First, your doctor will take down your history. The first sign of a brain tumour is not usually a headache but rather, neurological features such as paralysis, altered vision or speech, vomiting, or altered levels of consciousness. Often these problems are intermittent, rather than constant. Pituitary gland problems usually show up as changes in the menstrual cycle, abnormal growth, or sometimes diabetes.
Other things that point to tumours are the existence of a previous cancer which is known to spread to the brain or bones, and a history of wasting or loss of weight, especially if coupled with a continuing sense of weakness or malaise. These are all symptoms which can point towards a tumour of the head or neck. On the other hand, as you will immediately recognise, most of these symptoms can occur completely separately from a brain tumour, and it is unlikely that your doctor will be able to diagnose a brain tumour without doing a lot of complex tests.
The first thing your doctor will do is to arrange for a blood test to check the Erythrocyte Sedimentation Rate (ESR). This is a broad method of working out whether there is anything odd going on in the body, and simply measures the speed with which the red cells in the blood sink to the bottom of a tube of blood. Although a raised ESR means there’s something abnormal going on, a normal ESR doesn’t necessarily exclude a malignancy, unfortunately.
Next, your doctor is likely to get an X-ray, though this doesn’t give anything like as much extra information as you might think. Secondary deposits of cancer in the skull bones usually show up clearly, as punched-out areas where bone has been replaced by non-bony, malignant tissue. In addition, the X-ray will also show the shape and size of the cavity of the hollow in the bones, under the brain, where the pituitary gland sits. Tumours of the pituitary often alter the shape of this cavity.
On the other hand, simple X-rays are often unhelpful in spotting tumours of the brain itself; sometimes areas of the tumour will show up as white flecks on the X-ray, but because the consistency of a tumour is very much like the consistency of the brain itself, simple X-rays can’t show the difference between the two.
If the symptoms point towards a tumour of the pituitary, then your doctor will measure the levels of various hormones in the blood.
Much more sophisticated tests are now available for example, a CAT scan (Computer Assisted Tomography).
MRI scans are amazing in their ability to show up detail in soft tissues. X-rays can’t do this easily – most soft tissues in the body look exactly alike to X-ray. MRI scans are being used more and more to find the cause of problems deep within the body, without needing to stick in tubes, or perform operations to look around.
Finally, the doctor can organise an Electro-encephalogram (EEC) to measure the electrical activity of the brain. This can sometimes help to localise the site of a problem.
Although brain tumours are not common, they are not that rare, either. They are, unfortunately, extremely difficult to detect in their early stages. Often, the first inkling of a brain tumour is through some odd neurological event. Perhaps you have a stroke-like attack that goes away after a couple of days, though this is more likely due to a Transient Ischaemic Attack (TIA). Perhaps there is an attack of epilepsy occurring in someone who has never had epilepsy before; a first migraine occurring after the age of fifty may also be the first inkling of a brain tumour. As a general rule, any migraine which starts after the age of fifty should be treated with suspicion, and fits starting in adult life ought to be thoroughly investigated.
But even by this time it may be too late to save the patient. By the time a malignant tumour has progressed to the point where it is causing fits, paralysis or migraines it has often become incurable.
But all is not gloom – some types of brain tumour can be successfully treated. Let’s run through the list:
Benign tumours are relatively easy to treat. Simply removing them relieves the pressure on the brain and, provided the abnormal tissues have been completely removed (which is usually not too difficult to achieve), they are unlikely to re-grow again.
Malignant tumours affect two main groups of people: – children, and the elderly. Because children don’t usually get strokes or episodes of abnormal consciousness, it’s often possible to spot a brain tumour earlier in a child than in an elderly person. And the earlier the diagnosis, the more chance there is of doing something about it. Even so, by the time a malignant brain tumour is producing symptoms it may already be too late.
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