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Brain tumour, benign

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Brain tumour, benign



Introduction

A benign (non-cancerous) brain tumour is a mass of cells that grows slowly in the brain. It usually stays in one place and does not spread.

Generally, brain tumours are graded from 1 to 4 according to their behaviour, such as how fast they grow and how likely they are to spread. Grade 1 tumours are the least aggressive and grade 4 are the most harmful and cancerous. Cancerous tumours are described as malignant. 

Low-grade brain tumours – grades 1 or 2 – tend to be slow growing and unlikely to spread, so they're usually classed as benign.

These pages focus on low grade brain tumours. For information about brain tumours graded 3 or 4, read high-grade (malignant) tumours.

What are the symptoms?

The symptoms of a low-grade or benign brain tumour depend on how big it is and where it is in the brain. Some slow-growing tumours may not cause any symptoms at first.

Eventually, the tumour can put pressure on the brain and may cause headaches and seizures (fits). The tumour can also prevent an area of the brain from functioning properly. For example, a tumour in the occipital lobe (at the back of the brain) may cause loss of vision on one side.

Who is affected?

Brain tumours can affect people of any age, including children.

There are about 4,300 people diagnosed with benign brain tumours in the UK each year. The majority of these are low-grade gliomas, a type of tumour that starts in the supportive tissue of the brain.

Although the cause of most benign brain tumours is not known, it is thought that certain genetic conditions and previous radiotherapy treatment to the head may increase the risk of one developing.

 

 



 

Treatment

Benign brain tumours can be serious if they are not diagnosed and treated early. Although they remain in one place and do not usually spread, they can cause harm by pressing on and damaging nearby areas of the brain. 

Many benign brain tumours can be surgically removed and don't come back once they have been removed, causing no further problems. However, grade 2 gliomas will often grow back after treatment and have the potential to change into high-grade or malignant (cancerous) tumours, which are fast-growing and likely to spread. This change is called mutation.

Your treatment will depend on the type and location of the tumour, and your outlook will depend on whether the tumour grows back and whether it mutates (changes).

 

Recovery

After treatment, several types of therapy are available to help you recover.

Your doctor can refer you to a counsellor if you want to talk about the emotional aspects of diagnosis and treatment. There are also many organisations and helplines, such as Brain Tumour UK, that provide information and support.

 

Benign brain tumour: Debbie's story

Debbie describes being diagnosed with a benign brain tumour, the symptoms it caused, how she coped with it and what treatments she received.


Media last reviewed: 04/03/2014

Next review due: 04/03/2016

 


Types of benign brain tumour

There are different types of benign or slow-growing brain tumours, depending on the type of brain cells they have grown from. Examples are:



Gliomas. These are tumours of the glial tissue, which binds nerve cells and fibres together. Most brain tumours are gliomas.



Meningiomas. These are tumours of the membranes that cover the brain.



Acoustic neuromas. These tumours grow in the acoustic nerve, which helps to control hearing and balance. 



Craniopharyngiomas. These tumours grow near the base of the brain and are most often diagnosed in children, teenagers and young adults.



Haemangiomas. These are tumours of the brain's blood vessels, which can cause seizures and partial paralysis.



Pituitary adenomas. These are tumours of the pituitary gland (the pea-sized gland below the brain).



Mixed tumours

Mixed brain tumours are made up of two or more different types of tumour, sometimes of different grades.

You will be treated for the most aggressive part of the tumour and your outlook will depend on how much of the tumour is malignant (cancerous), the location of the tumour in your brain and other factors such as your general health.

 

Symptoms of a benign brain tumour

The symptoms of a low-grade or benign brain tumour depend on its size and where it is in the brain. Some slow-growing tumours may not cause symptoms at first.

When symptoms do occur, it is because the brain tumour is either putting pressure on the brain or preventing an area of the brain from functioning properly.

Increased pressure on the brain

If the tumour causes an increase in pressure inside the skull, it can lead to the following symptoms:



epilepsy or fits, which can be either major seizures or twitching in one area of the body



severe, persistent headache



irritability, drowsiness, apathy or forgetfulness



vomiting, which is sometimes sudden and for no apparent reason



dizziness



partial loss of vision or hearing



hallucinations



personality changes, including abnormal and uncharacteristic behaviour



It is important to see a doctor if you develop a persistent and severe headache that does not have any obvious cause, especially if you also have unexpected vomiting.

