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Brain Tumor - Overview

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2014

ON THIS PAGE: You will find some basic information about this disease and the parts of the body it may affect. This is the first page of Cancer.Net’s Guide to Brain Tumors. To see other pages, use the menu on the side of your screen. Think of that menu as a roadmap to this full guide.

About the brain and central nervous system

The brain and spinal column make up the central nervous system (CNS), where all vital functions, such as thought, speech, and body movements are controlled. When a tumor grows in the CNS, it can affect a person's thought processes or movements.

A primary brain tumor can be benign, meaning it does not spread, or cancerous, meaning it can spread. Generally, primary brain tumors do not spread outside of the CNS especially in adults. This section describes primary brain tumors, which are those that start in the brain. Secondary brain tumors, also called brain metastases, are much more common than primary tumors. A secondary brain tumor is a cancerous tumor that started in another part of the body, such as the breast, lung, or colon and then spread to the brain. Learn more about cancer that started elsewhere in the body and spread to the brain by reading about that specific type of cancer.

A primary brain tumor is described as low grade or high grade. A low-grade tumor generally grows slowly, but can turn into a high-grade tumor. A high-grade tumor is more likely to grow faster.

Anatomy of the brain

The brain is made up of four main parts: the cerebrum, the cerebellum, the brain stem, and the meninges.

The cerebrum. This is the largest part of the brain. It contains two cerebral hemispheres on either side of the brain that each control the opposite side of the body. It is divided into four lobes where specific functions occur:

  • The frontal lobe controls reasoning, emotions, problem-solving, expressive speech, and movement
  • The parietal lobe controls the sensations of touch, such as pressure, pain, and temperature, and parts of speech, visual-spatial orientation, and calculation
  • The temporal lobe controls memory, special senses such as hearing, and the ability to understand spoken or written words
  • The occipital lobe controls vision

The cerebellum. The cerebellum is located at the back part of the brain below the cerebrum. It is responsible for coordination and balance and controls functions on the same side of the body.

The brain stem. This is the portion of the brain that connects to the spinal cord, controls involuntary functions essential for life, such as the beating of the heart and breathing. In addition, messages for all the functions controlled by the cerebrum and cerebellum travel through the brain stem to the connections in the body.

The meninges. These are the membranes that surround and protect the brain and spinal cord. There are three meningeal layers, called the dura mater, arachnoid, and pia mater. The cerebrospinal fluid (CSF) is made near the center of the brain, in the lateral ventricles, and circulates around the brain and spinal cord between the arachnoid and pia layers.

View illustrations of the anatomy of the brain.

Types of brain tumors

There are many types of primary brain tumors, and some cannot be assigned an exact type because taking a sample of the tumor tissue is difficult because of where the tumor is located in the brain. For a complete list of the types of brain tumors and how often they are diagnosed, please refer to the Central Brain Tumor Registry of the United States. This section covers brain tumors diagnosed in adults; Learn about brain tumors in children. For practical purposes, this section’s coverage is divided into gliomas and non-glioma types of tumors in adults.

Gliomas

As a group, a glioma is one of the most common types of brain tumor. A glioma is a tumor that grows from a glial cell, which is a supportive cell in the brain. There are two main types of supportive cells: astrocytes and oligodendrocytes. Most gliomas are called either astrocytoma or oligodendroglioma, or a mix of both. A glioma is given a grade, which is a measure of how much the tumor appears like normal brain tissue. A higher grade is usually more likely to grow quickly.

Types of gliomas include:

Astrocytoma.  Astrocytoma is the most common type of glioma and begins in cells called astrocytes in the cerebrum or cerebellum. There are four grades of astrocytoma.

  • Grade I or pilocytic astrocytoma is a slow-growing tumor that is most often benign and rarely spreads into nearby tissue. It is more common in children. About 2% of all brain tumors are grade I astrocytomas.
  • Grade II or low-grade diffuse astrocytoma is a slow-growing tumor that can often spread into nearby tissue and can become a higher grade. This type makes up about 3% of all brain tumors.
  • Grade III or anaplastic astrocytoma is a cancerous tumor that can quickly grow and spread to nearby tissues. About 2% of all brain tumors are grade III astrocytomas.
  • Grade IV or glioblastoma is a very aggressive form of astrocytoma that makes up about 16% of all brain tumors.

Learn about astrocytoma in children.

Oligodendroglioma. Oligodendroglioma is a tumor that develops from cells called oligodendrocytes. These cells are responsible for making myelin, a substance that surrounds the nerves and is rich in protein and fatty substances called lipids. Oligodendrogliomas make up about 2% of primary brain tumors and are subclassified as either oligodendroglioma, which is considered low grade, or anaplastic oligodendroglioma.

Mixed gliomas. A mixed tumor is made up of more than one of the glial cell types and makes up about 1% of primary brain tumors.

Ependymomas. Ependymomas commonly begin in the passageways in the brain where CSF is made and stored, called the ependymal, and make up about 2% of primary brain tumors. Learn about ependymoma in children.

Brain stem glioma. A brain stem glioma begins in the glial cells in the brain stem. Learn about brain stem glioma in children.

Non-glioma tumors

The following section covers non-glioma tumors, which are tumors that arise from cells in the brain that are not glial or supportive tissue. Types of non-glioma tumors include:

Meningioma. Meningioma is the most common primary brain tumor, making up about 35% of all primary brain tumors. It begins in the meninges and is most often noncancerous. Meningioma can cause serious symptoms if it grows and presses on the brain or spinal cord or grows into the brain tissue. Learn more about meningioma.

Pineal gland and pituitary gland tumors. About 14% of all brain tumors are located in the pineal gland and pituitary gland.

Primary CNS lymphoma. This is a form of lymphoma. Lymphoma is a cancer that begins in the lymphatic system. Primary CNS lymphoma starts in the brain and can spread to the spinal fluid and eyes. It makes up about 2% of all brain tumors.

Medulloblastoma. Medulloblastoma begins in granular cells in the cerebellum. It is most common in children and is usually cancerous, often spreading throughout the CNS. Medulloblastomas make up about 2% of all brain tumors. Similar tumors can start in other parts of the brain, frequently in the pineal gland region, and are called primitive neuroectodermal tumors (PNET). Learn about medulloblastoma in children.

Craniopharyngioma. Craniopharyngioma is a benign tumor that begins near the pituitary gland located near the base of the brain. These tumors are rare, making up less than 1% of all brain tumors. Learn about craniopharyngioma in children.

Acoustic schwannoma. Acoustic schwannoma, also called acoustic neuroma or vestibular schwannoma, is a rare tumor that begins in the vestibular nerve, which is a nerve in the inner ear that helps control balance and is typically noncancerous.

Looking for More of an Overview?

If you would like additional introductory information, explore these related items. Please note these links take you to other sections on Cancer.Net:

  • ASCO Answers Fact Sheet: Read a one-page fact sheet (available as a PDF) that offers an easy-to-print introduction to this type of tumor.
  • Cancer.Net Patient Education Video: View a short video led by an ASCO expert in this type of tumor that provides basic information and areas of research.

To continue reading this guide, use the menu on the side of your screen to select another section.

Brain Tumor - Statistics

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2014

ON THIS PAGE: You will find information about how many people learn they have a brain tumor each year and some general survival information. Remember, survival rates depend on several factors. To see other pages, use the menu on the side of your screen.

