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Brain tumours

This factsheet is for people, or parents of children, who have a brain tumour.

A brain tumour is a lump created by an abnormal and uncontrolled growth of cells. It can either be malignant (cancerous) or benign.

Brain tumours are rare. Around 2000 men and 1500 women are diagnosed with a brain tumour each year in the UK. Brain tumours can occur at any age but are more common in children under 12 and adults over 40.

Cancer - a general overview animation

About brain tumours

Brain tumours grow from brain cells.

Malignant brain tumours can spread out of the brain and invade surrounding tissue. They rarely spread to other parts of the body.

Benign tumours do not spread to other parts of the body and so are not cancerous. However, if they continue to grow in the brain, they may cause a problem by pressing on the brain structures. Both malignant and benign tumours can be harmful because they increase pressure in the skull.

Brain tumours can be primary or secondary.

• Primary brain tumours originate in the brain.
• Secondary brain tumours are tumours that have occurred because cancer cells have spread into the brain from a cancer in another part of the body.

Primary brain tumours are rare. Most brain tumours are secondary, from other parts of the body.

Illustration showing the brain structure

Types of primary brain tumours

There are many types of primary brain tumours. They are generally named after the type of brain cells that they contain.

The most common type is glioma, which is a tumour that grows from glial cells. These are cells that support the nerve cells of the brain. Over half of all primary brain tumours in adults are gliomas.

Brain tumours are graded according to how quickly they grow (low grade is the slowest growing).

Symptoms

The symptoms that you or your child may experience will depend on the size of your tumour and its position in your brain.

You or your child may experience one or more of the symptoms listed below.

• Headaches, which are usually worse in the morning but wear off as the day goes on. They are a result of increased pressure in the skull. Although headaches are one of the most common symptoms of a brain tumour, it's important to realise that headaches are common and most are not caused by brain tumours.
• Seizures (epileptic fits) which can cause muscle spasms, or periods of unconsciousness. For this reason you may not be able to drive, but follow your doctor's advice.
• Vomiting or nausea.
• Blurred vision.
• Drowsiness or lethargy.
• Changes in personality, memory or mental ability - although these may only be slight.
• Weakness, which is often one-sided, in the arms or legs.
• Difficulties with speech such as slurring or inability to name objects.
• Problems with hearing.
• Problems with sense of smell.

Although not necessarily a result of brain tumours if you or your child experience these symptoms, you should visit your GP.

What causes brain tumours?

Secondary brain tumours are always caused by a cancer somewhere else in the body. The cause of primary brain tumours is still not known.

Brain tumours do tend to occur more often in certain types of people however, and there are a number of 'risk factors' including those listed below.

• Age is a factor. Although tumours can occur at any age, they are more common in adults over 40 and in children under 12.
• Radiation exposure, such as radiotherapy to the head given as treatment for another cancer can increase the risk of a brain tumour.
• Environmental factors such as excessive exposure to certain chemicals like pesticides can increase the likelihood of developing a brain tumour.
• Immune system disorders can increase the risk of developing a brain tumour such as a lymphoma (a malignant tumour of the lymphatic system which is part of the body's immune system). The immune system may be impaired by a defect present at birth, as a result of other treatments such as cancer treatments or organ transplantation or due to illnesses such as AIDS.

Diagnosis

Your doctor will ask you some questions about your, or your child's, symptoms. He or she may also carry out tests to assess muscle and brain function, such as memory, vision, muscle strength and co-ordination tests.

Your doctor may refer you to a neurologist or an oncologist if he or she suspects that you have a brain tumour. A neurologist is a specialist in conditions affecting the nervous system and an oncologist is a doctor who specialises in cancer treatment.

Your specialist may do one or more of the tests listed below.

• A CT (computerised axial tomography) scan, which is a type of X-ray that builds up a three dimensional picture of the brain to show the position of the tumour.
• An MRI (magnetic resonance imaging) scan - which is similar to a CT scan but uses magnetic fields, instead of X-rays, to build up a picture of the brain.
• An EEG (electroencephalogram) which is a painless test that records the electrical activity of the brain. It can detect abnormal brain activity.
• A lumbar puncture, where a sample of cerebrospinal fluid is taken from the lower back.
• An X-ray of the blood vessels (angiogram) to show the position of the tumour.
• A biopsy, where a small tissue sample is removed during surgery. The sample is examined in the laboratory to find out what type of tumour it is and how fast it is growing. This information can help your doctor to determine which treatment you should have.

Treatment

If the tumour is slow growing, you may not need treatment if it is not causing symptoms. It can be carefully monitored instead. Your doctor will advise you.

There are drug treatments to help control your, or your child's, symptoms. Although they will not remove the tumour, steroids, such as dexamethasone, may reduce swelling caused by brain tumours. They may be given before or after surgery or radiotherapy.

Anticonvulsants, such as phenytoin and carbamazepine, can control epileptic fits.

Surgery, radiotherapy or chemotherapy are the main treatment options to remove the tumour and may be used alone or in combination, depending on the type of tumour.

Surgery

If you or your child has a primary brain tumour, surgery is likely to be your first treatment option. Surgery can also be used to treat secondary brain tumours.

You will be given a general anaesthetic, which means that you will be asleep throughout the procedure and will feel no pain.

Your doctor will open your, or your child's, skull in an operation called a craniotomy. He or she will cut the scalp and the piece of skull over the tumour, remove as much of the tumour as possible and replace the piece of skull and scalp.

If the tumour has grown into the surrounding tissue in your, or your child's, brain, it will not be possible to remove it completely.

Surgery may be followed by radiotherapy and/or chemotherapy to try and destroy the remaining tumour.

Radiotherapy

Radiotherapy works by targeting radiation to damage the cancer cells of the tumour and prevent them growing, whilst doing as little harm as possible to normal cells. For more information, please see the separate BUPA factsheet:
Radiotherapy

Radiotherapy may be used before surgery to reduce the size of the tumour, after surgery to kill any tumour cells that were not removed, or as an alternative to surgery. It is a painless procedure.

Radiotherapy can also be used to treat both primary and secondary brain tumours.

Chemotherapy

Chemotherapy uses drugs that attack the cancer cells of the tumour and prevent them growing. It is usually given as tablets or by injection. For more information, please see the separate BUPA factsheet:
Chemotherapy

It is used alone or in combination with radiotherapy to treat primary brain tumours that cannot be removed surgically.

Chemotherapy can also be used to treat both primary and secondary brain tumours.

Further information

• Brain Tumour Action
  01506 436 164
  www.braintumouraction.org.uk
• Cancerbackup
  0808 800 1234
  www.cancerbackup.org.uk

References

• Cancer: number of new cases 2002, by sex and age. National Statistics.
  www.statistics.gov.uk
  accessed 1 July 2005
• Guidance on the use of temozolomide for the treatment of recurrent malignant glioma (brain cancer). National Institute for Clinical Excellence. 27 April 2001, Technology Appraisal Guidance No. 23.
  www.nice.org.uk
• Brain cancer. Cancer Research UK.
  www.cancerresearchuk.org
  accessed 27 June 2005
• Brain tumour information centre. Cancerbackup.
  www.cancerbackup.org.uk
  accessed 4 July 2005
• Cassidy J, Bissett D, Spence RAJ. Oxford Handbook of Oncology.Oxford: Oxford University Press, 2002.
• BNF British National Formulary 49, March 2005.

Published by BUPA's health information team, healthinfo@bupa.com, October 2005

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