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Brain Tumor - Introduction

Approved by the Cancer.Net Editorial Board, 11/2017

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. Use the menu to see other pages. Think of that menu as a roadmap for this complete guide.

The possibility of being diagnosed with a brain tumor is a shocking and life-changing event. If your doctor suspects a brain tumor, it is important to seek out other doctors specialized in diagnosing and treating brain tumors. The brain is a complex and vital organ, and treatment often causes life-long changes.

About the brain and central nervous system

The brain and spinal column make up the central nervous system (CNS), where all vital functions are controlled. These functions include thought, speech, and body movements. This means that when a tumor grows in the CNS, it can affect a person's thought processes, the way they talk, or movements.

Anatomy of the brain

The brain is made up of 3 main parts: the cerebrum, the cerebellum, and the brain stem. The meninges, which surround the brain, are also considered part of the brain.

  • The cerebrum. This is the largest part of the brain. It contains 2 cerebral hemispheres on either side of the brain that each control the opposite side of the body. It is divided into 4 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. It also controls 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 and the cerebellum. It controls involuntary functions essential for life, such as the beating of the heart and breathing. Messages for the functions controlled by the cerebrum and cerebellum travel through the brain stem to the body.

  • The meninges. These are the membranes that surround and protect the brain and spinal cord. There are 3 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. CSF circulates around the brain and spinal cord between the arachnoid and pia layers.

View illustrations of the anatomy of the brain.

About primary brain tumors

Primary brain tumors are those that start in the brain. A primary brain tumor is described as low grade or high grade. A low-grade tumor generally grows slowly, but it can turn into a high-grade tumor. A high-grade tumor is more likely to grow faster.

In adults, secondary brain tumors, also called brain metastases, are much more common than primary tumors.

About secondary brain 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.

If cancer spreads to the meninges and the cerebrospinal fluid (CSF), it is called leptomeningeal metastases or neoplastic meningitis. This condition occurs more commonly in people with leukemia, lymphoma, melanoma, breast cancer, or lung cancer.

This section covers primary brain tumors and provides some information on brain metastases. To learn more detailed information about cancer that started elsewhere in the body and spread to the brain, read about that specific type of cancer.

Types of brain tumors

There are many types of primary brain tumors. Some cannot be assigned an exact type because the tumor’s location makes it too difficult to remove. 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’s coverage is divided into glioma and non-glioma tumor types in adults. Learn about brain tumors in children.

Gliomas

As a group, gliomas are one of the most common types of brain tumors. A glioma is a tumor that grows from a glial cell. A glial cell is a type of supportive cell in the brain. The main types of supportive cells in the brain include astrocytes, oligodendrocytes, and ependymal cells. Gliomas may be considered astrocytomas, oligodendrogliomas, or ependymomas. Gliomas are assigned a grade, which is an indication of how aggressive a tumor is likely to be. A higher grade is usually more aggressive and more likely to grow quickly. However, doctors are moving toward using tumor genetics to better classify gliomas. This is discussed later in this guide.

Currently, the 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 4 grades of astrocytoma.

    • Grade I or pilocytic astrocytoma is a slow-growing tumor that is most often benign and rarely spreads into nearby tissue. Astrocytoma in children is more common than astrocytoma in adults.

    • 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.

    • Grade III or anaplastic astrocytoma is a cancerous tumor that can quickly grow and spread to nearby tissues.

    • Grade IV or glioblastoma is a very aggressive form of astrocytoma.

  • Oligodendroglioma. Oligodendroglioma is a tumor that develops from cells called oligodendrocytes. These cells are responsible for making myelin. Myelin surrounds the nerves and is rich in protein and fatty substances called lipids. They are subclassified as either oligodendroglioma, which is considered low grade, or anaplastic oligodendroglioma.

  • Ependymoma. Ependymoma commonly begins in the passageways in the brain where CSF is made and stored. In adults, they occur more often in the spine and can also be of the myxopapillary subtype. 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. These are tumors that arise from cells in the brain that are not glial cells. Types of non-glioma tumors include:

  • Meningioma. Meningioma is the most common primary brain tumor. 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. These are tumors that start 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.

