What are the symptoms and treatment options for brain tumors?

Symptoms of Brain Tumors

Brain tumor symptoms vary widely based on tumor location and size, but commonly include headache, seizures, cognitive changes, and focal neurologic deficits. 1

Common Presenting Symptoms

Brain tumors can manifest through various mechanisms including increased intracranial pressure, direct compression of brain tissue, shifting of intracranial contents, or secondary cerebral ischemia. The most common symptoms include:

• Headache (50%) 2

  • Typically persistent, worse in the morning or when lying down
  • Often associated with nausea and vomiting
  • Changes in established headache patterns warrant investigation

• Seizures (20-50%) 2, 3

  • May be the initial presenting symptom
  • Focal seizures with or without secondary generalization
  • Often resistant to antiepileptic medications

• Neurocognitive impairment (30-40%) 2

  • Memory problems
  • Difficulty concentrating
  • Personality changes
  • Confusion or disorientation

• Focal neurologic deficits (10-40%) 2

  • Weakness or numbness (often on one side)
  • Speech difficulties if tumor is in dominant hemisphere
  • Visual disturbances
  • Balance and coordination problems

• Other symptoms

  • Nausea and vomiting (related to increased intracranial pressure)
  • Fatigue
  • Psychiatric symptoms (depression, personality changes, mania) 4

Red Flags Requiring Urgent Evaluation

Any patient with the following should be evaluated immediately for a brain tumor:

• Chronic, persistent headache with protracted nausea/vomiting
• New-onset seizures in adults
• Neurologic symptoms that are progressive
• Changes in personality or mental status
• Headaches that worsen with position changes or in the morning 1, 5

Diagnostic Approach

Magnetic resonance imaging (MRI) with and without gadolinium contrast is the preferred initial imaging study for suspected brain tumors 5, 2. Comprehensive neurosurgical evaluation is necessary to obtain tissue for diagnosis and possible tumor resection.

Management Considerations

Treatment depends on tumor type but typically involves a multidisciplinary approach:

1. Surgical intervention

   • Maximal safe resection when feasible 6
   • Stereotactic biopsy for diagnosis when resection isn't possible

2. Radiation therapy

   • Standard fractionated external-beam RT is common for primary tumors
   • Stereotactic radiosurgery or whole-brain RT for metastases 6

3. Systemic therapy

   • Chemotherapy options vary by tumor type
   • Targeted therapies for specific molecular markers

4. Symptom management

   • Seizures: Antiepileptic drugs for patients with seizure history 6
   • Cerebral edema: Corticosteroids (methylprednisolone or prednisolone) 6
   • Pain: Appropriate analgesic treatment 6

Complications and Quality of Life Considerations

Brain tumors are associated with several complications that impact quality of life:

• Edema
• Seizures
• Endocrinopathy
• Fatigue
• Psychiatric disorders
• Venous thromboembolism 6

Prognosis

Prognosis varies dramatically by tumor type:

• Primary malignant brain tumors have a 5-year survival rate of approximately 36% 2
• Glioblastoma multiforme has a particularly poor prognosis despite treatment
• Factors affecting prognosis include age, functional status, tumor histology, and grade 6

Brain tumor management requires a multidisciplinary team including neurosurgeons, radiation oncologists, medical oncologists, neurologists, and neuroradiologists to optimize outcomes and quality of life 6.