Neurosurgery

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: 

1. Headaches: Red flags include headaches that:

• won’t go away even after you try over-the-counter pain medication
• make you throw up
• wake you up in the middle of the night from sleeping
• 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.”

2. 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.

3. Changes related to motor function and the brain: Depending on the location of the brain tumor, it might affect a person's motor function. 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.”

Meningiomas are a primary central nervous system tumor that make up 38% of all primary intracranial tumors. They are typically benign and often go undetected for many years. Even though these types of tumors grow slowly over time, they can become life-threatening.

Neurosurgeon and meningioma expert Franco DeMonte, M.D., breaks down what you should know and what to look out for.  

What is a meningioma?

A meningioma is a tumor that forms on the outside membranes that cover the brain and spinal cord. These membranes are called meninges. Meningiomas usually do not invade the brain but press on the brain or spinal cord as they grow. They can occasionally grow outward and cause the skull to thicken.

The vast majority of meningiomas are benign. About 20% show more aggressive growth, and 3% or less are cancerous. When making an official diagnosis, a physician will determine the tumor grade. The grades are based on how abnormal the tumor cells look under a microscope and how quickly the tumor might grow, spread or come back after treatment.   

“Grade 1 meningiomas are the least likely to reoccur and least likely to have an aggressive growth pattern. They’re also the most common type of meningioma,” DeMonte says. “As you get to a Grade 2, the tumor is more likely to reoccur after it has been removed and may have a more aggressive growth pattern. A Grade 3 meningioma will most likely regrow. This grade is cancerous and the most aggressive and difficult to treat.”

What are symptoms of meningioma?

While some patients will not experience any symptoms, others might have:

• headaches,
•  seizures,
•  personality changes,
• weakness or numbness of the face or limbs, and/or
• vision changes.

These meningioma symptoms depend on the tumor’s location. As meningiomas get closer to the nerve, the tumor can affect certain senses, including sight, hearing, taste or smell. If you’re experiencing symptoms or have any cause for concern, reach out to your primary care physician. If you’re having trouble with your vision, see an ophthalmologist.

How common are meningiomas?

Meningiomas are more common than people might think. “Let’s take the Houston metropolitan area, for example. We know that for every 100,000 MRIs done between 300 to 900 meningiomas will be diagnosed. Even taking the low number, 21,000 Houstonians will be diagnosed with a meningioma,” DeMonte says. “That’s a lot of people.”

How are people typically diagnosed with meningioma? 

Most patients are diagnosed through imaging tests. Often, someone will get an MRI or CT scan for another reason, and their results will show a mass. DeMonte says that an MRI with contrast dye is best for detecting meningiomas. In some circumstances, meningiomas cannot be seen without contrast. The gadolinium-based dye identifies meningiomas with ease and provides an accurate image and diagnosis.

How is meningioma typically treated?

Once you’ve been diagnosed with a meningioma, your care team will personalize your treatment plan based on the tumor grade and symptoms. If a tumor appears to be benign and does not press on the brain or cause symptoms, observation is typically recommended. “If the patient has a small tumor that is not in a critical location and under an inch in diameter, we almost always start with observation,” DeMonte says.

Treatment will be needed if the tumor begins to grow or cause symptoms. For most healthy adults, surgery is the next step. A neurosurgeon will perform a craniotomy to safely remove the brain tumor.

However, surgery might not be the best option for meningiomas in certain locations, and additional treatments are available. “We tend not to operate if you have a meningioma in a location like the cavernous sinus, because surgery brings more risks,” DeMonte says. “We don’t want to risk operating and causing cranial nerve damage. For those patients, we recommend radiation, and if the tumor is small enough, stereotactic radiosurgery.”

If a tumor comes back or if the tumor cannot be fully removed with surgery, patients may undergo radiation therapy to destroy tumor cells and stop them from growing. Chemotherapy is also used to treat meningiomas that come back after surgery and radiation.

While many patients only need surgery, it is important to seek care at a cancer center like MD Anderson that offers multidisciplinary care and sees a large number of meningiomas. That way, your team of experts can work together to coordinate your care and ensure all aspects of your care are supported. “It’s best to go somewhere that can do it all,” says DeMonte.

Will I need continuous care after meningioma treatment? 

If you need surgery, recovery time will vary depending on the size and location of the meningioma. Most patients have their energy back at six weeks, and tissues are completely healed around three months.

For patients who only need observation, how often you visit your doctor will depend on your health care needs.  

“Some people come in to get checked every 12 months, and some come every three or six months. Then it might turn into once a year or every other year if the tumor has not progressed,” DeMonte says. “I have meningioma patients that I’ve followed for 25 years. We never have to manage those tumors. As time goes on, the frequency of visits decreases unless we catch something on their scans.”

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