Understanding Brain Cancer

Brain Cancer Signs and Symptoms: Early Warnings and Advanced Indicators

A symptom is something you feel or notice in your own body, like a headache that will not go away, difficulty finding words, or a hand that feels weak for no clear reason. A sign is something a doctor can observe or measure, like an abnormal area on an MRI scan. Brain cancer can cause both signs and symptoms, and they can show up in many different ways depending on where in the brain the tumor is located and how fast it is growing.

Because the brain is so complex, brain tumor symptoms can be easy to dismiss or mistakenly attributed to other, more common causes such as stress, tiredness, or migraines. This is one reason brain cancer is sometimes diagnosed later than it might otherwise be. It is important to take any new or worsening neurological symptoms seriously and to report them to a doctor promptly, especially when they appear without a clear explanation or do not get better.

Some brain tumor symptoms come on suddenly, while others develop gradually over weeks or months. Symptoms that come on gradually, like slowly worsening headaches or a gradual change in personality, can be especially easy to overlook. Symptoms that appear suddenly and are severe, like a first-ever seizure, tend to send people to the doctor much more quickly.

One of the most important things to understand is that brain tumor symptoms are often easy to mistake for everyday problems. A headache might seem like stress. A moment of confusion might seem like a lack of sleep. A stumble might seem like clumsiness. This is why brain tumors are sometimes found later than they could have been; the early signs blend in with life. That said, when symptoms are new, persistent, gradually getting worse, or combine in unusual ways, it is worth talking to a doctor.

What Are the Signs and Symptoms of Brain Cancer?

Brain tumor symptoms fall into two broad categories.

1. General symptoms caused by increased pressure inside the skull, which show up regardless of where exactly the tumor is.
2. Focal symptoms, which are specific to the area of the brain the tumor is affecting.

Many people experience a mix of both. The earlier a brain tumor is identified and evaluated, the more treatment options are available.

What Are the Most Common Symptoms of Brain Cancer?

• Headaches: Headaches are one of the most frequently reported symptoms of brain tumors, though most headaches are not caused by brain cancer. When a brain tumor does cause headaches, they tend to have certain patterns that set them apart from typical tension or migraine headaches. They are often worse in the morning when you first wake up, because pressure inside the skull builds while you are lying down. They may get worse with coughing, sneezing, or bending over. They tend to become progressively more frequent and more severe over time, rather than coming and going like a typical headache. And they often do not respond well to regular pain medication.
• Seizures: A seizure is what happens when there is a sudden surge of abnormal electrical activity in the brain. Brain tumors irritate the surrounding brain tissue, which can trigger seizures. For some people, a seizure is the very first sign that something is wrong. Seizures can take many forms; a person might have convulsions (shaking of the body), staring spells, sudden confusion, unusual sensations, or repetitive movements like lip-smacking. Any new seizure in an adult should be evaluated by a doctor promptly.
• Cognitive or memory changes: A brain tumor in the frontal or temporal lobes can interfere with thinking, memory, concentration, and the ability to plan or make decisions. A person might find themselves forgetting words in the middle of a sentence, losing track of conversations, struggling to do tasks they normally do easily, or feeling mentally foggy. Family members sometimes notice these changes before the person does.
• Changes in personality, thinking, or behavior: The frontal lobe is responsible for personality, emotional regulation, and social behavior. A tumor in this area can cause a person to become more irritable, impulsive, or withdrawn. They may laugh or cry at inappropriate times, say things that seem out of character, or lose interest in things they normally care about. These changes can be subtle at first and are often mistaken for depression or stress.
• Weakness or numbness: A tumor pressing on or destroying motor pathways, the routes the brain uses to send movement signals down to the body, can cause weakness on one side of the body. This might show up as a hand that cannot grip properly, a leg that drags while walking, or one side of the face drooping. Numbness or tingling in the arms, legs, face, or hands can also occur when a tumor affects sensory pathways.
• Speech and language problems: A tumor near the language centers of the brain (usually on the left side) can make it hard to speak, find words, understand what others are saying, or read and write. A person might know exactly what they want to say but be unable to get the words out, or they may say the wrong word by accident. Doctors call language difficulties aphasia.

