When headaches could mean a tumour in the brain

SINGAPORE — Five years ago, Mr Nashrul Rasman, 20, was running after a football when a sharp, mind-numbing headache suddenly hit. A wave of giddiness followed.

Brushing it off as a lack of rest, he ignored the episode but the on-and-off headaches, which later intensified, continued plaguing him for the next three months.

The active student also started experiencing blurred vision. As his headaches and vision worsened, so did his academic performance.

“Nashrul used to be one of the top students in class. So when his school work slackened, we kept nagging at him and felt so frustrated, thinking he was going through a playful and restless phase,” said his mother, Mdm Zaiton, 49, a homemaker.

But Mr Nashrul’s headaches, which a polyclinic doctor initially attributed to stress, turned out to be a cancerous brain tumour.

“When I first received the diagnosis, I thought the worst would happen to me. We were all shocked and saddened by the news. My mum sobbed so badly,” said Mr Nashrul, who took a half-year break from school to undergo surgery, chemotherapy and radiotherapy.

Triggered by ailments ranging from sinus infections and colds to hangovers and stress, headaches affect almost everyone at some point in life.

But they can also be a harbinger of a tumour in the brain.

WHEN THE SIGNS ARE OMINOUS

Symptoms of brain tumours can vary greatly, depending on their type, size and location. Headaches are one of the more common symptoms, leading up to 40 per cent of brain tumour sufferers to seek medical attention, said assistant professor David Low, head of Neurosurgical Service in KK Women’s and Children’s Hospital, who is treating Mr Nashrul.

A brain tumour can cause headaches when it grows beyond a certain size, increasing pressure within the skull, said Dr Ng Puay Yong, a neurosurgeon at Mount Elizabeth Hospital.

He said brain-tumour-related headaches tend to be worse in the morning and are often accompanied by nausea and vomiting.

Persistent headaches that are accompanied by other symptoms such as nausea, vomiting, blurring of vision, weakness or numbness, seizures and hearing loss require immediate medical attention.

In children, however, the signs may be subtle. They may experience deteriorating school performance or delays in childhood developmental milestones, said Asst Prof Low, who is also vice-president of the Brain Tumour Society Singapore (BTSS) and consultant neurosurgeon at the National Neuroscience Institute.

Brain tumours are the second-most-common cancer after leukaemia in children under the age of 18. But there are no formal up-to-date statistics on the prevalence of brain tumours in Singapore, which can be difficult to track as there are more than 120 different types.

Asst Prof Low said the last report on brain tumours in Singapore, released by the cancer registry in 2007, detailed only malignant primary brain tumours, which refer to cancerous tumours that originate from the brain or tissues in the central nervous system.

“Recent cancer statistics focus mainly on the top 10 cancers in Singapore and not much was reported on brain tumours,” he said.

While brain tumours are not as common as other cancer types, doctors said there ought to be greater awareness.

Asst Prof Low said up to one-third of brain tumours that originate from the brain or tissues in the central nervous system are cancerous.

Even benign tumours located in critical areas of the brain “can be as bad as cancers in the brain”, said Dr Ng.

Whether benign or malignant, brain tumours can cause significant neurological consequences and be life-threatening. Surgery also entails certain risks and complications, said Asst Prof Low.

For instance, one of the major issues of using radiotherapy, especially in young children, is its possible long-term side effects on the developing nervous system, which may affect growth, development and IQ, he said.

Radiotherapy is commonly used in brain tumour treatment to kill any remaining microscopic cancerous cells, or shrink or control benign tumours in inoperable locations.

“Conversely, as a child’s nervous system is more dynamic and adaptable, it means that he or she has a high chance of eventually improving through rehabilitation should areas of the brain be affected by the tumour or during treatment,” he added.

WHAT CAUSES BRAIN TUMOURS

Up to one in five cancer patients will develop metastatic brain tumours that result from cancer that has spread from elsewhere, such as the breast, lung and colon, said Asst Prof Low.

For the majority of primary brain tumours, the cause is unclear. Some known risk factors include inherited genetic conditions linked to specific chromosomal abnormalities such as tuberous sclerosis and neurofibromatosis, which can cause tumours to grow inside the brain, spinal cord, organs, skin and bones.

Those who have had radiotherapy to the brain may also risk developing another brain tumour in the long term, said Asst Prof Low. While there is concern that radiation from mobile phones may be harmful, both doctors said there is no conclusive evidence directly linking mobile phone use and brain tumours.

For Mr Nashrul, the brain tumour changed his life entirely, affecting his eyesight and memory. The adverse effects continued even after his treatment ended. He had to rely on his mother to take him to and from school as his poor memory meant he would easily lose his way.

Unable to cope in the Express stream, Mr Nashrul went to a Normal Academic class but did well in his N Levels, with support from his family and school.

What pained him the most was his schoolmates avoiding him. “I think they were scared that they might catch the disease from me, but I told them that cancer is not contagious,” said Mr Nashrul, who is now in remission.

Currently on a work attachment as part of his curriculum at Mountbatten Vocational School, he expects to graduate next year and is also well enough to continue playing his favourite sport, football.

According to his doctor, there is a “small chance” of a relapse but the optimistic youth refuses to dwell on it. He hopes to use the S$2,500 welfare grant he has received from the BTSS to further his studies.

“My faith has taught me that every occurrence is a blessing in disguise. Today, I’m a stronger and more mature person because of what I’ve been through,” he said.

SUPPORTING EACH OTHER

Formed by a group of brain cancer survivors, the Brain Tumour Society (Singapore) provides befriending and support-group services as well as financial assistance to members with brain tumours. For more information, visit www.braintumoursociety.org.sg or www.facebook.com/braintumoursociety.