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Brain tumours

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

Video: how cancer develops

About brain tumours

Brain tumours are classed as 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 can be malignant (cancerous) or benign (not cancerous). Each year in the UK, about 5,000 people are diagnosed with a malignant brain tumour and about 4,300 with a benign brain tumour. 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 tumours. They are usually named after the type of brain cell that they develop from, but may also be named after the area of the brain where they are growing. The most common types of primary brain tumours are described below.

Gliomas

More than half of all primary brain tumours are gliomas. They grow from glial cells, which support the nerve cells in your brain. The most common types of gliomas are:

  • astrocytomas and glioblastomas, which grow from cells called astrocytes
  • oligodendrogliomas, which grow from cells called oligodendrocytes
  • ependymomas, which grow from cells called ependymal cells

Meningiomas

About one in four brain tumours in adults is a meningioma. These tumours start in the layers of tissue that cover your brain (the meninges) and are usually benign.

Pituitary tumours

About one in 10 brain tumours develops in the pituitary gland. These are called adenomas and are usually benign.

Medulloblastoma

Medulloblastoma is a type of tumour that usually develops in the cerebellum at the back of your brain. It rarely affects adults but is the most common malignant brain tumour in children.

Brain tumour grade

Grading is used to describe how your tumour looks under a microscope, which gives your doctor more information about how it may progress, and so how best to treat it. A low-grade cancer cell looks most similar to a normal cell and will probably grow slowly. A high-grade cancer cell looks abnormal and grows more quickly, and so is more likely to spread. The grades range from one to four, with one being a benign tumour that is the least likely to spread and four being malignant and the most likely to spread.

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 don’t 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 – this can happen even if your tumour is benign. Although headaches are one of the most common symptoms, it's important to realise that headaches are extremely common and brain tumours are very rare – most headaches 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 particular areas of your brain and is pressing down on them.

These symptoms aren't always caused by a brain tumour but if you have them, see your GP. More common causes of symptoms like this may be migraine headaches or stroke.

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 in your brain cells, but what causes these 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 high doses of radiation – for example, if you have radiotherapy 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 refer you to a neurologist (a doctor who specialises in identifying and medically treating conditions that affect the nervous system) or to a neurosurgeon (a surgeon who specialises in identifying and surgically treating conditions that affect the nervous system).

You may have the following tests to confirm diagnosis and to find out what type of brain tumour you have.

  • Blood tests – these assess your general health and check for specific chemical markers in your blood.
  • CT scan – this uses X-rays to make a three-dimensional image of your brain.
  • MRI scan – this uses magnets and radio waves to produce images of the inside of your brain.

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. 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

Because different brain tumours develop in different ways, your treatment will vary depending on which type you have, its size and grade, and position in your brain.

Depending on the type of tumour you have, the doctors and nurses looking after you will discuss your treatment options in more detail and give you further advice and information so you can make a decision about what treatment you wish to have.

You will be treated by a multidisciplinary team including neurologists, neurosurgeons, clinical oncologists (doctors who treat cancer using X-rays and medicines) and specialist nurses who support you through diagnosis and treatment.

Watchful waiting

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

Surgery

The aim of surgery is to get rid of as much of the tumour as possible. Malignant brain tumours can be difficult to remove completely, but your surgeon is still likely to recommend taking out as much of it as possible. This is called a subtotal resection or debulking and is intended to slow down growth and help ease your symptoms.

Depending on the type of brain tumour you have, as well as its size and position, your surgeon may recommend open surgery (craniotomy) or keyhole surgery. If you have a pituitary tumour, your surgeon may advise having it removed via your nose (called transsphenoidal surgery).

You will usually be given a general anaesthetic, which means you will be asleep. 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.

You may need to have chemotherapy or radiotherapy after surgery to make sure that all the cancer cells are destroyed.

Non-surgical treatment

Radiotherapy

Radiotherapy uses a targeted beam of radiation to destroy your tumour while minimising the damage to the surrounding healthy tissue. Radiotherapy is usually used either after surgery to kill any remaining tumour cells, or as an alternative to surgery. You may have it as a series of daily treatments over two to six weeks or as a single very highly focused treatment called radiosurgery (also known as gamma knife treatment).

Chemotherapy

Chemotherapy uses medicines to destroy cancer cells. You usually have it 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 medicines called procarbazine, lomustine (also called CCNU) and vincristine.

Temozolomide tablets are 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.

It’s possible that when your surgeon is removing your tumour, he or she will put small implants (called wafers) that release chemotherapy medicines into the affected area of your brain to kill any remaining tumour cells.

Steroids

Steroids are hormones (chemicals) that your body makes to help reduce swelling. Synthetic (man-made) steroids can help to reduce swelling that may be caused by your brain tumour, surgery or radiotherapy.

New treatments

New treatments for brain tumours are being tested in clinical trials all the time. Some of these act like chemotherapy medicines and others affect brain tumours in different ways. You may be given these as tablets or injections. It’s possible that you will be able to take part in a clinical trial to test one of these new treatments – 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. You may also find it helpful to see a counsellor.

 

Produced by Pippa Coulter, Bupa Health Information Team, April 2013.

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

For sources and links to further information, see Resources.

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  • This information was published by Bupa's Health Information Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals. Photos are only for illustrative purposes and do not reflect every presentation of a condition. The content is intended only for general information and does not replace the need for personal advice from a qualified health professional. For more details on how we produce our content and its sources, visit the about our health information page.

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