Brain tumours

The brain and spinal cord together are called the central nervous system. The brain controls how we think, feel, learn and move. It also controls other important things, such as breathing and heart rate. It is inside the skull, which protects it.

The spinal cord is a long bundle of nerves that runs down the middle of the spine. These nerves pass messages between the brain and the rest of the body. The bones of the spine protect the spinal cord.

Three thin layers of tissue cover the brain and spinal cord. These are called the meninges. Between two of these layers is a fluid called cerebrospinal fluid (CSF). The meninges and CSF also help to protect the brain and spinal cord.

Different parts of the brain do different things. The main parts of the brain are the:

• cerebrum
• pituitary gland
• cerebellum
• brain stem
• cranial nerves.

Cerebrum

This is the largest part of the brain and has two halves (hemispheres).

The cerebrum controls:

• thinking
• memory
• behaviour
• personality
• movement
• sensation.

The right half of the cerebrum controls movement and sensation in the left side of the body. The left half of the cerebrum controls the right side of the body. It also controls speech.

Pituitary gland

The pituitary gland is behind the nose and just below the base of the brain. It makes hormones (chemical messengers) that help control many processes in the body, including:

• how the body grows and develops from a child into an adult
• how the body uses energy from food
• water levels in the body
• monthly menstrual periods
• making sperm.

Cerebellum

This is the area below the cerebrum, at the back of the brain. It controls balance and co-ordination.

Brain stem

The brain stem is at the bottom of the brain and connects to the spinal cord. It controls important bodily functions that keep us alive. These functions include breathing, heart rate, blood pressure and body temperature. The brain stem also controls movements of the eyes and face, speech and swallowing.

Cranial nerves

These are nerves that go from the brain and brain stem to the eyes, nose, ears, tongue, face and shoulders. They carry messages from these areas about sensations such as taste, smell, vision and hearing. They also carry messages to the muscles that control eye and face movements, speech and swallowing.

Brain tumours can be either benign (not cancer) or malignant (cancer). This information is about both types.

Benign brain tumours usually grow slowly. They might not cause symptoms for a long time. They are very unlikely to spread into other parts of the brain. But they can cause problems as they grow and press on nearby areas of the brain. Some benign brain tumours do not come back after treatment. But other brain tumours can come back and need further treatment. Sometimes, a benign brain tumour can change over time and become malignant.

Malignant brain tumours grow faster than benign tumours. They cause problems by spreading into and damaging nearby areas of the brain. Some tumours may spread to other parts of the brain or to the spinal cord. They rarely spread to other parts of the body. Malignant brain tumours are more likely to come back after treatment.

For some types of brain tumour, your doctor may talk about their grade.

The grade depends on how the cells look under a microscope. The grade may affect how slowly or quickly a tumour grows:

• In grades 1 and 2, tumours are low-grade and benign and usually grow slowly.
• In grades 3 and 4, tumours are high-grade and malignant (cancer) and usually grow more quickly.

There are different types of brain tumour. They are usually named after the type of cell they develop from. Or sometimes they are named after the part of the brain they start in.

The types of brain tumour that are most likely to affect teenagers and young adults are:

• gliomas
• pituitary area tumours
• medulloblastomas
• germ cell tumours of the brain.

However, other types of brain tumour can also affect teenagers and young adults. Your doctor can give you more information about these.

Gliomas

Gliomas develop from supporting cells (glial cells) in the brain or spinal cord. There are different types. They get their name from the type of glial cell they develop from:

• Astrocytoma is the most common glioma. It develops from a glial cell called an astrocyte.
• Oligodendroglioma develops from a glial cell called an oligodendrocyte.
• Ependymoma develops from a glial cell called an ependymal cell. They line the fluid-filled spaces in the brain (ventricles) and the centre of the spinal cord.

All these tumours can be benign or malignant (cancer).

Pituitary area tumours

Tumours that grow in or near the pituitary gland are usually benign and slow-growing. They can affect how the pituitary gland produces hormones. They can also affect vision. The most common types are pituitary adenomas and craniopharyngiomas.

