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Brain tumour, benign

Introduction

A benign (non-cancerous) brain tumour is a mass of cells that grows slowly in the brain. It usually stays in one place and does not spread.

Generally, brain tumours are graded from 1 to 4 according to their behaviour, such as how fast they grow and how likely they are to spread. Grade 1 tumours are the least aggressive and grade 4 are the most harmful and cancerous. Cancerous tumours are described as malignant. 

Low-grade brain tumours – grades 1 or 2 – tend to be slow growing and unlikely to spread, so they're usually classed as benign.

Read about high-grade (malignant) tumours.

What are the symptoms?

The symptoms of a low-grade or benign brain tumour depend on how big it is and where it is in the brain. Some slow-growing tumours may not cause any symptoms at first.

Eventually, the tumour can put pressure on the brain and may cause headaches and seizures (fits). The tumour 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 Benign brain tumour - symptoms for more information.

Who is affected?

Brain tumours can affect people of any age, including children.

There are about 4,500 new cases of primary brain tumours in the UK each year (tumours that start in the brain). About 20% of these are low-grade gliomas, a type of tumour that starts in the supportive tissue of the brain. Doctors don't know what causes these.

See Benign brain tumour - causes for information about the possible causes of other types of benign brain tumour.

Treatment and outlook

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. 

Many benign brain tumours can be surgically removed and don't come back once they have been removed, causing no further problems. However, grade 2 gliomas will often grow back after treatment and have the potential to change into high-grade or malignant (cancerous) tumours, which are fast-growing and likely to spread. This change is called mutation.

See Benign brain tumour - treatment for more information on your treatment options.

In summary, your treatment will depend on the type and location of the tumour, and your outlook will depend on whether the tumour grows back and whether it mutates (changes).

Types of benign brain tumour

There are different types of benign or slow-growing brain tumours, depending on the type of brain cells they have grown from. Examples are:

  • Gliomas. These are tumours of the glial tissue, which binds nerve cells and fibres together. Most brain tumours are gliomas.
  • Meningiomas. These are tumours of the membranes that cover the brain.
  • Acoustic neuromas. These tumours grow in the acoustic nerve, which helps to control hearing and balance. 
  • Craniopharyngiomas. These tumours grow near the base of the brain and are most often diagnosed in children, teenagers and young adults.
  • Haemangiomas. These are tumours of the brain's blood vessels, which can cause seizures and partial paralysis.
  • Pituitary adenomas. These are tumours of the pituitary gland (the pea-sized gland below the brain).

For more information, read Brain Tumour UK's factsheets on meningiomas and pituitary tumours.

Mixed tumours

Mixed brain tumours are made up of two or more different types of tumour, sometimes of different grades.

You will be treated for the most aggressive part of the tumour and your outlook will depend on how much of the tumour is malignant (cancerous), the location of the tumour in your brain and other factors such as your general health.

Read more information on malignant brain tumours.

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Symptoms

The symptoms of a low-grade or benign brain tumour depend on its size and where it is in the brain. Some slow-growing tumours may not cause symptoms at first.

When symptoms do occur, it is because the brain tumour is either 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:

  • epilepsy or fits, which can be either major seizures or twitching in one area of the body
  • severe, persistent headache
  • irritability, drowsiness, apathy or forgetfulness
  • vomiting, which is sometimes sudden and for no apparent reason
  • dizziness 
  • partial loss of vision or hearing
  • hallucinations
  • 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 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 co-ordinating 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 co-ordination, 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.
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Causes

Benign brain tumours that are congenital (present at birth) are caused by abnormal development of the baby in the womb. It is not fully understood what causes non-congenital tumours.

Some genetic conditions can increase your risk of a benign brain tumour. These conditions include:

These conditions tend to cause gliomas (see Benign brain tumour - introduction) that appear in childhood or early adulthood, whereas most gliomas start later in adulthood.

Other possible causes

Radiotherapy to the brain increases your risk of a brain tumour, although this is still uncommon.

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

Can mobile phones cause brain tumours?

There have been reports in the media about a possible connection between brain tumours and the radiofrequency (RF) energy emitted by mobile phones. RF energy produces heat, which can increase body temperature and damage tissue exposed to it.

It is thought that the amount of RF energy people are exposed to by mobile phones is too low to produce significant tissue heating or an increase in body temperature.

However, research is under way to establish whether RF energy has any effects on our health in the long term. No definitive conclusions have yet been reached.

Read mobile phone safety for more information.

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Diagnosis

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 co-ordination
  • skin sensitivity to pinpricks, heat and cold
  • 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).

Tests

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

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.

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Treatment

Your healthcare team

You will be cared for by a team of healthcare professionals that may include:

  • a neurosurgeon, who will operate on your brain
  • a neurologist, who will treat illness caused by the tumour and manage your chemotherapy, if necessary
  • a radiologist, who will administer radiotherapy
  • a specialist nurse, who will give you information and support

You should be given the name and contact details of a key worker, who will support you during your brain tumour treatment.

Most benign tumours are removed with surgery and do not normally come back.

However, some slow-growing tumours (mainly gliomas) will grow back after treatment and have the potential to change into high-grade or malignant (cancerous) tumours. High-grade tumours are fast-growing and likely to spread. Therefore, it's essential to have follow-up appointments to monitor your condition.

Surgically removing a brain tumour

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 (this will put you 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.

Radiosurgery

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.

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Recovery

After being treated for a brain tumour, you may be offered physiotherapy, speech therapy 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.
  • 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 affect some patients for up to six months after surgery. On rare occasions epilepsy lasts longer than six months.

Sports and activities

After you have been treated for a brain tumour, you must 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.

Sex

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 medication needed with their specialist.

Going back to work

You will become tired more easily following treatment for a brain tumour. You may wish to return to work and normal life as soon as possible, but it is a good idea to return part-time to begin with and only 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.

There are many organisations and helplines, such as Brain Tumour UK, that provide information and support.

Can I drive or travel after a brain tumour?

If you drive and have, or have had, a brain tumour, you must give up your licence and notify the DVLA. They will speak to your GP to determine when you can drive again.

With up-to-date scans and advice from your medical team, you may be allowed to drive again once an agreed period has passed and you have successfully completed a medical test to determine your ability to control a vehicle.

Flying is usually possible from three months after treatment.

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