BRAIN TUMOURS

( By JASCAP )

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Symptoms and Diagnosis

Symptoms and diagnosis

Symptoms of brain tumours

A brain tumour may cause symptoms because the space it takes up in the skull puts pressure on the brain or because it is disturbing the function of the part of the brain it's growing in.

Symptoms of brain tumour may occur due to following reasons:

  • Symptoms due to increased pressure in the skull
  • Seizures
  • Symptoms connected with the tumour's position
  • Personality changes

Symptoms due to increased pressure in the skull

The brain is contained within the skull and has a fixed amount of space. If a tumour grows in the brain it will often cause an increase in pressure, which can cause symptoms to develop. An increase of pressure in the skull is called raised intracranial pressure (ICP). The most common symptoms of a rise in the pressure within the brain are headaches, feeling sick (nausea) and vomiting.

Of course, many other things can cause headaches or feelings of sickness, but if you have either of these for over a week with no sign of getting better, it's important to see your doctor.

A pressure headache may be most severe in the mornings, and can occasionally wake you. Usually this type of headache gets better during the day. However, it may get worse when you cough, sneeze, bend down or do any hard physical work. All of these tend to raise pressure in the brain. If the raised pressure makes you sick, it may be worse in the morning than during the day.

Another possible symptom of a brain tumour is drowsiness. This can happen as the pressure in the brain increases. You may find that you sleep more or that you drop off during the day when you wouldn't normally.

As well as the symptoms described here, raised intracranial pressure can also cause changes to your sight, such as blurred vision, 'floating objects' and tunnel vision. It may also make you confused or affect your balance.

Seizures

Seizures (fits) are another common symptom caused by brain tumours. Some people can may experience muscle spasms which could be twitching or jerking of an arm orleg or sometimes the whole body. Occasionally they can cause moments of unconsciousness.

It's important to remember that a seizure can be caused by medical conditions other than a brain tumour. A seizure can be a frightening experience. if you have one you should seek medical help so that the cause can be diagnosed and treated.

Symptoms connected with the tumour's position

Some symptoms may be caused by tumours in particular parts of the brain. Sometimes a headache can feel worse on the same side of the tumour. In general, each area of the brain controls particular functions. A tumour in a particular part of the brain may prevent that area of the brain from working normally.

Some of these symptoms are listed below, grouped under the different parts of the brain. They are included only as a guide. Exact diagnosis can only be made by a doctor and confirmed by tests.

The diagram showing the lobes and functions of the brain shows the different functions of each area of the brain.

Frontal lobe tumours − Changes in personality and intellect. Uncoordinated walking or weakness of one side of the body, loss of smell, occasional speech difficulties.

Parietal lobe − Difficulty speaking or understanding words. Problems with writing, reading or doing simple calculations. Difficulty in coordinating certain movements, and finding your way around. Numbness or weakness on one side of the body.

Occipital lobe − Loss of vision on one side. The person may not notice this at first and it may sometimes be discovered during routine eye tests. Temporal lobe − Fits, which may cause strange sensations: a feeling of fear or intense familiarity (déją vu), strange smells or blackouts. Speech difficulties and memory problems.

Cerebellum − Lack of coordination which affects walking and speech (dysarthria), unsteadiness, flickering involuntary movement of the eyes (nystagmus). Vomiting and neck stiffness.

Brain stem − Unsteadiness and an uncoordinated walk. Facial weakness, a one-sided smile or drooping eyelid. Double vision. Vomiting or headache just after waking (this is rare). Difficulty speaking and swallowing. Symptoms may appear gradually.

All the above symptoms may be caused by conditions other than a brain tumour. If you have any of the symptoms described it is important that you go to see your GP.

Personality changes

Sometimes brain tumours may cause changes in personality or behaviour. These symptoms usually occur when the tumour is in the brain‟s cerebral hemispheres. This situation can be very unsettling for the person and their family. Sometimes a referral to a psychologist for assessment and support can help.

Driving

As brain tumours can cause changes in the way that your brain works, it may be dangerous to drive. In the UK, there are laws which restrict some people with brain tumours from driving for a time. The restrictions vary with the type of tumour you have, and the type of driving license you hold.

However, you will not usually be allowed to drive for at least a year after the condition has been diagnosed and in some circumstances you may not be able to drive again. With some types of benign tumours you may be able to drive again once you have recovered from your treatment.

It is your legal responsibility, not your doctor's, to tell the Drivers and Vehicle Licensing Authority (DVLA) about your illness. The DVLA will advise of you of any restrictions on your right to drive. You should also inform your car insurance company.

How brain tumours are diagnosed

Usually, if you have slowly developing symptoms you'll see your GP, who will examine you. If a brain tumour is suspected, they will refer you to a specialist doctor, either:

  • a neurologist (a specialist in brain and nerve disorders) or
  • an oncologist (a doctor who specialises in cancer treatment).

Sometimes people with brain tumours have a sudden seizure (fit) or sudden onset of problems associated with the position of the tumour, and may be taken straight to hospital, where tests are carried out to diagnose the tumour. Brain tumours are often treated in specialist centres, so you may have to travel to your nearest centre.