Medulloblastomas

This type of cancer usually starts near the cerebellum at the back of the brain. Sometimes, medulloblastomas can spread to other parts of the brain or spinal cord. Or rarely they can spread to other parts of the body.

Germ cell tumours of the brain

These tumours develop from germ cells which are mainly in the ovaries or the testicles. Sometimes, there are small areas of germ cells in other parts of the body, such as the brain. Rarely, this results in germ cell tumours starting in the brain.

Germ cell tumours can be benign or malignant (cancer). The two main types of germ cell brain tumours are germinomas and non-germinomas. Your team may check samples of your blood or CSF for higher than normal levels of certain chemicals. These are released by some types of germ cell tumour, so can help your team diagnose and monitor the tumour. 

We do not know what causes most brain tumours, but research is going on to try to find out. Remember, it is not anything that you have done.

Rare genetic conditions that run in families can increase your risk of a brain tumour. 

People who have radiotherapy to the head as children are at slightly higher risk of brain tumours later in life.

Mobile phones, power lines and viruses have all been suggested as possible causes of brain tumours. But no research has found any strong evidence to link any of these to brain tumours.

A brain tumour can cause different symptoms depending on where it is in the brain. Some possible symptoms are:

• changes in your balance and walking
• weakness down one side of the body
• problems with speech
• changes in personality, thinking or behaviour
• seizures (fits)
• sight problems, including blurred vision, double vision, loss of eyesight or abnormal eye movements
• delayed puberty.

Sometimes, a tumour can increase pressure inside the skull. This is called raised intracranial pressure. It can also cause symptoms including:

• headaches
• sickness and vomiting
• confusion
• problems controlling when you need to pee (wetting yourself).

Other conditions can cause these symptoms. But you should visit your GP if you have any of these symptoms or are worried about brain tumours. They will talk to you about your symptoms. They can arrange for you to have tests or to see a specialist doctor if needed.

Some people are diagnosed with a brain tumour at hospital, after having a seizure (fit) or other sudden symptoms. Others go to see their GP about symptoms they are having.

If your GP thinks you may have a brain tumour, they may arrange for you to have a brain scan. Or they may send you to see a doctor who is a specialist in brain disorders (a neurologist). People with brain tumours have treatment in specialist hospitals. You may have to travel to your nearest one.

At the hospital

Your specialist will ask you questions about your symptoms and how you have been feeling. They may check your tummy area (abdomen) and listen to your chest.

They will also do a check of your nervous system, called a neurological examination. This includes simple questions to check your thinking and memory. You may also have hearing and eyesight tests. Your specialist may also:

• ask you to walk a few steps or do some simple actions to check your balance and movement
• check the strength of your arms and legs by asking you to push against something
• check your reflexes by tapping your arms and legs
• check if you can feel pinpricks on your skin, or feel the difference between hot and cold
• check the movement of your face and eyes
• shine a light at the back of your eye to check for swelling – a sign of increased pressure in the skull.

Your doctor or nurse will explain any tests you need. The results will help your doctor plan the best treatment for you. Your doctor and nurse will explain what to expect. But don’t be afraid to ask questions.

Your tests may include:

• an MRI scan, which uses magnetism to build a picture of the brain
• a CT scan, which uses a series of x-rays, to build a three-dimensional picture of the brain
• blood tests, to check your general health and sometimes measure the level of certain chemicals or hormones in your blood
• a lumbar puncture, to look for cancer cells in the fluid surrounding the brain and spinal cord
• eye tests, to check your eyesight.

Find further information on tests and scans

Having a biopsy

You may need to have a biopsy to find out the type of brain tumour you have. This is when your doctor removes a small part of the tumour. You often have a brain tumour biopsy while having surgery to remove the tumour.

We have more details about having a biopsy and surgery in the treatment section.

Waiting for results

Having tests and waiting for results can be scary. Remember, you don’t have to hide your worries. You could try talking to or getting support from family and friends or your specialist nurse and doctor.

