Brain Tumours and Brain Cancer

What are brain tumours and brain cancer?

​A brain tumour is an abnormal growth of cells inside the skull. These tumours can develop from the brain tissue itself or from surrounding structures such as the meninges, cranial nerves or glands.

A brain tumour may increase pressure inside the skull, potentially leading to symptoms such as progressively worsening headaches, nausea, vomiting, changes in vision, seizures or difficulties with balance, speech or memory. The effects of a brain tumour depend on its size, location and rate of growth. While some tumours grow slowly and may remain stable for years, others can be aggressive and require prompt treatment.

Brain tumours may occur at any age, though in general, the types of brain tumours seen in children differ from those found in adults. Childhood brain tumours often arise in different areas of the brain and tend to involve different types of cells. In adults, tumours are more likely to develop in the cerebral hemispheres and may be associated with slower-growing or more aggressive forms.

What are primary vs secondary brain tumours?

Brain tumours can be primary or secondary. Both affect brain function and the nervous system. If left unchecked, they may cause severe neurological deficits, functional impairment or even death.

Primary brain tumours

Primary brain tumours may grow from the cells or blood vessels in the brain, nerves that emerge from the brain or the membranes covering the brain. They can either be benign (non-cancerous) or malignant (cancerous).

• Benign tumours grow slowly and do not spread to other areas of the body. However, they can still result in severe dysfunction by exerting harmful pressure on adjacent parts of the brain.
• Malignant tumours (brain cancer) grow rapidly and invade healthy cells in the brain. They tend to spread to adjacent structures and to the spinal column through cerebrospinal fluid.

Secondary brain tumours

Secondary brain tumours, also known as metastatic brain tumours, are mostly malignant. They result from cancer cells that have spread from another part of the body. For example, breast, lung and colon cancers may spread to the brain via the bloodstream or the lymphatic system.

When are brain tumours brain cancer?

Brain tumours are categorised based on the type of cells from which they originate and whether they are benign (non-cancerous) or malignant (cancerous). They may develop within the brain itself (primary tumours) or spread from cancers elsewhere in the body (secondary or metastatic tumours). Common types of primary brain tumours include:

• Meningiomas: These tumours arise from the meninges, the protective layers surrounding the brain and spinal cord. Most meningiomas are benign and grow slowly, but they may cause symptoms by pressing on adjacent brain tissue.
• Gliomas: This group includes tumours that develop from glial cells, which provide support and protection for neurons. Subtypes include astrocytomas, oligodendrogliomas and glioblastomas. Glioblastoma is the most aggressive and rapidly growing form.
• Pituitary adenomas: These tumours originate in the pituitary gland at the base of the brain. Although usually benign, they may interfere with hormone production and cause symptoms such as vision changes or menstrual irregularities.
• Schwannomas: These are tumours of the nerve sheath, most commonly affecting the vestibular nerve. Vestibular schwannomas (also known as acoustic neuromas) may lead to hearing loss, tinnitus or balance problems.
• Medulloblastomas: These malignant tumours are more common in children and develop in the cerebellum. They can spread through the cerebrospinal fluid and require prompt treatment.
• Ependymomas: Arising from ependymal cells lining the brain's ventricles or the spinal cord, these tumours can occur at any age and vary in severity.

Cancers from other organs can spread to the brain and are called brain metastases. Brain metastases comprise cancer cells from the original site of cancer, such as lung cancer cells and breast cancer cells.

How common is brain cancer in Singapore?

This is an uncommon cancer in Singapore. Between 1968 and 2007 there were about 1903 cases reported. The most common cancer in the brain are brain metastases that originate from other organs. Among primary brain cancer, the most common are the astrocytomas of which glioblastoma predominates.

What are the symptoms of brain cancer and brain tumours?

​Depending on the tumour's size, location and rate of growth, symptoms may vary and present gradually.

Common symptoms include:

• Headaches that recur and get worse, especially in the morning
• Nausea and vomiting
• Seizures or fits
• Unexplained drowsiness
• Double vision, blurring or trouble seeing clearly
• Increasing difficulty with speech and hearing
• Growing weakness in the limbs
• Problems with hearing, balance and coordination
• Marked changes in memory, concentration or alertness

When should you see a doctor?

You should see a doctor if you experience persistent or unexplained symptoms that interfere with daily activities or worsen over time. While occasional headaches or fatigue may have common causes, any unusual or progressive neurological changes should be investigated. Seek medical attention if your symptoms disrupt sleep, limit mobility or impact your ability to work, study or perform everyday tasks.

