Brain tumour

Introduction

Brain tumours are quite rare. In Scotland, almost 500 people are diagnosed each year with cancerous (malignant) brain and central nervous system tumours, representing only about 2% of all types of cancer diagnosed.

Around 430 people in Scotland are diagnosed with non-cancerous (benign) brain and other central nervous system tumours each year.

Who gets brain tumours

Brain tumours are slightly more common in males than females. But one type, meningioma, is slightly more common in women.
There are over 100 different types of brain tumour and they can occur at any age. Generally they are more common in older people but some types are more common in younger adults. It's possible that more tumours are being diagnosed because people are living longer on average than they used to .

Although brain tumours are the most common solid tumour in children, they are still very rare, with only about 30 children diagnosed in Scotland each year.

How the brain works

The brain is the control centre of the body. Everything we do, think or feel involves the brain.

It is made up of many types of cells including nerve cells (neurones), supporting cells (glial cells) and nerve fibres. There are different types of glial cells including astrocytes, oligodendrocytes and ependymal cells.

Cells in the brain are arranged into lobes.

Electrical messages from the neurones pass along nerves into the base of the brain where the nerves join together to make the spinal cord. This cord of nerve fibres runs down the middle of the spine. From the spinal cord the nerve fibres spread out to all parts of the body. Together, the brain and spinal cord form the central nervous system. A clear fluid called cerebrospinal fluid (CSF) circulates around the brain and spinal cord.

The parts of the brain

The following parts of the brain are described in more detail below.

  • The meninges
  • The forebrain
  • The tentorium
  • The hindbrain (cerebellum)
  • The brain stem
  • The spinal cord
  • The pituitary gland
  • The ventricles

The meninges

The skull protects the brain. Inside the skull, and covering the brain, are 3 thin sheets of body tissue called the meninges. They also help protect the brain.

The forebrain

The forebrain is divided into two halves, called the right and left cerebral hemispheres.

The cerebral hemispheres control your movement, thinking, memory, emotions, senses and speech.

As the nerve fibres leave the brain, they cross over from one side to the other. This means that the nerves that come from the right side of your brain control the left side of your body. So if you have a brain tumour causing weakness on the left side of your body, the tumour will be in the right side of your brain.

Each hemisphere is divided into four areas:

Diagram of the brain. ©CancerHelp UKThis diagram, taken from the patient information of Cancer Research UK, shows the brain.

The frontal lobe contains areas that control your personality, thought, memory and behaviour. Towards the back of the frontal lobe are areas that control movement and feeling. A tumour in this part of the brain may also affect your sight or sense of smell.

The temporal lobe helps to control behaviour, memory, hearing, sight and your emotions. Your emotional memory is in this area so a tumour here can cause strange feelings of having been somewhere or done something before (also called déjà vu).

The parietal lobe is mainly to do with language. A tumour here can affect your speech, reading, writing or understanding of words.

The occipital lobe is the visual centre of the brain. A brain tumour in this area can cause sight problems.

The tentorium

Diagram showing where the tentorium in the brain is. © CancerHelp UKThis diagram, taken from the patient information of Cancer Research UK, shows where the tentorium is in the brain.

The tentorium is a flap of tissue that is part of the meninges. It separates the hindbrain and the brain stem from the rest of the brain.
Doctors use the word supratentorial to mean above the tentorium or anywhere apart from the hindbrain (cerebellum) or brain stem.
Infratentorial means below the tentorium, in the hindbrain (cerebellum) or brain stem.

The hindbrain (cerebellum)

Diagram showing the parts of the brain. © CancerHelp UKThis diagram, taken from the patient information of Cancer Research UK, shows the parts of the brain.

The hindbrain is also called the cerebellum and it controls balance and coordination. This means that cerebellar tumours can cause loss of balance or difficulty coordinating your movements.

Even something as simple as walking needs a lot of coordination. You have to get your arms and legs doing the right thing at the right time. Normally, we don't even think about this as the cerebellum does it for us.

The brain stem

The brain stem controls body functions that we usually don't think about such as blood pressure, swallowing, breathing and heartbeat.

The two main parts of the brain stem are called the pons and the medulla oblongata. The brain stem also includes a small area above the pons called the midbrain.

Diagram showing the brain stem which includes the medulla oblongata, the pons and the midbrain. © CancerHelp UKThis diagram, taken from the patient information of Cancer Research UK, shows the the brain stem which includes the medulla oblongata, the pons and the midbrain.

