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A terminal brain cancer diagnosis represents a profoundly serious and advanced stage of the disease. This condition often involves high-grade malignant brain tumours, such as glioblastoma, which account for around 32 percent of all malignant brain tumours1. The seriousness of terminal brain cancer, especially a stage 4 diagnosis, lies in its rapid progression and the profound impact it has on patients' physical, cognitive, and emotional well-being.
The purpose of this article is to provide information on the symptoms and progression timeline associated with terminal brain cancer. By understanding these symptoms, patients and caregivers can better manage the disease, seek appropriate palliative care, and improve the quality of life during this challenging time.
Understanding the Symptoms of Terminal Brain Cancer
What is Terminal Brain Cancer?
Terminal brain cancer refers to an advanced stage of cancer where the brain tumour is no longer responsive to available treatments and is expected to significantly shorten life expectancy. This stage is most commonly associated with high-grade, aggressive tumours such as glioblastoma, also known as grade 4 brain cancer.1
Advanced brain cancer typically describes tumours that are high grade (grade 3 or 4), grow rapidly, and have spread extensively within the brain or spinal cord. These tumours are more likely to recur after treatment and are considered malignant or cancerous.2
Metastatic brain cancer (also called secondary brain cancer) occurs when cancer cells from another part of the body spread to the brain.2 This is different from primary brain cancer, which originates in the brain itself. Metastatic brain tumours are more common than primary brain tumours and are considered advanced because they represent a late stage of cancer progression.3
Glioblastoma multiforme (GBM) is the most common and aggressive type of primary malignant brain tumour in adults.4 It is classified as a grade 4 brain tumour by the World Health Organization (WHO), indicating the highest level of malignancy.5 GBM tumours grow and spread rapidly, invading nearby brain tissue and making complete surgical removal nearly impossible.
Brain cancers can affect many areas of the brain, including the cerebellum, frontal lobe, temporal lobe, cerebral ventricles, brainstem, occipital lobe, parietal lobe, cranial nerves, and cerebral meninges.6
Several factors contribute to a patient being given a terminal diagnosis:7
- Tumour location: tumours in critical areas of the brain that control vital functions are often inoperable.
- Tumour size and spread: Large tumours, or those that have spread extensively throughout the brain, are more difficult to treat.
- Tumour grade: Higher-grade tumours (grades 3 and 4) grow more quickly and are more resistant to treatment
- Treatment response: If the tumour continues to grow despite aggressive treatment, it may be deemed terminal.
Symptom awareness is crucial for maintaining quality of life in terminal brain cancer patients. Common symptoms include persistent headaches, seizures, cognitive changes, personality alterations, and physical impairments.8 Recognising and managing these symptoms can help improve patient comfort and facilitate better palliative care. Additionally, understanding the progression of symptoms can help patients and caregivers prepare for end-of-life care and make informed decisions about treatment options.
What are the Stages of Brain Cancer?
Brain cancer is typically classified by grade rather than stage, as is common with other cancers. The grading system reflects the abnormality of the tumour cells as observed under a microscope and the likelihood of the tumour's rapid growth and spread. Grades range from 1 (least aggressive) to 4 (most aggressive), with grades 3 and 4 considered high-grade, malignant, or cancerous.9
Stages of Brain Cancer
- Grade 1 and 2 (Low grade): Slow-growing, less likely to spread, and often considered benign, though they can cause significant symptoms depending on their location.
- Grade 3 and 4 (High grade): Fast-growing, more likely to invade nearby brain tissue, and often recur after treatment. These are malignant and associated with more severe and rapidly progressing symptoms of brain cancer.
Stage 3 Brain Cancer Symptoms
Headaches
Headaches in terminal brain cancer are often severe, persistent, and worsen over time. Up to 36 percent of brain tumour patients experience headaches.10 Headaches typically occur due to increased intracranial pressure caused by tumour growth, swelling, or blockage of cerebrospinal fluid.11 They may not respond well to over-the-counter pain medications and can be accompanied by nausea, vomiting, and visual disturbances.12 The pain may be localised or generalised, depending on the tumour location, and can significantly impact the patient’s quality of life.
Motor Skill Impairment
Brain cancer can significantly affect movement and coordination as the tumour infiltrates or compresses areas of the brain responsible for motor function.13 Patients may experience weakness or paralysis on one side of the body, difficulty with fine motor skills, or problems with balance and walking. These impairments can manifest as an unsteady gait, frequent falls, or an inability to perform routine tasks such as writing or buttoning clothes. The severity and specific nature of motor skill issues depend on the tumour location and size, potentially leading to a progressive loss of independence in daily activities.
Emotional Changes
Terminal brain cancer frequently triggers significant emotional changes in patients.14 Common emotional symptoms include:
- Depression: Feelings of hopelessness and sadness are common as patients grapple with their diagnosis.
- Anxiety: Fear about the future and treatment outcomes can lead to persistent worry.
- Mood swings: Rapid and unpredictable changes in emotional state may occur.