  • Medulloblastoma. Medulloblastoma is thought to start from a specific type of cell in the cerebellum. These cells are called cerebellar granule progenitor cells. It is most common in children and is usually cancerous, often spreading throughout the CNS. Similar tumors can start in other parts of the brain 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. Learn about craniopharyngioma in children.

  • Schwannoma. Schwannoma is a rare tumor that begins in the nerve sheath, or the lining of the nerves. It may often occur in the vestibular nerve, which is a nerve in the inner ear that helps control balance. It is typically noncancerous.

Looking for More of an Introduction?

If you would like more of an introduction, explore these related items. Please note that these links will take you to other sections on Cancer.Net:

  • ASCO Answers Fact Sheet: Read a 1-page fact sheets that offer an introduction to brain tumors and brain metastases. These fact sheets are available as PDFs, so it they are easy to print out.

  • 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.

The next section in this guide is Medical Illustrations. It offers drawings of body parts often affected by this disease. You may use the menu to choose a different section to read in this guide. 

Brain Tumor - Medical Illustrations

Approved by the Cancer.Net Editorial Board, 11/2017

ON THIS PAGE: You will find drawings of the main body parts affected by this disease. Use the menu to see other pages. 

The image is two drawings showing different parts of a person’s brain. The largest part of the brain, the cerebrum, is made up of four lobes: the frontal lobe at the front of the skull, the parietal lobe at the upper rear of the skull, above the occipital lobe, which is at the back of the skull, and the temporal lobe, which is located under the frontal and parietal lobes on both sides of the cerebrum. The cerebellum is located under the occipital and temporal lobes at the rear of the skull. The brain stem includes the pons and the medulla oblongata, which connects to the spinal cord. Copyright 2004 American Society of Clinical Oncology. Robert Morreale/Visual Explanations, LLC.

The image is a drawing of a cross-section of the skull and meninges. It shows the layers of membranes that surround and protect the brain. The first layer shows the skin covering the skull bone. Beneath the skull is the dura mater, which surrounds the arachnoid mater.  Cerebrospinal fluid circulates in the sub arachnoid space between arachnoid mater and the pia mater, which covers the cerebral cortex (the brain). Copyright 2004 American Society of Clinical Oncology. Robert Morreale/Visual Explanations, LLC.

The next section in this guide is Statistics. It helps explain the number of people who are diagnosed with this disease and general survival rates. You may use the menu to choose a different section to read in this guide.

Brain Tumor - Statistics

Approved by the Cancer.Net Editorial Board, 11/2017

ON THIS PAGE: You will find information about the number of people who are diagnosed with a brain tumor each year. You will also read general information on surviving the disease. Remember, survival rates depend on several factors. Use the menu to see other pages.

A primary brain or spinal cord tumor is a tumor that starts in the brain or spinal cord. This year, an estimated 23,880 adults (13,720 men and 10,160 women) in the United States will be diagnosed with primary cancerous tumors of the brain and spinal cord this year. Brain tumors account for 85% to 90% of all primary CNS tumors.

Also, about 3,560 children will be diagnosed with a brain or CNS tumor this year. This rest of this guide deals with adult primary brain tumors. Learn about brain tumors in children.

In addition to primary brain tumors, there are also secondary brain tumors or brain metastases. This is when the tumor started somewhere else in the body and spread to the brain. The most common cancers that spread to the brain are bladderbreastkidney, and lung cancers, leukemia, lymphoma, and melanoma. This guide covers primary adult brain tumors only.

Brain and other nervous system cancer is the 10th leading cause of death for women. It is estimated that 16,830 adults (9,490 men and 7,340 women) will die from primary cancerous brain and CNS tumors this year.

The 5-year survival rate tells you what percent of people live at least 5 years after the tumor is found. Percent means how many out of 100. The 5-year survival rate for people with cancerous brain or CNS tumors is 34% for men and 36% for women. However, survival rates vary widely and depends on several factors, including the type of brain or spinal cord tumor. Talk with your doctor about what to expect with your diagnosis.