At the hospital

At the hospital the doctor will ask you about your general health and any previous medical problems. You will then have a general physical examination. The doctor may listen to your chest and feel your abdomen to check your general health, and you will have a detailed examination to test your nervous system. The examination of your nervous system may include:

  • Mental exercises, eg basic arithmetic and simple questions.
  • An eye examination using an instrument that shines a light at the back of the eye (ophthalmoscope). This test is done to see if the optic disc at the back of your eye is swollen. This swelling is known as papilloedema and is a sign of raised pressure in your skull. Your eyesight will also be tested.
  • Hearing tests.
  • Facial muscle tests − smiling, grimacing etc.
  • Tongue movement, checking your swallow (gag) reflex.
  • Checking the strength of your arms and legs, and your reflexes.
  • A test of your ability to feel pinpricks on areas of skin, to tell the difference between hot and cold, and possibly to recognise the feeling and shape of familiar objects like coins.
  • Checking your balance and coordination, for example by asking you to walk a few steps or perform repeated movements.

Further tests for diagnosing brain tumours

At the hospital you may have to have some of the following tests. Your doctor will select the most suitable ones for your particular situation and symptoms.

Following tests are routinely used for diagnosing brain tumours:

  • Brain MRI (magnetic resonance imaging) scan
  • Brain CT (computerised tomography) scan
  • Biopsy
  • Skull x-ray
  • PET (positron emission tomography) scan
  • SPECT (single photon emission computerised tomography) scan
  • Blood tests and chest x-rays

Brain MRI (magnetic resonance imaging) scan

This test uses magnetic fields to build up a detailed picture of the inside of your head. Before the scan you may be asked to complete and sign a checklist. This is to make sure that it's safe for you to have an MRI scan, because the scanner is a powerful magnet. The checklist asks about any metal implants you may have, for example a pacemaker, surgical clips, bone pins etc.

You should also tell your doctor if you have ever worked with metal or in the metal industry as very tiny fragments of metal can sometimes lodge in the body. If you do have any metal in your body it's likely that you won't be able to have an MRI scan. In this situation another type of scan can be used.

Before having the scan, you'll be asked to remove any metal belongings including jewellery. You are usually given an injection of dye into a vein in the arm, which doesn't usually cause discomfort. This is called a contrast medium and can help the images from the scan to show up more clearly.

During the test you'll be asked to lie very still on a couch inside a long cylinder (tube) that is open at both ends. The whole test can take up to an hour. It's painless but can be slightly uncomfortable, and some people feel a bit claustrophobic during the scan. It's also noisy, but you'll be given earplugs or headphones. You will be able to hear, and speak to, the person operating the scanner.

Brain CT (computerised tomography) scan

This is a series of x-rays, which builds up a three-dimensional picture of the inside of your head. During the test you will be asked to lie with your head inside an opening in the scanner. The scan is painless but takes longer than a normal x-ray (from 5 to 10 minutes). It may be used to identify the exact area and size of the tumour.

Most people who have a CT scan are given an injection of a liquid into a vein, to allow particular areas of the brain to be seen more clearly. The injection may make you feel hot all over for a few minutes. Before having the injection, it is important to tell your doctor and the person doing the scan if you are allergic to iodine or have asthma or diabetes. You'll probably be able to go home as soon as the scan is over.

A patient having a CT scan

Biopsy It's often necessary for the doctor to take a small part of the tumour (a biopsy) to find out exactly what type of tumour you have (see Surgery for more information).

Skull x-ray

Very rarely, brain tumours may show up on an x-ray picture. The test is simple and painless. You will have to lie on a couch in the hospital‟s x-ray department and you will be asked to keep your head still for a few seconds.

PET (positron emission tomography) scan

A PET scan uses low-dose radioactive glucose (a type of sugar) to measure the activity of cells in different parts of the body. A very small amount of the mildly radioactive substance is injected into a vein, usually in your arm. Tumours normally absorb more of the glucose and the radioactivity shows up on the scan.

After the injection you may be asked to lie in a dark room with your eyes closed. You'll then be taken to the scanning room and asked to lie on a couch with the scanning ring around you. The dose of radiation you receive is no more than a normal x-ray.

A PET scan is not routinely used to diagnose a brain tumour but it may help to tell whether a tumour is growing and whether it is cancerous (malignant) or benign. PET scans aren‟t available in all hospitals, and you may have to travel to a hospital some distance away from your home to have one.

SPECT (single photon emission computerised tomography) scan

This test is similar to a PET scan. It can help to detect abnormalities in the blood brain barrier as it looks at blood flow through the brain.

You are given an injection of a very mild radioactive substance, usually in your arm. This susbstance travels in the blood to the brain. Then, in the scanning room, pictures (scans) of the brain are taken.

Blood tests and chest x-rays

There isn't a specific blood test that can detect brain tumours, but you may have blood tests to check your general health. A chest x-ray may also be done as part of a general health check.

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