You may have to stop driving, or learning to drive, for a time after your diagnosis. This mainly depends on the type and grade of brain tumour you have. It can also depend on other things. These things include:

• whether you have had seizures
• the treatment you are having
• the type of driving license.

This can be frustrating but it is important to follow the advice you are given.

It is also important to tell the Driver and Vehicle Licensing Agency (DVLA) or the Driver and Vehicle Agency (DVA) about your diagnosis. If you do not tell them, you are breaking the law.

• In England, Scotland or Wales contact the DVLA or call 0300 790 6806.
• In Northern Ireland contact the DVA or call 0300 200 7861.

After treatment, you may be allowed to start driving again depending on your symptoms and most recent scans. Ask your doctor or nurse for advice about your situation. Some people are allowed to drive as soon as they recover from treatment. Others may be allowed to drive one or two years after treatment ends.

Doctors treat different types of brain tumours in different ways. The main treatments are:

• surgery, which is an operation to remove some or all of the tumour
• radiotherapy, which uses high-energy rays or particles to treat tumour cells
• chemotherapy, which uses anti-cancer drugs to treat tumour cells.

Some people do not need treatment straight away. Instead, they have active monitoring. This involves having regular scans to check the tumour and seeing their doctor regularly at a clinic. If their scan results or symptoms show the tumour is growing, they start treatment.

For some tumours, the treatment is surgery, radiotherapy or chemotherapy on its own. But most people have a combination of these treatments. You may also need other treatments to control symptoms before, during or after your main treatments.

A team of specialists will plan your treatment. Your team may include:

• a neurosurgeon – a doctor who specialises in brain operations
• a neurologist – a doctor who treats brain conditions
• a paediatric or medical oncologist – a doctor who treats brain tumours with chemotherapy
• a clinical oncologist – a doctor who treats brain tumours with radiotherapy and chemotherapy
• a specialist nurse who looks after people with conditions affecting the brain
• a specialist nurse for teenagers or young adults with cancer
• a radiographer, who gives radiotherapy treatment.

Your treatment will depend on the type and grade of brain tumour and where it is in the brain.

Your doctor and nurse will explain your treatment and answer any questions you have. It is important that you understand what to expect. You may need some time to talk about it with your family.

Doctors are working all the time to:

• improve treatments
• reduce the side effects of treatment.

They do this through research called clinical trials. Your doctor may talk to you about having your treatment as part of a clinical trial. 

You may have symptoms before, during or after your main treatments for a brain tumour. These can be difficult to cope with, but they can usually be controlled. Most people have drugs called steroids as part of their treatment. You may also have anti-convulsant drugs to prevent seizures (fits). Some people need a small operation to place a shunt in the body. This is a device that reduces pressure inside the skull. We have more information about shunts further down the page.

Steroids

Steroids help reduce the swelling that often surrounds a brain tumour. They do not treat the tumour itself. But they can improve symptoms and make you feel better. You will often have steroids before, during and after your main treatment.

It is important to take steroids as your doctor tells you. You should not suddenly stop taking them.

Steroids can cause the following side effects:

• Tummy pain. Take your tablets with food and tell your doctor if you have tummy pain. They may prescribe drugs to help or prevent this.
• Increased appetite and weight gain. If you are worried about gaining weight, talk to your doctor or nurse.
• Difficulty sleeping. Taking your tablets in the morning may help you sleep better.
• Feeling restless or agitated. Let your doctor know if this is a problem.
• Raised blood sugar levels. You will have regular blood or urine (pee) tests to check this. Let your doctor know if you become very thirsty, pass lots of urine or feel unwell.

Taking higher doses of steroids for a longer time may cause more side effects. For example, you may be more likely to get an infection. Or your muscles may get weaker, especially at the tops of your arms and legs. You may need medication to keep your bones strong. Your doctor or nurse can give you more information.

Side effects can be hard to cope with, especially with everything else you have to deal with. Remember, the side effects will gradually get better when you stop taking steroids.

