Low-grade or non-malignant brain tumours Part 2 – What are the symptoms and treatment?

We simply don’t know how many people with low-grade brain tumours are misdiagnosed or diagnosed too late each year.  This area is under-researched and under-reported.

If you read my first blog in this series, you will have learned that that there many types of low-grade or non-malignant brain tumour, most with complicated names and all with different characteristics.  You will have also learned that although ‘less scary’ sounding, the low-grade tumour still has a significant impact on our bodies.

Part 2 of my blog series explores the symptoms of these brain tumours and the treatment that could be available.

How fast can low-grade or non-malignant tumours grow?

The growth rates depend on the type of tumour. Typically, these tumours are slow growing, but some types of low-grade tumour may grow faster than others.  The period that a tumour may have been growing before anyone realises its existence could be a few years, or even 10 years.  Until an individual begins to develop symptoms, they may not even know that the tumour exists.

What are the symptoms of a low-grade or non-malignant brain tumour?

The symptoms of low-grade tumours are surprisingly non-specific and each tumour has a different set of symptoms.  However the general symptoms could include:

• Hearing loss (which might just affect one side)
• Changes to the sound and quality of your voice
• Tinnitus (ringing/pounding sound in the ears)
• Headaches
• Seizures (fits)
• Pins and needles
• Problems with balance
• Changes to eyesight
• Physical changes and muscle wasting
• Vomiting
• Personality changes

Some of these symptoms do not seem very worrying on their own and they could be attributed to lots of other less serious conditions.  But it’s often the grouping together of certain symptoms that should alert a medical professional to a more serious cause.

How are low-grade tumours diagnosed?

The relatively uncommon occurrence of these tumours and the fact that the symptoms can be attributed to other conditions, means that they can sometimes be overlooked by medical professionals.  But if the tumour is not diagnosed in time, the symptoms can worsen and can even become irreversible, which can have a huge impact on a person’s life.

Investigations to diagnose these types of tumour can include the medical professional taking a full history from the individual, finding out when the symptoms first started, whether they have worsened at any point and how they impact the person’s life.  The medical professional may then take blood tests, hearing tests, or a nasal endoscopy, and they may check the person’s balance and co-ordination for example.

However the clearest way of diagnosing a non-malignant or low-grade brain tumour is by way of a scan such as an MRI or CT scan.  The imaging will help to establish the size of the tumour and its position. It will help a specialist (normally a Neurologist and/or Neurosurgeon) to identify the options for treatment.  A biopsy may also be taken to confirm whether the tumour is cancerous or not.

What treatment is available?

After the tumour has been diagnosed, treatment will be considered.  Depending on the site of the tumour and its size, treatment could include:

• Full or partial surgical removal
• Radiotherapy
• Stereotactic Radiosurgery or Gamma Knife Surgery
• The ‘Watch and Wait’ option.

It’s worth pointing out that not all non-malignant or low-grade brain tumours are suitable for surgical removal.  The surgeon will need to consider the risks of complications arising with surgery, including the risk of causing irreparable damage to the surrounding tissues.  Unfortunately some tumours are not operable on because they are in a critical part of the brain or they might involve the blood supply or drainage of the brain.  Even if they are diagnosed appropriately in time, all the treatment options might not still be available.

For the tumours that are too large, or where there is some tumour left after surgery, radiotherapy may be offered to try and prevent the tumour from growing any larger.

Another treatment option is stereotactic radiosurgery (SRS) or gamma knife surgery.  This technology uses a high dose of focussed radiation beams or small gamma rays to prevent the tumour from growing.  The treatment is usually provided in one session, unlike radiotherapy which is often administered over several weeks.  The advantage of this treatment is that it avoids the risk of damage to surrounding tissues, unlike surgical removal.

Alternatively, if the non-malignant brain tumour is not causing many unpleasant symptoms, the individual may be advised to ‘watch and wait’.  This is where the tumour may be actively monitored by MRI scans, perhaps on an annual basis.  This may be the preferred option rather than treatment which could carry certain risks.  However it can be very difficult for someone to live with the knowledge of the low-grade tumour, waiting for their symptoms to worsen as it grows.

Why is the timing of the diagnosis so important?

With most non-malignant or low-grade brain tumours, early diagnosis is key to having the chance of a better outcome.

For example, if the tumour is too large, surgery might not be offered due to the risk of damaging surrounding areas.  Also, stereotactic radiosurgery/gamma knife surgery is only available at limited medical centres in the UK and there is a size limit for the tumours that can be treated by this method.

And although the ‘watch and wait’ option might also sound less risky, if the tumour grows too large, it may be one of the only options left.

In a lot of cases, the bigger the tumour has grown, the fewer treatment choices there are available.  Therefore, recognising the signs and symptoms of a low-grade brain tumour, and getting diagnosed early, is really important.

The team at Brain Tumour Research has been involved in some exciting research into diagnosing certain types of low-grade tumour.

Hugh Adams of the charity advised us:

‘Our Centre of Excellence at the University of Plymouth is one of Europe’s leading research institutes for low-grade brain tumours. Earlier this year, our researchers made an exciting discovery of a biomarker which helps to distinguish between Grade 1 or Grade 2 meningiomas. This could see a simple blood test reduce, or in some cases replace, the need for intrusive surgery to help determine the best course of treatment for patients and contribute to the development of more personalised treatment options for patients with meningioma. The more that is invested in this early-stage research, the closer we are going to get to improving options and outcomes for those diagnosed with a low-grade brain tumour.’

This is an exciting development and hopefully we will see further progress in this area.

Next time – I’ll be talking about what can go wrong if low-grade tumours are left undiagnosed and how this could give rise to a clinical negligence claim.  I’ll also be sharing a case study involving one of our clients.