Brain Tumors

Headaches and seizures are common brain tumor symptoms. But they can also be caused by other medical conditions.

So, how can you tell when a symptom is due to a brain tumor? And when should you see a doctor?

For more insight, we spoke with neuro-oncologist Shiao-Pei Weathers, M.D., and four survivors, who shared their first brain tumor symptoms and what led them to see a doctor.

Headache

Shelby Espinosa had had headaches in the past; doctors said they were related to back pain. But at age 22, she got a headache so severe that it caused her to stop mid-conversation.

“I had to stop talking and just hold my head,” she recalls. “It was so intense that I couldn’t think or respond. The pain would come and go, but the headache lingered for three days.”

Her back pain was gone, so she knew this was different. At the urging of her mom and then-fiancé, Shelby went to the emergency room, where she had a CT scan of her brain. Results revealed a tumor the size of a kiwi pressing against her brainstem. She had surgery to remove it, and a biopsy confirmed it was a type of brain tumor called medulloblastoma.

“Headaches that may indicate a brain tumor typically feel distinctly different from headaches you’ve had before,” says Weathers. “For example, people with chronic migraines are used to having headaches, but their headache usually feels the same each time.”

See a doctor if you have a history of headaches and suddenly have a new type of headache. Warning signs could be a headache that:

• wakes you up from sleep
• is worse in the morning
• feels worse when you’re lying flat
• causes nausea and vomiting that won’t go away

“Other potentially concerning signs could be a headache that lingers for days or weeks (especially if you rarely get headaches), or a headache that is accompanied by other symptoms, such as weakness, numbness, tingling or vision changes,” adds Weathers.

This was the case for Sean O’Brien. He was diagnosed with a brain tumor called juvenile pilocytic astrocytoma at age 20. He’d been suffering from a headache for years but didn’t find it too concerning because his family has a history of migraines and allergies. That was until the headache worsened during his sophomore year of college.

“At one point, the headache got so bad I sought out medical services on campus,” recalls Sean. “They told me I was overtired and needed to rest. Eventually, I did start to feel a little better.”

But then more symptoms arose.

He couldn’t sleep at night. And he began having blind spells where his vision would suddenly go out and return after a few moments. This started happening multiple times a day.

“I finally told my parents what was going on, and they got me to a doctor while I was home on Thanksgiving break,” says Sean. “The doctor discovered fluid buildup in my brain, and scans revealed a brain tumor.”

Seizure

Colin Clarke was playing soccer when he felt numbness on the left side of his face under his eye. Moments later, it happened again. Then he passed out.

“The next thing I know, I was on a gurney and put in an ambulance,” says Colin, who was 45 at the time. “I didn’t realize I’d had a seizure. I’d just headed the soccer ball! But I was told I had several seizures in the ambulance.”

He was later diagnosed with a grade II oligodendroglioma.

“A seizure is your body’s way of telling you something is going on medically. Sometimes it could be the hallmark of a new brain tumor that has yet to be discovered,” says Weathers. “But it doesn’t always mean a brain tumor. Any of us can seize under certain circumstances; for example, if your sodium drops low enough. Every person’s threshold to have a seizure is different.”

On two separate occasions, 39-year-old Chris Cook experienced a metallic taste in his mouth. It was subtle and sudden, and he assumed it was due to old cavities. Two weeks later, he noticed the metallic taste again while running with his dog. He began to feel faint. Then he blacked out.

“I woke up to my dog protecting me, first responders and the good Samaritans who called them to help me,” Chris recalls. “It was hard for me to comprehend what was happening, and I could not speak coherently. After a few minutes, I could think clearly, but I was unable to verbally express my thoughts until I was loaded into the ambulance.”

A neurologist diagnosed him with glioblastoma, the most aggressive type of brain tumor.

“A lot of patients think seizures are when your body stiffens all over, and you’re jerking on the ground losing consciousness because that’s what they show on TV,” says Weathers. “But seizures come in different types. It could be a flash of colored lights, stiffening and/or jerking of the face, arm and/or leg, or a period where you’re suddenly confused or unable to speak. It can also be an abnormal and typically foul smell or taste. Seizures usually present the same way each time.”

If it’s your first time having a seizure, see a doctor.

“It may not mean you have a brain tumor, but it could be indicating something else is going on in your body,” says Weathers. “The seizure is a warning sign to seek medical attention.”

Symptoms vary depending on the brain tumor's location

The type of symptom and its severity depend on where the tumor is in the brain.

Weathers classifies brain tumor symptoms into two buckets: global and focal. A global symptom is a more general symptom indicating something is growing in the brain and causing a buildup of pressure. A focal symptom tells you where the tumor likely is in the brain.

