World Brain Tumor Day - June 8, 2022

Brain tumors are a leading cause of death in children and adults, with more than 200,000 diagnosed each year. Brain tumor treatments have come a long way in recent years, but there is still much more to learn about these very complex tumors.

On World Brain Tumor Day, we raise awareness about brain tumors, pay tribute to those affected by them, and support efforts to fight these terrible diseases.

What are brain tumors?

A primary brain or spinal cord tumor is a tumor that starts in the brain or spinal cord. This year, an estimated 25,050 adults (14,170 men and 10,880 women) in the United States will be diagnosed with primary cancerous tumors of the brain and spinal cord. A person’s likelihood of developing this type of tumor in their lifetime is less than 1%. Brain tumors account for 85% to 90% of all primary central nervous system (CNS) tumors. Worldwide, an estimated 308,102 people were diagnosed with a primary brain or spinal cord tumor in 2020.

Brain and other nervous system cancer is the 10th leading cause of death for men and women. It is estimated that 18,280 adults in the United States (10,710 men and 7,570 women) will die from primary cancerous brain and CNS tumors this year. Worldwide, an estimated 251,329 people died from primary cancerous brain and CNS tumors in 2020.

Primary Brain Tumor

A primary brain tumor is a tumor that starts in the brain. A primary brain tumor is often described as "low grade" or "high grade." A low-grade tumor generally grows slowly, but it can turn into a high-grade tumor. A high-grade tumor is more likely to grow faster.

In adults, secondary brain tumors, also called brain metastases, are much more common than primary tumors.

There are many types of primary brain tumors. Some cannot be assigned an exact type because the tumor’s location makes it too difficult to remove for full testing. 

Secondary Brain Tumor

A secondary brain tumor is a cancerous tumor that started in another part of the body, such as the breast, lung, or colon, and then spread to the brain. A secondary brain tumor may also be called metastatic cancer or brain metastasis.

If cancer spreads to the meninges and the cerebrospinal fluid (CSF), it is called leptomeningeal metastases or neoplastic meningitis. This condition occurs more commonly in people with leukemia, lymphoma, melanoma, breast cancer, or lung cancer.

The rest of this guide mainly covers primary brain tumors, while providing some information on brain metastasis. To learn more detailed information about cancer that started elsewhere in the body and spread to the brain, read about that specific type of cancer.

Risk Factors

Although risk factors often influence the development of a brain tumor, most do not directly cause a brain tumor. Some people with several risk factors never develop a brain tumor, while others with no known risk factors do. Knowing your risk factors and talking about them with your doctor may help you make more informed decisions. But, at this time, there are no known ways to prevent a brain tumor through lifestyle changes.

Most of the time, the cause of a brain tumor is unknown, but the following factors may raise a person’s risk of developing a brain tumor:

Age

Brain tumors are more common in children and older adults, although people of any age can develop a brain tumor.

Gender

In general, men are more likely than women to develop a brain tumor. However, some specific types of brain tumors, such as meningioma, are more common in women.

Home and work exposures

Exposure to solvents, pesticides, oil products, rubber, or vinyl chloride may increase the risk of developing a brain tumor. However, there is not yet scientific evidence that supports this possible link.

Family history

About 5% of brain tumors may be linked to hereditary genetic factors or conditions, including Li-Fraumeni syndrome, neurofibromatosis, nevoid basal cell carcinoma syndrome, tuberous sclerosis, Turcot syndrome, and von Hippel-Lindau disease. Scientists have also found “clusters” of brain tumors within some families without a link to these known hereditary conditions. Studies are underway to try to find a cause for these clusters.

Exposure to infections, viruses, and allergens

Infection with the Epstein-Barr virus (EBV) increases the risk of CNS lymphoma. EBV is more commonly known as the virus that causes mononucleosis or “mono.” In other research, high levels of a common virus called cytomegalovirus (CMV) have been found in brain tumor tissue. The meaning of this finding is being researched. Several types of other viruses have been shown to cause brain tumors in research on animals. More data are needed to find out if exposure to infections, other viruses, or allergens increase the risk of a brain tumor in people. Of note, studies have shown that patients with a history of allergies or skin conditions have a lower risk of glioma.

Electromagnetic fields

Most studies evaluating the role of electromagnetic fields, such as energy from power lines or from cell phone use, show no link to an increased risk of developing a brain tumor in adults. Because of conflicting information regarding risk in children, the World Health Organization (WHO) recommends limiting cell phone use and promotes the use of a hands-free headset for both adults and children.

Race and ethnicity

In the United States, white people are more likely to develop gliomas but less likely to develop meningioma than Black people. Also, people from northern Europe are more than twice as likely to develop a brain tumor as people in Japan.