How are brain cancer and brain tumours prevented?

There is currently no known way to prevent brain tumours. Most brain tumours develop due to genetic mutations or inherited conditions, and the exact causes remain unclear. However, certain measures may help reduce the risk or support early detection:

• Consider genetic counselling: If you have a family history of brain tumours or genetic conditions associated with a higher risk, speak with a healthcare provider or genetic counsellor to assess the need for screening.
• Maintain a healthy lifestyle: Engage in regular physical activity, eat a balanced diet rich in fruits and vegetables and maintain a healthy weight to support general well-being.

What causes brain tumours and brain cancer?

​The cause of brain cancer and brain tumours is unknown. There is no clear evidence that injury, chemical exposure, viral infection, mobile phone use, environmental factors or mental stress can cause the condition.

What are the risk factors for brain cancer and brain tumours?

Risk factors for brain cancer and brain tumours may include:

• Age: While brain tumours can affect individuals of any age, some types are more common in children, while others occur more frequently in older adults.
• Genetic conditions: Certain inherited syndromes, such as neurofibromatosis, Li-Fraumeni syndrome or tuberous sclerosis, may increase the risk of developing brain tumours.
• Family history: Although rare, a family history of brain tumours may slightly increase the risk.
• Weakened immune system: People with weakened immune systems, including those with HIV/AIDS or those taking immunosuppressive drugs, may be at higher risk of developing specific types of brain tumours such as primary central nervous system lymphoma.

Diagnosing a brain tumour involves a combination of clinical assessment and specialised imaging techniques. The diagnostic process typically includes:

• Medical history and physical examination: The doctor will take a detailed history of the patient’s symptoms, such as headaches, vision changes or seizures. A physical and neurological examination will assess functions like coordination, reflexes, strength and cognitive abilities.
• Computed tomography (CT) scan: A CT scan uses X-rays to create detailed images of the brain. It is often used in emergency situations and can help detect bleeding, swelling or obvious masses.
• Magnetic resonance imaging (MRI): An MRI scan provides more detailed images of brain tissue using magnetic fields and radio waves. It is the preferred imaging technique for identifying brain tumours and evaluating their structure.
• Cerebral angiography: This is an imaging modality that involves injecting contrast dye into the brain’s blood vessels, followed by a series of X-rays. It helps visualise the blood supply to the tumour and may be useful in planning surgery for very vascular tumours.
• Functional MRI (fMRI): This advanced MRI technique measures brain activity by detecting changes in blood flow. It helps identify regions of the brain responsible for speech, movement and other critical functions, especially when the tumour is near these areas.
• MRI tractography: This specialised imaging method maps the white matter tracts of the brain, which are the pathways that connect different brain regions. It is particularly valuable when planning surgery near important neural pathways.

How are brain cancer and brain tumours treated?

Treatment options for brain tumours can be used on their own or in combination. The treatment for brain tumours depends on the type of tumour, size, location and the patient’s general health. Therapy may also be administered to reduce the risk of the tumour coming back.

In some cases, treatment may not be required. The tumour may simply be left alone and closely monitored.

Brain tumour treatment involves a multidisciplinary team of specialists, including neurosurgeons, neurologists, neuroradiologists, neuropathologists, oncologists, nurse clinicians and allied health professionals (therapists, social workers, psychologists, dieticians).

The treatment options include:

Surgery
In most cases, surgery is the first line of treatment. The goal is to remove as much of the tumour as possible while preserving healthy brain tissue. Specialised surgical instruments and advanced techniques are used to minimise damage. A computerised navigation system, also known as image-guided surgery or neuronavigation, assists the neurosurgeon in accurately locating the tumour and avoiding critical brain structures.

In selected cases, an awake craniotomy may be performed, especially when the tumour is close to brain regions responsible for essential functions such as speech or movement.

The patient remains conscious during part of the procedure, allowing real-time monitoring of neurological functions to reduce the risk of damage. Surgical risks may include infection, bleeding, seizures, neurological deficits, paralysis or, in rare cases, coma.

Radiation therapy
This involves the use of high-energy beams, such as X-rays or protons, to destroy tumour cells. Radiation therapy may be used as a primary treatment or after surgery to treat remaining tumour tissue. It can be delivered externally through external beam radiation, typically administered over a course of 2 to 6 weeks, or internally through brachytherapy, where radioactive material is placed close to or inside the tumour. Side effects may include fatigue, hair loss, nausea or localised skin irritation.