This year, an estimated 23,380 adults (12,820 men and 10,560 women) in the United States will be diagnosed with primary cancerous tumors of the brain and spinal cord. It is estimated that 14,320 adults (8,090 men and 6,230 women) will die from this disease this year.

About 4,300 children and teens will be diagnosed with a brain or central nervous system tumor this year. More than half of these are in children younger than 15. This section deals with adult brain tumors; learn about brain tumors in children.

In addition to primary brain tumors, there are also secondary brain tumors or brain metastases. The most common cancers that spread to the brain are lungbreastunknown primarymelanoma, kidney, nasopharynx and colon cancers. The rest of this section covers primary brain tumors only.

Statistics should be interpreted with caution. These estimates are based on data from thousands of people with a brain tumor in the United States each year, but the actual risk for a particular individual may differ. It is not possible to tell a person how long he or she will live with a brain tumor. Learn more about understanding statistics.

Statistics adapted from the American Cancer Society's publication, Cancer Facts Figures 2014, American Brain Tumor Association and the National Cancer Institute

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Brain Tumor - Risk Factors

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2014

ON THIS PAGE: You will find out more about the factors that increase the chance of developing a brain tumor. To see other pages, use the menu on the side of your screen.

A risk factor is anything that increases a person’s chance of developing a brain tumor. Although risk factors often influence the development of a brain tumor, most do not directly cause a brain tumor. Some people with several risk factors never develop a brain tumor, while others with no known risk factors do. However, knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and health care choices. At this time, there are no known ways to prevent a brain tumor.

Most of the time, the cause of a brain tumor is unknown, but the following factors may raise a person’s risk of developing a brain tumor:

Age. Brain tumors are more common in children and older adults, although people of any age can develop a brain tumor.

Gender. In general, men are more likely than women to develop a brain tumor. However, some specific types of brain tumors, such as meningioma, are more common in women.

Home and work exposures. Exposure to solvents, pesticides, oil products, rubber, or vinyl chloride may increase the risk of developing a brain tumor, although there is not yet scientific evidence that supports this possible link.

Family history. About 5% of brain tumors may be linked to hereditary genetic factors or conditions, including Li-Fraumeni syndrome, neurofibromatosis, nevoid basal cell carcinoma syndrome, tuberous sclerosis, Turcot syndrome, and von Hippel-Lindau disease. Scientists have also found “clusters” of brain tumors within some families without a link to these known hereditary conditions, and studies are underway to try to find a cause.

Exposure to infections, viruses, and allergens. Infection with the Epstein-Barr virus (EBV) increases the risk of CNS lymphoma; EBV is more commonly known as the virus that causes mononucleosis or “mono”. In other research, high levels of a common virus called cytomegalovirus (CMV) have been found in brain tumor tissue; the meaning of this finding is being researched. Several types of other viruses have been shown to cause brain tumors in research on animals; however, more data are needed to find out if exposure to infections, other viruses, or allergens increase the risk of a brain tumor in people.

Electromagnetic fields. Electromagnetic fields, such as energy from power lines or from cell phone use, may or may not increase the risk of developing a brain tumor, as current research has shown conflicting results. The World Health Organization (WHO) recommends limiting cell phone use and promotes the use of a hands-free headset for both adults and children.

Race and ethnicity. In the United States, white people are more likely to develop gliomas but less likely to develop meningioma than black people. Also, people from northern Europe are more than twice as likely to develop a brain tumor as people in Japan.

Ionizing radiation. Previous treatment to the brain or head with ionizing radiation, including x-rays, has shown, in some cases, to be a risk factor for a brain tumor.

Head injury and seizures. Serious head trauma has long been studied for its relationship to brain tumors. Some studies have shown a link between head trauma and meningioma, but not one between head trauma and glioma. A history of seizures has long been associated with brain tumors, but because a brain tumor can cause seizures, it is not known if seizures increase the risk of brain tumors, if seizures occur because of the tumor, or if anti-seizure medication increases the risk.

N-nitroso compounds. Some studies of diet and vitamin supplementation seem to indicate that dietary N-nitroso compounds may raise the risk of both childhood and adult brain tumors. Dietary N-nitroso compounds are formed in the body from nitrites or nitrates found in some cured meats, cigarette smoke, and cosmetics. However, additional research is necessary before a definitive link can be established.

Exposure to nerve agents. One study has shown that some Gulf War veterans have an increased risk of a brain tumor from exposure to nerve agents; however, more research is needed before a definitive link can be made.

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Brain Tumor - Symptoms and Signs

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2014

ON THIS PAGE: You will find out more about body changes and other things that can signal a problem that may need medical care. To see other pages, use the menu on the side of your screen.

People with a brain tumor may experience the following symptoms or signs. Sometimes, people with a brain tumor do not show any of these symptoms. Or, these symptoms may be caused by a medical condition that is not a brain tumor.

Symptoms of a brain tumor can be general or specific. A general symptom is caused by the pressure of the tumor on the brain or spinal cord. Specific symptoms are caused when a specific part of the brain is not working normally because of the tumor. For many people with a brain tumor, they were diagnosed when they went to the doctor after experiencing a problem, such as a headache or other changes. 

General symptoms include:

  • Headaches, which may be severe and may worsen with activity or in the early morning
  • Seizures. Motor seizures, also called convulsions, are sudden involuntary movements of a person’s muscles. People may experience different types of seizures, including myclonic and tonic-clonic (grand mal). Certain drugs can help prevent or control them. The differences between these types of seizures can be found below:
    • Myclonic
      • Single or multiple muscle twitches, jerks, spasms
    • Tonic-Clonic (Grand Mal)
      • Loss of consciousness and body tone, followed by twitching and relaxing muscles that are called contractions
      • Loss of control of body functions
      • May be a short 30-second period of no breathing and a person may turn a shade of blue
      • After this type of seizure a person may be sleepy and experience a headache, confusion, weakness, numbness, and sore muscles.
    • Sensory
      • Change in sensation, vision, smell, and/or hearing without losing consciousness
    • Complex partial
      • May cause a loss of awareness or a partial or total loss of consciousness
      • May be associated with repetitive, unintentional movements, such as twitching
  • Personality or memory changes
  • Nausea or vomiting
  • Fatigue

Symptoms that may be specific to the location of the tumor include:

  • Pressure or headache near the tumor
  • Loss of balance and difficulty with fine motor skills is linked with a tumor in the cerebellum.
  • Changes in judgment, including loss of initiative, sluggishness, and muscle weakness or paralysis is associated with a tumor in the frontal lobe of the cerebrum.
  • Partial or complete loss of vision is caused by a tumor in the occipital lobe or temporal lobe of the cerebrum.
  • Changes in speech, hearing, memory, or emotional state, such as aggressiveness and problems understanding or retrieving words can develop from a tumor in the frontal and temporal lobe of cerebrum.
  • Altered perception of touch or pressure, arm or leg weakness on one side of the body, or confusion with left and right sides of the body are linked to a tumor in the frontal or parietal lobe of the cerebrum.
  • Inability to look upward can be caused by a pineal gland tumor.
  • Lactation, which is the secretion of breast milk and altered menstrual periods in women, and growth in hands and feet in adults are associated with a pituitary tumor.
  • Difficulty swallowing, facial weakness or numbness, or double vision is a symptom of a tumor in the brain stem.
  • Vision changes, including loss of part of the vision or double vision can be from a tumor in the temporal lobe, occipital lobe, or brain stem.

