Brain tumour (brain tumor): symptoms, causes, treatment and outlook

The NHS says the symptoms vary depending on the exact part of the brain affected, and that sometimes you may not have any symptoms to begin with, or they may develop very slowly. Cancer Research UK explains that as a tumour grows it takes up space inside the skull and can raise the pressure within the brain. Symptoms can develop gradually over months or even years if the tumour is slow growing, or over days or weeks if it is fast growing.

Many of these symptoms are far more often caused by other medical conditions, but if you have any of them it is important to see your doctor.

• Headaches, particularly a headache that feels different from the type you usually get or is getting worse.

• Seizures (fits), which may involve jerking or twitching in the hands, arms or legs, or the whole body.

• Persistently feeling sick, being sick and drowsiness, or loss of consciousness.

• Mental or behavioural changes, such as memory problems, confusion or changes in personality.

• Progressive weakness or paralysis on one side of the body.

• Vision problems (such as blurred vision, flashing lights or loss of side vision) or speech problems.

Cancer Research UK lists symptoms that depend on where the tumour is. This table is a guide to why different people have different symptoms; it is not a way to diagnose yourself.

The NHS says to see a GP if you have these types of symptoms, particularly a headache that feels different from the type you usually get or if headaches are getting worse. You may not have a brain tumour, but the symptoms should be checked. If the GP cannot identify a more likely cause they may refer you to a neurologist for further assessment and tests, such as a brain scan.

Cancer Research UK says to see a doctor if you have headaches that come with feeling or being sick, that you did not have before, that wake you at night, with eye problems such as flashing lights or blind spots, or that have got steadily worse over weeks. It says if you have a seizure it is important to see your doctor or go to A&E immediately, and that people with severe symptoms that come on suddenly should go to A&E.

The NHS says treatment depends on the type of tumour, where it is in your brain, how big it is and how far it has spread, how abnormal the cells are and your overall health and fitness. Treatments include steroids, medicines to help with symptoms, surgery, radiotherapy and chemotherapy.

Surgery is often used. The NHS says the aim is to remove as much abnormal tissue as safely as possible, and that it is not always possible to remove all of a tumour, so further treatment with radiotherapy or chemotherapy may be needed. Cancer Research UK says surgery may also be used to take a biopsy or to drain fluid that has built up on the brain (hydrocephalus).

Radiotherapy uses high energy X-rays. Cancer Research UK says you usually have it as an outpatient each weekday over 3 to 6 weeks, and that side effects include tiredness and feeling sick. Some people have chemotherapy for some types of tumour.

After diagnosis, the NHS says steroids may be prescribed to reduce swelling around the tumour, anti-epileptic medicines can be used for seizures and painkillers for headaches. Cancer Research UK says there are follow-up appointments after treatment, and that treatment may include surgery, radiotherapy and chemotherapy again if a tumour comes back.

For non-cancerous tumours, the NHS says treatment is often successful and a full recovery is possible, although there is sometimes a small chance the tumour could return, so you may need regular follow-up.

Cancer Research UK explains that a brain tumour develops when something inside a cell goes wrong, making the cell carry on dividing until it forms a lump. Tumours that start in the brain are called primary brain tumours, which is different from cancers that have spread to the brain from elsewhere in the body, called secondary brain cancers or brain metastases. There are over 100 different types, usually named after the cell or tissue they started in.

The NHS says brain tumours are graded according to how fast they grow and how likely they are to grow back after treatment. Grade 1 and 2 are low grade and grade 3 and 4 are high grade. Cancer Research UK says around 6,700 people are diagnosed with a benign brain tumour in the UK each year and around 5,800 with a malignant one. It notes the grading system works well for most tumours but is less clear for some; a slow growing benign tumour can cause serious symptoms and may be life threatening if it is in a particular part of the brain.

The NHS and Cancer Research UK both say the cause of most brain tumours is unknown, but some factors may increase the risk. Many people who have these risk factors never get a brain tumour, and some people with none can still develop one.

• Age: the risk increases with age, and Cancer Research UK says it is greatest in people aged between 85 and 89 in the UK, although some types are more common in children.

• Overweight and obesity: Cancer Research UK says about 2% of primary brain tumours in the UK are caused by being overweight or obese, mainly a type called meningioma.

• Radiation: the NHS says it accounts for a very small number; Cancer Research UK says less than 1% of primary brain tumours are caused by ionising radiation, such as from X-rays and CT scans, and that the risk from medical scans is very low.

• Family history and genetic conditions: a slightly higher risk if a close relative has had one, and some rare genetic conditions such as neurofibromatosis types 1 and 2, tuberous sclerosis and Turner syndrome.

Cancer Research UK says you usually start by seeing your GP, who examines you and may refer you to a specialist, and that your GP should arrange to see a specialist if you have symptoms that could be due to a brain or spinal cord tumour. There is no national screening programme for brain tumours in the UK.

Tests include scans to look at your brain and a test of your nervous system (a neurological examination). A biopsy or surgery lets a pathologist examine cells to work out the type and grade, and doctors may also look for gene changes (biomarkers), which help them understand how the tumour might behave and how likely it is to respond to treatment. NICE guideline NG99 covers diagnosing, monitoring and managing primary brain tumours and brain metastases in people aged 16 or over.

The NHS says survival rates are difficult to predict because brain tumours are uncommon and there are many types, and that outlook depends on your age, the type of tumour, where it is, how effective treatment is and your general health. It says around 17 out of every 100 people with a cancerous brain tumour will survive for 5 years or more after diagnosis.

Cancer Research UK gives figures for all types of primary brain tumour in adults in the UK: almost 50 out of every 100 survive for 1 year or more, 25 out of every 100 survive for 5 years or more, and around 20 out of every 100 survive for 10 years or more. It stresses these are statistics based on large groups and cannot tell you what will happen in your individual case. Factors include the type and grade, biomarkers, position, size, age (the outlook is better under 40) and general health. Your doctor can give you a more individual picture.

The NHS says brain tumours can affect people of any age, including children, although they tend to be more common in older adults. Cancer Research UK says tumours affecting the brain and spinal cord are the second most common type of children's cancer in the UK, and that its main brain tumour information is for adults, with separate information for children.

Children with a suspected brain tumour are assessed by specialist paediatric teams. See a GP promptly about persistent headaches, vomiting, seizures, or changes in behaviour, vision or balance, and use A&E for severe symptoms that come on suddenly.

Cancer Research UK says some types of brain tumour and treatment can affect your ability to drive, and that the restrictions depend on the tumour type and treatment you have had. It says practical and emotional support is available for you, your family and friends, and that it is normal to feel angry, sad or shocked after a diagnosis.

Follow-up is part of care after treatment, to check how you are and whether there are any problems or worries. NICE guideline NG99 also covers neurorehabilitation and surveillance for late-onset side effects of treatment.

Brain tumours are diagnosed and treated by multidisciplinary NHS teams, usually through neurology, neurosurgery and oncology, with referral from a GP or from A&E for severe symptoms. Treatment is delivered in specialist centres, and your team will discuss your options and follow NICE guidance.

Some people seek a private opinion or scan. Whatever route you take, share results and plans with your GP and NHS team so that care stays joined up, and ask the specialist team who your key contact is.