Ionizing radiation

Previous treatment to the brain or head with ionizing radiation, including x-rays, has been shown to be a risk factor for a brain tumor.

Head injury and seizures

Serious head trauma has long been studied for its relationship to brain tumors. Some studies have shown a link between head trauma and meningioma but not between head trauma and glioma. A history of seizures has also been linked with brain tumors, but because a brain tumor can cause seizures, it is not known if seizures increase the risk of brain tumors, if seizures occur because of the tumor, or if anti-seizure medication increases the risk.

N-nitroso compounds

Some studies of diet and vitamin supplementation seem to indicate that dietary N-nitroso compounds may raise the risk of both childhood and adult brain tumors. Dietary N-nitroso compounds are formed in the body from nitrites or nitrates found in some cured meats, cigarette smoke, and cosmetics. However, additional research is necessary before a definitive link can be established.

Signs and Symptoms

Symptoms of a brain tumor can be general or specific. A general symptom is caused by the pressure of the tumor on the brain or spinal cord. Specific symptoms are caused when a specific part of the brain is not working well because of the tumor. For many people with a brain tumor, they were diagnosed when they went to the doctor after experiencing a problem, such as a headache or other changes.

General symptoms include:

• Headaches, which may be severe and worsen with activity or in the early morning
• Seizures. People may experience different types of seizures. Certain drugs can help prevent or control them. Motor seizures, also called convulsions, are sudden involuntary movements of a person’s muscles. The different types of seizures and what they look like are listed below:
• Myoclonic - Single or multiple muscle twitches, jerks, spasms
• Tonic-Clonic (Grand Mal) - Loss of consciousness and body tone, followed by twitching and relaxing muscles that are called contractions; loss of control of body functions, such as loss of bladder control; may be a short 30-second period of no breathing and a person's skin may turn a shade of blue, purple, gray, white, or green; after this type of seizure, a person may be sleepy and experience a headache, confusion, weakness, numbness, and sore muscles

• Sensory - change in sensation, vision, smell, and/or hearing without losing consciousness

• Complex partial - may cause a loss of awareness or a partial or total loss of consciousness; may be associated with repetitive, unintentional movements such as twitching

• Personality or memory changes
• Nausea or vomiting
• Fatigue
• Drowsiness
• Sleep problems
• Memory problems
• Changes in the ability to walk or perform daily activities

Symptoms that may be specific to the location of the tumor include:

• Pressure or headache near the tumor.
• Loss of balance and difficulty with fine motor skills is linked with a tumor in the cerebellum.
• Changes in judgment, including loss of initiative, sluggishness, and muscle weakness or paralysis is associated with a tumor in the frontal lobe of the cerebrum.
• Partial or complete loss of vision is caused by a tumor in the occipital lobe or temporal lobe of the cerebrum.
• Changes in speech, hearing, memory, or emotional state, such as aggressiveness and problems understanding or retrieving words can develop from a tumor in the frontal and temporal lobe of the cerebrum.
• Altered perception of touch or pressure, arm or leg weakness on 1 side of the body, or confusion with left and right sides of the body are linked to a tumor in the frontal or parietal lobe of the cerebrum.
• Inability to look upward can be caused by a pineal gland tumor.
• Lactation, which is the secretion of breast milk, and altered menstrual periods, as well as growth in hands and feet during adulthood, are linked with a pituitary tumor.
• Difficulty swallowing, facial weakness or numbness, or double vision is a symptom of a tumor in the brain stem.
• Vision changes, including loss of part of the vision or double vision can be from a tumor in the temporal lobe, occipital lobe, or brain stem.

If you are concerned about any changes you experience, please talk with your doctor. Your doctor will ask how long and how often you’ve been experiencing the symptom(s), in addition to other questions. This is to help figure out the cause of the problem, called a diagnosis.

If a brain tumor is diagnosed, relieving symptoms remains an important part of your care and treatment. This may be called "palliative care" or "supportive care." It is often started soon after diagnosis and continued throughout treatment. Be sure to talk with your health care team about the symptoms you experience, including any new symptoms or a change in symptoms.

How is a Brain Tumor Diagnosed?

Imaging tests can help doctors find out if the tumor is a primary brain tumor or if it is cancer that has spread to the brain from elsewhere in the body. Imaging tests show pictures of the inside of the body. Your doctor may consider these factors when choosing a diagnostic test:

• The type of tumor suspected
• Your signs and symptoms
• Your age and general health
• The results of earlier medical tests

Most brain tumors are diagnosed after symptoms appear. Often a brain tumor is first diagnosed by an internist or a neurologist. An internist is a doctor who specializes in treating adults. A neurologist is a doctor who specializes in problems with the brain and central nervous system.

In addition to asking the patient for a detailed medical history and doing a physical examination, the doctor may recommend the tests described below. These tests are to help find out the presence, and sometimes the type or grade, of a brain tumor.

