Tuesday, 7 September 2010

A brain tumour is a growth of cells in the brain which multiply in an abnormal, uncontrollable way.

A benign brain tumour is a non-cancerous growth. It usually grows slowly in one place and does not invade other areas of the brain or spread to other parts of the body. It is an uncommon condition.

There are different types of benign brain tumour, depending on the type of brain cells they have grown from.

The cause of benign brain tumours is often unknown, although a genetic disease, such as neurofibromatosis, can increase your risk of getting one.

Radiotherapy to the brain, used to treat childhood leukaemia, can also increase the risk. Around five in 100 people with a benign brain tumour have a family history of brain tumours.

Who is affected?
Brain tumours can affect people of any age, including children. Some benign brain tumours, such as meningiomas, are more common in women.

What are the symptoms?
A benign brain tumour can put pressure on the brain, causing symptoms such as irritability, headache and vomiting. It can also prevent an area of the brain from functioning properly. For example, a tumour in the occipital lobe (at the back of the brain) may cause loss of vision on one side. See Symptoms for more information.

Benign brain tumours can be serious if they are not diagnosed and treated early. Although they remain in one place and do not usually spread, they can cause harm by pressing on and damaging nearby areas of the brain.

Some benign brain tumours can be surgically removed. Tumours do not normally come back once they have been removed and no further problems are caused.

Symptoms of a benign brain tumour
A benign brain tumour causes symptoms by:

•putting pressure on the brain, or
•preventing an area of the brain from functioning properly.
Increased pressure on the brain
If the tumour causes an increase in pressure inside the skull, it can lead to the following symptoms:

•irritability, drowsiness, apathy or forgetfulness,
•severe, persistent headache,
•vomiting, which is sometimes sudden and for no apparent reason,
•epilepsy or fits, which can be either major seizures or twitching in one area of the body,
•partial loss of vision or hearing,
•hallucinations, and
•personality changes, including abnormal and uncharacteristic behaviour.
It is important to see a doctor if you develop a persistent and severe headache that does not appear to have any obvious cause, especially if you also have unexpected vomiting.

Loss of brain function
Different areas of the brain control different functions, so any loss of brain function will depend on where the tumour is located. For example:

•A tumour affecting the frontal lobe may cause changes in personality, weakness in one side of the body and loss of smell.
•A tumour affecting the parietal lobe may cause difficulty in speaking, understanding words, writing, reading and coordinating certain movements. There may also be numbness in one side of the body.
•A tumour affecting the occipital lobe may cause loss of vision on one side.
•A tumour affecting the temporal lobe may cause fits or blackouts, a sensation of strange smells and problems with speech and memory.
•A tumour affecting the cerebellum may cause a loss of coordination, difficulty walking and speaking, flickering of the eyes, vomiting and a stiff neck.
•A tumour affecting the brain stem may cause unsteadiness and difficulty walking, facial weakness, double vision and difficulty speaking and swallowing.

Causes of a benign brain tumour
Some brain tumours are congenital (present at birth) and are caused by abnormal development before birth. It is not fully understood what causes non-congenital tumours.

Underlying disease
Some people have a certain genetic condition that increases the risk of growths in the brain. These conditions include:

•tuberous sclerosis
•Turcot syndrome,
•Li-Fraumeni cancer syndrome,
•von Hippel-Lindau syndrome, and
•Gorlin syndrome.
These conditions tend to cause gliomas (see Introduction, above) that appear in childhood or early adulthood (most gliomas occur later in adulthood).

Other causes
Radiotherapy to the brain increases the risk of brain tumour, but this accounts for only a small number of new cases.

It is also thought that family history of brain tumours and exposure to chemicals (such as formaldehyde) may be risk factors.

Diagnosing a benign brain tumour
If you develop any of the symptoms of a benign brain tumour, such as a persistent and severe headache, see your GP. Your GP will examine you and refer you to a specialist if necessary.

Your GP will examine the back of your eye and look for changes to the optic disc (the inside of the back of the eye) caused by an increase in pressure inside the skull. Raised pressure in the skull may indicate the presence of a tumour.

If a growth is suspected, you will be referred to a neurologist (brain and nerve specialist).

