Neuro-oncologist advises not to ignore prolonged or unexplained neurological symptoms

• A neuro-oncologist from the global health system says benign and cancerous tumours can have the same symptoms, although cancerous ones are rare.

June 2023.- Ahead of World Brain Tumour Day, a Cleveland Clinic expert is urging patients not to ignore prolonged or unexplained neurological symptoms, as they may be caused by a benign brain tumour or, far more rarely, a cancerous one, in which case early diagnosis and treatment can significantly improve outcomes.

“The vast majority of brain tumours are benign, but the symptoms of benign and cancerous tumours can be exactly the same,” says neuro-oncologist Mark Malkin. “This is because symptoms are caused by the pressure the tumour puts on the brain, as well as by the tumour’s location and the part of the body controlled by that portion of the brain.”

Symptoms caused by pressure can include changes in thinking, mood, balance or vision, spontaneous vomiting or sudden headaches, says the specialist. Location-related symptoms occur, for example, when a tumour in the frontal lobe causes difficulties in the areas it controls, such as attention, concentration and multitasking. Similarly, a tumour in the cerebellum can cause difficulties with balance, dexterity or coordination, among others.

“When a patient has neurological symptoms, neurologists usually explore three main factors to determine the next steps,” says Dr. Malkin. “First, they consider whether there is a lesion or whether the patient’s symptoms are unrelated to the nervous system. Next, if there is a lesion, they need to know where it is, which can be determined through a neurological examination and scans such as a CT and/or MRI. Finally, they will want to know what type of lesion it is, which is determined from the scan as well as by examining the patient’s history and symptoms, while ruling out other lesions such as an abscess from an infection or a blood clot.”

Types of tumours

There are more than 100 types of brain tumour, but to keep things simple, three main types are identified: primary benign tumours, primary malignant tumours and metastatic tumours, which occur when cancer cells from other organs spread to the brain through the blood.

Metastatic brain tumours are the most common of all brain tumours, says Dr. Malkin. Most of them come from very prevalent cancers, such as lung and breast cancer, or from cancers more prone to spreading to the brain, such as melanomas.

Of the primary benign brain tumours, the most common are meningiomas, although the neuro-oncologist points out that, technically speaking, these occur in the meninges – the membranes covering the brain and spinal cord – rather than in the brain itself. Of these meningiomas, around 85% are slow-growing and generally benign, he adds. They are usually detected incidentally, for example during a scan after an injury or accident. If meningiomas cause no symptoms, they are generally just monitored with MRI scans rather than treated, says Dr. Malkin.

Of the primary malignant brain tumours, the most common are glioblastomas, which grow very quickly, so the sooner they are treated, the better.

Treatments and new developments

If any type of tumour is causing symptoms because of pressure or its location, the first step in treatment will be to surgically remove as much of it as can be done safely. The removed tissue will be sent to a pathology laboratory to determine whether it is malignant or benign, primary or metastatic.

If the tumours are found to be malignant, patients will be treated with a combination of radiotherapy and chemotherapy, the latter usually given as intravenous injections or tablets. For metastatic tumours, radiotherapy may take the form of stereotactic radiosurgery, which is not surgery but a very precise way of treating a tumour with radiotherapy to minimise radiation exposure to the surrounding normal brain.

Dr. Malkin adds that new, more personalised treatments are also being developed. “Many scientists are working to identify the mutations that cause tumours to grow, so that drugs targeting those specific mutations can be developed. Glioblastomas in two patients may look the same under the microscope but be caused by different mutations, so ultimately post-operative treatment could be different for each of them.”

There is also hope on the horizon for a glioblastoma vaccine, which would be especially beneficial for patients at risk of recurrent brain tumours, says the specialist. Cleveland Clinic is taking part in ongoing clinical trials of the SurVaxM vaccine, whose initial phase 2 results are promising. Dr. Malkin explains that the vaccine targets and inactivates a protein called survivin, which is found on the surface of 80% of glioblastoma cells and is needed for them to multiply.

“Given these important advances in the field, and bearing in mind that fewer than 1% of brain tumours are cancerous, patients should not be too afraid to report any unusual symptoms to their doctors so they can be assessed as soon as possible,” concludes the neuro-oncologist.

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About Cleveland Clinic

Cleveland Clinic is a nonprofit multispecialty academic medical centre that integrates clinical and hospital care with research and education. Located in Cleveland, Ohio, it was founded in 1921 by four renowned physicians with a vision of providing outstanding patient care based on the principles of cooperation, compassion and innovation. Cleveland Clinic has pioneered many medical breakthroughs, including coronary artery bypass surgery and the first face transplant in the United States.  

U.S. News & World Report consistently names Cleveland Clinic as one of the nation’s best hospitals in its annual “America’s Best Hospitals” survey. Among Cleveland Clinic’s 72,500 employees worldwide are more than 5,050 salaried physicians and researchers, and 17,800 registered nurses and advanced practice providers, representing 140 medical specialties and subspecialties.  Cleveland Clinic is a 6,500-bed health system that includes a 173-acre main campus near downtown Cleveland, 21 hospitals, more than 220 outpatient facilities, and locations in northeast Ohio; southeast Florida; Las Vegas, Nevada; Toronto, Canada; Abu Dhabi, UAE; and London, England.

 In 2021, there were 10.2 million outpatient visits, 304,000 hospital admissions and observations, and 259,000 surgeries across Cleveland Clinic’s health system. Patients came for treatment from every state and 185 countries.  

Visit us at clevelandclinic.org. Follow us at twitter.com/ClevelandClinic. News and resources available at newsroom.clevelandclinic.org.

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