Brain tumours, even though are rare, represent one of the most complex and delicate challenges in modern medicine. The impact that the tumour has on patient’s life is not limited to physical health but also extends to emotional balance and quality of life. Understanding the pathway, from diagnosis to treatment, helps to reduce uncertainty and to navigate this journey with greater awareness.
The diagnosis
Brain tumours don’t usually come with clear, noticeable signs. In the early stages, symptoms are often vague and can easily be mistaken for something far less serious (Rees, 2011). Unfortunately, most people discover the tumour when the symptoms appear. The most common signs are persistent headaches (23.5%), seizures (21.3%), changes in vision (3.2%) or speech (5.8%), or unilateral weakness (7.1%); unsteadiness (6.1%); and other symptoms (24.2%), such as memory loss, nausea and vomiting (Grant, 2004).
These signs often lead to neurological examinations and imaging tests such as MRI or CT scans.
When a brain tumour is suspected or confirmed, further investigations, such as biopsy, help define the exact type, grade, and location of the tumour. In most cases surgery is the first step, and whenever it’s safe to do so, removing as much of the tumour as possible is the mainstay of treatment, as it is the case for most gliomas(van den Bent et al., 2023).
Classification of Brain Tumours
The World Health Organization (WHO) in 2021 updated the classification of brain tumours into grades (1 to 4), which describe their growth rate and aggressiveness. In this new system of classification, biomarker evaluation has been included, which plays a key role in making the diagnosis more precise(Louis et al., 2021).
Treatment Options
Treatment strategies are highly individualised and depend on tumour type, size, location, and the patient’s overall health. The main approaches defined by the EANO guidelines on the diagnosis and treatment of diffuse gliomas of adulthood(Weller et al., 2022) include:
- Surgery: Whenever possible, neurosurgeons aim to remove as much as tumour tissue or reduce its mass while preserving neurological functions.
- Radiotherapy: are used to destroy residual tumour cells or control tumour growth, without inducing neurotoxicity. Radiotherapy should start within 3–5 weeks after surgery(Press et al., 2020).
- Chemotherapy: Anti-cancer drugs are administered orally or intravenously to slow down or stop tumour progression. Temozolomide, an oral chemotherapy that penetrates the blood brain barrier, is the most used drug in glioma treatment(Weller et al., 2022).
In many cases, these treatments are combined in an integrated, multidisciplinary approach that include neurosurgeons, neurologists, oncologists and radiologists due to the complexity of the care.
Living During Treatment
Patients may experience side effects due to the treatments and after the surgery(Krajewski et al., 2023), managing these is a key component of care. Supportive therapies, including physiotherapy, speech therapy, occupational therapy and psychological support, help to improve daily life and independence. However, it is the cognitive symptoms that impact quality of life the most. The speed difficulties, the lack of attention and concentration often persist after the postoperative recovery period and during the treatment. “Multidisciplinary cognitive rehabilitation is the standard of care for addressing cognitive impairments in many neurological diseases” (Weyer-Jamora et al., 2021). A crucial role is played by the family members and caregivers but often they need guidance and support themselves to manage the emotional and practical challenges. Nurses play a vital role, not only in caring for patients but also in supporting their families. By offering clear, tailored information and practical guidance, they help people navigate daily challenges and improve the overall success of care (Sherwood et al., 2016).
Conclusion
Living with a brain tumour is undoubtedly a very challenging experience, but awareness, timely diagnosis, and modern therapeutic options allow patients and families to face this path with greater confidence. The integration of medical care, psychological support, and continuous research represents the cornerstone for improving survival and quality of life.
Bibliography
Grant, R. (2004). Overview: Brain tumour diagnosis and management/Royal College of Physicians guidelines. Journal of Neurology, Neurosurgery, and Psychiatry, 75 Suppl 2(Suppl 2), ii18-23. https://doi.org/10.1136/jnnp.2004.040360
Krajewski, S., Furtak, J., Zawadka-Kunikowska, M., Kachelski, M., Soboń, J., & Harat, M. (2023). Functional State and Rehabilitation of Patients after Primary Brain Tumor Surgery for Malignant and Nonmalignant Tumors: A Prospective Observational Study. Current Oncology, 30(5), 5182–5194. https://doi.org/10.3390/curroncol30050393
Louis, D. N., Perry, A., Wesseling, P., Brat, D. J., Cree, I. A., Figarella-Branger, D., Hawkins, C., Ng, H. K., Pfister, S. M., Reifenberger, G., Soffietti, R., von Deimling, A., & Ellison, D. W. (2021). The 2021 WHO Classification of Tumors of the Central Nervous System: a summary. Neuro-Oncology, 23(8), 1231–1251. https://doi.org/10.1093/neuonc/noab106
Press, R. H., Shafer, S. L., Jiang, R., Buchwald, Z. S., Abugideiri, M., Tian, S., Morgan, T. M., Behera, M., Sengupta, S., Voloschin, A. D., Olson, J. J., Hasan, S., Blumenthal, D. T., Curran, W. J., Eaton, B. R., Shu, H. G., & Zhong, J. (2020). Optimal timing of chemoradiotherapy after surgical resection of glioblastoma: Stratification by validated prognostic classification. Cancer, 126(14), 3255–3264. https://doi.org/10.1002/cncr.32797
Rees, J. H. (2011). Diagnosis and treatment in neuro-oncology: an oncological perspective. The British Journal of Radiology, 84(special_issue_2), S82–S89. https://doi.org/10.1259/bjr/18061999
Sherwood, P. R., Cwiklik, M., & Donovan, H. S. (2016). Neuro-Oncology Family Caregiving: Review and Directions for Future Research. CNS Oncology, 5(1), 41–48. https://doi.org/10.2217/cns.15.43
van den Bent, M. J., Geurts, M., French, P. J., Smits, M., Capper, D., Bromberg, J. E. C., & Chang, S. M. (2023). Primary brain tumours in adults. The Lancet, 402(10412), 1564–1579. https://doi.org/10.1016/S0140-6736(23)01054-1
Weller, M., van den Bent, M., Preusser, M., Le Rhun, E., Tonn, J. C., Minniti, G., Bendszus, M., Balana, C., Chinot, O., Dirven, L., French, P., Hegi, M. E., Jakola, A. S., Platten, M., Roth, P., Rudà, R., Short, S., Smits, M., Taphoorn, M. J. B., … Wick, W. (2022). Author Correction: EANO guidelines on the diagnosis and treatment of diffuse gliomas of adulthood. Nature Reviews Clinical Oncology, 19(5), 357–358. https://doi.org/10.1038/s41571-022-00623-3
Weyer-Jamora, C., Brie, M. S., Luks, T. L., Smith, E. M., Hervey-Jumper, S. L., & Taylor, J. W. (2021). Postacute Cognitive Rehabilitation for Adult Brain Tumor Patients. Neurosurgery, 89(6), 945–953. https://doi.org/10.1093/neuros/nyaa552