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Brain tumours


Expert reviewer, Dr Oliver Lily, Consultant Neurologist
Next review due June 2021

Brain tumours form when cells in your brain grow in an abnormal and uncontrolled way.

Here we cover brain tumours that start in cells in and around your brain. These are called primary brain tumours. Tumours in the brain can also happen because cancer spreads from other parts of your body. These are called secondary brain tumours, or metastases. To find out more about these, see our information on individual types of cancer.

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About brain tumours

Brain tumours can be benign (non-cancerous) or malignant (cancerous). Usually, when we talk about tumours being benign or malignant, we can say that benign tumours aren’t so serious. However, in the case of brain tumours even benign ones can cause serious problems. This is because they grow inside a confined space – your skull – and can press on your brain.

So, doctors divide brain tumours into four grades, one to four, based on how fast they grow and how likely they are to come back. Grades one and two they call ‘low grade’. These tend to grow slowly and are less likely to spread, or come back after treatment. Your doctor may say they’re benign. Grades three and four are ‘high grade’ and may grow faster. They may spread to other parts of your body and are more likely to return after treatment. They may be called malignant tumours.

Low grade tumours can sometimes transform into higher grade (malignant) tumours after a number of years.

Each year in the UK, over 11,000 people are diagnosed with a brain tumour. You can get a brain tumour at any age, but they’re more common after you reach 50.

Children can also get brain tumours. Although they’re rare, they’re the second most common type of childhood cancer after leukaemia.

Types of brain tumour

There are many different types of brain tumour. They’re usually named after the type of brain cell they develop from, or the area of the brain where they’re growing. We describe the most common types below.

Gliomas

These are the most common type of brain tumour. They grow from glial cells, which support the nerve cells in your brain. The most common types of glioma are:

  • astrocytomas and glioblastomas
  • oligodendrogliomas
  • ependymomas

Meningiomas

About one in five brain tumours in adults is a meningioma. These tumours start in the layers of tissue that cover your brain and spinal cord (the meninges) and are usually low grade (benign). They may not need any treatment.

Pituitary tumours

About one in 10 brain tumours develops in the pituitary gland. This is a pea-sized gland in your brain which produces hormones. These tumours are usually benign, but may cause problems due to the hormones they release.

Medulloblastomas

Medulloblastomas usually develop in the cerebellum, which is low down at the back of your brain. It rarely affects adults but is the most common brain tumour in children.

Symptoms of brain tumours

The exact symptoms you’ll have will depend on things like the size of the tumour and where it is in your brain.

Depending on where the tumour is, it may cause symptoms because of its effect on your brain. These symptoms may include:

  • seizures (fits) – you might lose consciousness
  • problems walking
  • feeling weak on one side of your body
  • problems with speaking, your sight, hearing, or your sense of smell

These symptoms aren't always caused by a brain tumour, but may have other serious causes. If you have them, contact your GP urgently or go to a hospital A&E.

Other possible symptoms caused by the effect of a brain tumour on your brain include changes in your personality, memory or mental ability. If you notice these, contact your GP.

You might also get symptoms as a result of increased pressure on your brain from the tumour. These may include:

  • headaches – these may seem different to any headaches you may usually get from time to time. (But you may not get any pain at all from a brain tumour.)
  • feeling sick or vomiting
  • altered vision

Remember headaches are extremely common and brain tumours are very rare – most headaches aren’t caused by brain tumours.

Diagnosis of brain tumours

Your GP will ask you about your symptoms and examine you. This might include testing your reflexes and muscle strength, and looking at the back of your eyes with an ophthalmoscope.

They may refer you to see a neurologist or to a neurosurgeon. These are doctors who specialise in conditions that affect the nervous system.

You might need to have some more tests to see if you have a brain tumour, and to find out what type you have. These may include the following.

  • Blood tests – these assess your general health and check for specific chemical markers in your blood.
  • Magnetic resonance imaging (MRI) scan – this uses magnets and radio waves to produce images of the inside of your brain. You may have this done urgently.
  • Computerised tomography (CT) scan – this uses X-rays to make a three-dimensional image of your brain.

If your doctor recommends any tests they’ll explain what’s involved. You should feel free to ask them any questions you have about your tests.

