Brain Tumours

A brain tumour forms when abnormal cells grow into a mass in or around the brain. These tumours can be primary (starting in the brain) or secondary (spreading from other parts of the body). Depending on their location and size, brain tumours may affect thinking, movement, sensation, and other functions. As they grow, they can put pressure on the brain and may also block the flow of cerebrospinal fluid, leading to further complications.

Dr. Teo Kejia

Senior Consultant Neurosurgeon

MBBS (Singapore) | MRCS (Edinburgh) | FAMS (Neuro.Surg) | FRCS Ed (Neuro.Surg) | IFAANS

Symptoms Causes Types Diagnosis Treatment Prevention FAQ

Symptoms of Brain Tumours

Brain tumours can manifest through various symptoms, which often depend on the tumour’s location, size, and growth rate. Common symptoms include:

Persistent Headaches: These headaches typically worsen in the morning or when lying down and may be accompanied by nausea or vomiting. Unlike typical headaches, they often do not respond to standard pain medication.
Seizures: Sudden, uncontrolled electrical disturbances in the brain that can cause changes in behaviour, movements, or consciousness. These may occur even in people with no previous history of seizures.
Vision Changes: Problems including blurred vision, double vision, or loss of peripheral vision occur when tumours affect areas controlling eyesight. These changes may develop gradually or appear suddenly.
Balance Issues: Difficulty maintaining balance, coordination problems, or trouble walking, particularly when tumours affect the cerebellum. These symptoms may worsen over time
Memory Problems: Difficulties with short-term or long-term memory, confusion, or changes in ability to concentrate. These cognitive changes may affect work or daily activities.
Speech Difficulties: Problems forming or understanding words when tumours affect speech and language areas. This may include slurred speech or difficulty finding the right words.
Personality Changes: Alterations in behaviour, emotional responses, or daily functioning patterns. Family members often notice these changes before the patient does.

Causes and Risk Factors

Several factors can influence the development of brain tumours, though in many cases, the exact cause remains unknown.

Age

The likelihood of developing certain types of brain tumours increases with age, though they can occur at any life stage.
Genetic Factors

Some inherited conditions increase the risk of developing brain tumours. These include neurofibromatosis, von Hippel-Lindau disease, and Li-Fraumeni syndrome.
Radiation Exposure

Previous exposure to ionising radiation, particularly to the head area, can increase tumour risk. This includes therapeutic radiation and, rarely, diagnostic radiation.
Family History

Having close relatives with brain tumours may indicate an increased risk. The degree of risk depends on the type of tumour and number of affected relatives.
Immune System Disorders

Conditions that weaken the immune system may increase susceptibility to brain tumours. This includes HIV/AIDS and medications that suppress the immune system.

Types of Brain Tumours

Gliomas

Gliomas are tumours that develop from glial cells, which support nerve cells in the brain and spinal cord. They include astrocytomas, oligodendrogliomas, and ependymomas. Gliomas can appear in different areas of the brain and spinal cord, and their growth rates range from slow to aggressive. Treatment depends on the tumour type and grade.

Meningiomas

These develop in the meninges, the protective layers surrounding the brain and spinal cord. Most meningiomas grow slowly and are typically benign, though they can still cause symptoms by pressing on nearby brain tissue. Location often determines whether they require immediate treatment.

Pituitary Tumours

These form in the pituitary gland at the base of the brain. They can affect hormone production and cause various endocrine disorders. Some pituitary tumours cause excessive hormone production, while others restrict normal pituitary function. Treatment depends on hormone activity and tumour size.

Medulloblastomas

Medulloblastomas are fast-growing tumours that develop in the cerebellum (the lower back part of the brain). They can spread through cerebrospinal fluid to other areas of the brain and spinal cord. Treatment typically involves a combination of surgery, radiation therapy, and chemotherapy.

Acoustic Neuromas

These benign tumours develop on the vestibulocochlear nerve, which helps control hearing and balance. They typically grow slowly and can cause hearing loss, balance problems, and tinnitus. Treatment options depend on size and growth rate.

