Malignant brain tumour (cancerous)

Malignant brain tumour (cancerous) | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Malignant brain tumour (cancerous) Malignant brain tumour (cancerous) About malignant brain tumours Symptoms of malignant brain tumours Causes of malignant brain tumours Diagnosing malignant brain tumours Treating malignant brain tumours Recovering from malignant brain tumours About malignant brain tumours A malignant brain tumour is a fast-growing cancer that spreads to other areas of the brain and spine. Generally, brain tumours are graded from 1 to 4, according to their behaviour, such as how fast they grow and how likely they are to grow back after treatment. A malignant brain tumour is either grade 3 or 4, whereas grade 1 or 2 tumours are usually classed as benign or non-cancerous. Most malignant tumours are secondary cancers, which means they started in another part of the body and spread to the brain. Primary brain tumours are those that started in the brain. These pages focus on high-grade brain tumours. For information about grade1 or2 tumours, read our pages on low-grade (benign) brain tumours . Signs andsymptoms The symptoms of a malignant brain tumour depend on how big it is and where it is in the brain. Common symptoms include: severe, persistent headaches seizures (fits) persistent nausea, vomiting and drowsiness mental or behavioural changes, such as memory problems or changes in personality progressive weakness or paralysis on one side of the body, vision problems, or speech problems Speak to your GP if you have persistent symptoms of a brain tumour. While its unlikely to be a tumour, its best to be sure by getting a proper diagnosis. Read more about the symptoms ofmalignant brain tumours and diagnosingmalignant brain tumours . Types of malignant tumours Mostmalignant brain tumours develop from the glialtissue, which supports the brains nerve cells.These tumours are known asgliomas. Gliomas can be separated further, depending on the cells they developed from. For example: an astrocytoma develops from cells thought to provide the brains framework an oligodendroglioma develops from the cells that produce the fatty covering of nerves an ependymoma develops from the cells that line the cavities in the brain Its also possible to have a malignant tumour thats a mixture of these types or developed in a different part of the brain. Who is affected Brain tumours can affect people of any age, including children, although they tend to be more common in older adults. The exact cause of primary malignant brain tumours is unknown, although its thought that certain genetic conditions and previous radiotherapy treatment to the head may increase the risk of one developing. Read more about the causes of malignant brain tumours . How malignant brain tumours are treated A primary malignant brain tumour needs to be treated as soon as possible, because it can spread and damage other parts of the brain and spinal cord. Surgery will usually need to be carried out to remove as much of the tumour as possible. This may befollowed byradiotherapyand/or chemotherapy to kill any cancerous cells left behind and reduce the chances of the tumour regrowing. However, malignant tumours will often eventually return after treatment. If this happens, or if you have a secondary tumour, a cure isnt usually possible and treatment can instead be used to improve symptoms and prolong life. Readmore about treating malignant brain tumours . Living with a brain tumour Living with a brain tumour is not easy.You may feelworried and anxious about whats going to happen to you and your family. This is perfectly normal. It can help to seek accurate medical information about your specific tumour and its treatment, make sure youre closely involved in decisions about your care, and ask your care team about anything youre not sure about. You can read more about living with a brain tumour on The Brain Tumour Charitys website . Your doctormay be able torefer you to a counsellor if you want to talk about the emotional aspects of diagnosis and treatment. There are also many organisations and helplines that can help, such as The Brain Tumour Charity and Brain Tumour Research . Support for carers Being a carer is not an easy role. When you are busy responding to the needs of others, it can deplete your reserves of emotional and physical energy, and make it easy for you to forget your own health and mental wellbeing. Research on carers health shows that high numbers of carers suffer health effects through caring. If you are trying to combine caring with a paid job or looking after a family, this can cause even more stress. However, neglecting your own health doesnt work in the long term. If youre caring for someone else, its important to look after yourself and get as much help as possible. Its in your best interests and those of the person you are caring for. For more information on the support available to you and benefits you may be entitled to, visit Care Information Scotland . Symptoms of malignant brain tumours The symptoms of a malignant brain tumour depend on how big it is and where it is in the brain. When symptoms do occur, it is because the brain tumour is either putting pressure on the brain or preventing an area of the brain from functioning properly. Signs of increased pressure on the brain