Brain tumours

What is a brain tumour?

The brain and spinal cord make up the central nervous system (CNS). Together, the different parts of the CNS control the activities of the mind and body.

A brain or spinal cord tumour occurs when abnormal cells grow and form a mass or a lump. They are classified as benign or malignant. These terms are also used for tumours in other parts of the body, but with brain tumours the difference is not as clear. Both types can be serious and may need urgent treatment.

Every year an estimated 1,900 malignant brain tumours are diagnosed in Australia and they can affect people of any age. About 110 children (aged 0–14) are diagnosed each year.

Benign brain and spinal cord tumours are more common than malignant tumours.

Brain tumour symptoms

Symptoms depend on where the tumour is in the brain or spinal cord, its size and how slowly or quickly it is growing.

Brain tumours can increase pressure inside the skull, which can lead to general symptoms including:

• 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) – some jerking or twitching of your hands, arms or legs, or it can affect the whole body.
• Poor coordination
• Drowsiness or loss of consciousness.
• Weakness in parts of the body.
• Difficulty speaking or finding the right words.

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

Types of brain tumours

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

Glioma tumours

Gliomas are the most common type of brain tumour. Gliomas are tumours that start in the glial cells of the brain. They include:

• Astrocytoma –starts in glial cells called astrocytes, 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, common in adults and children. 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.

Non-glioma tumours

• Medulloblastoma – malignant tumour that starts in the cerebellum, more common in children and rarer in adults.
• Meningioma – most common primary brain tumour that starts in the membranes (meninges) covering the brain and spinal cord, usually benign and slow growing.
• Pituitary tumour – starts in the pituitary gland, usually benign
• Schwannoma – starts in Schwann cells which surround nerves in the brain and spinal cord, usually benign (includes acoustic neuromas).

Brain tumour risk factors

There are some things that can make it more likely to develop a brain or spinal cord tumour. These are called risk factors and they include:

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

Having these risk factors doesn’t mean you will develop a brain or spinal cord tumour. Often there is no clear reason for getting a brain or spinal cord tumour. If you are worried about your risk factors, ask your doctor for advice.

Diagnosing brain tumours

Your doctor may do some tests to check for a brain or spinal cord tumour:

• Physical examination – the doctor will assess your nervous system to check how different parts of your brain and body are working, including your speech, hearing, vision and movement.
• Blood tests – to check your overall health.
• MRI scan – uses a powerful magnet and radio waves to create detailed cross-sectional pictures of the inside of your body.
• CT scan – uses x-rays to take many pictures of the inside of the body and then compiles them into detailed, cross-sectional pictures.

Your doctor might ask you to have further tests. These may include:

• MRS scan – a specialised type of MRI that looks for changes in the chemicals in the brain.
• MR tractography – helps show the message pathways within the brain. It can help plan treatment for gliomas.
• MR perfusion scan – shows the amount of blood flowing to various parts of the brain. It can also be used to help identify the type of tumour.
• SPET or SPECT scan – shows blood flow in the brain. Areas with higher blood flow, such as a tumour, will show up brighter on the scan.
• PET scan – you will be injected with a small amount of radioactive solution, which helps cancer cells show up brighter on the scan.
• Lumbar puncture (also called a spinal tap) - uses a needle to collect a sample of cerebrospinal fluid from the spinal column, which is then checked for cancer cells.
• Surgical biopsy – if scans show an abnormality that looks like a tumour, some or all the tissue may be removed for examination.
• Molecular testing –a pathologist will run special tests on the biopsy sample to look for specific changes in the genes of the tumour cells (called molecular markers). These gene changes may happen during a person’s life (acquired) or be passed through families (inherited). The test results can help identify the features of the tumour so your doctors can recommend the most appropriate treatment.

Brain tumour grades and stages

The grade of the cancer means how quickly a cancer might grow. Knowing the grade helps your doctor work out the best treatment plan for you. The grading system commonly used for brain tumours is from the World Health Organization (WHO).

Brain and spinal cord tumours are usually given a grade from 1 to 4.

• Grade 1 – These tumours are low-grade, benign and grow slowly.
• Grade 2 – These tumours are low-grade and usually grow slowly. They are more likely to come back after treatment and can develop into a higher-grade tumour.
• Grades 3 and 4 – These tumours are 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 means how far it has grown in your body. Primary brain and spinal cord tumours are not staged in this way as most don’t spread to other parts of the body.

Ask your doctor or nurse to explain the stage of the cancer. You can also read more from Cancer Council about diagnosing brain tumours.

Brain tumour prognosis and survival rates

When someone is diagnosed with a brain or spinal cord tumour, their doctor will give them a prognosis. A prognosis is the doctor’s opinion of how likely the cancer will spread and the chances of getting better.

A prognosis depends on:

• type
• location
• genetic make-up
• grade of cancer
• whether the tumour has damaged the surrounding healthy brain tissue
• how well the tumour responds to treatment
• the person’s age, family history and general health.

Low-grade and high-grade tumours can be life-threatening, but the prognosis may be better if the tumour is low grade, or if the surgeon is able to remove the entire tumour.

