Symptoms

The signs and symptoms of a brain tumor vary greatly and depend on the brain tumor's size, location and rate of growth.

General signs and symptoms caused by brain tumors may include:

• New onset or change in pattern of headaches
• Headaches that gradually become more frequent and more severe
• Unexplained nausea or vomiting
• Vision problems, such as blurred vision, double vision or loss of peripheral vision
• Gradual loss of sensation or movement in an arm or a leg
• Difficulty with balance
• Speech difficulties
• Confusion in everyday matters
• Personality or behavior changes
• Seizures, especially in someone who doesn't have a history of seizures
• Hearing problems

When to see a doctor

Make an appointment with your doctor if you have persistent signs and symptoms that concern you.

Brain tumors that begin in the brain

Primary brain tumors originate in the brain itself or in tissues close to it, such as in the brain-covering membranes (meninges), cranial nerves, pituitary gland or pineal gland.

Primary brain tumors begin when normal cells acquire errors (mutations) in their DNA. These mutations allow cells to grow and divide at increased rates and to continue living when healthy cells would die. The result is a mass of abnormal cells, which forms a tumor.

In adults, primary brain tumors are much less common than are secondary brain tumors, in which cancer begins elsewhere and spreads to the brain.

Many different types of primary brain tumors exist. Each gets its name from the type of cells involved. Examples include:

• Gliomas. These tumors begin in the brain or spinal cord and include astrocytomas, ependymomas, glioblastomas, oligoastrocytomas and oligodendrogliomas.
• Meningiomas. A meningioma is a tumor that arises from the membranes that surround your brain and spinal cord (meninges). Most meningiomas are noncancerous.
• Acoustic neuromas (schwannomas). These are benign tumors that develop on the nerves that control balance and hearing leading from your inner ear to your brain.
• Pituitary adenomas. These are mostly benign tumors that develop in the pituitary gland at the base of the brain. These tumors can affect the pituitary hormones with effects throughout the body.
• Medulloblastomas. These are the most common cancerous brain tumors in children. A medulloblastoma starts in the lower back part of the brain and tends to spread through the spinal fluid. These tumors are less common in adults, but they do occur.
• Germ cell tumors. Germ cell tumors may develop during childhood where the testicles or ovaries will form. But sometimes germ cell tumors affect other parts of the body, such as the brain.
• Craniopharyngiomas. These rare, noncancerous tumors start near the brain's pituitary gland, which secretes hormones that control many body functions. As the craniopharyngioma slowly grows, it can affect the pituitary gland and other structures near the brain.

Cancer that begins elsewhere and spreads to the brain

Secondary (metastatic) brain tumors are tumors that result from cancer that starts elsewhere in your body and then spreads (metastasizes) to your brain.

Secondary brain tumors most often occur in people who have a history of cancer. But in rare cases, a metastatic brain tumor may be the first sign of cancer that began elsewhere in your body.

In adults, secondary brain tumors are far more common than are primary brain tumors.

Any cancer can spread to the brain, but common types include:

• Breast cancer
• Colon cancer
• Kidney cancer
• Lung cancer
• Melanoma

Risk factors

In most people with primary brain tumors, the cause of the tumor is not clear. But doctors have identified some factors that may increase your risk of a brain tumor.

Risk factors include:

• Exposure to radiation. People who have been exposed to a type of radiation called ionizing radiation have an increased risk of brain tumor. Examples of ionizing radiation include radiation therapy used to treat cancer and radiation exposure caused by atomic bombs.
• Family history of brain tumors. A small portion of brain tumors occurs in people with a family history of brain tumors or a family history of genetic syndromes that increase the risk of brain tumors.

Alternative medicine

Little research has been done on complementary and alternative brain tumor treatments. No alternative treatments have been proved to cure brain tumors. However, complementary treatments may help you cope with the stress of a brain tumor diagnosis.

