Brain Tumors: Are Headaches and Seizures Warning Signs? Types, Diagnosis, and Treatment of Brain Tumors

Brain tumors refer to abnormal masses within the cranial cavity. They are classified as primary (arising from brain cells) or secondary (metastatic from other cancers, which are actually more common). There are many types of primary brain tumors: gliomas (arising from glial cells, with glioblastoma being the most aggressive), meningiomas (mostly benign and slow-growing), pituitary tumors, schwannomas, and others.

A brain tumor is not necessarily 'cancer'—many are benign. However, because the cranial cavity has limited space, even benign tumors can compress brain tissue as they grow and require serious management. Symptoms vary widely depending on the tumor's location and size.

Causes and Risk Factors

The cause of most brain tumors is unknown. Currently, only two risk factors are clearly established: ionizing radiation (such as receiving head radiation therapy in childhood for other conditions) and a few hereditary syndromes (such as neurofibromatosis and Li-Fraumeni syndrome).

It is important to clarify that common concerns such as mobile phone use or previous head injury have no solid evidence linking them to brain tumors. The vast majority of patients have no identifiable risk factors—developing the disease is not anyone's fault.

Common Symptoms and Warning Signs

Warning signs of a brain tumor differ from ordinary headaches: gradually worsening headaches that are particularly pronounced in the morning, accompanied by nausea and vomiting; new-onset seizures (adults with a first seizure must undergo detailed evaluation); blurred vision or visual field defects; difficulty speaking or understanding; weakness or numbness on one side of the body; imbalance and unsteady gait.

Noticeable changes in personality or memory can also be warning signs, especially with frontal lobe tumors. Most of these symptoms are caused by other common conditions, but a combination of neurological symptoms that are 'new, persistent, and progressively worsening' warrants prompt brain imaging.

Diagnosis and Staging Concepts

Magnetic resonance imaging (MRI) is the gold standard for diagnosing brain tumors, clearly showing the tumor's location, size, and characteristics; computed tomography (CT) is often used in emergency situations. Some tumors can be preliminarily identified by imaging, but definitive diagnosis requires pathological examination of tissue obtained through surgery or biopsy.

Brain tumors do not use the general TNM staging system for cancer. Instead, the World Health Organization's 'grading' (grades 1 to 4) assesses the degree of malignancy: grade 1 grows slowly (such as most meningiomas), while grade 4 (such as glioblastoma) grows rapidly. Modern pathological diagnosis also tests for molecular markers such as IDH, MGMT, and 1p/19q; molecular classification has a major impact on prognosis and treatment selection.

Overview of Treatment Options

Surgery is the first choice for most brain tumors: removing as much of the tumor as safely possible while obtaining a pathological diagnosis. Benign meningiomas are often cured after complete resection; small, asymptomatic benign tumors sometimes only require regular MRI monitoring.

After surgery for malignant gliomas, radiation therapy and chemotherapy (such as temozolomide) are usually given; MGMT methylation status can predict chemotherapy response. Tumor treating fields (TTFields) is a newer physical therapy option. For recurrent or refractory cases, targeted drugs for specific genetic alterations (such as BRAF, NTRK) or participation in clinical trials may be considered. For brain metastases, treatment options include surgery, stereotactic radiosurgery, or whole-brain radiation therapy, depending on the number and location of lesions.

Clinical Trials: One More Treatment Option

Brain tumors (especially glioblastoma) are a difficult battlefield for new therapy development. Tumor treating fields, targeted drugs, immunotherapy, and novel drug delivery methods are all being explored in clinical trials. For patients with recurrence, clinical trials are often an important avenue.

The CancerLink platform can screen for brain tumor-related clinical studies recruiting in Hong Kong based on cancer type, stage, and genetic mutations. Once successfully matched and enrolled, study-related treatment costs are fully covered.

A new-onset seizure in an adult or persistent, worsening morning headaches warrants a brain evaluation. After a brain tumor diagnosis, first understand the tumor's type and molecular characteristics—they determine your treatment roadmap and what you can expect.