Loss of brain function

Different areas of the brain control different functions, so any loss of brain function will depend on where the tumour is located. For example, a tumour affecting:



the frontal lobe – may cause changes in personality, weakness in one side of the body and loss of smell



the parietal lobe – may cause difficulty in speaking, understanding words, writing, reading, co-ordinating certain movements and there may also be numbness in one side of the body



the occipital lobe – may cause loss of vision on one side



the temporal lobe – may cause fits or blackouts, a sensation of strange smells and problems with speech and memory



the cerebellum – may cause a loss of co-ordination, difficulty walking and speaking, flickering of the eyes, vomiting and a stiff neck



the brain stem – may cause unsteadiness and difficulty walking, facial weakness, double vision and difficulty speaking and swallowing



 

Causes of a benign brain tumour

Benign brain tumours that are present at birth (congenital) are caused by abnormal development of the baby in the womb. It is not fully understood what causes non-congenital tumours.

Some genetic conditions can increase your risk of a benign brain tumour. These conditions include:



neurofibromatosis



tuberous sclerosis



Turcot syndrome



Li-Fraumeni cancer syndrome



von Hippel-Lindau syndrome



Gorlin syndrome



These conditions tend to cause gliomas (tumours of the glial tissue, which binds nerve cells and fibres together) that appear in childhood or early adulthood, whereas most gliomas start later in adulthood.

 

Other possible causes

Radiotherapy to the brain increases your risk of a brain tumour, although this is still uncommon.

It is also thought that there is an increased risk if there is family history of brain tumours and exposure to chemicals (such as formaldehyde).

Can mobile phones cause brain tumours?

There have been reports in the media about a possible connection between brain tumours and the radiofrequency (RF) energy emitted by mobile phones. RF energy produces heat, which can increase body temperature and damage tissue exposed to it.

It is thought that the amount of RF energy people are exposed to by mobile phones is too low to produce significant tissue heating or an increase in body temperature.

However, research is under way to establish whether RF energy has any effects on our health in the long term. No definitive conclusions have yet been reached.

 

Diagnosing a benign brain tumour

If you develop any of the symptoms of a benign brain tumour, such as a persistent and severe headache, see your GP.

Your GP will examine you and refer you to a specialist if necessary.

They will examine the back of your eye and look for changes to the optic disc (the inside of the back of the eye) caused by increased pressure inside the skull. Raised pressure in the skull may be a sign of a tumour.

If a growth is suspected, you will be referred to a neurologist (brain and nerve specialist).

 

Referral to a specialist

The specialist will ask you about your medical history and symptoms. They will examine your nervous system, which may include tests of your:



reflexes, such as your swallow reflex and knee-jerk reflex



facial muscles (testing whether you can smile or grimace, for example)



hearing and vision



limb strength



balance and co-ordination



skin sensitivity to pinpricks, heat and cold



mental agility (simple questions or arithmetic)



A brain tumour is diagnosed based on your symptoms, examinations and the results of certain tests (see below).

Tests

The most common tests used to help diagnose a brain tumour include:



computerised tomography (CT) scan – this produces a detailed picture of your brain using a series of X-rays



magnetic resonance imaging (MRI) scan – this produces a detailed picture of your brain using a strong magnetic field and radio waves  



electroencephalogram (EEG) – electrodes record your brain activity



If a tumour is suspected, a biopsy (surgical removal of a small piece of tissue) may be taken to establish the type of tumour and the most effective treatment.

Under anaesthetic, a small hole (burr hole) is made in the skull and a very fine needle is used to obtain a sample of tumour tissue. You will probably need to stay in hospital for a few days.

 

Treating a benign brain tumour

Most benign tumours are removed with surgery and do not normally come back.

However, some slow-growing tumours (mainly gliomas) will grow back after treatment and have the potential to change into high-grade or malignant (cancerous) tumours. High-grade tumours are fast-growing and likely to spread. Therefore, it's essential to have follow-up appointments to monitor your condition.

Your healthcare team

Many hospitals use multidisciplinary teams (MDTs) to treat brain tumours. 

These are teams of specialists who work together to decide about the best way to proceed with your treatment.