In general, diagnosing a brain tumor usually begins with magnetic resonance imaging (MRI). Once MRI shows that there is a tumor in the brain, the most common way to determine the type of brain tumor is to look at the results from a sample of tissue after a biopsy or surgery. These tests and procedures are described below in more detail.

Magnetic resonance imaging (MRI)

An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. MRI can be used to measure the tumor’s size. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein or given as a pill or liquid to swallow. MRIs create more detailed pictures than CT scans (see below) and are the preferred way to diagnose a brain tumor. The MRI may be of the brain, spinal cord, or both, depending on the type of tumor suspected and the likelihood that it will spread in the CNS. There are different types of MRI. The results of a neuro-examination, done by the internist or neurologist, help determine which type of MRI to use.

Tissue sampling/biopsy/surgical removal of a tumor

A sample of the tumor’s tissue is usually needed to make a final diagnosis. A biopsy is the removal of a small amount of tissue for examination under a microscope and is the only definitive way a brain tumor can be diagnosed. A pathologist then analyzes the sample(s). A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease. A biopsy can be done as part of surgery to remove the entire tumor. Or surgery may be done as a separate procedure if completely removing the tumor is not possible because of its location or a patient’s health.

Your health care team may also recommend other tests to help make a diagnosis or find out how well treatment is working. Not all tests described here will be used for every person.

CT scan

A CT scan takes pictures of the inside of the body using x-rays taken from different angles. A computer combines these pictures into a detailed, 3-dimensional image that shows any abnormalities or tumors. A CT scan can help find bleeding and enlargement of the fluid-filled spaces in the brain, called ventricles. Changes to bone in the skull can also be seen on a CT scan, and it can be used to measure a tumor’s size. A CT scan may also be used if the patient cannot have an MRI, such as if the person has a pacemaker for their heart. Sometimes, a contrast medium is given before the scan to provide better detail on the image. This dye can be injected into a patient’s vein or given as a pill or liquid to swallow.

Positron emission tomography (PET) or PET-CT scan

A PET scan is used at first to find out more about a tumor while a patient is receiving treatment. It may also be used if the tumor comes back after treatment. A PET scan is usually combined with a CT scan (see above), called a PET-CT scan. However, you may hear your doctor refer to this procedure just as a PET scan. A PET scan is a way to create pictures of organs and tissues inside the body using various substances, such as sugars or proteins. A small amount of a radioactive substance is injected into the patient’s body. This substance is taken up by cells that are actively dividing. Because tumor cells are more likely to be actively dividing, they absorb more of the radioactive substance. However, the amount of radiation in the substance is too low to be harmful. A scanner then detects this substance to produce images of the inside of the body.

Cerebral arteriogram, also called a cerebral angiogram 

A cerebral arteriogram is an x-ray, or series of x-rays, of the head that shows the arteries in the brain. X-rays are taken after a special dye called a contrast medium is injected into the main arteries of the patient’s head.

Lumbar puncture or spinal tap

A lumbar puncture is a procedure in which a needle is used to take a sample of cerebrospinal fluid (CSF) to look for tumor cells, blood, or tumor markers. Tumor markers or biomarkers are substances found in higher-than-normal amounts in the blood, urine, spinal fluid, plasma or other bodily fluids of people with certain types of tumors. Typically, a local anesthetic is given to numb the patient’s lower back before the procedure.

Myelogram

The doctor may recommend a myelogram to find out if the tumor has spread to the spinal fluid, other parts of the brain, or the spinal cord. A myelogram uses a dye injected into the CSF that surrounds the spinal cord. The dye shows up on an x-ray and can outline the spinal cord to help the doctor look for a tumor. This test is only done occasionally; a lumbar puncture (see above) is more common.

Biomarker testing of the tumor

Your doctor may recommend running laboratory tests on a tumor sample to identify specific genes, proteins, and other factors, such as tumor markers, unique to the tumor. This may also be called molecular testing of the tumor. Some biomarkers may help doctors determine a patient’s prognosis, which is the chance of recovery (see Grades and Prognostic Factors). Researchers are examining biomarkers to find ways to diagnose a brain tumor before symptoms begin. Results of these tests may help determine your treatment options. 

Neurological, vision, and hearing tests

These tests help determine if a tumor is affecting how the brain functions. An eye examination can detect changes to the optic nerve, as well as changes to a person’s field of vision.

Neurocognitive assessment

This consists of a detailed evaluation of all major functions of the brain, such as storage and retrieval of memory, expressive and receptive language abilities, calculation, dexterity, and the overall well-being of the patient. These tests are done by a licensed clinical neuropsychologist. This specialist will write a formal report to compare with future evaluations or identify specific problems that can be helped through treatment.

