Brain tumour diagnosis and treatment in Barcelona

What is a brain tumour?

A brain tumour is an abnormal growth of cells inside the brain or in the structures surrounding it (meninges, cranial nerves, pituitary gland). Not all brain tumours are cancer: there are benign tumours, slow-growing and well-defined, and malignant tumours, more aggressive and infiltrative. It is worth noting that even a benign tumour can cause significant symptoms if it compresses important structures depending on its location.

Two main groups are distinguished: primary tumours, which arise from neural tissue itself or its coverings, and metastatic or secondary tumours, which originate in a cancer from another organ (lung, breast, kidney, melanoma...) that has spread to the brain.

Types of brain tumours

Knowing the specific tumour type is fundamental, as it determines prognosis and treatment. The most common are:

• Gliomas: arise from glial cells. They include astrocytomas, oligodendrogliomas and, in their most aggressive form, glioblastoma. Their grade (I to IV) and molecular profile guide treatment.
• Meningiomas: arise from the meninges. Usually benign and slow-growing; many are cured by surgery and some are monitored without immediate intervention.
• Brain metastases: the most common cause of brain tumour in adults, arising from cancers in other organs.
• Pituitary adenomas: pituitary tumours that may affect hormones or vision.
• Schwannomas (neuromas): such as the vestibular schwannoma, affecting hearing and balance.
• Others: medulloblastomas, ependymomas, skull base tumours and tumours specific to childhood.

The distinction between benign and malignant is not the only factor: location, size and, above all, molecular analysis have transformed the modern classification of brain tumours.

Warning symptoms

Symptoms depend on the tumour's location and size. Specialist consultation is warranted for persistent or recently onset neurological signs:

• New, severe and progressive headache, often worse in the morning or waking the patient at night.
• Nausea and vomiting without a clear digestive cause.
• Epileptic seizures (convulsions), especially in an adult with no prior history.
• Loss of strength, tingling or loss of sensation in part of the body.
• Disturbances of vision, speech, balance or gait.
• Changes in personality, memory, concentration or behaviour.

These symptoms do not necessarily indicate a tumour (they are non-specific), but they justify specialist assessment when persistent or progressive.

Diagnosis of brain tumours

Diagnosis begins with a neurological examination and is supported by neuroimaging. MRI with and without contrast is the reference test: it shows the location, size and characteristics of the tumour. It is supplemented by advanced techniques that help characterise it and plan surgery safely:

• MR spectroscopy: analyses the chemical composition of the tissue and indicates the nature of the tumour.
• Perfusion MRI: evaluates vascularisation and aggressiveness.
• Functional MRI and tractography: localise language and movement areas and nerve tracts to preserve them during surgery.

A definitive diagnosis requires, in most cases, a biopsy or analysis of the sample obtained during surgery. Histopathological study and, increasingly, molecular and genetic analysis confirm the exact tumour type and enable precision medicine.

Treatment of brain tumours

Treatment is always decided individually in a neuro-oncology multidisciplinary tumour board, where neurosurgeons, oncologists, radiation oncologists, neuroradiologists and pathologists agree on the best strategy. The main tools are:

Surgery

Surgery is, in many cases, the first step. The goal is to remove as much tumour as possible whilst preserving neurological function. For tumours near eloquent areas, awake craniotomy with cortical mapping is used: the patient cooperates by speaking or moving whilst the team identifies and respects critical zones. Microsurgery, neuronavigation and intraoperative neurophysiological monitoring increase precision and safety. You can find further details about our brain tumour surgery and the full range of brain surgery procedures.

Radiotherapy and chemotherapy

Radiotherapy (including stereotactic radiosurgery for small or multiple lesions) and chemotherapy or targeted therapies complement or replace surgery depending on tumour type. In many malignant tumours several modalities are combined to improve disease control.

Second opinion

Facing such a delicate diagnosis, a neurosurgical second opinion provides reassurance and, on occasion, opens new treatment possibilities. It allows review of imaging, confirmation of the diagnosis and assessment of all alternatives, especially when surgery has been ruled out at another centre or for complex cases. You can find out about our specialists' background on the medical team page.

Prognosis

The prognosis of a brain tumour varies enormously depending on type, grade, location, extent of resection and response to treatment. Many benign tumours are cured by surgery. For malignant tumours, advances in surgery, radiotherapy, targeted therapies and the molecular approach have significantly improved survival and quality of life in recent years. Early diagnosis and assessment by an expert team are therefore decisive.

Frequently asked questions