If you are concerned about one or more of the symptoms or signs on this list, please talk with your doctor. Your doctor will ask how long and how often you’ve been experiencing the symptom(s), in addition to other questions. This is to help find out the cause of the problem, called a diagnosis.

If a brain tumor is diagnosed, relieving symptoms remains an important part of your care and treatment. This may also be called symptom management, palliative care, or supportive care. Be sure to talk with your health care team about symptoms you experience, including any new symptoms or a change in symptoms. Learn more about managing symptoms of a brain tumor in the Treatment Options section.

The next section helps explain what tests and scans may be needed to learn more about the cause of the symptoms. Use the menu on the side of your screen to select Diagnosis, or you can select another section, to continue reading this guide.

Brain Tumor - Diagnosis

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2014

ON THIS PAGE: You will find a list of the common tests, procedures, and scans that doctors can use to find out what’s wrong and identify the cause of the problem. To see other pages, use the menu on the side of your screen.

Doctors use many tests to diagnose a brain tumor, find out the type of brain tumor, and rarely, find out if it has spread to another part of the body, called metastasis. Some tests may also determine which treatments may be the most effective. For most types of tumors, taking a sample of the tumor tissue, either by biopsy (see below) or by removing part or all of the tumor, is the only way to make a definitive diagnosis of a brain tumor. If this is not possible, the doctor may suggest other tests that will help make a diagnosis.

Imaging tests may be used to help determine whether the tumor is a primary brain tumor or if it is another type of cancer that has spread to the brain from elsewhere in the body. Your doctor may consider these factors when choosing a diagnostic test:

  • Age and medical condition
  • Type of tumor suspected
  • Signs and symptoms
  • Previous test results

Most brain tumors are not diagnosed until after symptoms appear. Often a brain tumor is initially diagnosed by an internist or a neurologist. An internist is a doctor who specializes in treating adults. A neurologist is a doctor who specializes in problems with the brain and central nervous system.

In addition to asking the patient for a detailed medical history and doing a physical examination, the doctor may recommend the tests described below to determine the presence, and perhaps the type or grade, of a brain tumor. This list describes options for diagnosing a brain tumor, and not all tests listed will be used for every person. Based on the combined results of the different tests, the doctor will recommend treatment options.

Imaging tests

The most effective and common tool for diagnosing a brain tumor is the use of a magnetic resonance imaging (MRI) scan, although computed tomography (CT or CAT) scans are also used. A positron emission tomography (PET) scan is used at first to find out more about a tumor while a patient is receiving treatment or if the tumor comes back after treatment.

Once an imaging scan shows that there is a tumor in the brain, the most common way to determine the type of brain tumor is to look at the results from a sample of tissue after a biopsy or surgery (see further below).

Each imaging test can provide specific information, but they must be combined with the results of the patient’s medical history, physical examination, and neurologic and other tests. The most common imaging tests used for diagnosing a brain tumor include:

MRI. An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. MRI can also be used to measure the tumor’s size. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein or given as a pill to swallow. MRIs create more detailed pictures than CT scans (see below) and are the preferred way to diagnose a brain tumor. The MRI may be of the brain, spinal cord, or both, depending on the type of tumor suspected and the likelihood that it will spread in the CNS. There are different types of MRI, and the results of a neuro-examination, done by the internist or neurologist, helps determine which type of MRI to use.

  • Intravenous (IV) gadolinium-enhanced MRI is typically used to help create a clearer picture of a brain tumor. This is when a patient first has a regular MRI, and afterwards is given a special type of contrast medium called gadolinium through an IV; a second MRI is then done to get another series of pictures using the dye.
  • A spinal MRI may be used to diagnose a tumor on or near the spine.
  • A functional MRI (fMRI) provides information about the location of specific areas of the brain that are responsible for muscle movement and speech. During the fMRI examination, the patient is asked to do certain tasks that cause changes in the brain and can be seen on the fMRI image. This test is used to help plan surgery, so the surgeon can avoid damaging the functional parts of the brain while removing the tumor.
  • Magnetic resonance spectroscopy (MRS) is a test using MRI that provides information on the chemical composition of the brain. It can help tell the difference between dead tissue caused by previous radiation treatments and new tumor cells in the brain.

CT scan. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. A CT scan can help find bleeding and enlargement of the fluid-filled spaces in the brain, called ventricles. Changes to bone in the skull can also be seen on a CT scan, and it can also be used to measure a tumor’s size. A CT scan may also be used if the patient cannot have an MRI, such as if the person has a pacemaker for his or her heart. Sometimes, a contrast medium is given before the scan to provide better detail on the image. This dye can be injected into a patient’s vein or given as a pill to swallow.

PET scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive sugar substance is injected into the patient’s body. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body.

Cerebral arteriogram, also called a cerebral angiogram. A cerebral arteriogram is an x-ray, or series of x-rays, of the head that shows the arteries in the brain. X-rays are taken after a contrast medium is injected into the main arteries of the patient’s head.

Lumbar puncture or spinal tap. A lumbar puncture is a procedure in which a doctor uses a needle to take a sample of cerebrospinal fluid (CSF) to look for tumor cells, blood, or tumor markers. Tumor markers or biomarkers are substances found in higher than normal amounts in the blood, urine, spinal fluid, plasma or other bodily fluids of people with certain types of cancer. Typically a local anesthetic is given to numb the patient’s lower back before the procedure.

Myelogram. Because some specific types of brain tumors can spread to the spinal fluid, other parts of the brain, or the spinal cord, the doctor may recommend a myelogram to look for areas where the tumor may have spread. A myelogram uses a dye injected into the CSF that surrounds the spinal cord. The dye shows up on an x-ray and can outline the spinal cord to help the doctor look for a tumor. This is rarely done; a lumbar puncture (see above) is more common.

Tissue sampling/biopsy/surgical removal of a tumor

As explained above, imaging tests are useful, but a sample of the tumor’s tissue is usually needed for the final diagnosis. A biopsy is the removal of a small amount of tissue for examination under a microscope and is the only definitive way a brain tumor can be diagnosed. The sample removed during the biopsy is analyzed by a pathologist. A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease. A biopsy can be done as part of surgery to remove the entire tumor or as a separate procedure if surgical removal of the tumor is not possible because of its location or a patient’s health.

Molecular testing of the tumor

Your doctor may recommend running laboratory tests on a tumor sample to identify specific genes, proteins, and other factors, such as tumor markers, unique to the tumor. Researchers are examining biomarkers to find ways to diagnose a brain tumor before symptoms begin. Results of these tests may help decide whether your treatment options include a type of treatment called targeted therapy (see Treatment Options).

Neurological, vision, and hearing tests

These tests help determine if a tumor is affecting how the brain functions. An eye examination can detect changes to the optic nerve, as well as changes to a person’s field of vision.

Neurocognitive assessment

This consists of a detailed assessment of all major functions of the brain, such as storage and retrieval of memory, expressive and receptive language abilities, calculation, dexterity, and the overall well-being of the patient. These tests are done by a licensed clinical neuropsychologist, who will write a formal report to be used for comparison with future assessments or to identify specific problems that can be helped through treatment.

