Woman, 70, noticed foul smell before her stage 4 cancer was diagnosed

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Treating a brain tumour successfully can be challenging, particularly when symptoms are misleading. For patients dealing with aggressive cancers, however, time is of the essence. As one case report highlights, it’s important not to rely too heavily on classic cancer signs to guide the diagnosis process.

In 2022, researchers followed a 70-year-old woman who had suffered frequent bouts of nausea in the six months running up to her doctor’s visit.

These episodes had increased in frequency from two to three times per week to four to five times, without any obvious triggers.

During an examination, she told her doctor that these episodes had come on with a sudden sensation of “foul smell as taste that caused her to feel […] dizzy, requiring her to sit down”, according to the report.

These episodes, which lasted seconds without loss of consciousness, were completely new to the patient.

With further tests, doctors were able to establish that a stage IV glioma – known as glioblastoma – was the cause of her symptoms.

The report, published in the Proceedings of Baylor University Medical Center, states: “Glioblastoma is a stage IV rapidly progressive glioma.”

It is the most common type of brain tumour in adults and has an extremely poor prognosis, meaning sufferers have slim chances of recovery.

Patients sometimes report focal neurological symptoms like phantosmia when specific nerves in the brain are compromised by a tumour.

Doctor Stuart Sanders, GP at The London General Practice said: “The olfactory nerve starts in receptor nerve cells in the nose and ends in a part of the brain known as the olfactory cortex.

“This is the region of the brain where smells are processed and recognised; it is a small area situated on the underside of the frontal lobe.

“If the olfactory cortex is damaged, infected or disturbed, it can generate phantom smells, the condition being known as phantosmia.

“This could be caused by cancer growing in the olfactory cortex or invading it from neighbouring tissues.”

While it is extremely rare for brain tumour patients to present solely with phantosmia as the first symptom, this was the case for the 70-year-old patient.

She denied experiencing any of the classic brain tumour symptoms, like headaches, numbness, tingling, loss of balance, and others.

Generally, episodic changes in smell and taste prompt investigations for organic causes, such as infections and vascular events.

Doctor Sanders noted: “[…] A haemorrhage or injury […] can also cause phantom smells. The Covid virus frequently affects the olfactory cortex causing anosmia, and loss of the sense of smell, less frequently it can cause phantosmia.

“There is no specific treatment for phantom smells but they should be taken seriously and investigated, usually with an MRI scan; treatment will then depend on identifying the cause.”

Thanks to her overall good health, doctors agreed that the patient could undergo a full course of chemotherapy.

“It is important to emphasise that olfactory hallucinations are very rarely caused by [brain] tumours, so it is important to not immediately jump to conclusions and instead book an appointment with your GP,” noted Doctor Brian Fisher, GP and Clinical Director at Well app.

A patient who experiences persistent neurological symptoms for more than two weeks is advised to see a doctor about their condition.

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