Referral to a specialist
The specialist will ask you about your medical history and symptoms. They will examine your nervous system, which may include tests of your:

•reflexes, such as your swallow reflex and knee jerk reflex,
•facial muscles (testing whether you can smile or grimace, for example),
•hearing and vision,
•limb strength,
•balance and coordination,
•skin sensitivity to pinpricks, heat and cold, and
•mental agility (simple questions or arithmetic).
Diagnosis of brain tumour is made based on your symptoms, the examinations above and the results of certain tests (see below).

You may have some of the following tests to help diagnose a brain tumour:

•Computerised tomography (CT) scan. This produces a detailed picture of your brain using a series of X-rays.
•Magnetic resonance imaging (MRI) scan. This produces a detailed picture of your brain using a strong magnetic field and radio waves.
•X-ray of the skull.
•Positron emission tomography (PET) scan. This produces an image of your brain by detecting radiation inside your head (after radiation is introduced into your body).
•Electroencephalogram (EEG). Electrodes record your brain activity.
If a tumour is suspected, a biopsy (surgical removal of a small piece of tissue) may be taken to establish the type of tumour and the most effective treatment.

A biopsy involves making a small hole in the skull and using a fine needle to obtain a sample of tumour tissue. It involves a few days in hospital.

Treating a benign brain tumour
Most benign tumours are removed with surgery. The tumour does not normally come back once it has been removed.

The aim of surgery is to remove as much of the tumour as possible without damaging the surrounding tissue. You will be given a general anaesthetic (put to sleep) and an area of your scalp will be shaved. A section of the skull is cut out as a flap to reveal the brain and tumour underneath. This is known as a craniotomy. The surgeon can then remove the tumour.

Some tumours are situated deep inside the brain and are difficult to remove without damaging surrounding tissue. In such cases, radiosurgery may be used to treat the tumour.

During radiosurgery, a dose of high-energy radiation is focused on the tumour to kill it. The treatment is completed in one session, recovery is quick and an overnight stay in hospital is not usually required. Radiosurgery is only available in a few specialised centres in the UK.

For some tumours in the base of the skull, the patient may be referred abroad for specialised proton radiotherapy.

Chemotherapy and radiotherapy
Occasionally, chemotherapy and radiotherapy may be used to shrink a benign tumour. Chemotherapy uses medication to kill tumour cells and can be given as a tablet, an injection or a drip. Radiotherapy involves controlled doses of high-energy radiation, usually X-rays, to kill the tumour cells.

overing from a benign brain tumour
After being treated for a brain tumour, you may be offered physiotherapy, speech therapy and/or occupational therapy. These therapies aim to speed up your recovery and help you cope with any problems caused by the tumour.

•An occupational therapist will recommend any equipment or alterations to your home that may help you carry out daily activities.
•A speech therapist will help you with any speech or swallowing problems.
•A physiotherapist will help you to use parts of the body that have been affected by the tumour.
The National Institute for Health and Clinical Excellence (NICE) has made recommendations on the standards of care that brain tumour patients should receive. For more information, read the Improving Outcomes guidelines

Epilepsy may affaect some patients for up to six months or rarely longer after surgery. See Brain Tumour UK's factsheet on epilepsy for more information.

Sports and activities
After you have been treated for a brain tumour, permanently avoid contact sports, such as rugby and boxing. You can start other activities again, with the agreement of your doctor, once you have recovered.

Swimming unsupervised is not recommended for around one year after treatment, as there is a risk that you could have an epileptic fit while in the water.

It is safe to have sex after treatment for a benign brain tumour. Women should avoid becoming pregnant for six months and should discuss the implications of any ongoing medication with their specialist.

Going back to work
You will become tired more easily following treatment for a brain tumour. Although you may wish to return to work and normal life as soon as possible, it is a good idea to return part-time to begin with and to go back full-time when you feel able to.

If you have experienced seizures, do not work with machinery or at heights.

Help and support
A brain tumour is often life-changing. You may feel angry, frightened and emotionally drained. Your doctor or specialist should be able to refer you to a social worker and counsellor for help with the practical and emotional aspects of your diagnosis.

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