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Brain tumours

Published by Bupa's health information team, March 2009.

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

A brain tumour is an abnormal and uncontrolled growth of cells in the brain.

• Animation - How cancer develops
• About brain tumours
• Types of primary brain tumour
• Symptoms of brain tumours
• Causes of primary brain tumours
• Diagnosis of brain tumours
• Treatment of primary brain tumours
• Help and support
• Further information
• Questions and answers
• Related topics
• Sources

How cancer develops

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About brain tumours

Brain tumours can be primary or secondary.

• Primary brain tumours originate in your brain.
• Secondary brain tumours are tumours that have spread to your brain from a cancer in another part of your body, for example, from tumours that originally started in your lung or breast.

Primary brain tumours are rare; around 4,200 people are diagnosed with a primary brain tumour each year in the UK. They can occur at any age but are more common the older you get. In the UK, about 300 children are diagnosed with a brain tumour each year.

Primary brain tumours can be either malignant or benign.

• Malignant brain tumours are relatively fast growing and may invade surrounding tissue. They rarely spread to other parts of your body outside of the central nervous system although some brain tumours (eg medulloblastoma) can spread to your spine through the cerebrospinal fluid.
• Benign tumours are relatively slow growing; they don't spread to other parts of your body and don't invade surrounding tissue. However, if they continue to grow in your brain, they may cause a problem by pressing on structures of the brain. Even small brain tumours can cause significant symptoms if they are close to crucial parts of your brain.

Both malignant and benign tumours can be harmful because they increase pressure in your skull and affect the function of your brain.

The different parts of the brain and the spinal cord

Types of primary brain tumour

There are many types of primary brain tumour, and they are generally named after the type of brain cells that they contain.

The most common type is a glioma, which is a tumour that grows from glial cells. These are cells that support the nerve cells of your brain. Around half of all primary brain tumours are gliomas. There are three main types of glioma - astrocytoma, ependymoma and oligodendroglioma. Other types of brain tumour include embroyonal (medulloblastoma); pineal; pituitary and germ-cell tumours; lymphoma; meningioma and schwannoma.

Brain tumours are graded according to how quickly they grow (low grade tumours are the slower growing and tend to have a better chance of recovery).

Symptoms of brain tumours

Your symptoms will depend on the size of the tumour and its position in your brain.

The most common symptoms are headaches and seizures (fits). Headaches 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 aren't caused by brain tumours.

Other symptoms include:

• being or feeling sick
• blurred vision
• drowsiness
• changes in personality, memory or mental ability
• weakness on one side of the body
• difficulties with speaking
• problems with hearing
• problems with sense of smell

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

Causes of primary brain tumours

The cause of primary brain tumours is still not known.

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

• age - brain tumours are more common in older people
• radiation exposure, such as radiotherapy to the head given as treatment for another cancer
• a weakened immune system

Other risk factors have been suggested as possible causes of brain tumours, such as mobile phones, power lines, certain viruses and exposure to certain chemicals used in industry. However, there is no evidence to date that they 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 muscle and brain function, such as memory, vision, muscle strength and co-ordination tests.

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

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

• A CT (computed tomography) scan, which uses X-rays to make 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 magnets and radiowaves to produce images of the brain. Specialised MRI scans can show the blood vessels (magnetic resonance angiography or MRA scans).
• 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.

Surgery is usually necessary to diagnose a brain tumour, as a biopsy (a small sample of tissue) is required to find out exactly what type of tumour you have.

The sample will be sent to a laboratory for testing to determine the type of cells and if these are benign or cancerous. The biopsy is usually performed under general anaesthesia which means that you will be asleep during the procedure.

Treatment of primary brain tumours

Some brain tumours are discovered by chance. If the tumour is slow growing, you may not need treatment if it's not causing symptoms. Your condition will be monitored closely with routine check-ups and scans instead. This is often called active monitoring or watchful waiting.

There are medicines available to help control your symptoms. Steroids such as dexamethasone may reduce the swelling (oedema) caused by brain tumours. For this reason, they may be given before or after surgery or during or after radiotherapy but won't treat the tumour itself.

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

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

Surgery

Surgery is likely to be your first treatment option. You will usually be given a general anaesthetic, which means that you will be asleep during the procedure.

Your surgeon will cut your scalp and the area of skull over the tumour, remove as much of the tumour as possible and replace the piece of skull and scalp. It may not be possible or advisable to remove the whole tumour. Your surgeon will talk to you about any potential risks before the operation.

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

Radiotherapy

Radiotherapy uses radiation (powerful X-rays) to destroy cancer cells. Cancer cells are more sensitive to radiation than non-cancerous cells, which can recover from treatment.

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

Radiosurgery (also known as gamma knife treatment) is a very highly focused type of radiotherapy. It's given as a single treatment.

Chemotherapy

Chemotherapy uses medicines to destroy cancer cells. It's usually given as tablets or by injection. However, because the brain is designed not to allow toxic substances in, only a few chemotherapy medicines are effective in treating brain tumours.

Chemotherapy can be used alone or in combination with radiotherapy to treat primary brain tumours that can't be removed surgically.

Recently, newer medicines called biological therapies have become available which appear to be highly promising for the treatment of malignant primary brain tumours.

Help and support

Being diagnosed with cancer can be distressing for you and your family. An important part of cancer treatment is having 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, and may also visit you at home. If you have more advanced cancer, further support is available to you in hospices or at home, and this is called palliative care.

Further information

• Cancer Research UK
  0808 800 4040
  www.cancerhelp.org.uk
• Macmillan Cancer Support
  0808 800 1234
  www.macmillan.org.uk
• Brain Tumour Action
  0131 466 3116
  www.braintumouraction.org.uk

Related topics

• Cancer - a general overview
• Chemotherapy
• CT scan
• Gamma knife treatment
• MRI scan
• Radiotherapy

Sources

• Brain tumours. Cancer Research UK. www.cancerhelp.org.uk, accessed 9 September 2008
• Brain tumour information centre. Macmillan Cancer Support. www.macmillan.org.uk, accessed 17 September 2008
• Cassidy J, Bissett D, Spence RAJ, et al. Oxford Handbook of Oncology. 2nd ed. Oxford: Oxford University Press, 2006:436-445
• Personal communication, Dr Eliot Sims, Consultant Clinical Oncologist, Spire Hartswood Hospital, 1 September 2008
• Joint Formulary Committee, British National Formulary. 54th ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain, 2007:243; 248; 380
• Vredenburgh JJ, Desjardins A, Herndon JE, et al. Bevacizumab plus irinotecan in recurrent glioblastoma multiforme. J Clin Oncol 2007; 25:4722-4729.
• Brain and central nervous system cancer incidence statistics. Cancer Research UK. http://www.cancerresearch.org, accessed 2 October 2008

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: March 2009