Common symptoms of increased pressure within the skull include: severe, persistent headaches  which are typically worse in the morning or when bending over or coughing persistent nausea and vomiting drowsiness vision problems  such asblurred vision,floaters andloss of vision that may come and go seizures (fits)  which may affect the whole body or just involve a twitch in one area Symptoms caused by the position of a tumour Different areas of the brain control different functions, so the symptoms caused by a brain tumour will depend on where the tumour is located. For example, a tumour affecting: the frontal lobe may cause changes in personality, weakness in one side of the body and loss of smell the temporal lobe may causeforgetfulness,language problems (aphasia) and seizures the parietal lobe may cause aphasia andnumbness or weakness in one side of the body the occipital lobe may cause loss of vision on one side the cerebellum may cause a loss of co-ordination, flickering of the eyes, vomiting and a stiff neck the brain stem may cause unsteadiness and difficulty walking, facial weakness, double vision, and difficulty speaking (dysarthria) and swallowing ( dysphagia ) When to speak to your GP Its important to speak to a doctor if you develop persistent and worrying symptoms that may be caused by a brain tumour. While its unlikely that you have a tumour, its best to be sure by getting a proper diagnosis. If your GP is unable to identify a more likely cause of your symptoms, they may refer you to a neurologist for further assessment and tests, such as a brain scan. Read more about diagnosingmalignant brain tumours . Causes of malignant brain tumours Most malignant brain tumours are caused by a cancer that started somewhere else in the body and spread to the brain, through the bloodstream. These are known as secondary tumours. Cancers that can spread to the brain include lung cancer , breast cancer , bowel cancer and melanoma skin cancer . Some primary malignant brain cancers(cancerous tumours that start in the brain) are caused by a previously benign brain tumour becoming cancerous, but usually the exact reason why a primarytumour develops is unknown. Age Brain tumours affect people of all ages, including children, but the risk tends to increase as you get older. Most tumours affect people over 50 years of age. Family history People with a family history of brain tumours may be at a slightly increased risk of developinga brain tumour themselves. Radiotherapy If your brain is exposed to radiation during radiotherapy , your risk of developingcertain types ofbrain tumour later on is increased. Genetic conditions Some genetic conditions can increase your risk of a brain tumour, such as: neurofibromatosis type 1orneurofibromatosis type 2 tuberous sclerosis Turcot syndrome Li-Fraumeni cancer syndrome von Hippel-Lindau syndrome Gorlin syndrome Unlike most brain tumours, tumours associated with these conditions tend to developin childhood or early adulthood. Can mobile phones cause brain tumours? There have beenreports in the media about a possible connection between brain tumours and the radiofrequency (RF) energy emitted by mobile phones. RF energy produces heat, which can increase body temperature and damage tissue exposed to it. However, its thought that the amount of RF energy people are exposed to from mobile phones is too low to produce significant tissue heating or an increase in body temperature. Research is underway to establish whether RF energy has any long-term health effects, but the balance of evidence currently available suggests that its unlikelymobile phones cause health problems. Diagnosing malignant brain tumours Speak to your GP if you develop any of the symptoms of a malignant brain tumour , such as a persistent and severe headache. Your GP willexamine you and ask about your symptoms. They may also carry out a simple neurological examination. If they suspect you may have a tumour, or they are not sure whats causing your symptoms, youll probably be referred to a neurologist (brain and nerve specialist). Neurological examination Your GP or neurologist maycarry out a test of your nervous system, called a neurological examination, to look for problems associated with abrain tumour. Thismay involve tests of your: hand and limb strength reflexes, such as your knee-jerk reflex hearing and vision skin sensitivity balance and co-ordination memory and mental agility (using simple questions or arithmetic) A neurologist may also recommend one or morefurther tests. Further tests Other tests you may have to help diagnose a brain tumour include: a computerised tomography (CT) scan  this produces a detailed picture of your brain using a series of X-rays a magnetic resonance imaging (MRI) scan  this produces a detailed picture of your brain using a strong magnetic field and radio waves an electroencephalogram (EEG) where electrodes attached to your scalp record your brain activity to look for any abnormalities If a tumour is suspected, a biopsy (surgical removal of a small piece of tissue) may be taken to establish the type of tumour and the most effective treatment. Under anaesthetic, a small hole (known as a burr hole) is made in the skull and a very fine needle is used to obtain a sample of tumour tissue. Youll probably need to stay in hospital for a few days afterwards. Treating