Your team may include:



a neurosurgeon, who will operate on your brain



a neurologist, who will treat illness caused by the tumour and manage your chemotherapy, if necessary



an oncologist, who will administer radiotherapy and chemotherapy



a specialist nurse, who will give you information and support



You should be given the name and contact details of a key worker, who will support you during your brain tumour treatment. 

Choosing a treatment

Deciding on the treatment that's best for you can often be confusing. Your team will recommend what they think is the best treatment option, but the final decision will be yours.

Before visiting hospital to discuss your treatment options, you may find it useful to write a list of questions that you'd like to ask the specialist. For example, you may want to find out the advantages and disadvantages of particular treatments.

Medication

You may be given medication to help treat symptoms of a brain tumour before or after surgery, including:



anticonvulsants to prevent seizures (fits)



corticosteroids to reduce swelling around the tumour



Surgically removing a brain tumour

The aim of surgery is to remove as much of the tumour as possible without damaging the surrounding tissue. You will be given a general anaesthetic (this will put you to sleep) and an area of your scalp will be shaved. A section of the skull is cut out as a flap to reveal the brain and tumour underneath. This is known as a craniotomy. The surgeon can then remove the tumour.

 

Radiosurgery

Some tumours are situated deep inside the brain and are difficult to remove without damaging surrounding tissue. In such cases, radiosurgery may be used to treat the tumour.

During radiosurgery, a dose of high-energy radiation is focused on the tumour to kill it. The treatment is completed in one session, recovery is quick and an overnight stay in hospital is not usually required. Radiosurgery is only available in a few specialised centres in the UK and is only suitable for a selected group of people, based on the characteristics of their tumour.

For some tumours in the base of the skull, the patient may be referred abroad for specialised proton radiotherapy.

 

Chemotherapy and radiotherapy

Occasionally, chemotherapy and radiotherapy may be used to shrink a benign tumour.

Chemotherapy uses medication to kill tumour cells and can be given as a tablet, an injection or a drip. Radiotherapy involves controlled doses of high-energy radiation, usually X-rays, to kill the tumour cells.

Side effects of these treatments can include tiredness, headaches, hair loss, nausea and reddening of your skin.



side effects of radiotherapy



side effects of chemotherapy



 

Recovering from a benign brain tumour

After being treated for a brain tumour, you may be offered physiotherapy, speech therapy or occupational therapy.

These therapies aim to speed up your recovery and help you cope with any problems caused by the tumour.



An occupational therapist will recommend any equipment or alterations to your home that may help you carry out daily activities.



A speech therapist will help you with any speech or swallowing problems.



A physiotherapist will help you to use parts of the body that have been affected by the tumour.



The National Institute for Health and Care Excellence (NICE) has made recommendations on the standards of care that brain tumour patients should receive. For more information, read the Improving Outcomes guidelines. 

Epilepsy may affect some patients for up to six months after surgery. On rare occasions epilepsy lasts longer than six months.

 

Driving and travelling

If you drive and have, or have had, a brain tumour, you must give up your licence and notify the DVLA. They will speak to your GP to determine when you can drive again.

With up-to-date scans and advice from your medical team, you may be allowed to drive again once an agreed period has passed and you have successfully completed a medical test to determine your ability to control a vehicle.

Flying is usually possible from three months after treatment.

 

Sports and activities

After you have been treated for a brain tumour, you must permanently avoid contact sports, such as rugby and boxing. You can start other activities again, with the agreement of your doctor, once you have recovered.

Swimming unsupervised is not recommended for around one year after treatment, as there is a risk that you could have an epileptic fit while in the water.

 

Sex

It is safe to have sex after treatment for a benign brain tumour. Women may be advised to carry on using contraception for up to a year after chemotherapy or radiotherapy. Your specialist will also discuss the implications of any medications needed.

 

Going back to work

You will become tired more easily following treatment for a brain tumour. You may wish to return to work and normal life as soon as possible, but it is a good idea to return part-time to begin with and only to go back full-time when you feel able to.

If you have experienced seizures, do not work with machinery or at heights.

 

Help and support

A brain tumour is often life changing. You may feel angry, frightened and emotionally drained. Your doctor or specialist should be able to refer you to a social worker and counsellor for help with the practical and emotional aspects of your diagnosis.

There are many organisations and helplines, such as Brain Tumour UK, that provide information and support.