Anti-convulsants

Tumours in the brain can sometimes cause seizures (fits). Anti-convulsant drugs (also called anti-epileptics) can help prevent them. Your doctor might give you these to take before surgery, or to take long-term. There are different types and some people may need more than one type. Your doctor will explain the likely side effects of any drugs they give you.

Shunts

Sometimes, brain tumours block the flow of fluid (CSF) around the brain. This means pressure can build up and cause symptoms.

To reduce this pressure, some people have a small operation to place a long, thin tube (called a shunt) in the body. This lets some of the fluid drain from the brain to another area of the body. You cannot see the tube from outside the body. But you may be able to feel the tube under the skin behind your ear.

It is natural to feel worried and frightened about having brain surgery. You may have questions such as:

• Will it change the way my brain works?
• How will I feel after the operation?
• Will I have scars?
• Will the surgeon shave my head?

Your surgeon and specialist nurse will talk to you about the operation and the possible benefits and risks. If there is a risk of damage to the brain during surgery, they will explain how this may affect you. If they need to shave some of your hair, they will explain what to expect.

Make sure you have as much information as you need and ask any questions you have. The more you know about what to expect, the easier it may be to cope. 

Biopsy

A biopsy is when the surgeon removes a piece of the tumour. This can then be examined to find out the type of tumour or what treatments are likely to work best.

There are different ways to take a brain biopsy. Sometimes, it is only safe to remove a tiny part of the tumour to look at under the microscope. But often, the surgeon will take a biopsy as part of a larger operation to remove the tumour. Your surgeon will explain what to expect in your situation.

You usually have a biopsy taken under a general anaesthetic. The surgeon uses scans to guide them while taking the biopsy. The scans are taken before or sometimes during the operation.

Sometimes the surgeon does a biopsy while you are awake. They inject some local anaesthetic into the scalp so you don’t feel anything. This can sound scary, but it should not take long. You can talk to the doctors and nurses looking after you while it is happening.

Removing the tumour

Surgery is often the main treatment for brain tumours. Your surgeon tries to remove all of the tumour, or as much as possible.

You usually have a general anaesthetic. For some types of brain tumours, your surgeon might suggest doing an operation while you are awake. This is called an awake craniotomy. It may sound frightening, but people usually cope with it well. Because you are awake, the surgeon can check that the surgery is not affecting your speech and movement.

For an awake craniotomy, you are usually asleep (sedated) for the first part of the surgery. The surgeon uses local anaesthetic injections to numb the scalp. They gently wake you when they are ready to operate on the brain. The brain has no nerve endings, so you should not feel any pain during the operation.

Your surgeon or nurse will tell you what to expect before and after your operation. When you can go home and how quickly you recover will depend on the type of operation you had. Your doctor and nurse will talk to you about preparing to go home. They will arrange any further support you might need.

More information about surgery

Radiotherapy uses high-energy rays or particles to treat cancer cells. You may have it:

• after surgery, to treat any cells that may have been left behind
• instead of surgery, when it is not possible to remove the brain tumour
• as your main treatment
• if a brain tumour comes back after surgery.

For some types of tumour, you have radiotherapy to your spinal cord as well as your brain. Your doctor will explain what to expect.

Types of radiotherapy

You may have radiotherapy in several ways for brain tumours. Your doctor will give you more information about your treatment plan. You can read more about having radiotherapy in our radiotherapy section.

Doctors may treat brain tumours with:

• Standard radiotherapy. You usually have this over several weeks, at your nearest cancer treatment centre.
• Stereotactic radiosurgery. You have this all at once, on a single day. You may have to travel to another hospital to have this treatment.
• Proton beam therapy. You sometimes have this to treat certain types of tumour in the brain and spinal cord.

When you have radiotherapy, you may need to wear a light-weight mask or head frame. The mask covers your face and the front of your head. The mask or frame helps keep your head and neck still during the treatment. They should not be uncomfortable. But if you feel nervous, tell the nurse or radiographer so they can help.

Usually, each radiotherapy treatment only takes a few minutes. It is not painful, but you need to lie still. You will be on your own in the room, but you can talk to the radiographers. You can talk through an intercom or signal to them during the treatment. They can see and hear you from the next room. You can usually bring music to listen to if you want.