Radiosurgery
Despite its name, radiosurgery does not involve an actual surgical incision. Instead, it delivers multiple highly focused beams of radiation to a specific target within the brain. Techniques such as Gamma Knife or CyberKnife are often used. Radiosurgery is typically performed as a one-time, non-invasive outpatient procedure and is particularly effective for small, well-defined tumours or those in hard-to-reach locations.

Chemotherapy
Chemotherapy uses drugs to destroy cancer cells or stop them from growing. These medications may be administered orally or through intravenous infusion.

Chemotherapy may be used alone or in combination with other treatments such as radiation therapy. Common side effects include fatigue, nausea, lowered immunity and hair loss.

Targeted drug therapy
This approach involves the use of drugs that specifically target genetic or molecular changes within tumour cells. Unlike traditional chemotherapy, targeted therapies aim to block the growth and spread of cancer cells while causing less harm to normal cells. These treatments are often guided by tumour profiling or biomarker testing to determine which drugs are most likely to be effective.

What are the potential side effects of treatment?

​Side effects from radiation therapy may include fatigue, headaches and scalp irritation. Patients undergoing chemotherapy may experience nausea and hair loss, while those undergoing radiosurgery may have headaches and nausea.

Surgery for a tumour that is close to a nerve or located in a critical or sensitive area of the brain may affect body functions such as sight, speech and movement.

What are the early warning signs of brain tumours or brain cancers?

Early symptoms may include persistent headaches, seizures, nausea, difficulty with balance, changes in vision or cognitive and behavioural alterations. These symptoms can vary depending on the size and location of the tumour.

Can brain tumours or cancers be cured?

The possibility of a cure depends on the type, size, location and stage of the tumour, as well as the patient’s age and overall health. While some brain tumours can be treated successfully with surgery, radiotherapy or chemotherapy, others may be managed to control symptoms and slow progression.

I have headaches all the time. Could I be suffering from a brain tumour or brain cancer?

Headaches have many causes, such as stress, eyesight problems and migraine. Seek medical help if there are worrisome symptoms, such as vomiting, double vision, weakness on one side of the body, seizures or if the headache is getting progressively worse.

My mother had breast cancer. Now she has brain cancer. Why does she have so many illnesses? Will she die soon?

When breast cancer spreads to the brain, the cancer cells there are still breast cancer cells. It is an advanced stage of breast cancer. With appropriate treatment, some of her symptoms may be controlled. Cancer that has spread to the brain does not necessarily mean that it is immediately life-threatening if appropriate treatment is sought.

What is the prognosis of brain tumours?

Clinical examinations, x-rays and pathology reports all help the medical team decide what the progress of an individual case of brain tumour may be. The appropriate course of treatment will then be put into action. The treatment strategy will vary from person to person. Features that influence the outcome of the tumour include the patient's exact type of brain tumour including its biological characteristics, the extent of brain function affected by the tumour, whether the tumour can be operated on and the age and functional status of the patients.

What is the age of onset for brain cancer?

Although infants have been reported to have brain cancers as well, the risk increases after the age of 35 years. During the childhood years, primary brain and spinal cord cancers are the second leading cause of death from solid cancer.

Can a brain tumour return after treatment?

Yes, some brain tumours may recur even after successful treatment. The likelihood of recurrence depends on the type of tumour, how completely it was removed and whether additional therapies such as radiotherapy or chemotherapy were used.

How does a brain tumour affect mental and emotional health?

A brain tumour can impact mood, behaviour and cognitive function. Some individuals may experience memory issues, personality changes, anxiety or depression. Psychological support and cognitive therapy may help manage these effects.

Are brain tumours always detected early?
Not always. Some brain tumours grow slowly and may not cause noticeable symptoms until they are quite large or affect specific brain functions. Others may present with vague symptoms that are easily mistaken for other conditions.

​What support is available during brain tumour rehabilitation?
Recovery depends on the brain’s ability to heal from damage caused by the tumour. Therapists such as physiotherapists, occupational therapists and speech therapists can help support rehabilitation. If there is persistent disability, the patient may be sent to a community hospital for further neuro-rehabilitation.

During rehabilitation, the patient and family should maintain a positive attitude, set realistic goals and work steadily to accomplish each goal.

The Brain Tumour Society Singapore (BTSS) is a community of brain tumour patients, caregivers and survivors. The BTSS provides community support and resources such as befrienders, financial assistance and public education. Started by brain tumour survivors, BTSS meets once a month so that members can share experiences and advice on how to cope with the disease.

Download the Brain Tumours brochure.