- Irritability: Patients may become easily frustrated or angered.
Mental health support is crucial for both patients and their families as they navigate these emotional challenges. Professional counselling, support groups, and palliative care teams can provide valuable resources to help manage these symptoms and improve quality of life.
Behavioural Changes
Behavioural changes in terminal brain cancer patients can be dramatic and distressing.14 Examples include:
- Aggression: Patients may exhibit uncharacteristic hostility or become combative.
- Personality shifts: Dramatic changes in temperament or core personality traits can occur.
- Disinhibition: Loss of social filters leading to inappropriate behaviour.
- Apathy: Lack of interest in previously enjoyed activities or relationships.
These changes often result from tumour growth affecting areas of the brain responsible for regulating personality and behaviour.15 Management strategies include medication to address specific symptoms, environmental modifications to reduce triggers, and education for caregivers on how to respond effectively to these changes. It is crucial to remember that these behaviours are symptoms of the disease, not reflections of the patient’s true nature.
Stage 4 Terminal Brain Cancer Symptoms
End-stage brain cancer symptoms are typically similar to Stage 3, however, with worsening effects on the body and brain.
Persistent, Severe Headaches
Headaches are present in about 33-48 percent of patients with terminal brain cancer, often caused by increased pressure within the skull.12,16 They may worsen with movement or changes in position.
Loss of Bladder and Bowel Control
Incontinence is reported in about 40 percent of patients in the end-of-life stage, reflecting loss of neurological control over bodily functions.16
Seizures
Seizures are a common symptom of terminal brain cancer, affecting about half of all patients.17 They can vary in type and intensity, ranging from focal seizures (affecting a specific part of the body) to generalised seizures (involving the entire body). Seizures occur due to abnormal electrical activity in the brain, which is caused by the tumour or surrounding inflammation.18 They can be particularly distressing for patients and caregivers, often leading to falls, injuries, and increased anxiety. As the cancer progresses, seizures may become more frequent or difficult to control with medication.19
Significant Cognitive Decline
Cognitive decline is a hallmark symptom of terminal brain cancer, significantly impacting patients’ daily lives.20,21 Common cognitive symptoms include:
- Memory loss: Patients may struggle with short-term memory, forgetting recent events or conversations.
- Confusion: Disorientation about time, place, or personal information can occur.
- Difficulty concentrating: Focusing on tasks or maintaining conversations can become challenging.22
- Impaired problem-solving: Complex thinking and decision-making abilities may deteriorate.23
- Language difficulties: Patients might struggle to find words or understand complex sentences.24
These symptoms can profoundly affect a patient’s ability to perform daily activities. Simple tasks, such as managing finances, following recipes, or remembering appointments, become increasingly difficult. As the disease progresses, patients may lose the ability to live independently, requiring constant supervision and assistance. This cognitive impairment can be particularly distressing for both patients and their loved ones.
Profound Personality and Behavioural Changes
As the tumour progresses to stage 3, personality changes, mood disturbances, and behavioural shifts become more common as it affects different brain regions. These changes can be distressing for both patients and families.
Furthermore, delirium and agitation may occur as brain function declines, sometimes accompanied by hallucinations, especially in the final days or weeks. One review found that 22 percent of brain tumour cases have experienced psychotic symptoms such as delusions and hallucinations.25
Loss of Consciousness
As terminal brain cancer progresses, patients often experience a gradual decline in consciousness. In a study of glioblastoma patients, 95 percent experienced a decrease in the level of consciousness in the last 10 days of life.26
This decrease in consciousness is a significant indicator of disease progression, often signalling that the tumour is affecting areas of the brain responsible for arousal and awareness. It may be caused by intracranial pressure, tumour growth in specific brain regions, or complications from treatments.27 As consciousness declines, it becomes increasingly challenging to communicate with the patient, highlighting the importance of advance care planning and discussions about end-of-life wishes.
Speech and Swallowing Difficulties
As terminal brain cancer progresses, patients often develop speech and swallowing problems.16 Speech difficulties can range from slurred speech to complete inability to communicate verbally, depending on the affected brain areas. Swallowing issues (dysphagia) are common, especially in end-stage brain cancer, making eating and drinking challenging and increasing the risk of aspiration.28,29 They significantly impact the patient’s ability to communicate, maintain nutrition, and engage in social interactions, often requiring alternative communication methods and feeding strategies.
Increased Pain, Involuntary Movements, and Skin Cooling
Progressive neurological deficits, which may include pain, involuntary movements, and skin cooling, are seen in over half of patients (52 percent), especially as the body’s systems begin to shut down.16
What is the Life Expectancy of Someone with Terminal Brain Cancer?
Terminal brain cancer is associated with poor prognosis and limited life expectancy. The median survival for adults diagnosed with glioblastoma is typically 12-18 months, even with aggressive treatment, with around 25 percent of patients surviving beyond two years.30 This drops to under 5 percent at 5 years.31 Life expectancy can vary based on factors such as age, overall health, and the extent of surgical removal or response to therapy; however, for most, the terminal stage typically means survival is measured in months.