“If you have a constant headache for weeks that makes you nauseous or vomit, that’s a global symptom,” explains Weathers. “If you have anything growing in your brain, it will give you a headache if it grows large enough and starts pushing. But that doesn’t tell me exactly where it might be.”

Sometimes a brain tumor can cause a certain symptom based on where it’s growing in the brain. Depending on the location, you may have:

• difficulty speaking or understanding
• changes in vision, like a visual field cut or double vision
• weakness in the face, arm and/or leg
• numbness or tingling in the face, arm and/or leg
• hearing loss
• trouble swallowing
• slurred speech

Data suggests some symptoms are more common with certain types of brain tumors.

“It’s not a perfect correlation, but we tend to see seizures more often in patients with oligodendrogliomas than in patients with astrocytomas,” says Weathers.

Bottom line: See a doctor for new or different brain tumor symptoms

Brain tumor symptoms can be subtle, like a vision change. Or they can be more urgent, like a first-time seizure.

“Whether you visit an emergency room or make an appointment with your primary doctor may depend on the severity of your symptoms and how sick you feel,” notes Weathers. “If you have a new or different symptom that is concerning you or a family member, err on the side of caution. Brain tumor symptoms can mimic those of other medical conditions, so it’s important to see a doctor to get checked out.”

Request an appointment at MD Anderson online or call 1-877-632-6789.

Glioma and glioblastoma might sound similar, but there are differences between these two types of brain tumor diagnoses.

Here, neuro-oncologist Ashley Aaroe, M.D., explains the distinctions between glioma and glioblastoma – and shares insights on their diagnoses and treatments.

Glioblastoma is a type of glioma

A glioma is one of the most common categories of primary brain tumor. Glioblastoma is a type of glioma.

Glioma is an umbrella term for cancer of the glial cells that surround nerve endings in the brain. Glial means “glue,” and these cells provide support for neurons, which are responsible for walking, talking, thinking, seeing, and more. 

“Think of it this way: neurons are like messy teenagers; they don’t clean up after themselves and need help from their parents,” Aaroe says. “They need glial cells to help protect them, clean up after them and help nourish them. When something goes wrong, glial cells turn into a glioma. In most patients, we don’t know what causes this.”

• Related: Glioblastoma symptoms

Gliomas are categorized by grade

Many gliomas are named for the type of glial cell they most closely resemble. Slower growing gliomas are also called “low grade.” These include Grades 1 and 2 gliomas. High grade gliomas are Grades 3 and 4. Gliomas are graded based on how aggressively or rapidly the cells divide. The higher the grade, the more aggressive the brain cancer is. By definition, a glioblastoma is always a Grade 4 glioma.

Low grade tumors are typically seen more commonly in younger patients. Older patients are more likely to have a higher grade diagnosis like glioblastoma. These are some of the most common types of gliomas categorized by grade:

• Grade 1: There are many kinds of Grade 1 gliomas. Pilocytic astrocytomas are one example. These are more common in children.
• Grade 2: Diffuse glioma, either astrocytoma or oligodendroglioma.
• Grade 3: Anaplastic glioma, either astrocytoma or oligodendroglioma.
• Grade 4: Either glioblastoma IDH wildtype or IDH-mutated astrocytoma. Glioblastoma IDH wildtype is the most aggressive. 

 How glioma and glioblastoma are diagnosed

Thanks to advances in diagnostic techniques, doctors are able to make more precise glioblastoma and other glioma diagnoses.

The most common imaging test for glioma is an MRI. If the MRI shows a tumor, your physician will most likely want to take a sample to perform a biopsy. A biopsy is a surgical procedure where a piece of the tumor is cut away and removed for testing. The sample will be sent to a laboratory for analysis. After the sample arrives in the lab, a pathologist will inspect the tissue. Doctors used to only look at cancer cells under a microscope to identify the glial cell. Now, they’re able to identify these types of tumors by their molecular features, which are the genetics within the cancer cells themselves. 

In 2021, the World Health Organization (WHO) updated their classification of tumors of the central nervous system, which includes gliomas. A tumor’s cancer cells might look like a lower grade glioma under a microscope, but the genetic features of the tumor might show that it acts more like a glioblastoma. This means the tumor could be more aggressive than originally thought.

Certain genetic features can distinguish between different kinds of gliomas. Physicians test for IDH, an enzyme that affects metabolism in the cancer cells. Testing is also done for the genetic marker 1p19q, which helps distinguish oligodendroglioma and astrocytoma.  

Risk factors for gliomas and glioblastoma

While gliomas usually occur at random, there are two known situations that might cause a glioma to form. If a person has had radiation therapy to treat head and neck or brain cancer at a young age, they are at a higher risk for secondary cancers. If genetic diseases run in a patient’s family, this might stem from a glioma diagnosis. Otherwise, there are no known factors that cause gliomas.

