How do you know if you have brain cancer?

Sometimes, brain cancer and brain tumors grow without creating any symptoms. Doctors may find a brain tumor accidentally while scanning a patient for another reason. If patients do have symptoms, they may experience a severe headache or a weak arm or leg. How do you know if a seemingly common symptom is brain cancer?

“Brain tumors and brain cancer can present in a variety of ways. They can show up as persistent headaches that don’t get better or are worse in the morning. It can be any type of neurological deficit, such has acting confused, having trouble moving or losing feeling your arm or leg,” said Dr. Matthew Pease, IU Health neurosurgeon. “These can all be signs of a tumor, or they could mean a million other things. Basically, if you are not acting yourself or feeling yourself, it’s important to see your doctor. They can help determine whether symptoms are related to something significant.”

It's important to know that that brain tumors and brain cancer are two different conditions that can also be the same thing. Brain tumors are abnormal growth of cells in or near the brain that are sometimes cancerous and sometimes benign (non-cancerous). Brain cancer describes brain tumors that are cancerous. This includes complex brain tumors that are challenging to treat. Basically: all brain cancers are tumors, but not all brain tumors are cancerous.

No one knows why people develop most primary brain cancers, but they are not caused by injury or trauma. Brain cancer begins in a couple different ways. A cancerous tumor can grow in or near the brain. This is called a “primary brain tumor.” Another type of brain cancer occurs when a cancer in a different part of the body spreads (metastasizes) to the brain. This is called a “secondary cancer.”

“When people say ‘brain cancer,’ they can mean different things,” said Dr. Angela Richardson, an IU Health neurosurgeon. “A primary brain tumor like glioma doesn’t typically spread to other parts of the body. They stay in the brain and spine, but they can return frequently and cause other problems. On the other hand, meningiomas, or pituitary tumors, are non-cancerous tumors that aren’t likely to recur.”

Diagnosing brain tumors

People are diagnosed with a brain tumor using imaging tests such as magnetic resonance imaging (MRI). This is the most common imaging used for brain tumors since it gives the best quality picture of the brain. Since people are increasingly getting MRIs for a lot of different reasons, it’s more common to find brain tumors purely by accident. Your doctor may also use a computed tomography (CT) scan for quicker, more general images.

If your doctor thinks the tumor is cancerous, a neurosurgeon will remove part of the tumor, if possible, for a biopsy. Sometimes, the tumor is in a challenging location, and a biopsy isn’t possible. Physician researchers at IU Health are performing clinical trials to find better ways to diagnose patients without doing invasive procedures.

“Sometimes spots aren’t clear, so we use some advanced MRI and imaging modalities to better view the tumor. IU Health has the only FET-PET (18-fluoride-fluoro-ethyl-tyrosine positron emission tomography) scan for clinical use in the country, and that’s a great tool for seeing if brain tumors have progressed and how to care for them,” Dr. Pease said. “I specialize in using advanced AI within imaging to diagnose tumor genetics and types without doing invasive procedures. We’re working to develop tools like liquid biopsy to look for markers in blood or spinal cord fluid to identify genetic markers of tumor without having to stick a needle into the brain.”

Brain tumor treatment

Some people with non-cancerous brain tumors can live their entire lives without knowing it. But if the tumors grow, they can push on other areas of the brain. This can affect your vision, speech, movement or thought processing. These types of tumors may benefit from surgical removal.

The treatment for cancerous brain tumors very dependent upon the type and location of the tumor. The treatment options mirror treatments for other types of cancer. Most brain tumors are removed through surgery. Some patients may need radiation or chemotherapy to shrink the tumor or prevent it from returning. And patients may need a combination of all three treatments. Doctors may use targeted therapies after surgery, such as radiosurgery or stereotactic surgery, to eliminate any remaining cancer cells from the brain tissue.

It takes a multi-disciplinary team to treat patients with brain tumors. During treatment, you may interact with:

• Neurologists who specialize in the brain’s anatomy
• Neuro-oncologists who specialize in treating brain cancer
• Neurosurgeons who perform the surgery or biopsy
• Radiation oncologists who deliver radiation treatment
• Medical oncologists who deliver chemotherapy treatment
• Nurses who manage your care
• Social workers who help patients access supportive resources
• Rehabilitation specialists who help with recovery

Physician researchers at IU School of Medicine and IU Health are studying ways to improve brain cancer treatment. They’re investigating implanting radiation during tumor removal and implanting ultrasound devices to deliver a higher concentration of drugs to the tumors. They’re also studying a targeted therapy that trains cells from the patient’s own immune system to destroy the tumors.

Brain cancer prognosis

There are 120 different types of brain tumors. They can vary in size, shape, location and aggression. So, while some brain tumors may not need treatment, others may need several forms of therapies. There are also brain cancers, like glioblastoma, that have no cure. The prognosis of each tumor depends on a lot of factors. The prognosis can also change throughout treatment, as therapies affect the tumor. Oftentimes, there’s no way to predict how long a tumor has existed or its long-term outcome.

“There’s a lot of information out there, but a patient’s treatment and prognosis should be individualized to that patient. I worry about patients Googling their diagnosis and making assumptions about the outcome for their brain tumor,” Dr. Richardson said. “In general, we try to individualize everyone’s treatment and prognosis because there are a lot of different variables.”

Some brain cancers and tumors are more likely than others to recur after treatment. It’s important to maintain checkups with your care team to monitor your brain for any new concerns.

A diagnosis of brain cancer can be a scary experience. Many hospitals like IU Health offer support groups and social groups to allow patients to connect people who have been through this diagnosis. It’s important to remember that every case is different, and your care team will plan your treatment to fit your specific needs and goals.