Stage 4 Brain Cancer Timeline
The timeline for progression and survival rates for stage 4 brain cancer varies based on tumour type, patient age, overall health, and whether treatment is pursued.
Typical Timeline with Treatment
- Median survival for glioblastoma is 12-18 months with standard treatment (surgery, radiation, and chemotherapy).30
- The 5-year survival rate is very low, around 5 percent in the United Kingdom.32
- Younger patients (under 40) and those with better overall health may experience slightly longer survival.32
- Symptom progression is usually rapid, with increasing neurological deficits, cognitive decline, and loss of function over months.
Timeline Without Treatment
- Median survival drops dramatically without treatment, averaging just 3-4 months.33
- Symptoms worsen quickly, with a rapid decline in mobility, cognition, and overall well-being.
- Death is typically due to widespread tumour infiltration, cerebral oedema (brain swelling), and increased intracranial pressure.
Palliative Care Approaches
Palliative care plays a crucial role in managing symptoms and providing comfort for terminal brain cancer patients. Its primary goal is to improve quality of life by addressing physical, emotional, and spiritual needs.34
Key aspects of palliative care include:
- Pain management: Tailored medication regimens to control pain, often including opioids and adjuvant therapies.
- Symptom control: Interventions to manage nausea, seizures, and other distressing symptoms.
- Emotional support: Counselling and therapy for patients and families to cope with anxiety, depression, and grief.
- Spiritual care: Support from chaplains or spiritual advisors to address existential concerns.
- Family support: Education and resources for caregivers to manage patient care and their own well-being.
- Advance care planning: Assistance in making decisions about future care and end-of-life preferences.
Facilitating moves to hospice care: This can reduce the burden on caregivers and the family if treatment stops working or if the cancer worsens.
Palliative intervention might include using a combination of drugs to control pain, seizures, and other symptoms; incorporating massage, music therapy, or aromatherapy for relaxation and comfort; providing tools to help patients communicate as verbal abilities decline; offering feeding assistance or alternative nutrition methods when swallowing becomes difficult; and providing cognitive behavioural therapy or mindfulness techniques to manage anxiety and depression.35
Palliative care teams work closely with patients, their families, and other healthcare providers to ensure comprehensive, compassionate care throughout the course of the illness, with a focus on maximising comfort and quality of life.
What to Expect in the Final Days
Terminal brain cancer, particularly glioblastoma, progresses rapidly in its final stages. Symptoms intensify as the tumour infiltrates brain tissue, disrupts neurological function, and increases intracranial pressure.
For many people with this terminal disease, the final days may include a lot of sleeping; they may also be drowsy and less engaged or interested in what’s happening around them when they are awake.36 This is a typical response, and caregivers may need to use facial expressions or body language to understand how the individual might be feeling. While some people may become calm, others may become increasingly agitated and confused. Eventually, they may drift into unconsciousness; however, they may still know you’re with them. Playing familiar music or discussing happy memories with them may help comfort them.
Summary: What are the Symptoms of Terminal Brain Cancer?
Terminal brain cancer presents a complex array of symptoms affecting physical, cognitive, and emotional well-being. From persistent headaches and seizures to cognitive decline and behavioural changes, these symptoms significantly impact patients’ quality of life. Recognising and managing these symptoms is important to provide effective care and comfort to those affected. As the condition progresses, palliative care becomes increasingly important, focusing on pain management, symptom control, and emotional support for both patients and their families. If you or a loved one is facing terminal brain cancer, don’t hesitate to reach out to healthcare providers for both patients and their families.
If you or your family wants to be proactive about your brain health, why not book an Ezra MRI scan? Our annual scan catches potential cancer earlier, leveraging artificial intelligence throughout the screening process to make it more efficient, affordable, and faster.
FAQs
Q: How long can you live with brain cancer?
A: Survival varies widely, but for all malignant brain tumours, about 40 percent survive at least one year, and around 15 percent survive five years or more, depending on tumour type and grade.
Q: Is brain cancer terminal?
A: High-grade brain cancers, such as glioblastoma, are usually terminal, while some low-grade tumours can be slow-growing and not immediately life-threatening.
Q: Is glioblastoma terminal?
A: Glioblastoma is almost always terminal, with an average survival of 12–18 months and less than 1 percent of patients living beyond ten years.
Q: How long can you live with stage 4 brain cancer?
A: The average survival for stage 4 brain cancer (glioblastoma) is 12–18 months, with only about 5 percent surviving more than five years.
Q: Can you recover from brain cancer?
A: Some low-grade brain tumours can be treated successfully, but high-grade or terminal brain cancers like glioblastoma are generally not curable.
Q: Is terminal brain cancer curable?
A: Terminal brain cancer is not curable, and treatment focuses on prolonging life and improving quality of life.
Q: Has anyone survived terminal brain cancer?
A: Long-term survival with terminal brain cancer is extremely rare, but a very small number of patients have lived many years beyond their diagnosis.
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