It is important to remember that statistics on the survival rates for people with a brain tumor are an estimate. The estimate comes from annual data based on the number of people with this tumor in the United States. Also, experts measure the survival statistics every 5 years. So the estimate may not show the results of better diagnosis or treatment available for less than 5 years. People should talk with their doctor if they have questions about this information. Learn more about understanding statistics.

Statistics adapted from the Central Brain Tumor Registry of the United States; the National Cancer Institute; and the American Cancer Society's publication, Cancer Facts & Figures 2018.

The next section in this guide is Risk Factors. It explains what factors may increase the chance of developing a brain tumor. Use the menu to choose a different section to read in this guide.

Brain Tumor - Risk Factors

Approved by the Cancer.Net Editorial Board, 11/2017

ON THIS PAGE: You will find out more about the factors that increase the chance of developing a brain tumor. Use the menu to see other pages.

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. Knowing your risk factors and talking about them with your doctor may help you make more informed decisions. But, at this time, there are no known ways to prevent a brain tumor through lifestyle changes.

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. However, there is not yet scientific evidence that supports this possible link.

  • 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. More data are needed to find out if exposure to infections, other viruses, or allergens increase the risk of a brain tumor in people. Of note, studies have shown that patients with a history of allergies or skin conditions have a lower risk of glioma. 

  • Electromagnetic fields. Most studies evaluating the role of electromagnetic fields, such as energy from power lines or from cell phone use, show no link to an increased risk of developing a brain tumor in adults. Because of conflicting information regarding risk in children, 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 been shown 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 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.

The next section in this guide is Symptoms and Signs. It explains what body changes or medical problems this disease can cause. You may use the menu to choose a different section to read in this guide.  

Brain Tumor - Symptoms and Signs

Approved by the Cancer.Net Editorial Board, 11/2017

ON THIS PAGE: You will find out more about body changes and other things that can signal a problem that may need medical care. Use the menu to see other pages.

People with a brain tumor may experience the following symptoms or signs. Sometimes, people with a brain tumor do not have any of these changes. Or, the cause of a symptom may be a different 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 well 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 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 are listed 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

  • Drowsiness

  • Sleep problems

  • Memory problems

  • Changes in ability to walk or perform daily activities

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 the cerebrum.

  • Altered perception of touch or pressure, arm or leg weakness on 1 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 linked 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 any changes you experience, 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 figure 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 the 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 in this guide is Diagnosis. It explains what tests may be needed to learn more about the cause of the symptoms. You may use the menu to choose a different section to read in this guide.

Brain Tumor - Diagnosis

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ON THIS PAGE: You will find a list of common tests, procedures, and scans that doctors use to find the cause of a medical problem. Use the menu to see other pages.

Doctors use many tests to find, or diagnose, a brain tumor and learn the type of brain tumor. They also do tests to learn if it has spread to another part of the body from where it started. This is called metastasis and is rare for a brain tumor. Doctors may also do tests to learn which treatments could work best.

For most types of tumors, taking a sample of the possible tumor is the only sure way for the doctor to know whether an area of the body has a tumor. This may be done in a procedure called a biopsy or by removing part or all of the tumor with surgery. In a biopsy, the doctor takes a small sample of tissue for testing in a laboratory. If this is not possible, the doctor may suggest other tests that will help make a diagnosis.

Imaging tests can help doctors find out if the tumor is a primary brain tumor or if it is cancer that has spread to the brain from elsewhere in the body. Imaging tests show pictures of the inside of the body. Your doctor may consider these factors when choosing a diagnostic test:

  • The type of tumor suspected

  • Your signs and symptoms

  • Your age and medical condition

  • The results of earlier medical tests

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. These tests are to help find out the presence, and perhaps the type or grade, of a brain tumor.

In general, diagnosing a brain tumor usually begins with magnetic resonance imaging (MRI). Once MRI 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. These tests and procedures are described below in more detail.

  • MRI. An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. MRI can 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. 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. Then, a second MRI is 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.

  • Tissue sampling/biopsy/surgical removal of a tumor. 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. A pathologist then analyzes the sample(s). 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 surgery may be done as a separate procedure if completely removing the tumor is not possible because of its location or a patient’s health.

Your health care team may also recommend other tests to help make a diagnosis or find out how well treatment is working. Not all tests listed below will be used for every person.