Some brain or spinal cord tumours (particularly gliomas) can come back and may change into a higher-grade tumour. In this case, treatments such as surgery, radiation therapy and/or chemotherapy may be used to control the growth of the tumour for as long as possible, relieve symptoms and maintain quality of life.

If you have a brain or spinal cord tumour, your doctor will talk to you about your individual situation when working out your prognosis. Every person’s experience is different, and there is support available to you.

Brain tumour treatment

Treatment for a brain or spinal tumour depends on various factors and may take into account:

• aim of treatment – to remove, slow its growth or relieve symptoms
• nature of the tumour
• your symptoms
• your general health.

Surgery

Surgery in the brain or spinal cord is called neurosurgery. You may have surgery to:

• remove the whole tumour (total resection)
• remove part of the tumour (partial resection or debulking)
• help diagnose a brain tumour (biopsy).

Different types of operations may be used for brain and spinal cord tumours. These include:

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

Sometimes a tumour 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 tumour.

Radiation therapy

Radiation therapy uses a controlled dose of radiation to kill or damage cancer cells in the area being treated. Treatment is carefully planned to do as little harm as possible to the healthy body tissue near the cancer.

Radiation therapy is typically given after surgery and possibly along with chemotherapy (chemoradiation).

Chemotherapy

Chemotherapy is the use of drugs to treat cancer. The 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).

Anticonvulsants

You may be given anticonvulsants to help control seizures which can also affect your mood and energy. An experienced counsellor, psychologist or psychiatrist can help you manage any mood swings or behavioural changes.

Steroids

Steroids are made naturally in the body, but they can also be produced artificially and used as drugs. Brain tumours and their treatments can both lead to swelling in the brain. Steroids may help to reduce this swelling, and can be given before, during and after surgery and radiation therapy.

Treatment side effects

All cancer treatments can have side effects. Your treatment team will discuss these with you before you start treatment. Talk to your treating team about any side effects you are experiencing.

Some side effects can be upsetting and difficult, but there is help if you need it. Call Cancer Council 13 11 20 or email askanurse@cancervic.org.au to speak with a caring cancer nurse for support.

Managing lifestyle changes when you have a brain tumour

A brain or spinal cord tumour and its treatments can change how the mind and body work. You may experience changes to your speech, personality, memory, movement, balance or coordination.

Rehabilitation

A range of therapies can support you in your recovery, including:

• physiotherapy
• cognitive rehabilitation
• exercise
• speech therapy
• help with vision impairment
• occupational therapy.

Seizures

A brain tumour or its treatment can sometimes cause seizures (fits). They can involve the whole body, or just affect 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 also increase your risk of having a seizure. Try to get 6–8 hours sleep each night. Drinking less alcohol may also help.

Driving

Tumours, seizures, and certain treatments and medicines can affect the skills needed to drive safely. These can include:

• having good vision and perception
• being able to concentrate and plan
• processing speed and reaction time
• being able to remember directions
• good hand–eye coordination
• planning and problem-solving.

When you are diagnosed with any type of brain tumour, 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.

You probably need to wait for some time before you drive again after surgery and possibly after radiation therapy. There are also some set exclusion periods your doctor will follow after certain treatments or events such as seizures.

Before you start driving again, always check with your doctor. Laws in Australia require drivers to let their driver licensing authority know about any permanent or long-term illness or injury that is likely to affect their ability to drive.

Working

It can be hard to predict how well you will recover from treatment for a brain or spinal cord tumour, and when and whether you will be able to return to work. This may also depend on the type of work you do.

Some people find it hard to concentrate or make decisions after treatment. 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 about whether returning to work is safe or possible. They 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 won’t be possible to return to your former role.

Sexuality

Cancer can affect your sexuality in physical and emotional ways. The impact of these changes depends on many factors, such as treatment and side effects, your self-confidence, and if 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. During this time palliative care services can help.

Most people continue to have treatment for advanced cancer as part of palliative care, as it helps manage the cancer and improve their day-to-day lives.

Many people think that palliative care is for people who are dying but palliative care is for any stage of advanced cancer. There are doctors, nurses and other people who specialise in palliative care.

Palliative care treatment may include chemotherapy, radiation therapy or another type of treatment. It can help in these ways:

• slow down how fast the cancer is growing
• shrink the cancer
• help you to live more comfortably by managing symptoms, like pain.

Treatment depends on:

• where the cancer started
• how far it has spread
• your general health
• your preferences and what you want to do.

Ask your doctor about treatment and palliative care services that may help you.

Where to get help

• Your GP (doctor)
• Nurse on Call Tel. 1300 60 60 24
• Brain Tumour Alliance Australia Tel. 1800 857 221 – (also available to carers and family members)
• Your treatment team
• Cancer Council cancer information and support line on Tel. 13 11 20 (or 13 14 50 for an interpreter) – can also help carers and family members
• Cancer Council Victoria, My Cancer Guide - Find support services that are right for you.
• Canteen Tel. 1800 835 932 – for young people affected by cancer
• Multilingual Cancer Information Line Victoria Tel. 13 14 50
• WeCan website helps people affected by cancer find the information, resources and support services they may need following a cancer diagnosis
• Carer Gateway Tel. 1800 422 737
• Carers Australia Tel. 1800 242 636
• Carers Victoria Tel. 1800 514 845