Brain Tumors

What are Brain Tumors?

Brain tumors are abnormal growths of cells in or near the brain. They may be benign, meaning noncancerous, or malignant, meaning cancerous. Some brain tumors begin in the brain, called primary brain tumors, while others spread to the brain from cancer elsewhere in the body, called metastatic brain tumors.

Brain tumors can affect brain function by pressing on nearby tissue, causing swelling, blocking the flow of cerebrospinal fluid, or interfering with areas that control speech, movement, vision, memory, balance, mood, or behavior. The seriousness of a brain tumor depends on the tumor type, size, location, growth pattern, grade, molecular features, and the patient’s symptoms and overall health.

De Novo Brain & Spine evaluates adult patients with suspected or confirmed brain tumors to help determine the next appropriate step. Evaluation may include neurological examination, brain MRI, CT imaging, biopsy, surgical consultation, or coordination with oncology, radiation oncology, neurology, or other specialists when needed.

Common Signs and Symptoms

Brain tumor symptoms vary depending on the tumor’s size, location, growth rate, and effect on surrounding brain tissue. Some brain tumors are found after symptoms develop, while others are found incidentally during imaging for another reason.

Common signs and symptoms may include:

• Persistent or worsening headaches
• Headaches with nausea or vomiting
• New-onset seizures
• Weakness, numbness, or tingling in the face, arm, or leg
• Trouble speaking, understanding speech, or finding words
• Vision changes, including blurred vision, double vision, or loss of part of the visual field
• Hearing changes or ringing in the ears, depending on tumor location
• Balance problems, dizziness, or trouble walking
• Memory problems, confusion, or difficulty concentrating
• Personality changes, mood changes, or behavior changes
• Hormonal changes, menstrual changes, fatigue, or changes in thirst or urination when the tumor involves the pituitary region
• Drowsiness, decreased alertness, or worsening neurological function

Seek emergency medical care or call 911 for a first-time seizure, sudden weakness, sudden speech difficulty, severe confusion, loss of consciousness, or a rapidly worsening headache with vomiting or neurological changes.

What Causes This Condition

Many brain tumors develop without a clearly known cause. A brain tumor diagnosis does not usually mean that the patient did something to cause it.

Brain tumors may be related to several different medical situations, including:

• Primary brain tumors, which begin from cells in the brain, coverings of the brain, cranial nerves, pituitary region, or nearby structures
• Metastatic brain tumors, which spread to the brain from cancer in another part of the body
• Prior therapeutic radiation exposure to the head or brain
• Rare inherited tumor syndromes, which can increase the risk of certain brain or nervous system tumors
• Tumor-specific molecular features, which may help classify the tumor and guide treatment planning but are not the same as lifestyle causes

Doctors may use the tumor’s location, imaging pattern, pathology, grade, and molecular markers to better understand the diagnosis. These details help guide treatment recommendations.

How It Is Diagnosed

Brain tumors cannot be diagnosed by symptoms alone. Evaluation usually begins with a medical history, neurological examination, and brain imaging.

Common diagnostic steps may include:

• Medical history and neurological examination to evaluate strength, sensation, reflexes, vision, speech, coordination, balance, memory, and cognitive function
• MRI of the brain with and without contrast, often the main imaging study used to evaluate a suspected brain tumor
• CT scan of the head, especially in urgent situations or when MRI is not immediately available
• Advanced MRI techniques, such as MRI perfusion, MR spectroscopy, functional MRI, or diffusion tensor imaging when needed for treatment or surgical planning
• Pituitary hormone testing when a pituitary tumor or sellar region tumor is suspected
• Body imaging or oncology evaluation when a metastatic brain tumor is possible
• Stereotactic brain biopsy when tissue is needed and removal of the tumor is not the safest first step
• Image-guided craniotomy and brain tumor resection when surgery is appropriate for diagnosis, tumor removal, or relief of pressure
• Neuropathology review to determine tumor type and grade
• Molecular testing when appropriate, which may help classify certain tumors and guide treatment planning

The goal of diagnosis is to identify the tumor type, understand how it is affecting the brain, and determine whether observation, surgery, radiation, chemotherapy, medication, or additional specialty care may be needed.

Why Is Identifying the Specific Brain Tumor Type Important?

The term brain tumor includes many different conditions. Identifying the specific tumor type can provide healthcare professionals with more detailed information about its characteristics and how it may behave.

Imaging can provide important clues, while pathology and other laboratory testing may provide additional information when tissue is available. These findings are considered together with the tumor’s location, symptoms, and individual medical history.

Treatment Options

Brain tumor treatment depends on the tumor type, location, size, growth pattern, symptoms, imaging findings, pathology, molecular features, neurological examination, and the patient’s overall health. Not every brain tumor requires surgery right away.

Treatment options may include:

• Observation with repeat imaging for selected tumors that are small, slow-growing, not causing symptoms, or found incidentally
• Medication for symptom control, such as corticosteroids to reduce brain swelling or anti-seizure medication when seizures occur
• Stereotactic brain biopsy to obtain tissue when diagnosis is uncertain or when tumor removal is not the safest first step
• Image-guided craniotomy for brain tumor resection to remove as much tumor as safely possible when surgery is appropriate
• Maximal safe resection, which means removing tumor while protecting important brain functions such as speech, movement, vision, memory, and sensation
• Functional brain mapping or awake brain mapping when a tumor is near areas that control language, movement, or other critical functions
• Radiation therapy, which may be recommended for some malignant tumors, metastatic tumors, recurrent tumors, or tumors that cannot be fully removed
• Chemotherapy, targeted therapy, or immunotherapy, when recommended by oncology or neuro-oncology based on tumor type
• Cerebrospinal fluid diversion, such as shunt placement, when a tumor causes hydrocephalus or blocked fluid flow
• Rehabilitation and supportive care to help with strength, balance, speech, cognition, or daily function when symptoms are present

Surgery is considered when it may help confirm the diagnosis, remove tumor, relieve pressure on the brain, reduce symptoms, or support the next stage of treatment. The safest plan depends on the tumor’s relationship to important brain structures and the patient’s individual condition.

Frequently Asked Questions

Are all brain tumors cancerous?

No. Brain tumors can be benign, meaning noncancerous, or malignant, meaning cancerous. A benign tumor can still cause symptoms or require treatment if it presses on nearby brain tissue or blocks the flow of cerebrospinal fluid, even though it isn’t cancer. The tumor type, not just whether it’s benign or malignant, guides the treatment plan.

Does every brain tumor need to be treated right away?

Not always. Some brain tumors are small, slow-growing, or found incidentally during imaging for an unrelated reason, and these may be monitored with observation and repeat imaging rather than immediate treatment. Others need more prompt evaluation depending on size, location, and symptoms. This is determined case by case.

How is a brain tumor diagnosis confirmed?

Brain imaging, usually an MRI, is typically the first step in identifying a suspected brain tumor. Confirming the exact tumor type often requires tissue, obtained either through a biopsy or during surgical removal, which is then reviewed by pathology. This tissue review helps guide what treatment options may be appropriate.

Is it possible to get a second opinion on a brain tumor diagnosis?

Yes. A second opinion can help confirm a diagnosis, review imaging findings, or discuss treatment options before moving forward with a treatment plan. Many patients find this a helpful step after a new brain tumor finding.