Side effects of radiotherapy

You may have some side effects during radiotherapy. These usually get better over a few weeks or months after your treatment. Your doctor, nurse or radiographer will tell you more about what to expect.

Some people find side effects get worse for a short time after they have finished treatment. This does not mean your treatment isn’t working. It is usually just a normal reaction to the treatment. Always tell your doctor or nurse about any side effects you have. They can usually help make things easier.

Common side effects of radiotherapy to the brain include:

• tiredness
• headaches
• hair loss
• skin changes
• feeling sick.

Late effects of radiotherapy

Radiotherapy can sometimes cause side effects months or years later. These are called late effects or long-term side effects. Newer ways of giving radiotherapy help to reduce the chances of late effects as much as possible.

Late effects depend on where the treated area is and the dose of radiotherapy you had. Your specialist doctor or nurse will talk to you about any risk of late effects.

The main late effects of brain tumour treatments are:

• effects on thinking and memory
• an increased risk of stroke
• a small risk of damage to the normal brain
• risk of a second tumour in later life.

These may sound scary, but for most people the risk of them happening is small. It is important to talk to your doctor about anything you are worried about.

For several years after radiotherapy, you will go to the clinic for regular check-ups. Your doctor will check for late effects so they can manage or treat these as early as possible. They will advise you to follow a healthy lifestyle to help reduce the chances of problems. This includes things like not smoking. They will arrange regular checks of your blood pressure, cholesterol levels and for diabetes. You may also need checks of your hearing, eyesight and hormone levels.

Chemotherapy uses anti-cancer drugs to treat cancer cells. You might have chemotherapy:

• to shrink a tumour, to make it easier to remove with surgery
• when it is not possible to remove the tumour completely with surgery
• during radiotherapy, to make the tumour more sensitive to radiation
• after radiotherapy or surgery, to reduce the chance of the tumour coming back
• when a brain tumour has come back after treatment.

You may have a variety of chemotherapy drugs. You usually have chemotherapy for brain tumours by injection into a vein (intravenously). Or you may have tablets. You may have one chemotherapy drug, or two or three drugs in combination.

You may also have chemotherapy:

• directly into the spine ([intrathecal chemotherapy])
• directly into the brain through a device called an ommaya reservoir
• directly into the brain during surgery to remove a tumour (called a Gliadel implant).

More information about chemotherapy

Side effects of chemotherapy

Different chemotherapy drugs cause different side effects. Some people just have a few side effects, and others have more. Everyone is different.

Most side effects are short-term (temporary), and gradually disappear once treatment stops.

The most common short-term side effects are:

• risk of getting an infection
• losing your hair
• feeling sick
• tiredness

Effects on fertility

Some chemotherapy drugs can affect your ability to father a child or get pregnant (fertility). Your doctor or nurse should talk to you about this before you start treatment. If treatment could affect your fertility, you may be able to have treatment to preserve it. We have more information about fertility and fertility preservation.

You may need extra support to recover from side effects or changes that the tumour or treatment has caused. This is sometimes called neuro-rehabilitation.

Your doctor or nurse will talk to you about how you are managing to do normal activities or things you enjoy. Let them know if anything is more difficult than usual. They can arrange extra support.

If you need this support after your treatment, your team may include different people depending on what you need.

For example, you may see:

• A physiotherapist, who can help you improve your strength, balance or co-ordination. They can show you exercises to do and give you advice to help you.
• A speech and language therapist, who can help if you have problems speaking or communicating clearly. They can also help if you have difficulty eating, drinking, or swallowing. They will give you advice and show you exercises to do.
• An occupational therapist, who will help you get back to doing everyday tasks. These could include washing, dressing, eating, shopping or managing your money. They may also give you equipment that can help make things easier.
• A neuro-psychologist, who can help you cope with any changes that affect your thinking, feelings, behaviour or personality.

Your team may help in the early stages of your recovery, or for a while after you finish treatment. You may see them when you are in hospital, as an outpatient in a clinic, or at home.