  • CT scan. A CT scan creates a 3-dimensional picture of the inside of the body using x-rays taken from different angles. A computer 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 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.
  • Positron emission tomography (PET) or PET-CT scan. A PET scan is used at first to find out more about a tumor while a patient is receiving treatment. It may also be used if the tumor comes back after treatment. A PET scan is usually combined with a CT scan (see above), called a PET-CT scan. However, you may hear your doctor refer to this procedure just as a PET scan. A PET scan is a way to create pictures of organs and tissues inside the body using various substances, such as sugars or proteins. A small amount of a radioactive substance is injected into the patient’s body. This substance is taken up by cells that are actively dividing. Because tumor cells are more likely to be actively dividing, they absorb 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. The doctor may recommend a myelogram to find out if the tumor has spread to the spinal fluid, other parts of the brain, or the spinal cord. 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.
  • 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. Some biomarkers may help doctors determine a patient’s prognosis, which is the chance of recovery (see Grades and Prognostic Factors). Researchers are examining biomarkers to find ways to diagnose a brain tumor before symptoms begin. Ultimately, results of these tests may help decide whether your treatment options include a type of treatment called targeted therapy (see Treatment Options). The markers most commonly looked at for brain tumors include:
    • For oligodendroglioma, the loss of the p-arm of chromosome 1 and the loss of the q-arm of chromosome 19. This is called a 1p/19q co-deletion. It is linked to more successful treatment, particularly with chemotherapy. It 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. 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 linked with a better prognosis in both low-grade and high-grade tumors.

    • In glioblastoma, whether a gene called methyl guanine methyl transferase (MGMT) is changed can help the doctor understand a patient’s prognosis and how well treatment will work. Its role in determining the benefit of treatment is being tested in clinical trials.

  • 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. This specialist will write a formal report to compare with future assessments or 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 brain 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 in this guide is Grades and Prognostic Factors. It explains the system doctors use to describe a brain tumor. You may use the menu to choose a different section to read in this guide.

Brain Tumor - Grades and Prognostic Factors

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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. Use the menu to see other pages.

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. 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 Diagnosissection, a sample of the tumor is removed for analysis. Tumor histology includes the type of tumor, the grade, and additional molecular features that predict how quickly the tumor can grow. Together, these factors will help your doctor understand how the tumor will behave. These factors may also help determine a patient’s treatment options.

    Grade describes specific features in the tumor that are linked with specific outcomes. For example, doctors may consider whether the tumor cells are growing out of control or if there are a lot of dead cells. Tumors with features generally linked with growing more quickly are given a higher grade. For most tumors, the lower the grade, the better the prognosis.

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

    • Grade I. These tumors are slow growing and unlikely to spread. They can often be cured with surgery.

    • Grade II. These tumors are less likely to grow and spread but are more likely to come back after treatment.

    • Grade III. These tumors are more likely to have rapidly dividing cells but no dead cells. They can grow quickly.

    • Grade IV. In a grade IV tumor, cells in the tumor are actively dividing. In addition, the tumor has blood vessel growth and areas of dead tissue. These tumors can grow and spread quickly.

  • Age. In adults, a person’s age 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.

  • Symptoms. The symptoms a patient has and how long they last may also help determine prognosis. For example, seizures and having symptoms for a long time are linked with a better prognosis.

  • Extent of tumor residual. Resection is surgery to remove a tumor. Residual refers to how much of the tumor remains in the body after surgery. A patient’s prognosis is better when all of the tumor can be surgically removed. There are 4 classifications:

    • 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.

  • 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.

  • Molecular features. Certain genetic mutations found in the tumor may help determine prognosis. These include: IDH1, IDH2, MGMT, and a 1p/19q co-deletion.

  • 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

  • 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.

  • Recurrent tumor. A recurrent tumor is one that has come back after treatment. If the tumor does return, there will be another round of tests to learn about the extent of the recurrence. These tests and scans are often similar to those done at the time of the original diagnosis.

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, Eighth Edition published by Springer-Verlag New York, www.cancerstaging.org.

Information about the tumor’s grade, as well as the prognostic factors, will help the doctor recommend a specific treatment plan. The next section in this guide is Treatment Options. You may use the menu to choose a different section to read in this guide.