Electroencephalography (EEG)

An EEG is a noninvasive test in which electrodes are attached to the outside of a person's head to measure electrical activity of the brain. It is used to monitor for possible seizures (see Symptoms and Signs).

Evoked potentials

Evoked potentials involve the use of electrodes to measure the electrical activity of nerves and can often detect acoustic schwannoma, a noncancerous brain tumor. This test can be used as a guide when removing a tumor that is growing around important nerves.

Test results

After diagnostic tests are done, your doctor will review all of the results with you. If the diagnosis is a tumor, additional tests will be done to learn more about the tumor. The results help the doctor describe the tumor and plan treatment.

The next section helps explain the different grades and prognostic factors for a brain tumor. Use the menu on the side of your screen to select Grades and Prognostic Factors, or you can select another section, to continue reading this guide.

Brain Tumor - Staging and Prognostic Factors

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2014

ON THIS PAGE: You will learn about how doctors describe a brain tumor’s growth or spread. This is called the grade. You will also learn about the prognostic factors doctors use to help plan treatment. To see other pages, use the menu on the side of your screen.

A staging system is used for most other types of cancer to describe where a tumor is located, if or where it has spread, and whether it is affecting other parts of the body. However, there is no recommended systemic staging system for adult brain tumors because most primary tumors do not usually spread beyond the central nervous system; however, the grading system described below is always used instead because how cancerous a tumor is and how likely it is to grow depends on its specific features.

Prognostic factors

To decide on the best treatment for a brain tumor, both the type and grade of the tumor must be determined. There are several factors that help doctors determine the appropriate brain tumor treatment plan and determine prognosis:

Tumor histology. As outlined in the Diagnosis section, a sample of the tumor is removed for analysis. Tumor histology includes the type of tumor and the grade.

Grade describes how much the tumor cells look like healthy cells when viewed under a microscope. The doctor compares the tissue from the tumor with healthy tissue. Healthy tissue usually contains many different types of cells grouped together. If the tumor looks similar to healthy tissue and contains different cell groupings, it is called differentiated or a low-grade tumor. If the tissue looks very different from healthy tissue, it is called poorly differentiated or a high-grade tumor. Generally, the lower the grade, the better the prognosis, which is the chance of recovery, and the likelihood of controlling the tumor’s growth over a long period of time.

Specifically for glial tumors, the grade is determined by its features, as seen under a microscope, according to the following criteria:

  • Grade I is a separate group of tumors called juvenile pilocytic astrocytoma (JPA). The term juvenile does not refer to the age of the patient, but the type of cell. This is a noncancerous, slow-growing tumor that can often be cured with surgery. It is different from a low-grade astrocytoma or Grade II glioma, which are likely to come back after treatment.
  • A grade II tumor does not have dead cells in the tumor, called necrosis, but shows an abnormally large number of cells, called hypercellular.
  • A grade III tumor is hypercellular and has cells that are actively dividing, called mitosis. It is often called anaplastic astrocytoma.
  • A grade IV tumor is usually a glioblastoma, also called glioblastoma multiforme or GBM. Cells in the tumor are actively dividing, and it has blood vessel growth and areas of dead cells in addition to the factors common to grade II and III tumors.

Age of patient. In adults, the age of the patient and his or her level of functioning, called functional status (see below) when diagnosed is one of the best ways to predict a patient’s prognosis. In general, a younger adult has a better prognosis.

Extent of tumor residual. Resection is surgery to remove a tumor, and residual refers to how much of the tumor remains in the body after surgery. Four classifications are used:

  • Gross total: The entire tumor was removed. However, microscopic cells may remain.
  • Subtotal: Large portions of the tumor were removed.
  • Partial: Only part of the tumor was removed.
  • Biopsy only: Only a small portion, used for a biopsy, was removed.

A patient’s prognosis is better when all of the tumor can be surgically removed.

Tumor location. A tumor can form in any part of the brain. Some tumor locations cause more damage than others, and some tumors are harder to treat because of their location.

Functional neurologic status. The doctor will test how well a patient is able to function and carry out everyday activities by using a functional assessment scale, such as the Karnofsky Performance Scale (KPS), outlined below. A higher score indicates a better functional status. Typically, someone who is better able to walk and care for themselves has a better prognosis.

100 Normal, no complaints, no evidence of disease

90 Able to carry on normal activity; minor symptoms of disease

80 Normal activity with effort; some symptoms of disease

70 Cares for self; unable to carry on normal activity or active work

60 Requires occasional assistance but is able to care for needs

50 Requires considerable assistance and frequent medical care

40 Disabled: requires special care and assistance

30 Severely disabled; hospitalization is indicated, but death not imminent

20 Very sick, hospitalization necessary; active treatment necessary

10 Moribund, fatal processes progressing rapidly

0  Dead

Metastatic spread. A tumor that starts in the brain or spinal cord, if cancerous, rarely spreads to other parts of the body in adults, but may grow within the CNS. For that reason, with few exceptions, tests looking at the other organs of the body are typically not needed. A tumor that does spread to other parts of the brain or spinal cord is linked with a poorer prognosis.

Biogenetic markers. Certain molecular markers found in the tumor tissue can provide information on whether treatment will work well. For instance, for oligodendroglioma, the loss of part of chromosome 1 on the p part of the chromosome, and the loss of part of chromosome 19 on the q part of the chromosome, called a 1p and 19q co-deletion, is linked to more successful treatment, particularly with chemotherapy, and can be used to help plan treatment, especially for anaplastic oligodendroglioma.

Mutations in the isocitrate dehydrogenase (IDH) gene which is found in about 70% to 80% of low-grade gliomas in adults has been linked with a better prognosis. Higher-grade tumors can also have IDH gene mutations, which suggests that these tumors started as lower-grade tumors that became a higher grade. This mutation is also linked with a better prognosis in higher-grade tumors.

In glioblastoma, whether a gene called methyl guanine methyl transferase (MGMT) is changed can help understand a patient’s prognosis, and it is being tested in clinical trials.

Recurrent tumor. A recurrent tumor is one that has come back after treatment. If there is a recurrence, the tumor may need to be graded again using the system above.

Currently, the factors listed above are the best indicators of a patient’s prognosis. As discussed in Diagnosis, researchers are currently looking for biomarkers in the tumor tissue that could make a brain tumor easier to diagnose and allow for the staging of an adult brain tumor in the future. Researchers are also looking at other genetic tests that may predict a patient’s prognosis. These tools may someday help doctors predict the chance that a brain tumor will grow, develop more effective treatments, and more accurately predict prognosis.

Used with permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Manual, Seventh Edition (2010) published by Springer-Verlag New York, www.cancerstaging.net.

Information about the tumor’s stage, as well as the prognostic factors, will help the doctor recommend a treatment plan. The next section helps explain the treatment options for this type of cancer. Use the menu on the side of your screen to select Treatment Options, or you can select another section, to continue reading this guide.

Brain Tumor - Treatment Options

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2014

ON THIS PAGE: You will learn about the different ways doctors use to treat people with a brain tumor. To see other pages, use the menu on the side of your screen.

This section outlines treatments that are the standard of care (the best proven treatments available) for brain tumors. When making treatment plan decisions, patients are also encouraged to consider clinical trials as an option. A clinical trial is a research study to test a new approach to treatment to evaluate whether it is safe, effective, and possibly better than the standard treatment. Clinical trials may test such approaches as a new drug, a new combination of standard treatments, or new doses of current therapies. Your doctor can help you review all treatment options. For more information, see the Clinical Trials and Latest Research section.

