THE words brain tumour strike fear into the hearts of even the most steely minded, and rightly so.

Despite astounding advances in their treatment, they remain among those cancers with the lowest survival rate at five years.

Added to this, a recent report by the Brain Tumour Research Charity highlights the financial burden of living with a brain tumour is even greater than that associated with other cancers.

Partly this is due to several sufferers having to give up their driving licence, with loss of independence, and often being unable to continue in many occupations.

Brain tumours are split into primary and secondary.

Primary tumours arise from the brain and structures surrounding it, whereas secondary tumours are those which have spread from another site.

These are also called metastases, and may have spread from lung, breast or skin cancers, to name the main ones.

Secondary tumours are much more common than primary brain tumours, by a factor of roughly ten times.

Primary tumours are split into benign and malignant. If you imagine the skull as a fixed box, and the brain as a soft spongy organ within it, anything else growing inside this box will interfere with the brain, once it has reached a certain size. So despite being known as benign, these tumours cause problems by pressing on other parts of the brain. Malignant tumours invade normal brain tissue damaging it directly and hence causing symptoms. The classic symptoms of a brain tumour are headaches, loss of bodily functions, or seizures.

Headaches to watch out for are those that get steadily worse or are very different from the normal, if you usually suffer headaches. Headaches that repeatedly wake you from sleep should definitely be taken seriously.

Any new weakness, for example of an arm or leg, may be a sign. A tumour in the frontal lobe, where your emotions are processed, may cause a rapid change in personality. Seizures are due to the tumour causing irritation to nerves in the brain, which then fire in an uncoordinated manner.

Thankfully the majority of headaches are not due to a brain tumour, however if you have any concerning symptoms, I would advise an urgent consultation with your GP. They will take a history and examine you, and if any red flags for potential cancer are found, it is likely that they will organise an urgent scan of your brain.

Secondary brain tumours are not curable. The treatment of primary brain tumours depends on their type and size when discovered. Many patients where there is a chance of cure and they are fit enough, will be offered surgery. However if the tumour is extensive, radiotherapy may be used on its own or in addition.

Some tumours may be appropriate for chemotherapy. Treatment walks a fine line of attempting to rid the patient of cancer, while at the same time trying to avoid or limit damage to the surrounding healthy brain tissue and all its vital functions.

Ask Dr Zak

Question: I had unprotected sex with another man and am very worried about the chance of HIV. What can I do – Steven, 21

Answer: If this person is a casual acquaintance or somebody you do not know, you should have post exposure prophylaxis (PEP), but ideally it needs to be given within 72 hours of having unprotected sex. This is the same treatment a healthcare professional gets after a needle stick injury if there is concern about the risk of HIV transmission. Any GUM clinic should be able to assist you, with most having same day walk-in slots. They will also be able to screen for other STIs. Pre-exposure Prophlaxis (PreP) is now being trialled across many centres in the UK and involves the same medicine which you either take every day, or before any high-risk sexual encounter. However for peace of mind, most doctors would still advise condoms as well.

Question: I had a heart attack four weeks ago. It came out of the blue. I had always been fit and well beforehand, and had no warning signs. I had excellent treatment at the hospital and was well enough to go home in two days. Now I find myself very teary and reluctant to even leave the house – Violet, 74

Answer: What you are describing is a common phenomenon. An event you weren’t expecting has caught you out of the blue and now you may be spending every day doing almost nothing for fear that even slight exertion may put excess strain on your heart. However if you left the hospital in two days, it is likely that the damage to your heart was not severe. Heart disease is unfortunately very common, and the first sign of it can be a heart attack. However, I would advise you to try to return to normality as much as possible. The heart is like any other muscle, and needs to be exercised to keep it healthy. In addition to taking your new medication as prescribed, attending cardiac rehabilitation will introduce you to other people in a similar situation and provide you with support and greater understanding of your condition.

If you have a question for Dr Zak, please email: askdoctorzak@gmail.com W: doctorzak.co.uk T: @AskDoctorZak Dr Uddin’s advice is provided in good faith and in accordance with currently accepted evidence. However, this content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. You should always seek the advice of a GP, or other qualified health provider, regarding a medical condition.