Brain tumours are abnormal growths of cells within or near the brain. They are broadly classified into two main categories: primary and secondary.
Primary Brain Cancers are those that begin in or next to the brain. In India, many people are diagnosed with a primary brain tumour each year.
Secondary Brain Cancers (also called brain metastases) occur when cancer from another part of the body spreads to the brain or spinal cord. Around 100,000 people a year are diagnosed with secondary brain cancers in India.
While most primary brain cancers may spread within the brain, it is rare for them to spread outside the central nervous system. Because the skull is rigid, any tumour growth can press on vital parts of the brain that control movement, speech, sight, or other critical functions.
Even if a brain tumour is benign (not cancerous), it can cause serious issues. Non-cancerous tumours usually grow slower than malignant ones, but as they expand, they can still damage and press against normal brain tissue, the spine, or the spinal cord.
The brain, protected by the hard, bony skull, is the control centre for emotions, thought, speech, vision, hearing, and movement. It connects to the spinal cord, and together they form the central nervous system (CNS). The brain is composed of four main parts:
The largest, outermost part, responsible for emotions, reasoning, language, muscle movement, and the senses (seeing, hearing, smelling, touch, and pain perception).
Located deeper inside, they are involved in muscle movement.
At the back of the brain, it helps control and coordinate movement, such as walking and swallowing.
At the base of the brain, its nerve fibres carry messages between the cerebrum and the rest of the body. It controls essential functions like breathing and heartbeat.
Tumours are classified by the cells they originate from. Each type grows and is treated differently.
A class of primary tumours, some of which are fast-growing. Types include:
Spreads throughout the brain and mixes with healthy tissue. Glioblastoma (GBM) is a Grade IV astrocytoma, the most common and fastest-growing malignant adult brain tumour.
Arises from cells lining the brain's ventricles and spinal cord. More common in children.
Generally slow-growing, diagnosed as a Grade II or Grade III tumour.
The most common primary brain tumour, developing from the protective layer of tissue (meninges) around the brain and spinal cord. Most are benign and slow-growing.
The most common paediatric malignant brain tumour. Rare in adults.
Non-cancerous, slow-growing tumours near the pituitary gland, mostly seen in children and middle-aged adults.
Slow-growing tumours developing from blood vessel cells, typically in the brainstem and cerebellum.
Usually benign growths on the pituitary gland, a key part of the endocrine system.
Can be benign or malignant, located deep in the brain where melatonin is produced.
Tumours that form in bones and soft tissues. Chordomas are rare sarcomas that grow in the base of the skull and bones of the spine.
While no definitive risk factors have been found for all brain tumours, certain factors may increase your risk:
Prior radiation exposure to the head, often as treatment for another cancer.
Family history of certain genetic conditions, including Neurofibromatosis type 1 and 2, Tuberous sclerosis, von Hippel-Lindau disease, and Li-Fraumeni syndrome.
Weakened immune system due to illness or medication.
Age, as certain tumours are more prevalent in specific age groups.
History of cancer that can spread to the brain.
Brain tumour symptoms vary greatly depending on the tumour's location, growth rate, and the amount of pressure it causes inside the skull (intracranial pressure). Tumours can invade brain tissue, put pressure on nearby areas, or block the normal circulation of cerebrospinal fluid.
May become more frequent over time and often do not improve with over-the-counter pain medicine.
Especially when accompanied by headaches.
Can include becoming withdrawn, moody, drowsy, confused, unable to think clearly, or having a sudden onset of depression or anxiety.
Difficulty thinking clearly, remembering things, or focusing.
Trouble speaking or finding the correct words.
Can manifest in various forms, such as numbness, tingling, uncontrollable movements, strange sensations, staring spells, or convulsions.
As a tumour grows, more serious symptoms can develop:
Worsening headaches: Especially when lying down, bending over, or bearing down.
Changes in vision: Such as double or blurry vision, or peripheral vision loss.
Hearing or smelling problems.
Loss of balance or trouble walking.
Weakness or numbness in parts of the body.
Loss of coordination or control over movements.
Change in the ability to feel heat, cold, pressure, light touch, or sharp objects.
A brain tumour does not directly cause pain to the brain itself. Instead, the symptoms arise from the pressure it places on nerves or the disruption of brain tissue. Common signs include persistent headaches, nausea, seizures, and difficulty with balance.
It is important to remember that these symptoms may be caused by conditions other than a brain tumour, such as:
Migraines or chronic headaches
Seizure disorders (e.g., epilepsy)
Stroke
Multiple sclerosis (MS)
Mental health conditions (e.g., depression or anxiety)
Infections (e.g., meningitis or encephalitis)
Neurodegenerative diseases (e.g., Alzheimer's or Parkinson's)
Any new, worsening, or unexplained neurological symptoms should be evaluated by a healthcare provider. Please consult your doctor if you:
Have headaches that worsen or do not go away.
Experience new or unusual seizures.