The brain stem is also the part of the brain that connects the forebrain (the cerebral hemispheres) and the cerebellum with the spinal cord. All the nerve fibres leaving the brain to go to the limbs and trunk of the body pass through here.

Diagram showing the parts of the brain. © CancerHelp UKThis diagram, taken from the patient information of Cancer Research UK, shows the parts of the brain.

The spinal cord

The spinal cord is made of all the nerve fibres that pass down from the brain. There is a space in the middle of the spinal cord that is filled with fluid called cerebrospinal fluid.

It is possible for cancers to start in the spinal cord, but this is rare. With some types of brain tumour, the cancer can spread down to the spinal cord unless it is treated with radiotherapy.

A tumour growing in the spinal cord will press on the nerves in the cord and can cause many different symptoms depending on where it is.

The pituitary gland

Diagram showing the parts of the brain. © CancerHelp UKThis diagram, taken from the patient information of Cancer Research UK, shows the parts of the brain.

This is a small gland right in the middle of the brain. It makes a lot of different hormones and controls many different body functions such as:

  • growth
  • the speed of body processes (your metabolism)
  • the production of natural steroids in the body
  • periods and egg production in women
  • sperm production in men
  • breast milk production after the birth of a baby.

The ventricles

 

Diagram showing where the ventricles are in the brain. © CancerHelp UKThis diagram, taken from the patient information of Cancer Research UK, shows where the ventricles are in the brain.

Ventricles are spaces inside the brain filled with the fluid called cerebrospinal fluid (CSF). The ventricles connect with the space in the centre of the spinal cord and with the membranes covering the brain (the meninges) so the fluid can circulate around and through the brain and around the spinal cord. The fluid is mainly water with a little protein, sugar (glucose), some white blood cells and some hormones.

A growing brain tumour can block the circulation of the fluid. The resulting increased pressure inside the skull from fluid build-up is called hydrocephalus and can cause symptoms such as headaches, vomiting and nausea.

With some types of brain tumours cancer cells can spread in the CSF. This causing symptoms similar to meningitis such as headaches, sickness, and problems with sight and movement.

How does cancer begin?

Cancer occurs when the cells in a certain area of your body divide and multiply too rapidly. This produces a lump of tissue known as a tumour.

Brain tumours arise from the individual cells of the brain, particularly the glial cells. The tumours take the name of the particular cell from which they arise. So astrocytomas give rise to astrocytomas, oligodendroglial cells to oligodendrogliomas and so on.

Further information

Last updated: 28 October 2013

Symptoms of brain tumours

Brain tumours can cause symptoms in two main ways. These are local effects and global effects.
If you regularly experience any of these symptoms, which are not normal for you, it is important that you see your GP.

It is unlikely that your symptoms are caused by a serious problem but it is important to be checked out. It is most likely to be a benign (non-cancerous) condition that can easily be treated by seeing the GP.

The earlier a cancer is picked up, the easier it is to treat it and the more likely the treatment is to be successful.

Local effects

Different parts of the brain perform different jobs. For example speech and right-sided movement is normally controlled in the left parietal lobe and personality in the frontal lobes. By growing in a particular part of the brain a tumour can interfere with speech, movement, personality or any other job that the brain does. 

A local tumour may interfere with one or more elements of function when everything else is working normally.

Global effects

Since the brain sits inside the skull, which is fixed in size, when a tumour develops there is no available space for it to take up. Therefore, as it grows the rest of the brain gets squashed and distorted.

The pressure inside the head (intracranial pressure or ICP) increases and this affects the way the whole of the brain works; hence a global effect.

Some of the symptoms of raised ICP are:

  • headaches
  • nausea and vomiting
  • change in personality or ability to do things
  • drowsiness
  • seizures or fits.

Headaches  

Headaches are very common in patients with brain tumours, occurring in about 70% of affected people at some time. However, a headache is an extremely common problem for lots of other reasons and the vast majority of people with headaches do not have a tumour.

If you are worried by a new headache, you should seek advice from your doctor.

Headaches from raised ICP may have a characteristic pattern, perhaps occurring at particular times of the day or when doing certain activities. They may get worse over time and be accompanied by other worrying symptoms or signs, which the doctor will look for.

Nausea and vomiting

Nausea and vomiting often occur as the pressure inside the head rises and the brain gets squashed. It is often worse in the morning.