What Are the Less Common Symptoms of Brain Cancer?

Beyond the most recognized symptoms, brain tumors can cause a range of less obvious signs that are easy to overlook or attribute to something else.

• Vision problems: A tumor in or near the occipital lobe or optic pathways can cause blurred vision, double vision, loss of vision in part of the visual field, or flickering lights. These are easy to chalk up to needing new glasses, which is why they are sometimes missed initially.
• Hearing problems or ringing in the ears: Tumors near the acoustic nerve (such as acoustic neuromas/vestibular schwannomas) can cause one-sided hearing loss or a persistent ringing sound called tinnitus.
• Balance and coordination problems: A tumor in the cerebellum can make it hard to walk in a straight line, reach for things accurately, or coordinate movements. A person might seem clumsy or unsteady, or feel dizzy frequently.
• Nausea and vomiting: Increased pressure inside the skull can cause nausea and vomiting, particularly in the morning. This is more common with fast-growing tumors that produce a lot of swelling.
• Fatigue: Feeling unusually tired, even after adequate rest, is common with brain tumors. This may be caused by the tumor itself, the energy the body uses fighting disease, or the effects of brain swelling on the body's systems.
• Hormonal changes: Tumors near the pituitary gland can interfere with hormone production and cause a wide range of symptoms irregular periods, unexpected weight gain or loss, changes in sexual function, excessive thirst and urination, or abnormal growth.
• Facial pain or weakness: Tumors affecting the cranial nerves, the nerves that emerge directly from the brain and control the face, eyes, and other head structures, can cause facial pain, weakness, or changes in sensation.
• Personality or mood changes: A person may become more irritable, anxious, or depressed, or their personality may seem different to family members.
• Difficulty swallowing: Related to tumors near the brain stem.

These less common symptoms may not immediately point a person or their doctor toward a brain tumor. But when they persist, worsen, or combine with other neurological symptoms, imaging of the brain should be considered.

What Are the Symptoms of Advanced (Metastatic) Brain Cancer?

When brain cancer has grown significantly or spread within the brain or to the spinal cord, symptoms become more pronounced and may affect many systems at once. Advanced brain tumors can cause severe and unremitting headaches, repeated seizures, significant personality changes, profound weakness or paralysis on one side of the body, complete loss of speech or comprehension, and loss of the ability to swallow safely.

If cancer from another part of the body has spread to the brain (called brain metastases), the symptoms are similar to those of primary brain tumors: headaches, seizures, weakness, and confusion, but may also come alongside the symptoms of the original cancer, such as shortness of breath from lung cancer or bone pain from metastatic breast cancer.

Swelling of brain tissue around a tumor (cerebral edema) often amplifies symptoms significantly. This swelling is commonly treated with steroid medications to reduce pressure and provide symptom relief. In some cases, a tumor that blocks the flow of cerebrospinal fluid can cause hydrocephalus, a dangerous pressure buildup inside the skull, which is a medical emergency.

References

1. American Cancer Society. Brain and Spinal Cord Tumors in Adults: Signs and Symptoms. https://www.cancer.org/cancer/types/brain-spinal-cord-tumors-adults/detection-diagnosis-staging/signs-symptoms.html

2. National Cancer Institute. Adult Central Nervous System Tumors Treatment (PDQ) – Patient Version. https://www.cancer.gov/types/brain/patient/adult-brain-treatment-pdq

3. National Brain Tumor Society. Symptoms of Brain Tumors. https://braintumor.org/brain-tumors/about-brain-tumors/symptoms/

4. Wen PY, Kesari S. Malignant Gliomas in Adults. New England Journal of Medicine. 2008;359(5):492–507. https://www.nejm.org/doi/full/10.1056/NEJMx080027

5. Mehta M, Khan A, Danish S, et al. Neurologic Deficits in Brain Tumor Patients. Journal of Neuro-Oncology. 2009. https://pubmed.ncbi.nlm.nih.gov/22882948/

6. American Brain Tumor Association. Brain Tumor Symptoms. https://www.abta.org/about-brain-tumors/signs-and-symptoms/