While there are no modifiable risk factors for glioblastomas, male patients who are in their 50s are more likely to be diagnosed with this kind of tumor.

 Treatments for glioma and glioblastoma differ, too

Most of the time, gliomas tend to infiltrate the brain. When this happens, it can be difficult to completely get rid of the cancer cells. This means that the tumor could grow back or become more aggressive. That’s why surgery is an important part of a patient’s treatment plan, but radiation therapy or chemotherapy might also be needed. 

Because glioblastomas are more aggressive, they are often treated with a combination of radiation therapy and a low dose of chemotherapy. This is often followed by more chemotherapy.

Typically, other types of gliomas may be treated by radiation alone followed by chemotherapy. They might also be treated with different types of chemotherapy depending on the type of glioma. But they’re not usually treated with chemotherapy and radiation therapy together. 

After completing treatment for glioma, patients undergo regular MRIs to make sure their tumor has not recurred. How often a patient is seen varies, depending on their diagnosis and treatment plan. 

“There are many different types of gliomas, and our understanding of what makes certain ones act differently than others is continuing to evolve,” Aaroe says. “It’s important to make that distinction because these advances identify different prognoses and different optimal treatment options for patients.” 

 Request an appointment at MD Anderson online or by calling 1-877-632-6789.

Receiving a brain tumor diagnosis can be overwhelming. There are so many different types of brain tumors and treatment options, and you may feel like you have more questions than answers.

To help you navigate your diagnosis and questions, neurosurgeon Jeffrey Weinberg, M.D., and neuro-oncologist Shiao-Pei Weathers, M.D., break down the most commonly searched questions about brain tumors.

How many types of brain tumors are there?

There are 120 types of brain tumors described in the master neuro-pathology handbook, according to the World Health Organization. While there are many different types of brain tumors, most are extremely rare.

“The types of brain tumors that Dr. Weinberg and I see most often are gliomas and specifically glioblastomas,” Weathers says. “They are not only the most common, but also the most aggressive.”

The Central Brain Tumor Registry of the United States shows that the three most common brain tumor diagnoses include meningioma, glioblastoma and tumors of the pituitary gland. Most pituitary tumors are non-cancerous growths.

• Related topic: Brain tumor symptoms

What causes brain tumors?

Tumors are caused by changes in the DNA of cells. When cells start dividing in a manner that is not controllable, this causes a mass.

Weinberg explains it like this: “Imagine your desk covered with salt, and then sprinkle pepper on top of the salt,” he says. “Those tiny pepper flakes scattered throughout are the tumor cells that have walked away from the mass. The difficulty in treating a tumor is not the mass. I can remove it through surgery. The hard part is treating the tumor cells that are left behind, where chemotherapy has difficulty getting to.”

Often, patients worry that everyday items, like cell phones and hair dye, cause brain tumors. These different exposures might seem toxic, but have not been proven to cause brain tumors. Weathers confirms that the only known risk factor for developing a brain tumor is previous exposure to ionizing radiation. “This might apply to patients who were diagnosed with leukemia at a younger age who underwent radiation treatment to the brain. As a result of that direct radiation exposure to their brain as a child, they are at high risk for developing a secondary brain tumor.”

Some rare genetic cancer syndromes, such as Li-Fraumeni Syndrome, also increase the risk of a brain tumor diagnosis in addition to other cancer diagnoses.

How common is a brain tumor diagnosis?

A brain tumor diagnosis is considered rare compared to other cancer types. “Most general oncology practices in the community may only see a few patients with a diagnosis such as a glioblastoma a year,” says Weathers.

About 700,000 Americans are living with a primary brain tumor, according to the Central Brain Tumor Registry of the United States. Approximately 70% of all brain tumors are benign (non-cancerous), and 30% are malignant (cancerous).

If I have a brain tumor, can I pass it on to my children?

Brain tumors, in general, are not hereditary, unless you have a rare hereditary cancer syndrome like Li-Fraumeni Syndrome. “The overwhelming majority of brain tumors are sporadic or random without risk of passing the diagnosis to your children,” says Weathers.

What treatment options are available for patients with a brain tumor diagnosis?

Treatment depends on the type of brain tumor, as well as the tumor size and location.

“For a newly diagnosed tumor, first we determine the actual tumor type. This can be identified through a biopsy or preferably surgery to safely remove as much of the tumor as possible,” says Weinberg. “If we cannot perform a resection safely or cannot remove enough of the tumor, we will confirm the diagnosis through a biopsy.”

The three most common treatments are surgery, radiation therapy and chemotherapy. For patients who are diagnosed with gliomas or glioblastoma, MD Anderson offers many clinical trial options, which give patients access to cutting-edge treatments such as laser interstitial thermal therapy (LITT) and targeted therapies that aren’t widely available yet.

