are to be distinguished from brain tumors . Here the original tumor is in another organ, for example in the breast or in the intestine. From there it sends cancer cells to the brain via the bloodstream. Brain metastases occur in some types of cancer, such as breast , lung and colon cancer. 

Brain tumor: causes

The causes of brain tumors are still largely unknown to this day. In most cases, doctors cannot determine why one person develops a brain tumor and another does not. Risk factors, as in other cancers, for example smoking, obesity or excessive alcohol consumption do not seem to play a role in brain tumors.

Also, stress , emotional stress, contact with chemicals and pollutants or traumatic brain injuries probably will not come as a cause of a brain tumor in question. And it has not been proven that a brain tumor can arise from cell phones, smartphones and other devices that emit electromagnetic radiation.

A risk factor for brain tumors appears to be the increased exposure to ionizing radiation. For example, radiation therapy to the head due to another cancer can increase the risk of brain tumors.

Some very rare hereditary diseases such as neurofibromatosis type 1 and type 2, Von Hippel-Lindau syndrome or Li-Fraumeni syndrome are associated with the development of brain tumors. Even if the genes are involved and there is a hereditary predisposition, one cannot say that the brain tumor is hereditary - at least not directly.

Brain tumor: diagnosis

One thing in advance: there is no simple brain tumor test that doctors could use to identify the danger in the head at an early stage. Most people see their doctor for unusual symptoms. Sometimes doctors discover the brain tumor by chance during another exam.

The diagnosis of a brain tumor belongs in the hands of an experienced neurologist, a neurologist. At first he asks you about your medical history. Among other things, the following questions are of interest to him:

• What symptoms do you have exactly, since when and how frequent and intense are they? Headache, epilepsy etc.
• Do the symptoms improve in some situations, for example the headache? When do they get worse?
• Are you, unlike in the past, particularly easily irritable, aggressive, lackluster or unfocused?
• Do you suffer from underlying diseases? If yes, which?
• Have you had radiation therapy for cancer?
• Are you aware of hereditary diseases in your family?

From your answers, the doctor already gets the first clues as to whether a brain tumor could be present or not. This is followed by a physical and neurological exam . The doctor tests, among other things, the reflexes, movement sequences, coordination or the function of the muscles. If a brain tumor is suspected, a blood test is routine. Although it does not provide any specific information about the brain tumor, it shows in general how well the organs are functioning.

Brain tumor: treatment

The treatment of the brain tumor belongs in the hands of an experienced team of doctors. This includes doctors from a wide variety of disciplines who work closely together: neurosurgeons, oncologists, radiologists, neurologists, pathologists or psycho-oncologists. In so-called tumor boards, you can advise which treatment is best for a brain tumor. There are clinics that specialize in the treatment of brain tumors.

The therapy of a brain tumor always depends on various factors: the type of brain tumor, its location, size, aggressiveness, speed of growth and spread. That is why the question of one brain tumor therapy cannot be answered across the board, but only on an individual basis. There are several treatment that doctor can use to remove brain tumors. Usually they combine several with each other.

Brain tumor: surgery comes first

The operation is the most important therapy for brain tumors. During the operation, doctors try to remove the brain tumor as completely as possible and to protect healthy tissue . The subsequent impairments are thus less serious. Whether this succeeds depends on the type, size and spread of the brain tumor. Some brain tumors grow quickly into healthy tissue and can hardly be removed completely, only partially. Other tumors are inoperable from the start.

A brain tumor operation can have health consequences because it is a tricky business that requires a lot of experience for the surgeon too. Which impairments occur and how pronounced they are always depends on the location and size of the tumor. Seeing, hearing, walking, speaking, memory or the ability to concentrate can be disturbed after a brain tumor operation.

Brain tumor: radiation

In radiation therapy (radiation, radiotherapy), radiologists “bombard” the tumor locally with high-energy rays . In this way, they try to get rid of any remaining cancer cells. The rays damage the genetic material of the tumor cells, which they can hardly repair - they die. Radiologists do not administer the rays all at once, but divide them into different, smaller "portions". Those affected usually have to undergo radiation for a few weeks every day.

Brain tumor: chemotherapy

During chemotherapy , oncologists administer cell toxins, so-called cytostatics, to their patients . These intervene in the division and reproduction mechanism of cancer cells and act in the entire body (systemic). The cell-killing agents ensure that the cancer cells die. There are different chemotherapy drugs that doctors use for brain tumors. And: not every cytostatic agent is suitable for every brain tumor.

Targeted drugs ("targeted therapy") help against some types of brain tumors. Some target certain characteristics of cancer cells, while others cut off the supply of oxygen and nutrients to the tumor. The idea is to starve the cancer out like this.