malignant brain tumours If you have a malignant brain tumour, youll usually need surgery to remove as much of it as possible. Radiotherapy and/or chemotherapy may then be used to treat any remaining cancerous tissue. The aim of this is to remove or destroy as much of the tumour as possible, ideally getting rid of thecancerous cells completely. However, this isnt always possible and mostmalignantbrain tumours will eventually return after treatment. If your tumour does return after treatment, or youhave a secondary brain tumour (where cancer has spread to your brain from another part of your body), a cure isnt usually possible. Treatmentcan insteadbe usedto control your symptoms andprolong life. Your treatment plan There are a number of different treatments formalignant brain tumours, and deciding on what you feel is the best treatment can be confusing. A group of different specialists called a multidisciplinary team (MDT) will be involved in your care and will recommend what they think is the best treatment option for you, but the final decision will be yours. Before visiting hospital to discuss your treatment options, you may find it useful to write a list of questions that youd like to ask. For example, you may want to find out the advantages and disadvantages of particular treatments. Surgery Surgery will be recommended for most people with a malignant brain tumour. If the size or position of the tumour mean surgery is not possible, one or more of the treatments described below may be recommended instead. The main operation used to treat people with brain tumours is called a craniotomy. You will be given a general anaesthetic so you are asleep while theprocedure is carried out. An area of your scalp will be shaved and a section of the skull is cut out as a flap to reveal the brain and tumour underneath. The surgeon can then remove asmuch of the tumour as possible and secure the flap of skull back in place with metal screws. After surgery, treatment withradiotherapyand/or chemotherapy may be recommended to kill any cancer cells left behind and reduce the risk of the tumour coming back. Radiotherapy Radiotherapy is a treatment where a beam ofhigh-energy radiationis focused on the tumour to kill the cancerous cells. It can be used after surgery or as the main treatment for tumours thatare difficult to remove. Radiotherapy isusually given in several doses (fractions) spread over the course of a week. An entire course of treatment will usually last up to 6 weeks in total. Possible side effects of radiotherapy for a brain tumour include nausea, temporary hair loss, tiredness and red, sore skin. Read more about the side effects of radiotherapy . In a smallnumber of cases, a similar treatment calledproton beam therapy may be recommended. However, this is only suitable in very specific cases and currently, youll need to be referredfor treatment abroad if your doctor thinks its appropriate. Chemotherapy Chemotherapy is a medication used to kill cancerous cells. It may beused alongside radiotherapy or on itsown, eitherto help kill any cancerous cells leftbehind after surgery or to help relieve your symptoms when a cure is not possible. Chemotherapy medication for brain tumours can be given in a number of ways, including as: tablets (orally) temozolomide and procarbazineare given in this way injections into a vein (intravenously) vincristine is given in this way small, disc-likeimplants placed in the brain during surgery  carmustinecan begiven in this way, but isonly recommended if90% or more of the tumour has beenremoved The side effects of chemotherapy largely depend on the specific medication youre taking. Common general side effects include tiredness, headaches, temporary hair loss and nausea. Read more about the side effects of chemotherapy . For more information about some of the treatments used, see the guidelines from theNational Institute for Health and Care Excellence (NICE) on carmustine implants to treat gliomas and temozolomide for recurrent malignant glioma . Radiosurgery Stereotactic radiosurgery (SRS) is a special type of radiotherapy thats sometimes used to treat brain tumours that cant be safely removed with surgery. During the treatment, several small beams of radiation are used to very accuratelydeliver a high dose of radiation to the tumour,usually in a single treatment session. As the radiation beams can be aimed very precisely, a high dose of radiation can be delivered to the tumour with minimal damage to the surrounding healthy cells. This means youre less likely to experience many of the usual side effects of radiotherapy. Recoverytends to be much fasterand an overnight stay isnt usuallynecessary. However, radiosurgery is currently only available in a few specialised centres across the UK and is only suitable for certain people, based on the characteristics of their tumour. Treating symptoms You may also be given medication to relieve some of the symptoms you mayhave as a result of yourbrain tumour. These may include: anticonvulsants to prevent seizures (fits) corticosteroids to reduceswelling and pressure in the brain painkillers to treat headaches anti-emetics to prevent vomiting Depending on your circumstances, these medications may be given before, after, or instead of surgery. Choosing not to have treatment If your tumour is at an advanced stage or in a difficult