Some complementary treatments that may help you cope include:

• Acupuncture
• Art therapy
• Exercise
• Meditation
• Music therapy
• Relaxation exercises

Talk with your doctor about your options.

Coping and support

A diagnosis of a brain tumor can be overwhelming and frightening. It can make you feel like you have little control over your health. But you can take steps to cope with the shock and grief that may come after your diagnosis. Consider trying to:

• Learn enough about brain tumors to make decisions about your care. Ask your doctor about your specific type of brain tumor, including your treatment options and, if you like, your prognosis. As you learn more about brain tumors, you may become more confident in making treatment decisions.
• Keep friends and family close. Keeping your close relationships strong will help you deal with your brain tumor. Friends and family can provide the practical support you'll need, such as helping take care of your house if you're in the hospital. And they can serve as emotional support when you feel overwhelmed by cancer.
• Find someone to talk with. Find a good listener who is willing to listen to you talk about your hopes and fears. This may be a friend or family member. The concern and understanding of a counselor, medical social worker, clergy member or cancer support group also may be helpful.

Ask your doctor about support groups in your area. Or check your phone book, library or a cancer organization, such as the National Cancer Institute or the American Cancer Society.

Preparing for an appointment

Make an appointment with your doctor if you have any signs or symptoms that worry you. If you're diagnosed with a brain tumor, you may be referred to specialists, such as:

• Doctors who specialize in brain disorders (neurologists)
• Doctors who treat cancer (oncologists)
• Doctors who use radiation to treat cancer (radiation oncologists)
• Doctors who specialize in nervous system cancers (neuro-oncologists)
• Surgeons who operate on the brain and nervous system (neurosurgeons)
• Rehabilitation specialists

It's a good idea to be well-prepared for your appointment. Here's some information to help you get ready, and what to expect from your doctor.

What you can do

• Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Write down key personal information, including any major stresses or recent life changes.
• Make a list of all medications, vitamins or supplements that you're taking.
• Consider taking a family member or friend along. Sometimes it can be difficult to remember all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions can help you make the most of your time together. List your questions from most important to least important in case time runs out. For a brain tumor, some basic questions to ask your doctor include:

• What type of brain tumor do I have?
• Where is my brain tumor located?
• How large is my brain tumor?
• How aggressive is my brain tumor?
• Is my brain tumor cancerous?
• Will I need additional tests?
• What are my treatment options?
• Can any treatments cure my brain tumor?
• What are the benefits and risks of each treatment?
• Is there one treatment you feel is best for me?
• Should I see a specialist? What will that cost, and will my insurance cover it?
• Are there brochures or other printed material that I can take with me? What websites do you recommend?
• What will determine whether I should plan for a follow-up visit?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask other questions that occur to you.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may allow time later to cover other points you want to address. Your doctor may ask:

• When did you first begin experiencing symptoms?
• Have your symptoms been continuous or occasional?
• How severe are your symptoms?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?

Overview

Embryonal tumors of the central nervous system are cancerous (malignant) tumors that start in the fetal (embryonic) cells in the brain. Embryonal tumors can occur at any age, but most often occur in babies and young children.

Types of embryonal tumors include:

• Medulloblastomas. The most common type of embryonal tumor, these fast-growing cancerous brain tumors start in the lower back part of the brain, called the cerebellum. The cerebellum is involved in muscle coordination, balance and movement. Medulloblastomas tend to spread through cerebrospinal fluid (CSF) to other areas around the brain and spinal cord, though they rarely spread to other areas of the body.
• Embryonal tumors with multilayered rosettes (ETMRs). Rare tumors that are cancerous, ETMRs typically occur in infants and young children. These aggressive tumors most often start in the largest part of the brain, called the cerebrum, which controls thinking and voluntary movement. ETMRs can also occur in other parts of the brain and are often characterized by a certain genetic change.
• Medulloepitheliomas. These rare, fast-growing cancerous tumors typically occur in the brain or spinal cord of infants and young children.
• Atypical teratoid/rhabdoid tumors. These rare, cancerous tumors are most often found in the cerebellum of infants and children under 3 years of age.
• Other embryonal tumors. A category called embryonal tumors not otherwise specified includes most cancerous tumors that were formerly called primitive neuroectodermal tumors (PNETs), occurring in the brain and spinal cord.