Treatment overview

In brain tumor care, different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatment. This is called a multidisciplinary team and can include neuro-oncologists, medical oncologists, radiation oncologists, surgeons, nurses, social workers, rehabilitation therapists, neuropsychologists, and other specialists.

Descriptions of the most common treatment options for a brain tumor are listed below, including treatments that help manage symptoms. Treatment options and recommendations depend on several factors, including the size, type, and grade of the tumor, if it is putting pressure on vital parts of the brain, whether it has spread to other parts of the CNS or body, possible side effects, and the patient’s preferences and overall health. Some types of brain tumors grow rapidly; other tumors grow slowly. Considering all these factors, your doctor will talk with you about how soon treatment should start after diagnosis.

Treatment options include those described below, such as surgery, radiation therapy, and chemotherapy. Your care plan may also include treatment for symptoms and side effects, an important part of your medical care.

For a low-grade brain tumor, surgery may be the only treatment needed especially if all of the tumor can be removed. If there is visible tumor remaining after surgery, radiation and chemotherapy may be used. For higher-grade tumors, treatment usually begins with surgery, followed by radiation therapy and chemotherapy. Your exact treatment plan will be made by your health care team.

Successfully treating brain tumors can be challenging. The body’s blood-brain barrier normally protects the brain and spinal cord from harmful chemicals entering those structures through the bloodstream. However, this barrier also keeps out many types of chemotherapy. Surgery can be difficult if the tumor is near a delicate part of the brain or spinal cord. Even when the surgeon can completely remove the original tumor, there may be parts of the tumor remaining that are too small to be seen or removed during surgery. And, radiation therapy can damage healthy tissue.

However, research in the past two decades has helped to significantly lengthen the lives of people with brain tumors. More refined surgeries, a better understanding of the types of tumors that respond to chemotherapy, and more targeted delivery of radiation therapy have lengthened lives and improved the quality of life for many people diagnosed with a brain tumor.

Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Also, talk about the goals of each treatment with your doctor and what you can expect while receiving the treatment. Learn more about making treatment decisions.

Getting care for symptoms and side effects

A brain tumor and its treatment often cause side effects. In addition to treatment to slow, stop, or eliminate the tumor, an important part of care is relieving a person’s symptoms and side effects. This approach is called palliative or supportive care, and it includes supporting the patient with his or her physical, emotional, and social needs.

Palliative care can help a person at any stage of illness. People often receive treatment for the tumor and treatment to ease side effects at the same time. In fact, patients who receive both often have less severe symptoms, better quality of life, and report they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, and other therapies. You may also receive palliative treatments similar to those meant to eliminate the tumor, such as chemotherapy, surgery, and radiation therapy. Talk with your doctor about the goals of each treatment in your treatment plan.

Some of the symptoms of a brain tumor can be severe and have an enormous impact on a patient’s life. However, they can often be managed with the use of certain medications. Supportive care for people with a brain tumor includes:

  • Pain medication to help manage the pain from headaches, a common symptom of a brain tumor. Often, drugs call corticosteroids are used to lower swelling in the brain, which can lessen pain from the swelling without the need for prescription pain medications.
  • Antiseizure medication to help control seizures. There are several types of drugs available, and they are prescribed by your neurologist.
  • Corticosteroids are also used to decrease the amount of swelling in the brain. 

Before treatment begins, talk with your health care team about the possible side effects of your specific treatment plan and supportive care options. And during and after treatment, be sure to tell your doctor or another health care team member if you are experiencing a problem so it is addressed as quickly as possible. Learn more about palliative care.

Surgery

Surgery is the removal of the tumor and surrounding tissue during an operation. It is usually the first treatment used for a brain tumor and is often the only treatment needed for a low-grade brain tumor. Removing the tumor can improve neurological symptoms, provide tissue for diagnosis, help make other brain tumor treatments more effective, and, in many instances, improve the prognosis of a person with a brain tumor.

A neurosurgeon is a doctor who specializes in surgery on the brain and spinal column. Surgery to the brain requires the removal of part of the skull, a procedure called a craniotomy. After the surgeon removes the tumor, the patient's own bone will be used to cover the opening in the skull.

There have been rapid advances in surgery for brain tumors, including the use of cortical mapping. This technique allows doctors to identify certain areas of the brain that control the senses, language, and motor skills. In addition, enhanced imaging devices give surgeons more tools to plan and perform surgery. For example, computer-based techniques, such as Image Guided Surgery (IGS), help surgeons map out the location of the tumor very accurately. For a tumor that is near the brain’s speech center, it is increasingly common to perform the operation when the patient is awake for part of the surgery; typically, the patient is awakened once the surface of the brain is exposed, and special electrical stimulation techniques are used to locate the specific part of the brain that controls speech and thereby avoid causing damage while removing the tumor.

In addition to removing or reducing the size of the brain tumor, surgery can provide a tissue sample for biopsy analysis, as explained in Diagnosis. For some tumor types, the results of this analysis can help determine if chemotherapy or radiation therapy will be useful. For a cancerous tumor, even if the cancer cannot be cured, removing it can relieve symptoms from the tumor pressing on the brain.

Sometimes, surgery cannot be performed because the tumor is located in a place the surgeon cannot reach or is near a vital structure; these tumors are called inoperable. If the tumor is inoperable, the doctor will recommend other treatment options.

Before surgery, talk with your health care team about the possible side effects and how they will be managed or relieved. Learn more about surgery.

Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. Doctors may use radiation therapy to slow or stop the growth of the tumor. It is typically given after surgery and possibly along with chemotherapy. A doctor who specializes in giving radiation therapy to treat a tumor is called a radiation oncologist. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. When radiation treatment is given using implants, it is called internal radiation therapy or brachytherapy. A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a set period of time.

External-beam radiation therapy can be directed at the tumor in the following ways:

Conventional radiation therapy. The treatment location is determined based on anatomic landmarks and x-rays. In certain situations, such as whole brain radiation therapy for brain metastases, this technique is appropriate. For more precise targeting, different techniques are needed. The amount of radiation given depends on the tumor’s grade.

Three-dimensional conformal radiation therapy (3D-CRT). Using images from CT and MRI scans (see Diagnosis), a three-dimensional model of the tumor and normal tissue surrounding the tumor is created on a computer. This model can be used to aim the radiation beams directly at the tumor, sparing the healthy tissue from high doses of radiation therapy.

Intensity modulated radiation therapy (IMRT). IMRT is a type of 3D-CRT (see above) that can more directly target a tumor, delivering higher doses of radiation to the tumor while giving less to the surrounding healthy tissue. In IMRT, the radiation beams are broken up into smaller beams and the intensity of each of these smaller beams can be changed. This means that the more intense beams, or the beams giving more radiation, can be directed only at the tumor.

Proton therapy. Proton therapy is a type of external-beam radiation therapy that uses protons rather than x-rays. At high energy, protons can destroy cancer cells. Proton beam therapy is typically used for tumors that have grown into nearby bone, such as the base of skull.