Electroencephalography (EEG)

An EEG is a noninvasive test in which electrodes are attached to the outside of a person's head to measure electrical activity of the brain. It is used to monitor for possible seizures (see Symptoms and Signs).

Evoked potentials

Evoked potentials involve the use of electrodes to measure the electrical activity of nerves and can often detect acoustic schwannoma, a noncancerous brain tumor. This test can be used as a guide when removing a tumor that is growing around important nerves.

After diagnostic tests are done, your doctor will review the test results with you. If the diagnosis is a brain tumor, additional tests will be done to learn more about the tumor. The results help the doctor describe the tumor and plan your treatment.

Brain Tumor: Latest Research

Doctors are working to learn more about brain tumors, ways to prevent them, how to best treat them, and how to provide the best care to people diagnosed with a brain tumor. The following areas of research may include new options for patients through clinical trials. Always talk with your doctor about the best diagnostic and treatment options for you.

Enhanced imaging tests

New techniques for imaging scans are being researched. These may help doctors better track how well treatment is working and watch for possible tumor recurrence or growth.

Biomarkers

Researchers are examining biomarker tests that may help diagnose a brain tumor, estimate a patient’s prognosis, and/or predict whether a specific treatment may work. A biomarker is a substance found in your blood, urine, or body tissue. Biomarker tests give the doctor more information about the cancer.

Immunotherapy

Immunotherapy, also called biological response modifier (BRM) therapy, is designed to boost the body's natural defenses to fight the tumor. It uses materials either made by the body or in a laboratory to improve, target, or restore immune system function. Different methods are being studied for brain tumors, such as the use of dendritic cells or the use of vaccines aimed against a specific molecule on the surface of the tumor cells. Several methods are currently being tested in clinical trials.

Oncolytic virus therapy

This therapy uses a virus that infects and destroys tumor cells, sparing healthy brain cells. It is currently being researched as a treatment for brain tumors.

Targeted therapy

As outlined in Types of Treatment, this type of medication therapy targets faulty genes or proteins that contribute to a tumor’s growth and development. Research continues on the use of different therapies for brain tumors that target the different ways a tumor grows, how a tumor spreads, and how tumor cells can be destroyed.

Blood-brain barrier disruption

This technique temporarily disrupts the brain’s natural protective barrier to allow chemotherapy to more easily enter the brain from the bloodstream.

New drugs and combinations of drugs

Researchers are looking at using drugs currently available for other types of cancer as treatment for a brain tumor. In addition, combinations of drugs that target the different ways a tumor grows and spreads are being explored. Since tumors can develop resistance to chemotherapy, meaning the treatment stops working, another approach is to use a treatment that targets how tumor cells develop resistance.

Gene therapy

This type of therapy seeks to replace or repair abnormal genes that are causing or helping tumor growth.

Genetic research

Researchers are seeking more information about specific gene mutations and how they relate to the risk and growth of a brain tumor. In particular, The Cancer Genome Atlas Program is a large, ongoing effort by the U.S. National Institutes of Health to find out more about the link between genetics and glioma. Recent results include the discovery of 3 specific genetic mutations not previously linked to glioblastoma: NF1, ERBB2, and PIK3R1. Other research is focused on how the MGMT gene and mutations of IDH gene are linked to brain tumors. This information is useful to researchers and may eventually lead to advances in the diagnosis and treatment of glioma. Precision medicine approaches that target tumor-specific mutations are being explored.

Palliative care/supportive care

Clinical trials are underway to find better ways of reducing symptoms and side effects of current brain tumor treatments to improve comfort and quality of life for patients.

Observing World Brain Tumor Day

Health organizations and healthcare facilities around the world host a variety of events for World Brain Tumor Day. These events include educational seminars, conferences, and fundraisers. The day also focuses on those diagnosed with brain tumors. They are encouraged to share their stories as a way of helping others. People who have lost loved ones to a brain tumor also find ways to remember and honor them.

To participate:

• Reach out to someone who has lost someone to brain cancer or was diagnosed with a brain tumor.
• Donate to an organization that funds research for brain tumors.
• Educate yourself on the topic of brain tumors, symptoms, and treatment options.
• Wear a grey ribbon to promote awareness of brain tumors and brain cancer.
• Learn about famous people who have survived brain tumors, such as Jimmy Carter, Scott Hamilton, Sheryl Crow, and Michelle Stafford.

Spread awareness for this day on social media with #WorldBrainTumorDay.

Sources:

https://nationaldaycalendar.com/world-brain-tumor-day-june-8/

https://www.cancer.net/cancer-types/brain-tumor/introduction

https://braintumor.org/take-action/gbm-awareness-day/

https://www.cancer.net/cancer-types/brain-tumor/latest-research