Signs and symptoms of embryonal tumors vary, depending on the type of tumor, location, severity and other factors, such as pressure buildup within the brain. Symptoms may include, for example, headaches, nausea, vomiting, unusual tiredness, dizziness, double vision, unsteady walk, seizures or other issues.

Diagnosis

The process of diagnosis usually starts with a medical history review and a discussion of signs and symptoms. Tests and procedures used to diagnose embryonal tumors include those below, but additional tests may be needed to find out if the cancer has spread.

• Neurological exam. During this procedure, vision, hearing, balance, coordination and reflexes are tested. This helps determine which part of the brain might be affected by the tumor.
• Imaging tests. Imaging tests can help determine the location and size of the brain tumor. These tests are also very important to identify pressure or blockage of the CSF pathways. A computerized tomography (CT) scan or magnetic resonance imaging (MRI) may be done right away. These tests are often used to diagnose brain tumors. Advanced techniques, such as perfusion MRI and magnetic resonance spectroscopy, also may be used.
• Removal of tissue for testing (biopsy). A biopsy is usually not done before the tumor is surgically removed, but it may be recommended if the imaging features aren't typical of embryonal tumors. The sample of suspicious tissue is analyzed in a lab to determine the types of cells.
• Removal of cerebrospinal fluid for testing (lumbar puncture). Also called a spinal tap, this procedure involves inserting a needle between two bones in the lower spine to draw out cerebrospinal fluid from around the spinal cord. The fluid is tested to look for tumor cells or other abnormalities. This test is only done after managing the pressure in the brain or removing the tumor.

Treatment

Treatment for embryonal tumors depends on the patient's age (typically babies and young children), tumor type and location, tumor grade and extent, and other factors. Options include:

• Surgery to relieve fluid buildup in the brain. Some embryonal tumors may grow to block the flow of cerebrospinal fluid, which can cause a buildup of fluid that puts pressure on the brain (hydrocephalus). ). Surgery to create a pathway for the fluid to flow out of the brain (external ventricular drain or ventriculoperitoneal shunt) may be recommended. Sometimes this procedure can be combined with surgery to remove the tumor.
• Surgery to remove the tumor. A pediatric brain surgeon (neurosurgeon) removes as much of the tumor as possible, taking care not to harm nearby tissue. Typically, all children with embryonal tumors should receive additional treatments after surgery to target any remaining cells.
• Radiation therapy. A pediatric radiation oncologist administers radiation therapy to the brain and spinal cord using high-energy beams, such as X-rays or protons, to kill cancer cells. Standard radiation therapy can be used, but proton beam therapy — available at a limited number of major health care centers in the United States — delivers higher targeted doses of radiation to brain tumors, minimizing radiation exposure to nearby healthy tissue.
• Chemotherapy. Chemotherapy uses drugs to kill tumor cells. Typically, children with embryonal tumors receive these drugs as an injection into the vein (intravenous chemotherapy). Chemotherapy may be recommended after surgery or radiation therapy, or in certain cases, at the same time as radiation therapy. In some cases, high dose chemotherapy followed by stem cell rescue (a stem cell transplant using the patient's own stem cells) may be used.
• Clinical trials. Clinical trials enroll eligible participants to study the effectiveness of new treatments or to study new ways of using existing treatments, such as different combinations or timing of radiation therapy and chemotherapy. These studies provide a chance to try the latest treatment options, though the risk of side effects may not be known. Talk with your doctor for advice.

To ensure correct diagnosis and treatment, children with embryonal tumors need to be seen at a center that has a team of pediatric specialists with expertise and experience in pediatric brain tumors, with access to the latest technology and treatments for children.