Brain tumors

The brain and spinal cord make up the central nervous system (CNS). Together, the parts of the CNS control the activities of the mind and body. A brain or spinal cord tumor occurs when abnormal cells grow and form a mass or lump.

Brain tumors are classified as benign or malignant. These terms are also used for tumors elsewhere in the body, but with brain tumors the difference is not as clear, and both types can be serious and may need urgent treatment.

Brain tumors can affect people of any age, including children. Benign brain and spinal cord tumors are more common than malignant ones.

Symptoms#

Symptoms depend on where the tumor is in the brain or spinal cord, its size, and how slowly or quickly it is growing. A tumor can increase pressure inside the skull, which can lead to general symptoms such as:

• Headaches, often worse when you wake up.
• Nausea and vomiting, often worse in the morning or after changing position (such as moving from sitting to standing).
• Confusion and irritability.
• Blurred or double vision.
• Seizures (fits), which may cause jerking or twitching of the hands, arms or legs, or affect the whole body.
• Drowsiness or loss of consciousness.
• Weakness in parts of the body.
• Difficulty speaking or finding the right words.
• Poor coordination.

Not everyone with these symptoms has a brain or spinal cord tumor. If you have any of these symptoms or are worried, see your doctor.

Types of brain tumor#

There are more than 40 types of primary brain and spinal cord tumors, and they can start in any part of the brain or spinal cord.

Glioma tumors#

Gliomas start in the glial cells of the brain and are the most common type of brain tumor. They include:

• Astrocytoma – starts in glial cells called astrocytes and may be benign or malignant.
• Ependymoma – starts in glial cells called ependymal cells, more common in children than adults, and may be benign or malignant.
• Glioblastoma (GBM) – a type of malignant astrocytoma that makes up more than half of all gliomas and occurs in adults and children. It may develop from a slow-growing astrocytoma.
• Oligodendroglioma – starts in glial cells called oligodendrocytes, more common in children than adults, and may be benign or malignant.
• Medulloblastoma – a malignant tumor that starts in the cerebellum, more common in children and rarer in adults.

Non-glioma tumors#

• Meningioma – the most common primary brain tumor, starting in the membranes (meninges) covering the brain and spinal cord. It is usually benign and slow growing.
• Schwannoma – starts in the Schwann cells that surround nerves in the brain and spinal cord, and is usually benign (this group includes acoustic neuromas).
• Pituitary tumor – starts in the pituitary gland and is usually benign.

Risk factors#

Some things can make a brain or spinal cord tumor more likely. These risk factors include:

• Family history – it is rare for brain tumors to run in families, though some people inherit a gene change that slightly increases their risk.
• Radiation therapy – people who have had radiation therapy to the head, particularly to treat childhood leukemia, may have a slightly higher risk.
• Chemical exposure – the chemical vinyl chloride, some pesticides, and work in rubber manufacturing and petroleum refining have been linked with brain tumors.
• Overweight and obesity – a small number of meningiomas are thought to be linked to high body weight or obesity.

Having these risk factors does not mean you will develop a tumor, and often there is no clear reason why one develops. If you are worried about your risk factors, ask your doctor for advice.

Diagnosis#

To check for a brain or spinal cord tumor, your doctor may carry out a physical and neurological examination to assess how different parts of your brain and body are working, including speech, hearing, vision and movement. You may also have blood tests.

Your doctor might ask you to have further tests, which can include:

• MRI scan and CT scan – detailed images of the brain and spinal cord.
• MRS scan – a specialized MRI that looks for changes in the chemicals in the brain.
• MR tractography – helps show the message pathways within the brain and can help plan treatment for gliomas.
• MR perfusion scan – shows the amount of blood flowing to various parts of the brain and can help identify the type of tumor.
• SPECT scan and PET scan – show blood flow in the brain; areas with higher blood flow, such as a tumor, show up brighter on the scan.
• Lumbar puncture and surgical biopsy – to obtain samples for testing.
• Molecular testing – looks for gene changes, which may be acquired during a person’s life or inherited through families. The results help identify the features of the tumor so your doctors can recommend the most appropriate treatment.

Grades and stages#

The grade of a cancer describes how quickly it might grow, and knowing the grade helps your doctor work out the best treatment plan. Brain and spinal cord tumors are usually given a grade from 1 to 4 using an internationally recognised grading system:

• Grade 1 – low-grade, benign and slow growing.
• Grade 2 – low-grade and usually slow growing, but more likely to come back after treatment and able to develop into a higher-grade tumor.
• Grades 3 and 4 – high-grade, faster growing and malignant. They can spread to other parts of the brain and tend to come back after treatment.

The stage of a cancer describes how far it has grown in the body. Primary brain and spinal cord tumors are not usually staged in this way, as most do not spread to other parts of the body. Ask your doctor or nurse to explain the stage of the cancer.

Prognosis#

When someone is diagnosed with a brain or spinal cord tumor, their doctor will give them a prognosis, which is the doctor’s opinion of how likely the cancer is to spread and the chances of getting better. A prognosis depends on factors such as the tumor’s type, location, genetic make-up and grade, whether it has damaged surrounding healthy brain tissue, how well it responds to treatment, and the person’s age, family history and general health.