Stereotactic radiosurgery. Stereotactic radiosurgery is the use of a single, high dose of radiation given directly to the tumor and not healthy tissue. It works best for a tumor that is only in one area of the brain and certain noncancerous tumors, but it can also be used when a person has more than one metastatic brain tumor. There are many different types of stereotactic radiosurgery equipment, including:

  • A modified linear accelerator is a machine that creates high-energy radiation by using electricity to form a stream of fast-moving subatomic particles.
  • A gamma knife is another form of radiation therapy that concentrates highly focused beams of gamma radiation on the tumor.
  • A cyber knife is a robotic device used in radiation therapy to guide radiation to the tumor target—particularly in the brain, head, and neck regions.

Fractionated stereotactic radiation therapy. Radiation therapy is delivered with stereotactic precision but divided into small daily doses called fractions given over several weeks, in contrast to the one-day radiosurgery. This technique is used for tumors located close to sensitive structures, such as the optic nerves or brain stem.

With these different techniques, doctors are trying to be more precise and reduce radiation exposure to the surrounding normal brain tissue. Depending on the size and location of the tumor, the radiation oncologist may choose any of the above radiation techniques. In certain situations, a combination of two or more techniques may work best.

Short-term side effects from radiation therapy may include fatigue, mild skin reactions, hair loss, upset stomach, and neurologic symptoms. Most side effects go away soon after treatment is finished. Also, radiation therapy is usually not recommended for children younger than five because of the high risk of damage to their developing brains. Longer term side effects of radiation depend on how much healthy tissue received radiation therapy and include memory and hormonal problems and cognitive (thought process) changes, such as difficulty understanding and performing complex tasks.

Learn more about radiation therapy on this website, or see the American Society for Therapeutic Radiology and Oncology’s pamphlet, Radiation Therapy for Brain Tumors.

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by stopping the cancer cells’ ability to grow and divide. The goal of chemotherapy can be to destroy cancer cells remaining after surgery, slow a tumor’s growth, or reduce symptoms. As explained above, chemotherapy to treat a brain tumor is typically given after surgery and possibly along with radiation therapy or after radiation therapy, particularly if the tumor has come back after initial treatment.

Chemotherapy is given by a medical oncologist, a doctor who specializes in treating tumors with medication, or a neuro-oncologist. A chemotherapy regimen (schedule) usually consists of a specific number of cycles given over a set period of time. A patient may receive one drug at a time or combinations of different drugs at the same time. Systemic chemotherapy is delivered through the bloodstream to reach cancer cells throughout the body. Common ways to give chemotherapy include a pill or capsule that is swallowed (orally) or by intravenous (IV) injection placed into a vein using a needle, through a catheter or port, which are used to make injections easier. 

Some drugs are better at going through the blood-brain barrier, and these drugs are often used for a brain tumor because of this ability. Gliadel wafers are one way to give the drug carmustine, which involves placing the wafers in the area where the tumor was removed during surgery. For people with glioblastoma, the latest standard of care is radiation therapy with daily low-dose temozolomide (Temodar), followed by monthly doses of temozolomide after radiation therapy for six months to one year. A combination of three drugs, lomustine (CeeNU), procarbazine (Matulane), and vincristine (Vincasar) have been used along with radiation therapy. This approach has helped lengthen the lives of patients with grade III oligodendroglioma with a 1p19q co-deletion (see Biogenetic markers in the Grades and Prognostic Factors section) when given either before or right after radiation therapy. It has also been shown to lengthen lives of patients when given after radiation therapy for low-grade tumors that could not be completely removed with surgery. Clinical trials on the use of chemotherapy to delay radiation therapy in patients with low-grade glioma are also ongoing.

Patients are monitored with a brain MRI every two to three months while receiving active treatment. Then, the length of time between MRI scans increases depending on the tumor’s grade. Patients often have regular MRIs to monitor their health even once treatment is finished and the tumor has not grown. If the tumor grows during treatment, other treatment options will be considered.

The side effects of chemotherapy depend on the individual and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite and diarrhea. These side effects usually go away once treatment is finished. Rarely, certain drugs may cause some hearing loss. Others may cause kidney damage. Patients may be given extra fluid by IV to protect their kidneys. The doctor may also prescribe corticosteroids to reduce swelling and help to relieve symptoms.

Learn more about chemotherapy and preparing for treatment. The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions by using searchable drug databases.

Targeted therapy

In addition to standard chemotherapy, targeted therapy is a treatment that targets the tumor’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of tumor cells while limiting the damage to healthy cells.

Recent studies show that not all tumors have the same targets, and some tumors may have more than one target. To find the most effective treatment, your doctor may run tests to identify the genes, proteins, and other factors in your tumor. As a result, doctors can better match each patient with the most effective treatment whenever possible. In addition, many research studies are taking place now to find out more about specific molecular targets and new treatments directed at them. Learn more about targeted treatments.

For a brain tumor, anti-angiogenesis therapy is one type of targeted therapy used, and others are being researched. It is focused on stopping angiogenesis, which is the process of making new blood vessels. Because a tumor needs the nutrients delivered by blood vessels to grow and spread, the goal of anti-angiogenesis therapies is to “starve” the tumor. Bevacizumab (Avastin) is an anti-angiogenesis therapy used to treat glioblastoma multiforme when prior treatment has not worked. Talk with your doctor about possible side effects for a specific medication and how they can be managed.

Remission and the chance of recurrence

A remission is when the tumor cannot be detected in the body. A remission can be temporary or permanent. For most primary brain tumors, despite imaging tests showing that the tumor growth is controlled or there are no visible signs of a tumor, it is common for a brain tumor to recur. Patients will often continue to receive MRI scans to watch for a recurrence. This uncertainty leads to many survivors feeling worried or anxious about when the tumor will come back. It is important to talk with your doctor about the possibility of the tumor returning. Understanding the risk of recurrence and the treatment options may help you feel more prepared if the tumor does return. Learn more about coping with the fear of recurrence.

If the tumor does return after the original treatment, it is called a recurrent tumor. A recurrent brain tumor generally comes back near where it originally started. Rarely, it may come back in another place, called multifocal.

When this occurs, a cycle of testing will begin again to learn as much as possible about the recurrence, including whether the tumor’s grade has changed. After testing is done, you and your doctor will talk about your treatment options. Often the treatment plan will include the therapies described above such as surgery, radiation therapy, chemotherapy, and targeted therapy, but they may be used in a different combination or given at a different pace. Temozolomide has been approved to treat Grade III recurrent tumors. Bevacizumab (see above) may also be used for a recurrent tumor. In addition, alternating electric field therapy is approved by the U.S. Food and Drug Administration for patients with recurrent high-grade glioma. Alternating electric field therapy interferes with parts of a cell that are needed for the tumor cells to grow and spread. It is given by placing electrodes that produce an electric field on the outside of a person’s head. While this treatment approach has not been shown to increase survival when compared with standard chemotherapy, it causes fewer side effects than chemotherapy.

There is no single approach to treating a recurrent brain tumor, and your treatment plan will be based on many factors. Supportive care will also be important to help relieve symptoms and side effects. Your doctor may suggest clinical trials of new drugs that are being created and tested to treat brain tumors that may help with recurrent tumors. Many of these new drugs are called "molecularly targeted therapies" because they are small in size, which means they can be taken by mouth, and/or can target specific parts of the brain tumor cells. These new drugs are being tested either alone or in combination with standard chemotherapy. Learn more about clinical trials on brain tumor treatment in the Latest Research section.

