Brain Tumour Treatment

A brain tumour is a growth of abnormal cells inside the skull. It may arise from brain tissue itself, from the membranes covering the brain, from the nerves entering it, or from the pituitary gland at its base. Growths that have spread to the brain from a cancer elsewhere in the body are more common than those that begin in the brain, and they are handled differently.

Two things describe a tumour, and both are needed. The first is what it is made of, which decides how fast it grows and how it responds to treatment; tumours are graded from slow-growing to aggressive. The second is where it sits. Location often matters more than grade, because the skull is a closed box with no room to expand, and a slow, entirely benign growth pressing on a critical structure can cause more trouble than a faster one in a quieter part of the brain.

That combination of what and where is why no two people with a brain tumour are given the same plan. A small growth found incidentally on a scan taken for another reason may be watched for years with repeat imaging. Others need treatment promptly. The decision is taken by a team including a neurosurgeon, an oncologist, a radiologist and a pathologist, who look at the images and the tissue together.

The neurological examination maps function region by region, and the findings point to where in the brain the problem sits.

Your doctor tests vision and, importantly, the field of vision at the edges, which people lose without noticing. The back of the eye is examined with a light to look for swelling of the optic disc, which indicates raised pressure inside the skull. Eye movements, facial movement and sensation, hearing, swallowing and tongue movement are each checked, since they correspond to specific nerves and specific locations.

The examination then covers power in each limb, tone, reflexes, coordination, balance and the pattern of your walking. Speech is assessed for both fluency and understanding, and memory, attention and orientation are tested, because changes there are often the first thing a family notices and the last thing the person themselves reports. Bring whoever has been with you day to day, since their account of what has changed over recent months is part of the assessment.

Imaging follows the examination. In most cases the exact nature of the growth cannot be known from a scan alone, and a sample of tissue is needed before the team can say what they are treating.

After an operation on the brain, expect a short period in intensive care or a high-dependency unit for close observation, then a ward for several days. Most people are up and walking within a day or two, and the hospital stay is commonly four to seven days when things go smoothly.

Fatigue is the dominant experience afterwards and it is consistently underestimated. It is normal to need a long sleep in the afternoon for six to twelve weeks, and to find concentration and word-finding harder than before for a similar period. Headache settles over two to three weeks. Where speech, memory or movement have been affected, therapy over months is what recovers them, and improvement continues well past the first few weeks.

Desk work is often possible in a graded way at six to twelve weeks, and physical work takes longer. Driving is restricted after brain surgery and after any seizure, and the period depends on what happened and what treatment you are on, so ask your neurosurgeon directly and do not assume. Where radiotherapy or drug treatment follows, it usually starts several weeks after surgery and runs on its own schedule.