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Brain Tumors

Brain tumors — or neoplasms of the central nervous system (CNS) encompass a diverse group of conditions that differ in origin, biological characteristics, location, clinical progression, and therapeutic strategies.

Diagnosis and treatment require a specialized, multidisciplinary approach.

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What Are Brain Tumors?

Brain tumors arise from abnormal and uncontrolled cell growth within the tissues of the central nervous system. The central nervous system consists of two main components:

  • Brain: an organ composed of the cerebrum, cerebellum, and brainstem, enclosed within the skull. It weighs approximately 1.4 kg and is responsible for processing thoughts, emotions, sensory information, and controlling movement.
  • Spinal cord: an extension of the brain within the vertebral column, acting as the communication pathway between the brain and the rest of the body.

The central nervous system coordinates and regulates the entire body. It governs both voluntary actions (such as movement and speech) and vital involuntary functions (including breathing, heartbeat, and digestion). It is also responsible for processing sensory stimuli (sight, hearing, smell, taste, and touch), managing emotions, and supporting key cognitive functions such as memory, learning, and understanding.

Types of Brain Tumors

Brain tumors are classified based on their origin:

  • Primary tumors.
    These originate directly within the central nervous system and are divided into two categories:
    • Benign tumors: slow-growing, well-circumscribed, and generally less invasive.
    • Malignant tumors: aggressive growth, infiltrate surrounding tissues, and have a higher likelihood of recurrence.
  • Secondary tumors (metastases).
    These originate in other organs (such as the lungs, breast, melanoma, or kidneys) and spread to the nervous tissue through the bloodstream. They account for approximately 50–60% of all tumors affecting the brain.

Main Types of Primary Brain Tumors

Gliomas (about 40% of primary brain tumors)
They originate from glial cells—the supporting cells that protect and nourish neurons. They include:

  • Astrocytomas (grades I–IV): arise from astrocytes. Glioblastoma (grade IV) is the most aggressive form.
  • Oligodendrogliomas: generally slow-growing.
  • Ependymomas: originate from cells that produce cerebrospinal fluid.

Meningiomas (about 30% of primary brain tumors)

They develop from the meninges, the three membranes that surround and protect the brain and spinal cord. In most cases, they are benign, slow-growing, and well-circumscribed.

Germinomas

Rare tumors that arise from primitive germ cells. They occur more frequently in adolescents and young adults and may be benign or malignant.

Neuromas (Schwannomas)

Benign tumors that develop from Schwann cells, which form the myelin sheath surrounding nerve fibers. Acoustic neuroma is the most common type.

Craniopharyngiomas

Rare benign tumors that originate from embryonic remnants located near the pituitary gland. They are more common in children and young adults.

Central Nervous System Lymphomas

Rare tumors that arise from lymphocytes (cells of the immune system). They are particularly aggressive and occur more frequently in older individuals or in those with compromised immune systems (e.g., patients with HIV/AIDS).

Causes of Brain Tumors

In most cases, the causes of brain tumors are not completely understood. They are believed to be driven by genetic mutations that lead to uncontrolled cell growth. However, in the majority of patients, it is not possible to identify a specific cause.

Risk Factors for Brain Tumors

Although it is not always possible to identify a precise cause, some factors are associated with an increased risk of developing brain tumors:

  • Exposure to ionizing radiation: therapeutic radiation, nuclear explosions, occupational exposure.
  • Exposure to carcinogenic substances: in occupational or environmental settings.
  • Age: certain tumors are more common in specific age groups (e.g., medulloblastomas in children, glioblastomas in adults).
  • Family history and genetic predisposition: Li-Fraumeni syndrome, neurofibromatosis type 1 and 2, tuberous sclerosis.
  • Compromised immune system: patients who have undergone organ transplants or those with HIV infection.

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What Are the Symptoms of Brain Tumors?

Symptoms of brain tumors vary significantly depending on:

  • Tumor size: larger tumors are more likely to cause symptoms.
  • Location: each area of the nervous system controls specific functions; a tumor in a given location may disrupt those abilities.
  • Growth rate: fast-growing tumors cause more acute symptoms, while slow-growing tumors may remain asymptomatic for a long time.

General Symptoms

Some symptoms are caused by increased intracranial pressure due to the tumor:

  • Persistent or progressive headache: often worse in the morning and may be associated with nausea.
  • Nausea and vomiting: sometimes without an apparent cause (projectile vomiting).
  • Visual disturbances: blurred vision, double vision, or partial loss of the visual field.
  • Balance and coordination problems: lack of coordination (ataxia), unsteady gait.

Focal Symptoms

These are related to the specific location of the tumor:

  • Weakness or loss of sensation in part of the body (arm, leg, face).
  • Speech difficulties: difficulty speaking (dysarthria) or understanding language (aphasia).
  • Seizures: especially in patients with no prior history of epilepsy; they are the first symptom in 20–30% of patients with brain tumors.
  • Cognitive, sensory, or personality changes: behavioral changes, hallucinations, memory loss.
  • Hearing problems: especially in acoustic neuromas.
  • Autonomic dysfunctions: urinary or fecal incontinence, changes in appetite.

The Importance of Timely Evaluation

The onset of one or more of these symptoms, especially if persistent or progressive, requires prompt medical evaluation. Early diagnosis allows treatment to begin before the tumor causes irreversible neurological damage.

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How Do You Diagnose Brain Tumors?

The diagnosis of brain tumors is based on a comprehensive clinical and instrumental pathway. When symptoms suggest a possible central nervous system neoplasm, the physician prescribes a series of diagnostic tests.

Initial Clinical Evaluation

  • Medical history and complete neurological examination: assessment of memory, orientation, motor function, sensation, reflexes, and cranial nerve function.
  • Visual field testing: to identify specific visual deficits.