People with recurrent cancer often experience emotions such as disbelief or fear. For most patients, a diagnosis of a recurrent brain tumor is very stressful and, at times, difficult to bear. Patients and their families are encouraged to talk about the way they are feeling with doctors, nurses, social workers, or other members of the health care team and to ask about support services to help them cope. It may also be helpful to talk with other patients, including through a support group. Learn more about dealing with cancer recurrence.

If treatment fails

Recovery from a brain tumor is not always possible. If treatment is not successful, the disease may be called an advanced or terminal brain tumor.

This diagnosis is stressful, and this is difficult to discuss for many people. However, it is important to have open and honest conversations with your doctor and health care team to express your feelings, preferences, and concerns. The health care team is there to help, and many team members have special skills, experience, and knowledge to support patients and their families. Making sure a person is physically comfortable and free from pain is extremely important.

Patients who have an advanced brain tumor and who are expected to live less than six months may want to consider a type of palliative care called hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to think about where you would be most comfortable: at home, in the hospital, or in a hospice environment. Nursing care and special equipment can make staying at home a workable alternative for many families. Learn more about advanced care planning.

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.

The next section helps explain clinical trials, which are research studies. Use the menu on the side of your screen to select About Clinical Trials, or you can select another section, to continue reading this guide.

Brain Tumor - About Clinical Trials

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2014

ON THIS PAGE: You will learn more about clinical trials, which are the main way that new medical approaches are tested to see how well they work. To see other pages, use the menu on the side of your screen.

Doctors and scientists are always looking for better ways to treat patients with a brain tumor. To make scientific advances, doctors create research studies involving volunteers, called clinical trials.

Many clinical trials are focused on new treatments, evaluating whether a new treatment is safe, effective, and possibly better than the current (standard) treatment. These types of studies evaluate new drugs, different combinations of existing treatments, new approaches to radiation therapy or surgery, and new methods of treatment. Patients who participate in clinical trials are often among the first to receive new treatments before they are widely available. However, there is no guarantee that the new treatment will be safe, effective, or better than a standard treatment.

There are also clinical trials that study new ways to ease symptoms and side effects during treatment and managing the late effects that may occur after treatment. Talk with your doctor about clinical trials regarding side effects. In addition, there are ongoing studies about ways to prevent the disease.

Patients decide to participate in clinical trials for many reasons. For some patients, a clinical trial is the best treatment option available. Because standard treatments are not perfect, patients are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Other patients volunteer for clinical trials because they know that these studies are the only way to make progress in treating a brain tumor. Even if they do not benefit directly from the clinical trial, their participation may benefit future patients with a brain tumor.

Sometimes people have concerns that, by participating in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill.” The use of placebos in cancer clinical trials is rare. When a placebo is used in a study, it is done with the full knowledge of the participants and often is used in combination with a standard treatment to compare the addition of a study medication to a standard treatment. Find out more about placebos in cancer clinical trials.

To join a clinical trial, patients must participate in a process known as informed consent. During informed consent, the doctor should list all of the patient’s options, so that the person understands how the new treatment differs from the standard treatment. The doctor must also list all of the risks of the new treatment, which may or may not be different than the risks of standard treatment. Finally, the doctor must explain what will be required of each patient in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment.

For specific topics being studied for brain tumors, learn more in the Latest Research section.

Patients who participate in a clinical trial may stop participating at any time, for any personal or medical reason. This may include that the new treatment is not working or there are serious side effects. Clinical trials are also closely monitored by experts who watch for any problems with each study. It is important that patients participating in a clinical trial talk with their doctor and researchers about who will be providing their treatment and care during the clinical trial, after the clinical trial ends, and/or if the patient chooses to leave the clinical trial before it ends.

Cancer.Net offers a lot of information about clinical trials in other areas of the website, including a complete section on clinical trials and places to search for clinical trials for a specific type of tumor.

The next section helps explain the areas of research going on today about brain tumors. Use the menu on the side of your screen to select Latest Research, or you can select another section, to continue reading this guide.

Brain Tumor - Latest Research

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2014

ON THIS PAGE: You will read about the scientific research being done now to learn more about brain tumors and how to treat them. To see other pages, use the menu on the side of your screen.

Doctors are working to learn more about brain tumors, ways to prevent them, how to best treat them, and how to provide the best care to people diagnosed with a brain tumor. The following areas of research may include new options for patients through clinical trials. Always talk with your doctor about the diagnostic and treatment options best for you.

Enhanced imaging tests. New techniques for imaging scans are being researched. These may help doctors better track how well treatment is working and watch for possible tumor recurrence or growth.

Biomarkers. Researchers are examining biomarkers to find better ways of using blood or other tests to determine the presence of a brain tumor before symptoms begin.

ImmunotherapyImmunotherapy, also called biological response modifier (BRM) therapy, is designed to boost the body's natural defenses to fight the cancer. It uses materials either made by the body or in a laboratory to improve, target, or restore immune system function. Different methods are being studied for brain tumors, such as the use of dendritic cells or the use of vaccines aimed against a specific molecule on the surface of the tumor cells. Several methods are currently being tested in clinical trials.

Targeted therapy. As outlined in Treatment Options, this type of treatment targets faulty genes or proteins that contribute to cancer growth and development. Research continues on the use of therapies for brain tumors that target the different ways a tumor grows, how a tumor spreads, and how tumor cells die.

Blood-brain barrier disruption. This technique temporarily disrupts the brain’s natural protective barrier in order to allow chemotherapy to more easily enter the brain from the bloodstream.

New drugs and combinations of drugs. Researchers are looking at using drugs currently used for other types of cancer as treatment for a brain tumor. In addition, combinations of drugs that target different pathways a tumor uses to grow and spread are being explored. Since tumors can develop resistance to chemotherapy, meaning the treatment stops working, another approach is to use a treatment that targets how tumor cells develop resistance.

Gene therapy. This type of therapy seeks to replace or repair abnormal genes that are causing or helping tumor growth.

Genetic research. Researchers are seeking to learn more about mutations of specific genes and how they relate to the risk and growth of brain tumors. In particular, The Cancer Genome Atlas Research Network is a large, ongoing effort by the National Institutes of Health to find out more about the link between genetics and glioblastoma. Recent results include the discovery of three specific genetic mutations not previously linked to glioblastoma: NF1, ERBB2, and PIK3R1. Other findings focused on the involvement of the MGMT gene and mutations of IDH gene. This information is useful to researchers and may eventually lead to advances in the diagnosis and treatment of this type of brain tumor. Learn more about cancer genome research.

Supportive care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current brain tumor treatments, in order to improve patients’ comfort and quality of life.

Looking for More About the Latest Research?

If you would like additional information about the latest areas of research regarding brain tumors, explore these related items that take you outside of this guide:

  • To find clinical trials specific to your diagnosis, talk with your doctor or search online clinical trial databases now.
  • Review research announced at the 2013 and 2012 ASCO Annual Meeting.
  • Visit ASCO’s CancerProgress.Net website to learn more about the historical pace of research for brain tumors. Please note this link takes you to a separate ASCO website.

The next section addresses how to cope with the symptoms of the disease or the side effects of its treatment. Use the menu on the side of your screen to select Coping with Side Effects, or you can select another section, to continue reading this guide.