Both low-grade and high-grade tumors can be life-threatening, but the prognosis may be better if the tumor is low grade or if the surgeon can remove the entire tumor. Some tumors, particularly gliomas, can come back and may change into a higher-grade tumor. In that case, treatments such as surgery, radiation therapy and chemotherapy may be used to control growth for as long as possible, relieve symptoms and maintain quality of life. Every person’s experience is different, and support is available.

Treatment#

Treatment depends on factors such as the aim of treatment (to remove the tumor, slow its growth or relieve symptoms), the nature of the tumor, your symptoms and your general health.

Surgery#

Surgery on the brain or spinal cord is called neurosurgery. You may have surgery to help diagnose a tumor (biopsy), to remove the whole tumor (total resection) or to remove part of it (partial resection or debulking). Different operations may be used, including:

• Craniotomy – to remove a brain tumor.
• Brain mapping – an electrode is placed on the outer layer of the brain to stimulate and pinpoint important areas.
• Awake craniotomy – to remove a tumor near parts of the brain that control speech or movement.
• Endoscopic transsphenoidal surgery – to remove a pituitary tumor.
• Laminectomy – to remove a spinal cord tumor.

Sometimes a tumor cannot be safely removed because it is too close to certain parts of the brain and surgery would cause blindness or partial paralysis. This is called an inoperable or unresectable tumor.

Radiation therapy#

Treatment is carefully planned to do as little harm as possible to the healthy tissue near the cancer. Radiation therapy is typically given after surgery and sometimes together with chemotherapy (chemoradiation).

Chemotherapy#

Chemotherapy drugs travel through the bloodstream and damage or destroy rapidly dividing cells, such as cancer cells, while causing the least possible damage to healthy cells. You may have chemotherapy after surgery and possibly with radiation therapy (chemoradiation).

Other medicines#

• Anticonvulsants – help control seizures, which can also affect your mood and energy. An experienced counselor, psychologist or psychiatrist can help you manage mood swings or behavioral changes.
• Steroids – are made naturally in the body but can also be produced as drugs. Brain tumors and their treatments can both cause swelling in the brain, and steroids may help reduce this swelling. They can be given before, during and after surgery and radiation therapy.

Side effects#

All cancer treatments can have side effects. Your treatment team will discuss these with you before you start, and you should tell them about any side effects you experience. Some side effects can be upsetting and difficult, but help is available if you need it.

Living with a brain tumor#

A brain or spinal cord tumor and its treatment can change how the mind and body work. You may notice changes to your speech, personality, memory, movement, balance or coordination. A range of therapies can support your recovery, including physiotherapy, cognitive rehabilitation, exercise, speech therapy, help with vision impairment and occupational therapy.

Seizures#

A brain tumor or its treatment can sometimes cause seizures, which can involve the whole body or just one area such as an arm or leg. Seizures can often be prevented with anticonvulsant medicines (also called anti-epileptic or anti-seizure medicines). Feeling overstimulated or very tired can increase your risk of having a seizure, so try to get 6 to 8 hours of sleep each night. Drinking less alcohol may also help.

Driving#

Tumors, seizures, and certain treatments and medicines can affect the skills needed to drive safely, including good vision and perception, concentration and planning, processing speed and reaction time, remembering directions, and hand-eye coordination. When you are diagnosed with a brain tumor, it is very important to ask your doctor how your condition or treatment will affect your ability to drive.

Your doctor will usually advise you not to drive for a while, and you may need to wait some time before driving again after surgery and possibly after radiation therapy. There are also set periods your doctor will follow after certain treatments or events such as seizures. Always check with your doctor before you start driving again, and follow any legal requirement to notify the relevant licensing authority of an illness or injury that is likely to affect your ability to drive.

Working#

It can be hard to predict how well you will recover and when, or whether, you will be able to return to work, which may also depend on the type of work you do. Some people find it hard to concentrate or make decisions after treatment, and at least at first it may not be safe to operate heavy machinery or take on a lot of responsibility. An occupational therapist can advise you and can also give your employer information about whether you could return to work with altered duties or on a part-time basis. In some cases it will not be possible to return to your former role.

Sexuality#

Cancer can affect your sexuality in physical and emotional ways. The impact depends on many factors, such as treatment and side effects, your self-confidence, and whether you have a partner. Although sexual intercourse may not always be possible, closeness and sharing can still be part of your relationship.

Living with advanced cancer#

Advanced cancer usually means cancer that is unlikely to be cured. Some people can live for many months or years with advanced cancer, and support services can help during this time.

Most people continue to have treatment for advanced cancer as part of palliative care, as it helps manage the cancer and improve day-to-day life. Many people think palliative care is only for people who are dying, but it is for any stage of advanced cancer. Palliative care treatment may include chemotherapy, radiation therapy or another type of treatment, and it can:

• Help you live more comfortably by managing symptoms such as pain.
• Slow down how fast the cancer is growing or shrink the cancer.

Treatment depends on where the cancer started, how far it has spread, your general health and your preferences. Ask your doctor about treatment and palliative care services that may help you.

Key points#

• Both benign and malignant brain tumors can be serious and may need urgent treatment.
• Benign brain and spinal cord tumors are more common than malignant tumors.
• Symptoms depend on where the tumor is, its size and how quickly it is growing.
• Not everyone with these symptoms has a brain or spinal cord tumor.
• If you have any of these symptoms or are worried, see your doctor.

Where to get help#