Notice changes in your vision, speech, balance, or personality.
Feel very confused, drowsy, or forgetful.
Have symptoms that do not improve or keep returning.
An accurate and definitive diagnosis is crucial to help your doctor pinpoint the tumour, allowing for the most advanced treatment plan with the least impact on your body. SSCHRC utilises modern and accurate equipment, supported by specialised staff, including neuropathologists who focus exclusively on diagnosing brain and spine tumours.
If a brain tumour is suspected, your doctor will perform an examination and ask about your health, lifestyle, and family history. One or more of the following tests may be used:
These non-invasive tests help determine if a tumour is present and if it has spread. They typically include:
CT (Computed Tomography) scans
MRI (Magnetic Resonance Imaging)
While imaging suggests an area of concern, a tissue sample is needed for a definitive diagnosis of a primary brain tumour. A biopsy involves removing a small tissue sample with a needle, or removing all or part of the tumour through surgery. Your neurosurgeon will determine the best type of biopsy.
A small amount of cerebrospinal fluid (CSF) is removed with a needle and examined. This is often performed if doctors suspect the tumour has spread to the meninges (the tissue layers covering the brain) and into the spinal fluid.
This testing identifies key molecular features resulting from tumour cell mutations, which are used to diagnose the tumour, provide a more accurate prognosis, and enhance the treatment plan. Key mutations tested include:
Generally indicates a better prognosis for Grade II and III gliomas.
Required for an oligodendroglioma diagnosis, this feature generally suggests the tumour will be more responsive to chemotherapy.
May indicate a better prognosis and response to chemotherapy, and is often tested for clinical trials.
Unlike many other cancers which are grouped by stage (describing how far the cancer has spread), primary brain tumours are typically graded because they rarely spread outside the brain. The World Health Organization (WHO) grading system classifies tumour cells by how abnormal they look under a microscope and how quickly they are dividing:
Cells are nearly identical to healthy cells. These tumours are slow-growing and are usually associated with long-term survival.
Cells look slightly different from healthy cells. Still considered low-grade, but more aggressive than Grade 1 and have the potential to transform into a higher grade.
Cells look abnormal and actively reproduce, growing faster than Grade 2 tumours and having the potential to transform into a Grade 4 tumour.
The most aggressive tumours. Cells do not look like normal cells and are actively reproducing and growing. Areas of dead cells may be present within the tumour.
If you are diagnosed with a brain tumour, your doctor will discuss the best treatment options, which are customised to your specific needs. The approach depends on several factors, including the tumour's location, type, and your general health. One or more of the following therapies may be recommended:
Surgery is often the first treatment for brain tumours. Even when complete removal is not possible, surgery may help to:
Reduce the tumour's size.
Relieve symptoms caused by the tumour.
Help doctors decide what other treatments are needed.
The most common surgery is a craniotomy, which involves opening the skull. While some tumours can be removed with little damage to the brain, many grow in complex areas, making complete removal difficult without affecting important parts of the brain.
SSCHRC offers advanced surgical techniques, such as the Brainsuite® iMRI, an innovative open MRI system that allows neurosurgeons to view the tumour during surgery. This helps them remove as much of the tumour as possible while sparing other brain regions.
Radiation therapy uses high-energy rays to stop or slow the growth of tumours that cannot be removed with surgery. It may be used alone or in combination with chemotherapy or targeted therapies to destroy remaining cancer cells. SSCHRC uses advanced methods to target tumours precisely, delivering the maximum amount of radiation with minimal damage to healthy cells, including:
Gamma Knife radiosurgery
Focused radiation therapy
Whole-brain radiation therapy (for multiple tumours)
Intensity-modulated radiotherapy (IMRT)
LITT is a minimally invasive treatment where a laser catheter is implanted into the tumour and heated to a temperature high enough to kill the tumour cells. It often requires only a small incision and allows most patients to return home quickly. LITT is used for both primary and metastatic brain tumours, and can help patients who have not responded to stereotactic radiosurgery or who have radiation necrosis.
Chemotherapy involves drugs taken orally or by injection, given alone or with other treatments. These drugs can kill cancer cells, but their effectiveness for brain cancer can sometimes be limited by the blood-brain barrier, a network of small blood vessels that protects the brain from harmful substances but can also shield chemotherapy drugs.
These are newer drugs that specifically target the gene changes that cause cancer growth. SSCHRC is involved in discovering these agents, and many of our brain tumour clinical trials include analysis of the molecular profiles of patients' tumours to guide the use of these therapies.
As a major cancer research centre, SSCHRC is focused on developing and evaluating new approaches to brain cancer diagnosis and treatment. Researchers are investigating biological therapies, screening existing drugs for combinations that can penetrate the blood-brain barrier, and working on cutting-edge immunotherapy approaches to harness the immune system to fight the cancer. There is also a focus on regenerative medicine to protect and repair the brain during and after treatment, aiming for better and safer solutions for both primary and secondary brain tumours.