You should seek help if you have a headache and vomiting together. However, this combination can occur with other more common conditions such as migraine.

Change in personality or ability to do things

A change in personality or ability can occur as the pressure increases and the brain stops functioning properly. Again, a combination of headache and personality change is a reason to seek medical advice.

Drowsiness

Drowsiness is usually a late symptom in a person with raised ICP, and hopefully any problem will have been diagnosed before this happens. However, you can eventually lose consciousness if you have raised ICP and it is not treated.

Seizures or fits

Seizures or fits can arise from either the local problem or from rising ICP when the brain is irritated and sends out muddled electrical signals.

The seizure may affect just part of the body or conscious functioning (such as loss of alertness or comprehension, disorientation, delirium, loss of meaningful communication and loss of movement in response to pain). Or it may be generalised, affecting all the body with complete loss of consciousness.

Seizures are not always a sign of a serious problem, but new onset seizure (a fit that happens suddenly to someone who does not have a medical condition that can cause fits) is always a reason to consult a doctor, particularly in adults.

Further information

Last updated: 28 October 2013

Causes and risk factors of brain tumours

The exact cause of brain tumours is unknown but we do know that brain tumours occur more commonly in some situations so there are known risk factors. A risk factor is something that makes a person more likely to develop cancer.

Having one or more risk factors does not mean that you will definitely get brain cancer. Many people with one or more risk factors never get it. And sometimes people with none of these risk factors develop brain cancer. Risk factors are only a guide to what may increase the risk.

Some of the risk factors are outlined in more detail below.

Age

Just as with many other tumours, as we get older our risk of developing a brain tumour increases. However, the risk remains much less than for many other cancers.

There are many different types of brain tumours and a few of these are more common in younger people, children and young adults. Overall, more brain tumours are diagnosed now than in the past but this is most likely because we are living longer and brain tumours are more common in older people. Also we have more sophisticated ways of detecting brain tumours.

Genetic conditions and family history

Genetic conditions that predispose to brain tumours are very rare and less than 1 in 20 brain tumours are related to a known genetic syndrome.

A few ‘brain tumour families’ have a higher incidence than expected even though a genetic syndrome is not recognised. These families are very unusual.

Radiation

In our environment, the only factor that we know definitely increases the risk of developing a brain tumour is exposure to ionising radiation. For example, X-rays or products of radioactive materials. Other types of radiation such as those produced by power lines and mobile phones have not been proven to increase the risk. However, research into these is on-going.

Previous cancers

Women who have had breast cancer have a slightly increased risk of having a primary brain tumour.

Head injury

People with a brain tumour often recall having had a previous head injury. However, head injuries are very common and there is no confirmation of a link with developing a brain tumour.

Further information

Last updated: 28 October 2013

Diagnosing brain tumours

Depending on the symptoms there are a number of tests that can help determine if someone might have a brain tumour.

To begin with a family doctor can ask questions about general health or specific symptoms and perform an examination with particular emphasis on the nervous system. This can be helpful in deciding whether a tumour might be present and a referral to a hospital doctor specialising in neurological disease is necessary. The hospital doctor will be either a neurologist or a neurosurgeon.

If either the family or hospital doctor is sufficiently concerned they will organise a brain scan (CT scan or MRI scan), which is very effective in detecting tumours. The scan should show whether a tumour is the cause of the symptoms. It should help to diagnose what type of tumour it is and show just where and how big it is. This is vital in deciding how best to manage the tumour.

They may also do blood tests. However, these are rarely helpful in detecting brain tumours except in rare cases where changes in specific markers (including hormones) occur.

When you see the specialist, they will ask you about your medical history and symptoms. The specialist will then examine you. You may have blood tests and a chest X-ray to check your general health. Then your specialist will arrange for you to have some tests, which may include some or all of the following:

Brain scan

A brain scan is essential to diagnose whether a brain tumour is present or not. When looking for a tumour it is usual to scan with and without a contrast material. The contrast material is injected into a vein part way through the scanning session and helps show up some tumours more clearly.

CT scan

CT scan is a computerised scan using X-rays. It is generally readily available quick to perform and shows up the majority of brain tumours.

MRI scan

An MRI scan uses strong magnetic fields and radio-waves. It usually gives the clearest picture of the brain and is most sensitive in showing tumours but is less readily available and takes longer to do.