Brain tumour grading

If your tests find a tumour, you’ll probably need to have a biopsy taken. Your doctor will use your scans to accurately find the position of the tumour and remove a small sample of tissue. They’ll send this to a laboratory to be tested. They might do this as part of an operation to treat a brain tumour.

The biopsy will show your doctor what type and grade of brain tumour you have. For more information about grading brain tumours, see our section ‘about brain tumours’. Doctors can also test the genetic information of your tumour, which may guide them in deciding which treatment is best for you.

Treatment of brain tumours

Different brain tumours develop in different ways. Your treatment will vary depending on which type you have, how advanced it is, and where it is in your brain. Your doctor will discuss what your treatment options are and help you decide what’s best for you.

A team of doctors and other cancer specialists will be involved in planning your care. They’ll include neurologists, neurosurgeons, clinical oncologists (doctors who treat cancer using X-rays and medicines) and specialist nurses who support you through diagnosis and treatment.

We give you some basic information about the various types of treatment here. If you want more details, see the websites of the organisations listed below under ‘other helpful websites’.

Watchful waiting

If your tumour is slow-growing and you don’t have many symptoms, you might not need any treatment straightaway. Your healthcare team will monitor you closely and you’ll have routine check-ups and scans. This is called active monitoring or watchful waiting.

Surgery

The aim of surgery is to remove as much of the tumour as possible – called ‘debulking’ surgery. For some types of brain tumour this can cure them. And for others, it can slow down the growth of tumours and help to ease your symptoms.

The type of surgery you have will depend on the type of brain tumour, as well as its size and position. Your surgeon will explain your options, and talk to you about what the surgical procedure will involve.

Surgery for brain tumours most commonly involves a craniotomy. This is an operation where your surgeon removes an area of bone from your skull to reach the brain tissue beneath. In some situations keyhole surgery may be possible. This involves your surgeon making only a small hole in the bone of your skull. If you have a pituitary tumour, your surgeon may be able to remove it through your nose, which is called transsphenoidal surgery.

You’ll usually be given a general anaesthetic during these operations, which means you’ll be asleep. But you might need to be awake for the procedure if your surgeon needs to check how your brain is working during the operation. If so, you’ll be given a local anaesthetic so you won’t feel pain.

Non-surgical treatment

Radiotherapy

Radiotherapy uses a targeted beam of radiation to destroy your tumour while aiming to minimise any damage to your surrounding healthy tissue. You usually have radiotherapy after surgery to kill any remaining tumour cells, but sometimes you can have it as an alternative to surgery.

There are different ways of giving radiotherapy for brain tumours. Your doctor will discuss the best options for you in your particular circumstances. You may have radiotherapy every day over two to six weeks, or as a single very highly focused treatment called radiosurgery. Another name for this type of radiotherapy is stereotactic radiosurgery (SRS) or stereotactic radiotherapy (SRT), which you might hear called cyberknife or gamma knife treatment. For more information about what’s involved in stereotactic radiosurgery see our information on Gamma knife.

You’ll be guided through your treatment at each stage and your doctor and nurses will answer any questions or concerns you have.

Chemotherapy

Chemotherapy uses medicines to destroy cancer cells. Only a few chemotherapy medicines work for brain tumours, so it’s not usually the main type of treatment.

You might have chemotherapy on its own or in combination with other treatments. You might also have chemotherapy if your tumour comes back after having other types of treatment.

When your surgeon removes your tumour, they might put small implants called wafers into the affected area of your brain. These will release chemotherapy medicines to kill any remaining cancer cells.

Other medicines

Your doctor may offer you steroid medicines (also called corticosteroids) to help reduce any swelling you have in and around your brain. You may also need medicines to help prevent seizures – these are called anticonvulsants.

New treatments

New treatments for brain tumours are being tested in clinical trials all the time. For instance, you may have heard of proton beam therapy which is a new type of radiotherapy. You might be able to take part in a clinical trial to test one of these new treatments. If you’re interested, ask your doctor about this.

