Brain tumours

Published by Bupa's Health Information Team, November 2010.

This factsheet is for people who have a brain tumour, or who would like information about it.

Brain tumours are an abnormal and uncontrolled growth of cells in the brain. They are usually treated with surgery, radiotherapy or chemotherapy.

How cancer develops

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About brain tumours

Brain tumours can be either primary or secondary.

• Primary brain tumours develop from normal cells in your brain.
• Secondary brain tumours develop when cancer cells from other parts of your body, such as your lung or breast, spread to your brain.

This factsheet will focus on primary brain tumours.

Primary brain tumours are rare; around 4,500 people are diagnosed each year in the UK. Brain tumours can occur at any age but are more common in older people. About 300 children are diagnosed with a brain tumour each year. Cancerous brain tumours are the second most common type of childhood cancer after leukaemia.

Types of primary brain tumour

There are many different types of primary brain tumour and most grow within your brain (intrinsic). They are generally named after the type of brain cell that they develop from. Most intrinsic primary brain tumours are gliomas. Gliomas grow from glial cells, which support the nerve cells in your brain. The most common types of gliomas are astrocytomas (which grow from astrocytes) and oligodendrogliomas (which grow from oligodendrocytes).

Some tumours grow outside your brain (extrinsic), often from the lining tissues (meninges), and are most frequently called meningiomas. These are usually benign (non-cancerous).

Brain tumours are also given a grade that reflects how fast they are growing and whether they can spread into surrounding tissues (malignant). The grades vary from one to four, with one being the most benign and four the most malignant. Your doctor may refer to a grade one or two tumour as ‘low-grade’ and a grade three or four tumour as ‘high-grade’.

Symptoms of brain tumours

The exact symptoms you have will depend on many factors, including the size of the tumour and its position in your brain. Some brain tumours do not cause any symptoms and may only be discovered by chance.

The most common symptoms of brain tumours are headaches and seizures (fits). If you have a headache, it may be worse at night and early in the morning, but wears off as the day goes on. You may also feel sick or vomit and have blurred vision. These symptoms can be caused by increased pressure in your skull from the tumour. Although headaches are one of the most common symptoms, it's important to realise that headaches are common and most aren't caused by brain tumours.

If your brain tumour causes you to have seizures, you may become unable to speak and have moments of unconsciousness.

Alternatively, you may have weakness on one side of your body, difficulties with speaking, reading and writing, problems with hearing or sense of smell and changes in your personality, memory or mental ability. This may be because your brain tumour has grown into, and is pressing down upon, important areas of your brain.

These symptoms aren't always due to brain tumours but if you have them, you should visit your GP.

Causes of brain tumours

The exact reasons why you may develop a brain tumour aren’t fully understood at present. Most brain tumours are thought to develop from unusual and random changes (sporadic mutations) in your brain cells, but what causes these changes isn’t known.

There are a number of factors that slightly increase your risk of developing a brain tumour, including:

• your age – the older you are, the more likely you are to get a brain tumour
• having an inherited disease – for example, neurofibromatosis (a condition that affects the development and growth of nerve cells)
• being exposed to radiation – for example, if you have radiotherapy applied to your head as treatment for another cancer
• having a weakened immune system – for instance, if you have HIV/AIDS, or if you take medicines that suppress your immune system

Currently, there is no evidence to show that mobile phones can cause brain tumours.

Diagnosis of brain tumours

Your GP will ask you about your symptoms and examine you. He or she may carry out tests to assess your reflexes, co-ordination, muscle strength, memory and vision.

Your GP may initially refer you to a neurologist (a doctor specialising in conditions that affect the nervous system) or to a neurosurgeon (a surgeon who operates on the brain and spinal cord).

Your doctor may refer you to have one or more of the tests listed below.

• A CT scan – this uses X-rays to make a three-dimensional image of your brain.
• A MRI scan – this uses magnets and radiowaves to produce images of the inside of your body.
• An electroencephalogram (EEG) – this is a painless test that records the electrical activity of the brain. It is used to diagnose epilepsy.

If your doctor suspects you have a brain tumour, you will be referred to a hospital that specialises in treating brain conditions. You may need to have a biopsy (where a small sample of tissue is removed) to find out the type and grade of your tumour. This is usually done under local anaesthesia (often with some sedation) but is sometimes carried out under general anaesthesia. Your doctor will use your CT and MRI scans to accurately find the position of the tumour. The biopsy will then be sent to a laboratory for testing. Your treatment will be planned according to the type and grade of brain tumour you have.

Treatment of brain tumours

The treatment you receive will depend on the type of brain tumour you have, as well as its size and grade, and its position in your brain.

If your tumour is slow-growing and not causing many symptoms, you may not need any treatment. Your condition will be monitored closely with routine check-ups and scans. This is often called active monitoring or watchful waiting.

Surgery, radiotherapy or chemotherapy are the main treatment options for brain tumours and may be used alone or in combination.

Surgery

Your surgeon may advise you to have a procedure known as a craniotomy to remove the tumour. You will usually be given a general anaesthetic, which means you will be asleep during the operation. However, it’s possible that you may need to be awake for the procedure if your surgeon has to assess your brain function during the operation. This is important for removing tumours from areas of your brain that control vital functions such as movement, feeling and speech.

Your surgeon will cut your scalp and the area of skull over the tumour. He or she will then remove as much of the tumour as possible and replace the piece of skull and scalp. It might not be possible to remove the whole tumour, particularly if it’s high-grade. If this happens, you will usually need to have further treatment such as radiotherapy and/or chemotherapy to control the remaining tumour.

During the operation, your surgeon may also put some small tabs (wafers) that release chemotherapy into the affected area of your brain to kill any remaining tumour cells, but this isn’t suitable for everyone.

Your surgeon will talk to you about any potential risks and follow-up treatment before the operation.

Radiotherapy

Radiotherapy uses X-rays to treat cancer. A beam of radiation is targeted at your tumour to destroy cancer cells with minimal damage to the surrounding healthy tissue.

Radiotherapy is usually used either after surgery to kill any tumour cells that were not removed, or as an alternative to surgery. It is a painless procedure and is usually given as a series of daily treatments over two to six weeks.

Radiosurgery (also known as gamma knife treatment) is a very highly focused type of radiotherapy. It's usually given as a single treatment and is more often used for extrinsic brain tumours such as meningiomas and neuromas. Speak to your surgeon for more information.

Chemotherapy

Chemotherapy uses medicines to destroy cancer cells. It is usually given as tablets or by injection. Only a few chemotherapy medicines are effective at treating brain tumours – the most commonly used are temozolomide or a combination of three drugs called procarbazine lomustine/CCNU vincristine (PCV).

Temozolomide chemotherapy is now frequently used in combination with radiotherapy to treat malignant brain tumours called glioblastomas. This treatment may also be used if your tumour comes back (recurs).

Medicines

You may be given medicines to help control any symptoms you have either before or after surgery, or during or after radiotherapy. Steroids help to reduce the swelling caused by your brain tumour. Anticonvulsants help to prevent fits.

Newer medicines known as biological therapies have become available that appear to be highly promising for the treatment of malignant primary brain tumours. They may be particularly helpful for people whose brain tumours come back (recur), but won’t be suitable for everyone. Speak to your doctor for more information.

Help and support

Being diagnosed with cancer can be distressing for you and your family. Dealing with the emotional aspects, as well as the physical symptoms, is an important part of treatment. Specialist cancer doctors and nurses are experts in providing the support you need, and may visit you at home. If you have more advanced cancer, further support is available to you in hospices or at home – this is called palliative care.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.