Diagnostic Methods

Neurological Examination

A series of tests assess vision, hearing, balance, coordination, and reflexes. These evaluations help identify which parts of the brain may be affected and guide further diagnostic testing. The findings determine whether additional imaging or other tests are needed.
MRI (Magnetic Resonance Imaging)

This imaging technique uses magnetic fields and radio waves to create detailed images of the brain. Different types of MRI scans can reveal the tumour’s location, size, and, in some cases, its type. A contrast dye may be used to highlight specific areas more clearly. MRI techniques, such as functional MRI or diffusion tensor imaging, can also assist in surgical planning by mapping critical brain structures.
CT (Computed Tomography) Scan

CT scans use X-rays to generate cross-sectional images of the brain. They can detect bleeding, swelling, and some tumours and are often used in emergency situations or when MRI is not suitable. In some cases, CT scans help guide biopsy procedures by providing a clearer view of the tumour’s position in relation to surrounding structures.
Biopsy

A small sample of the tumour tissue is removed and examined under a microscope. This procedure determines the tumour type and grade, which helps guide treatment decisions. Some tumours require stereotactic biopsy, using computer guidance for precise sampling.

Treatment Options

The treatment approach for brain tumours depends on multiple factors, including the tumour’s type, size, location, and the overall health of the individual. Treatment may involve one or a combination of the following methods.

Non-Surgical Treatment

Radiation Therapy: Radiation therapy uses high-energy beams to destroy tumour cells. It can be delivered as external beam radiation therapy (EBRT) over multiple sessions or as stereotactic radiosurgery (e.g., Gamma Knife), which delivers highly focused radiation to small tumours. Treatment planning ensures precision while minimising damage to healthy brain tissue.

Chemotherapy: Chemotherapy uses drugs that travel through the bloodstream to target tumour cells. Some chemotherapy drugs can cross the blood-brain barrier, making them more effective for certain brain tumours. Treatment is typically given in cycles over several months, with breaks in between to allow the body to recover. Regular blood tests monitor side effects such as lowered blood counts.

Targeted Therapy: This approach uses drugs that specifically target genetic or molecular abnormalities within tumour cells. Molecular testing of the tumour helps determine whether targeted therapy is a suitable option. Unlike chemotherapy, targeted therapy aims to affect cancerous cells while limiting damage to normal cells. Treatment duration depends on response and side effects, with regular imaging to assess effectiveness.

Surgical Treatment

Surgical removal of a brain tumour involves opening the skull (craniotomy) to access and remove as much of the tumour as possible. Specialised surgical navigation systems and imaging techniques assist in planning the approach while minimising the impact on critical brain structures.

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Prevention and Management

Regular medical check-ups help detect neurological changes early, though brain tumours cannot always be prevented. Maintaining overall health through regular exercise and a balanced diet can support treatment and recovery. Patients may need to adjust daily activities and living environments to accommodate changes during treatment and recovery.

Frequently Asked Questions (FAQ)

How long is the recovery period after brain tumour surgery?

Initial recovery in the hospital typically takes 3-7 days. Full recovery can take 6-12 weeks, depending on the surgery’s extent and location. Physical therapy and occupational therapy often form part of the recovery process. Each patient’s recovery timeline varies based on individual circumstances.

Can brain tumours return after treatment?

Some tumours can recur even after successful initial treatment. Follow-up scans and appointments help monitor for any signs of recurrence, allowing for early intervention if needed. The likelihood of recurrence varies by tumour type.

How often should follow-up scans occur after treatment?

The frequency of follow-up scans varies based on the tumour type and treatment received. Initially, scans might occur every 3-6 months, with intervals gradually extending if no changes appear. This schedule may be adjusted based on individual risk factors.

Dr. Teo Kejia

Senior Consultant Neurosurgeon

MBBS (Singapore)|MRCS (Edinburgh)|FAMS (Neuro.Surg)|FRCS Ed (Neuro.Surg)|IFAANS

Dr. Teo’s expertise lies in complex brain tumour surgeries employing advanced techniques like brain mapping and awake brain surgery. He also manages neurovascular conditions, traumatic head injuries and spinal disorders.

Dr. Teo graduated from the National University of Singapore with a Bachelor of Medicine and Bachelor of Surgery in 2006. He completed his general surgery training and advanced neurosurgery training at the National University Hospital Singapore. He furthered his education in the United Kingdom, obtaining advanced certifications and completing specialist training in various neurosurgical disciplines.
Dr. Teo’s AMDA award facilitated his training at Queen’s Hospital in London, where he specialized in functional neurosurgery, neuro-oncology, neurovascular, skull base, and spinal surgery. He also underwent fellowship training in brain mapping and awake brain surgery at renowned institutions in Italy and France, working with leading experts in the field.

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