It is very important that you tell your doctor if you have any metal inside your body as this may mean you cannot have an MRI scan.

Magnetic resonance angiography scans (MRA)

An MRA can show the blood vessels in the brain. This can be useful to the surgeon planning an operation.

Magnetic resonance spectroscopy (MRS)

An MRS analyses the chemical composition of the tumour. It can help in providing an exact diagnosis.

Surgical biopsy 

Taking a sample of tissue is the only sure way to diagnose many brain tumours. Looking at the cells under a microscope identifies the type and grade of the tumour. A surgical biopsy may be a separate operation in its own right or take place when the whole tumour is being removed. Once the biopsy has been analysed and a full diagnosis made then the full range of treatment options can be reviewed and the outlook following treatment discussed.

Questions to ask

You may want to ask the specialist some questions before your tests start, such as:

  • How will I know if I have a brain tumour?
  • Will my diet, drinking or smoking habits increase my risk of a brain tumour?
  • Can I be screened for a brain tumour?
  • Do brain tumours run in families?
  • Will using my mobile phone increase my risk of developing a brain tumour?
  • Does where I live increase my risk of a brain tumour?
  • I have had breast cancer - does this increase my risk of a brain tumour?
  • What tests will I have?
  • What are you looking for?
  • Will the tests show whether I have a brain tumour?
  • Will the tests show if the brain tumour is benign or malignant?
  • Will the tests show whether my brain tumour can be removed?
  • Are any of the tests painful?
  • Do any of the tests have after effects?
  • Can I have these tests as an outpatient?
  • Should I bring someone with me when I have the tests?
  • How long will the results take?
  • Who will give me the test results?
  • Will you need to discuss the results with other specialists to help decide the best treatment for me?

Getting test results

When the results of the tests are all finally done and assessed you will be called to see your consultant for the results.

Having tests then ultimately receiving a diagnosis of cancer is a frightening and often shocking experience. Many people find they struggle to take in everything that is said at their appointment, so it can be helpful to take someone with you to important appointments.

Around this time a clinical nurse specialist may take over co-ordination of your case. He or she will oversee the continuity of treatments, appointments and your best interests. They can also interpret any jargon and explain what will happen in more detail.

If you have been diagnosed with cancer and haven't been assigned a clinical nurse specialist, ask if one is available.

Further information

Last updated: 28 October 2013

Treating brain tumours

Surgery, chemotherapy and radiotherapy are all used to treat tumours of the brain. A patient may have just one treatment or a combination.

Steroids are drugs used to reduce the swelling that often surrounds brain tumours. Although steroids don’t treat the tumour itself, they help improve symptoms and make you feel better. They may be used before or after surgery, or during or after radiotherapy.

You can find out more about steroids on the Macmillan website.

Surgery

Surgery is usually performed to remove as much of the tumour as possible. Complete removal cannot always be achieved and a partial removal will then be done. Sometimes only a biopsy is possible or needed.

The aims of surgery are to obtain a certain diagnosis, to relieve symptoms and help control the tumour in the longer term. If not all the tumour has been removed it is common for additional treatments to be offered. 

Radiotherapy

Radiotherapy involves the use of high energy radiation beams to destroy tumour cells. It may be used after surgery to consolidate the operation or as a treatment on its own.

The planning and delivery of radiation is complex and may take several weeks. The decision of how much of the brain (and possibly the spinal cord) to irradiate (treat with radiotherapy) is also a highly specialised one.

If radiotherapy is recommended you will be referred to a clinical oncologist (doctor who specialises in the treatment of cancer) and a course of treatment will be recommended after consultation with you.

The treatment will take place in one of the five radiotherapy departments in Scotland (Aberdeen, Dundee, Edinburgh, Glasgow and Inverness).

The type of machine that is used will depend on the reason for your treatment and the condition that you are being treated for.

Chemotherapy 

Chemotherapy  is the use of anti-tumour (or cytotoxic) drugs to destroy tumour cells . It can be given alongside radiotherapy as an initial treatment or on its own in some situations, including for tumours that have come back after initial treatment.

Chemotherapy drugs can be given orally or via a drip and sometimes can even be given directly into the brain by the surgeon. The choice will depend on the type of tumour, the stage it is at and the characteristics of the patient.

The main chemotherapy drugs used to treat primary brain tumours include (links go to Macmillan website):

If chemotherapy is recommended it may be provided locally, unless the chemotherapy treatment is complex.

