What a brain tumour is
A brain tumour is an abnormal growth of cells inside the skull. Benign tumours, such as most meningiomas and many pituitary tumours, do not spread, but can still press on the brain as they grow. Malignant tumours, such as high-grade gliomas, grow into the brain around them. Metastases are cancers that started elsewhere in the body, most often the lung or breast, and travelled to the brain.
Where a tumour sits matters as much as what it is. A small tumour beside the areas that control speech, movement or vision needs a different plan from a larger one in a quieter part of the brain.
Signs that need a scan
- A new headache that keeps getting worse, especially if it is worse in the morning or comes with vomiting
- A first seizure (fit) in an adult
- Weakness or numbness on one side of the body
- Trouble finding words, or understanding them
- Blurred or double vision, or loss of part of the field of vision
- A change in personality, memory or behaviour that family members notice
Most headaches are not tumours. But a headache that is new, changing, or comes with any of the other signs here should be seen.
How it is diagnosed
An MRI with contrast is the main test: it shows the size, position and character of the tumour and the brain around it. A CT scan is often the first scan done in an emergency. Depending on the tumour, specialised MRI sequences (perfusion, spectroscopy, tractography to map the nerve pathways) and blood tests may follow. The final answer on the type of tumour comes from the tissue itself, examined under the microscope after a biopsy or surgery.
Treatment options
Not every tumour needs an operation straight away. Small, slow-growing tumours that cause no symptoms are often watched with repeat scans. When treatment is needed, the options are:
- Surgery to remove as much of the tumour as can be removed safely, which relieves pressure and gives the tissue diagnosis
- Biopsy when a tumour is too deep or too spread out to remove
- Radiotherapy and radiosurgery, including focused treatments such as Gamma Knife for selected small tumours
- Chemotherapy and newer drug treatments, for tumour types that respond to them
Many patients need a combination, planned together with oncologists and radiation specialists.
How Dr Gupta approaches tumour surgery
Dr Gupta’s areas of work include neuro-oncology and skull base surgery. The aim of every operation is the same: remove as much tumour as is safe, and protect the function you came in with. The tools that make that possible:
- Neuronavigation, a GPS for the brain that shows exactly where the instruments are against your own scan
- Neuromonitoring, which checks the nerve pathways for movement and sensation throughout the operation
- Intraoperative ultrasound and MRI to see what is left before the operation ends
- Awake brain surgery for tumours beside the speech and movement areas, so those functions can be tested while the tumour is removed
Recovery
Most people spend a day or two in intensive care after brain surgery and go home within about a week, depending on the operation and how they were before it. Stitches come out after around ten to fourteen days. Some people need physiotherapy or speech therapy for a while. The tissue report usually takes one to two weeks and decides what, if anything, comes next.
Questions
Is every brain tumour cancer?
No. Many brain tumours, including most meningiomas and pituitary tumours, are benign: they do not spread to other parts of the body. They can still need treatment if they press on the brain or nerves.
Does every brain tumour need surgery?
No. Small tumours that are not causing symptoms are often watched with repeat MRI scans. Surgery, radiotherapy, radiosurgery and medicines are all options, and the right one depends on the type, size and position of the tumour.
Can I get a second opinion on a tumour another hospital has seen?
Yes. Bring the MRI films or the CD, the report and any discharge summaries to the consultation. A second opinion before a major decision is reasonable, and it is common.
What is awake brain surgery?
An operation in which you are woken up for part of the procedure, so the team can check your speech or movement while working near those areas. The scalp is numbed and the brain itself does not feel pain.
About Dr Gupta
This page explains the condition in general terms and is written for patients and families. It is not a diagnosis. Decisions about treatment are made in consultation, with your scans. In an emergency, go to the nearest hospital emergency department.