Brain Tumor - Coping with Side Effects

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2014

ON THIS PAGE: You will find out more about steps to take to help cope with physical, social, and emotional side effects. This page includes several links outside of this guide to other sections of this website. To see other pages, use the menu on the side of your screen.

Fear of treatment side effects is common after a diagnosis of a brain tumor, but it may help to know that preventing and controlling side effects is a major focus of your health care team. This is called palliative or supportive care, and it is an important part of the overall treatment plan, regardless of the stage of disease.

Common side effects from each treatment option for a brain tumor are described in detail within the Treatment Options section. Learn more about the most common side effects of a tumor and different treatments, along with ways to prevent or control them. Side effects depend on a variety of factors, including the type of tumor, the grade, the length and dosage of treatment(s), and your overall health.

Before treatment begins, talk with your doctor about possible side effects of each type of treatment you will be receiving. Ask which side effects are most likely to happen, when they are likely to occur, and what can be done to prevent or relieve them. And, ask about the level of caregiving you may need during treatment and recovery, as family members and friends often play an important role in the care of a person with a brain tumor. Learn more about caregiving, or watch a video about caring for a person with a brain tumor.

In addition to physical side effects, there may be emotional and social effects as well. Patients and their families are encouraged to share their feelings with a member of their health care team who can help with coping strategies, including concerns about managing the cost of your medical care

During and after treatment, be sure to tell the health care team about the side effects you experience, even if you feel they are not serious. Sometimes, side effects can last beyond the treatment period, called a long-term side effect. A side effect that occurs months or years after treatment is called a late effect. Treatment of both types of effects is an important part of survivorship care. Learn more by reading the After Treatment section or talking with your doctor.

The next section helps explain medical tests and check-ups needed after finishing treatment. Use the menu on the side of your screen to select After Treatment, or you can select another section, to continue reading this guide.

Brain Tumor - After Treatment

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2014

ON THIS PAGE: You will read about your medical care after treatment is finished and why this follow-up care is important. To see other pages, use the menu on the side of your screen.

After treatment for a brain tumor ends, talk with your doctor about developing a follow-up care plan. This plan may include regular physical examinations and/or medical tests to monitor your recovery for the coming months and years. Many brain tumors are very likely to recur, so you should be routinely monitored for new symptoms and with regular MRI scans. How often you schedule follow-up visits and have scans depends on the type of the tumor and other factors, so your health care team will talk with you about your exact schedule.

ASCO offers treatment summary forms to help keep track of the treatment you received and develop a survivorship care plan once treatment is completed.

As described in previous sections, a brain tumor and its treatment can affect how your brain functions, as well as your overall well-being. For this reason, it is important for your health care team to evaluate your quality of life and your cognitive and functional abilities through specialized tests, typically given by a neuropsychologist. A neuropsychologist is a psychologist who has special training in the brain’s capacity and behaviors. These evaluations could identify situations when specific rehabilitative therapies would be helpful, such as speech therapy, occupational therapy, counseling with a social worker, and/or medications that can help to reduce fatigue or enhance memory. Learn more about rehabilitation.

Whenever possible, participation in a support group with other people diagnosed with brain tumors is highly encouraged.

People recovering from a brain tumor are encouraged to follow established guidelines for good health, such as maintaining a healthy weight, not smoking, eating a balanced diet, and having recommended health screening tests. Talk with your doctor to develop a plan that is best for your needs. Moderate physical activity can help rebuild your strength and energy level. Your doctor can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about the next steps to take in survivorship, including making positive lifestyle changes.

The next section offers a list of questions you may want to ask. Use the menu on the side of your screen to select Questions to Ask the Doctor, or you can select another section, to continue reading this guide.

Brain Tumor - Questions to Ask the Doctor

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2014

ON THIS PAGE: You will find some questions to ask your doctor or other members of your health care team, to help you better understand your diagnosis, treatment plan, and overall care. To see other pages, use the menu on the side of your screen.

Talking often with the doctor is important to make informed decisions about your health care. These suggested questions are a starting point to help you learn more about your care and treatment. You are also encouraged to ask additional questions that are important to you. You may want to print this list and bring it to your next appointment, or download Cancer.Net’s free mobile app for an e-list and other interactive tools to manage your care.

  • What type of brain tumor do I have?
  • Is the tumor cancerous?
  • What is the tumor’s grade? What does this mean?
  • Can you explain my pathology report (laboratory test results) to me?
  • Will an experienced neuropathologist review my pathology slides?
  • What are my treatment options?
  • What clinical trials are open to me? Where are they located, and how do I find out more about them?
  • How many brain tumors do you treat each year?
  • What treatment plan do you recommend? Why?
  • What is the goal of each treatment? Is it to eliminate the tumor, help me feel better, or both?
  • Would any of these treatment options keep me from participating in a clinical trial in the future?
  • When should I start treatment?
  • Who will be part of my health care team, and what does each member do?
  • Who will be coordinating my overall treatment and follow-up care?
  • Should I get a second opinion?
  • Do you attend expert meetings to discuss complicated tumor cases?
  • Are there brain tumor centers of excellence that you recommend I contact?
  • Does your practice include multidisciplinary care? What does this mean?
  • Who will be part of my health care team, and what is each person’s role?
  • What are the possible side effects of each treatment, both in the short term and the long term?
  • How will this treatment affect my daily life? Will I be able to work, exercise, and perform my usual activities?
  • Could this treatment affect my sex life? If so, how and for how long?
  • Could this treatment affect my ability to become pregnant or have children? If so, should I talk with a fertility specialist before treatment begins?
  • What level of caregiving will I need during treatment and recovery?
  • If I’m worried about managing the costs related to my medical care, who can help me with these concerns?
  • What support services are available to me? To my family?
  • Do you know of a local support group for people with brain tumors?
  • Do you have reading material that would help me understand my disease?
  • After treatment, what follow-up tests will I need, and how often will I need them?
  • What are the chances that the tumor will recur? If it does, will there be other treatment options available to me?
  • Whom should I call for questions or problems?

The next section offers some more resources that may be helpful to you. Use the menu on the side of your screen to select Additional Resources, or you can select another section, to continue reading this guide.

Brain Tumor - Addtional Resources

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2014

ON THIS PAGE: You will find some helpful links to other areas of Cancer.Net that provide information about medical care and treatment. This is the final page of Cancer.Net’s Guide to Brain Tumors. To go back and review other pages, use the menu on the side of your screen.

Cancer.Net includes many other sections about the medical and emotional aspects of a brain tumor, both for the person diagnosed and their family members and friends. This website is meant to be a resource for you and your loved ones from the time of diagnosis, through treatment, and beyond. Here are a few sections that may get you started in exploring the rest of Cancer.Net:

- Search for a specialist in your local area using this free database of doctors from the American Society of Clinical Oncology.

- Review dictionary articles to help understand medical phrases and terms used in your care and treatment.

- Read more about the first steps to take when newly diagnosed with a tumor.

- Find out more about clinical trials as a treatment option.

- Learn more about coping with the emotions that a tumor can bring, including those within a family or a relationship.

- Find a national, not-for-profit advocacy organization that may offer additional information, services, and support for people with a brain tumor.

- Explore next steps a person can take after active treatment is complete.

This is the end of Cancer.Net’s Guide to Brain Tumors. Use the menu on the side of your screen to select another section to continue reading this guide.