Causes of brain tumours

Doctors don’t yet know the exact reasons why people develop a brain tumour. But there are a number of things that might increase your risk of getting one. These include:

  • 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 – if you have radiotherapy to your head as treatment for another cancer, for example
  • your age – the older you are, the more likely you are to get a brain tumour
  • having a weakened immune system – if you have human immunodeficiency virus (HIV/AIDS), or take medicines that suppress your immune system, for example

Experts have looked to see if brain tumours are caused by various other things, including mobile phones and electromagnetic fields. The work they’ve done so far doesn’t show that these cause brain tumours.

Help and support

Being diagnosed with a brain tumour can be distressing for you and your family. An important part of your treatment will be support to deal with the emotional aspects as well as the physical symptoms. Specialist cancer doctors and nurses are experts in providing the support you need. Talk to your doctor or nurse if you’re finding your feelings hard to cope with.

Everyone has their own way of coping. But for further support and advice you may find it helpful to contact a cancer or brain tumour organisation or visit their websites. They have information in more detail than we can go into here. Some have a telephone helpline you can ring, or an online forum you can join for a chat with others in your position. There may also be local groups where you can meet other people with similar medical issues, or other carers. Your cancer team may know of some.

See our section ‘other helpful websites’ below for contact details of relevant organisations. You may also find our general cancer articles helpful. These include the following.


You may also like to read our information on mindfulness and cancer, and returning to work after cancer.

Frequently asked questions

  • Some brain tumours are cured with the first round of treatment. Others can come back. If your tumour does come back, you may be able to have more treatment to try and cure it. If this isn’t possible, further treatment can help to ease your symptoms.

    The options for further treatment are similar to those used for the initial treatment. These are surgery, chemotherapy and radiotherapy. But they may be used in a different combination or given in a different way.

    Your team of doctors and other cancer specialists will discuss what the best option is for you in your particular circumstances. What further treatment they recommend will depend upon a number of things including what type of tumour you have and what treatment you’ve had already. They’ll also take into account your general health and your personal feelings about further treatment.

    It can be very distressing to hear that a brain tumour has come back. Your nurses and doctors will help you decide what the best option is for you and offer support. You may also find it helpful to read our section on help and support.

  • You’ll need to have regular check-ups after you’ve finished your treatment. This is to see how effective your treatment has been, and to check your general health. These appointments also give you a chance to talk to your doctor and nurse about any concerns you have.

    The check-ups may be with your oncologist (a doctor who specialises in cancer care), surgeon or another specialist. They may examine you and talk to you about whether you’ve had any symptoms. You may also need to have blood tests, and perhaps a CT or MRI scan.

    It’s important to go to all the appointments arranged for you.

    If your brain tumour comes back, you may get similar symptoms to the ones you had with the first tumour. But you might get these symptoms for many other reasons. Always tell your doctor everything, no matter how insignificant you may feel it is. If your treatment has been a success, as time goes by you may need to have check-ups less often.

  • Not at first. As soon as you’ve been diagnosed with a brain tumour, you must stop driving and contact the Driver and Vehicle Licensing Agency (DVLA).

    You won't be allowed to drive until the medical department at the DVLA, or your doctor confirms that you're safe to do so. This is for your safety and that of other road users. How long you must stop driving for will depend on the type of tumour you have, what type of treatment you have and how well this works. It also depends on how long it’s been since your last seizure if you’ve had one.

    If you have a bus and lorry licence (Group 2), the restrictions will be more severe than for a car or motorcycle licence (Group 1).

    The DVLA may need to contact your doctor to come to a decision about how long it will be unsafe for you to drive. Once this time has passed you’ll probably be able to drive again, but you may need to pass a medical assessment.

    If you have a brain tumour you should also inform your motor insurer, as it may affect your cover.


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Related information

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    • Overview of brain tumours. BMJ Best practice. bestpractice.bmj.com, last reviewed May 2018
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    • Brain and central nervous system cancers – recognition and referral. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised November 2015
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    • Brain tumours. Cancer Research UK. www.cancerresearchuk.org, last reviewed November 2015
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    • Assessing fitness to drive – a guide for medical professionals. Driver and Vehicle Licensing Agency. www.gov.uk, reviewed January 2018
    • Personal communication, Dr Oliver Lily, Consultant Neurologist, July 2018
  • Reviewed by Dr Kristina Routh, Freelance Health Editor, Bupa Health Content Team, June 2018.
    Expert reviewer, Dr Oliver Lily, Consultant Neurologist
    Next review due June 2021



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