place in the brain, a cure may not be possible and treatment may only be able to control the cancer for a period of time. This means you will be getting the side effects of treatment without getting rid of the tumour. In this situation, it may be difficult to decide whether or not to go ahead with treatment. Talk to your doctor about what will happen if you choose not to be treated, so you can make an informed decision. If you decide not to have treatment, you will still be given palliative care , which will control your symptoms and make you as comfortable as possible. Recovering from malignant brain tumours After being treated for a brain tumour, you may need additional care to monitor and treat any further problems. Follow-up appointments Malignantbrain tumours often grow back after treatment, so regular follow-up appointments will be recommended to look for signs that this may have happened. These appointments may include a discussion of any worrying new symptoms you experience, a physical examination, andoccasionally a brain scan. You willusuallyhave follow-up appointments at least every few months to begin with, but they may be needed less frequently over time if no problems develop. Supportive treatment Problems caused by a brain tumourdont always resolve as soon asthe tumour is removed or treated. For example, some people have persistent weakness, seizures (fits), difficulty walking and speech problems. In these cases,you may needextra support to help you overcome or adapt toany problems you have. This may includetherapies such as: physiotherapy to help with any movement problems you have occupational therapy  to identify any problems youre having with daily activities andarrange forany equipment or alterations to your home that may help speech therapy  to help you with anycommunication or swallowing problems Some people may also need to continue taking medication for seizures for a few months or more after their tumour has been treated or removed. The National Institute for Health and Care Excellence (NICE) has made recommendations on the standards of care that brain tumour patients should receive. For more information, see the service guidance for improving outcomes for people with brain and other central nervous system tumours. Drivingand travelling You may not be allowed to drive for a while after youve had a brain tumour. This willdepend on things such asthe type of brain tumour you had, where it was in the brain, and what symptoms you have. If you are required to give up your driving licence and notify the DVLA , they will speak to your GP or specialistto determine when you can drive again. With up-to-date scans and advice from your medical team, you may be allowed to drive again once an agreed period has passed and you have successfully completed a medical test to determine your ability to control a vehicle. You can find out about brain tumours and driving on the Cancer Research UK website. Flying is usually possible from 3 months after treatment. Sports and activities After you have been treated for a brain tumour, you must permanently avoid contact sports, such as rugby and boxing. You can start other activities again, with the agreement of your doctor, once you have recovered. Swimming unsupervised is not recommended for around 1 year after treatment, as there is a risk you could have anepileptic fit while in the water. Sex and pregnancy Its safe to have sex after treatment for a brain tumour. Women may be advised to avoid becoming pregnant for 6 months or more after treatment.If youre planning to become pregnant, you should discuss this with your medical team. Going back to work Youll usually tiremore easily following treatment for a brain tumour. You may wish to return to work and normal life as soon as possible, but its probably a good idea to return part-time to begin with and only go back full-time when you feel able to. If youve experienced seizures,you shouldntwork with machinery or at heights. Emotional support A brain tumour is often life-changing. You may feel angry, frightened and emotionally drained. If it will help, your doctor or specialist may be able to refer you to a social worker and counsellor for help with the practical and emotional aspects of your diagnosis. There are also many organisations that canprovide information and support, such as The Brain Tumour Charity and Brain Tumour Research . Social support If you have been diagnosed with a brain tumour, your treatment and medical care will probably be the first thing on your mind. But there are other aspects of your life to think about and it is important to know exactly what kind of assistance is available and where you can get it. If you are finding it hard to cope with day-to-day life, talk about your needs with your doctor or nurse, who will refer you to a social worker. Your social worker will assess exactly the kind of help you need. Help you may need might include: a care attendant, who can help with housework, dressing and washing, or even just keep you company and give your carer a break a meals on wheels service income support, disability living allowance or attendance allowance equipment andadaptationsfor your home For more information about whathelp youmight need and how you can access it, visit Care Information Scotland . 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