What should I look for when deciding where to seek brain tumor treatment?

Every patient who visits MD Anderson’s Brain and Spine Center for brain tumor treatment receives personalized care from the nation’s top brain tumor experts. We have one of the most active programs in the country for treatment of benign and malignant brain tumors.

“Because brain tumors are rare, you need a team with the highest level of expertise,” says Weathers. “Brain tumors often carry a poor prognosis, so it matters where you go first for treatment. I tell patients that it can make a big difference in the long run to come some place like MD Anderson from the beginning. We have a dedicated multidisciplinary team of more than 70 highly trained brain tumor experts who will work together to develop a personalized treatment plan for your specific case.”

Weinberg adds: “It might be your first time dealing with a brain tumor, but it’s not ours.”

Request an appointment at MD Anderson online or by calling 1-877-632-6789.

Headaches, seizures and weakness throughout the body can all be potential brain tumor symptoms. Because these symptoms can also be signs of other conditions, how do you know the difference between a common headache and something more serious?

We met with neurosurgeon Jeffrey Weinberg, M.D., and neuro-oncologist Shiao-Pei Weathers, M.D., to learn about brain tumor symptoms. But first, let’s start with the basics.

What is a brain tumor?

A brain tumor is an abnormal growth of cells in the brain that might be benign (non-cancerous) or malignant (cancerous). When people think about brain tumors, they most likely think it’s anything that occurs inside the head.

The way brain tumors are categorized depends on where they are in the skull. “Tumors are typically named by the cells that they derive from,” Weinberg says. “For example, astrocytoma is a type of cancer that can occur in the brain or spinal cord. It begins in cells called astrocytes that support nerve cells.”

What are common brain tumor signs and symptoms?

There are a few common brain tumor symptoms. These include:

Headaches

Red flags include headaches that:

• won't go away after you try over-the-counter pain medication
• make you vomit
• wake you up in the middle of the night 
• are worse when you lie flat

“If you have a headache and notice other neurologic symptoms, such as weakness or feeling uncoordinated, these are all warning signs that something may be going on that warrants medical attention,” Weathers says. “It might not mean that it’s a brain tumor, but it’s a sign that you should see a doctor urgently.

Seizures 

A seizure can be related to many different types of diagnoses. For a brain tumor, a seizure might occur because the tumor is irritating that part of the brain. Seizures also vary in how they present. “A seizure doesn’t have to be a big event where someone loses consciousness and shakes all over,” Weathers says. “It can be more subtle than that.” A seizure might target a certain part of the body and cause tingling in the arm or leg, confusion, or trouble speaking.

Changes related to motor function of the brain

Depending on the location of the brain tumor, it might affect the motor function of the brain. Some people might experience weakness of the face, arms or legs. If a tumor involves a sensory area, a patient may experience numbness.

“The person could also have difficulty speaking, understanding or both,” Weathers says. “And very rarely, if a tumor involves the back part of the brain near the brainstem, they can present with incoordination. This includes difficulty with balance, either with walking or using the arms and legs.”

“If there’s pressure on the cranial nerves, you’re going to have dysfunction from what that nerve does,” Weinberg says. “An acoustic neuroma might present itself through ringing in the ear or weakness of the face. You can have pressure on the nerve that controls the tongue, so your tongue might not stick out straight. Pituitary tumors might cause blind spots. You can have an eye movement disability, and sometimes patients won’t be able to look straight up.”

Are symptoms different for malignant versus benign brain tumors?

Unfortunately, there is no specific symptom that confirms whether someone has a brain tumor, whether it be malignant or benign.

Sometimes, low-grade tumors, such as oligodendrogliomas, have a higher tendency to present with a seizure versus a high-grade tumor such as a glioblastoma, says Weathers. If a tumor is growing rapidly, the patient may experience new headaches that cause nausea and vomiting.

• Related: Glioblastoma symptoms

When should I contact you’re my doctor if I start to notice brain tumor symptoms?

Reach out to your primary care doctor when a symptom is new and different.

“All of these symptoms might be caused by something different, but if symptoms like a headache continue to become more painful or severe over the course of a few weeks, it deserves to be looked at,” Weinberg says.

How will my doctor determine if I have a brain tumor?

Your primary care doctor will most likely evaluate you in person to look for anything abnormal. This evaluation might include imaging tests, such as a CT scan or MRI. If there’s an urgent need for care, such as extreme headaches or a seizure, you may need to go to an emergency room for evaluation.

Brain tumor symptoms can overlap with symptoms related to other medical conditions. Experiencing any of these symptoms does not necessarily mean you have a brain tumor, but it’s important to see a doctor to determine

Request an appointment at MD Anderson online or by calling 1-877-632-6789.