Brain tumours that come back

Some brain tumours will be completely cured with the first round of treatment. Others will come back at some time after they were first treated. Depending on the treatment you had at first, it may be possible for the specialist to give further treatment to try to control the tumour once again.

Even if it is not possible to cure the tumour, further treatment may keep it under control for longer and control the symptoms of the tumour.

Availability of treatment

You should note that the availability of treatment can vary across the local hospitals in Scotland, but all treatments your doctors think are appropriate will be available to you (often at a hospital within your health board area).

Clinical trials

All the time, scientists (including doctors and other health professionals) are developing new treatments or tests for all types of cancers.

Clinical trials test potential treatments to see if they should be approved for wider use in the general population. Any new potential treatment must be extensively and objectively tested to check that it works, is safe and doesn't have unacceptable side effects.

You may be able to take part in a clinical trial aimed at finding better treatments for brain tumours. You can use these resources to find current trials:

Your doctor or nurse will be able to tell you more about taking part in a trial.

After brain tumour treatment

After treatment has finished all cancer patients have follow-up appointments to check their progress. If you've been through treatment the follow-up procedure will be explained to you.

During this time you may have questions you would like to ask, like:

  • How long will it take me to recover from the effects of my treatment?
  • Will I get back to how I was before the brain tumour?
  • Can you refer me to physiotherapy or speech therapy to help me get better more quickly?
  • Will I develop long term effects from my treatment - if so, when would you expect this to happen?
  • Can you put me in touch with someone to help me deal with my feelings about what has happened?
  • Are there any counselling services here I could use?
  • Will I have to pay for counselling?
  • When will I be able to go back to work/college/school?
  • Can I take up my usual sports, hobbies and activities again?
  • Is there anything I shouldn't do?
  • When will I be able to drive again?
  • Is there anyone who can help me with my finances?
  • Can anyone help me with claiming benefits and grants?
  • Can I go abroad on holiday?
  • Will you write a letter to help me get travel insurance?
  • How likely is it that my brain tumour will come back?
  • How will I know if the brain tumour is coming back?
  • If my brain tumour is likely to come back, when is this likely to happen?
  • What symptoms will I have?
  • What help can you offer to help me cope with my symptoms?
  • Can you refer me to a specialist nurse?
  • What help can I get at home?

You can read more about living with cancer in our Cancer Zone .

Further information about living with a brain tumour:

Last updated: 28 October 2013

Before brain tumour treatment

Once all investigations have been carried out a specialist multi-disciplinary team (MDT) will meet to discuss the results.

The MDT will consider several different factors when working out the best treatment, including:

  • the type of brain tumour
  • the stage of brain tumour
  • where the cancer is located
  • the general health of the patient, including previous, and current, health conditions and fitness
  • what the patient’s wishes are for treatment.

If the case is new to the MDT, the nurse specialist (or other appointed person) will call the patient after the initial MDT discussion to tell them the outcome of the meeting and explain the next steps.

At this stage an outpatient appointment is usually made so that a face-to-face discussion can take place. This is an opportunity to ask questions and get results. Information can be given about future treatment plans, and often, the patient will be given some time to go away and consider all the options.

Questions you may want to ask

If you have been told you have a brain tumour you are likely to have a lot of questions. Some questions you may want to ask your doctor could include:

  • What can you tell me about the type of brain tumour I have?
  • What is the likely outcome for this type of brain tumour?
  • What type of treatment do I need?
  • What written information can you give me about these treatments?
  • Is there any choice of treatments?
  • I have a low grade brain tumour, should I see a neurosurgeon?
  • Should I have any treatment before surgery?
  • Should I have any other treatment after surgery?
  • What about radiotherapy or chemotherapy?
  • Would stereotactic radiotherapy or radiosurgery be an option for me?
  • What are the risks and benefits of these treatments?
  • What are the side effects?
  • How can I help to reduce the side effects?
  • How often will I have to come to the hospital for treatment?
  • Is there any transport available?
  • Is it possible to have any help with the cost of fares to the hospital?
  • How long will the treatment last?
  • Can I have a second opinion?
  • Are there any experimental treatments or trials that might help me?
  • Is there a counsellor here I could talk things through with?
  • How often will you see me when my treatment is finished?
  • What will happen at my follow up appointments?
  • How often will I have a brain scan?
  • What should I do if I am worried between appointments?
Last updated: 28 October 2013