Neuroradiological Imaging

  • Brain Magnetic Resonance Imaging (MRI): This is the most sensitive test for diagnosing brain tumors. It provides detailed images of the brain and spinal cord, allowing evaluation of the tumor’s location, size, and extent. It can be performed with or without contrast.
  • Computed Tomography (CT) of the brain:Used as a first-line approach in suspected acute cases or when MRI is contraindicated. It is less sensitive than MRI but faster and widely available in emergency settings.
  • PET (Positron Emission Tomography): A functional imaging test that provides information on the tumor’s cellular metabolism, useful for assessing biological aggressiveness and distinguishing recurrence from scar tissue.
  • MR or CT Angiography: Evaluates the tumor’s vascularization and its relationship with surrounding blood vessels, which is essential for surgical planning.

Additional Tests

  • Electroencephalogram (EEG): Used when the patient has experienced seizures, to characterize abnormal brain activity.
  • Lumbar puncture (spinal tap): Collection of cerebrospinal fluid from the spinal canal; useful for tumors involving the meninges or spinal cord, or when cerebrospinal dissemination is suspected.

Tumor Biopsy

Essential for histopathological diagnosis, it allows microscopic analysis of tumor tissue and identification of the tumor type and its biological characteristics. It can be performed via:

  • Surgical approach: during tumor resection.
  • Percutaneous approach: using a needle under stereotactic or imaging guidance.

Biopsy provides crucial information for prognosis and treatment selection.

Molecular Profiling

Advanced tumor analyses (genetic mutations, gene expression, methylation status) that guide increasingly personalized and targeted treatment strategies.

Importance of Early Diagnosis

Timely and accurate diagnosis allows:

  • Planning of the most appropriate treatment.
  • Assessment of the true prognosis.
  • Initiation of therapy before the tumor causes irreversible neurological damage.
  • Implementation of personalized follow-up strategies.

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How Do You Treat Brain Tumors?

Treatment for brain tumors is personalized and depends on several factors:

  • Type of tumor (histology and grade of malignancy).
  • Location and size.
  • Patient’s age and overall clinical condition.
  • Presence of comorbidities.
  • Extent of the disease (involvement of the spinal cord, distant metastases).

The main treatment options may be used alone or in combination.

Surgery

Often represents first-line treatment, with the goal of completely removing the tumor or, when this is not possible, reducing its size (cytoreduction).

Modern neurosurgical techniques include:

  • Standard open resection: removal of the tumor through conventional surgical access.
  • Minimally invasive endoscopic neurosurgery: uses endoscopes to access tumors in deep areas, reducing tissue trauma.
  • Intraoperative neuronavigation: a guidance system combining preoperative imaging with real-time tracking during surgery.
  • Intraoperative neurophysiological monitoring: continuous recording of neural activity to preserve critical neurological functions.
  • Intraoperative fluorescence: use of fluorescent markers to highlight the tumor during surgery, improving visualization and completeness of resection.

Surgery is not always feasible due to tumor location in critical areas (motor, language, visual regions). In such cases, alternative treatments are used.

Stereotactic Radiosurgery

A non-invasive technique that uses highly precise radiation beams to target the tumor without surgery. It is used for:

  • Small, well-defined tumors.
  • Tumors in critical or inoperable locations.
  • Residual lesions after surgery.

Main technologies:

  • Gamma Knife: uses multiple converging gamma-ray beams.
  • CyberKnife: a robotic linear accelerator delivering highly focused X-rays.
  • Linear accelerator (LINAC) with IMRT or VMAT: conventional accelerator with intensity-modulated radiation.

Conventional External Beam Radiotherapy

Used for larger tumors, high-grade malignant tumors, or multiple brain metastases. It delivers fractionated radiation doses over time (usually 5 days a week for 4–6 weeks).

Chemotherapy

Uses specific drugs to inhibit tumor cell proliferation. It is particularly effective in:

  • Glioblastomas (in combination with radiotherapy).
  • Central nervous system lymphomas.
  • Brain metastases.

Targeted Therapies and Immunotherapy

Innovative treatments based on the specific biological characteristics of the tumor:

  • Tyrosine kinase inhibitors (TKIs): drugs that block specific genetic mutations (e.g., EGFR, ALK).
  • BRAF inhibitors: for tumors with BRAF mutations.
  • Immunotherapy: stimulates the patient’s immune system to recognize and destroy cancer cells (e.g., checkpoint inhibitors, CAR-T cell therapy in trials).
  • Anti-angiogenic therapy: inhibits the formation of new blood vessels that supply the tumor.

Symptom Management and Rehabilitation

A key component of treatment is symptom control and neurological support:

  • Antiepileptic therapy: to prevent or control seizures.
  • Corticosteroids: to reduce brain edema.
  • Speech therapy, physiotherapy, occupational therapy: for functional recovery after treatment.
  • Psychological support: to address the emotional and psychosocial impact of diagnosis and treatment.

Multidisciplinary Approach

In most cases, treatment involves close collaboration among:

  • Neurosurgeons.
  • Oncologists.
  • Radiation oncologists.
  • Neurologists.
  • Neuroradiologists.
  • Specialized nurses.
  • Psychologists.

This integrated approach ensures the best possible, personalized treatment pathway, focused on preserving quality of life.

Follow-up and Monitoring

After completion of primary treatment, patients enter a surveillance program based on:

  • Periodic brain MRI scans: at intervals determined by tumor type and treatment received.
  • Clinical and neurological evaluations: to detect early signs of recurrence or late treatment effects.
  • Cognitive screening: assessment of memory and cognitive function, as some treatments may cause delayed brain effects.
  • Ongoing rehabilitation support: to maintain and improve residual neurological functions.

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Reviewed June 2026.