Brain Tumor - Treatment Options

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ON THIS PAGE: You will learn about the different treatments doctors use for people with a brain tumor. Use the menu to see other pages.

This section tells you the treatments that are the standard of care for a brain tumor. “Standard of care” means the best treatments known. When making treatment plan decisions, patients are encouraged to consider clinical trials as an option. A clinical trial is a research study that tests a new approach to treatment. Doctors want to learn whether the new treatment is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug, a new combination of standard treatments, or new doses of standard drugs or other treatments. Your doctor can help you consider all your treatment options. To learn more about clinical trials, see the About 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. Cancer care teams include a variety of other health care professionals, such as physician assistants, oncology nurses, social workers, pharmacists, counselors, dietitians, and others. It is important to have a care team that specializes in caring for people with a brain tumor, which may mean talking with medical professionals not in your immediate area to help with diagnosis and treatment planning.

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:

  • The size, type, and grade of the tumor

  • Whether the tumor is putting pressure on vital parts of the brain

  • If the tumor has spread to other parts of the CNS or body

  • Possible side effects

  • 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 therapy 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. 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, parts of the tumor may remain that are too small to be seen or removed during surgery. Radiation therapy can also damage healthy tissue.

However, research in the past 20 years has helped to significantly lengthen the lives of people with a brain tumor. 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. Talk with your doctor about the goals of each treatment 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 treatments intended 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 is any treatment that focuses on reducing symptoms, improving quality of life, and supporting patients and their families. Any person, regardless of age or type and stage of cancer, may receive palliative care. It works best when palliative care is started as early as needed in the treatment process. People often receive treatment for the tumor at the same time that they receive treatment to ease side effects. In fact, patients who receive both at the same time often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional support, and other therapies. You may also receive palliative treatments similar to those meant to eliminate the tumor, such as chemotherapy, surgery, or 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 the daily lives of patients and their family caregivers. However, symptoms can often be managed with the use of certain medications. Supportive care for people with a brain tumor includes:

  • Drugs called corticosteroids. These are used to lower swelling in the brain, which can lessen pain from the swelling without the need for prescription pain medications. These drugs may also help improve neurological symptoms by decreasing the pressure from the tumor and swelling in the healthy brain tissue.

  • Antiseizure medicines. These help control seizures, and there are several types of drugs available. They are prescribed by your neurologist.

Before treatment begins, talk with your health care team about the possible side effects of your specific treatment plan and palliative care options. It is also important to talk about the level of caregiving needed at home. During and after treatment, be sure to tell your doctor or another health care team member if you are experiencing a problem so it can be addressed as quickly as possible. Learn more about palliative care.

Surgery

Surgery is the removal of the tumor and some surrounding healthy 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, enhanced imaging, and fluorescent dyes.

  • Cortical mapping allows doctors to identify areas of the brain that control the senses, language, and motor skills.

  • 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. However, this is a very specialized technique that may not be widely available.

  • A fluorescent dye, called 5 aminolevulinic acid, can be given by mouth the morning before surgery. This dye is taken up by tumor cells. Doctors can use a special microscope and light to see the cells that have taken up the dye during the surgery. This helps doctors safely remove as much of the tumor as possible.

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. Then, special electrical stimulation techniques are used to locate the specific part of the brain that controls speech. This approach can 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 it 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 it is near a vital structure. These tumors are called inoperable. If the tumor is inoperable, the doctor will recommend other treatment options that may also include a biopsy or removal of a portion of the tumor.

Before surgery, talk with your health care team about the possible side effects from the specific surgery you will have. Learn more about the basics of surgery.

Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to destroy tumor 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, or 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.

  • 3-dimensional conformal radiation therapy (3D-CRT). Using images from CT and MRI scans (see Diagnosis), a 3-dimensional model of the tumor and healthy 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. It can deliver 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 tumor cells. Proton beam therapy is typically used for tumors when less radiation is needed because of the location. This includes tumors that have grown into nearby bone, such as the base of skull, and those near the optic nerve.

  • 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 1 area of the brain and certain noncancerous tumors. It can also be used when a person has more than 1 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 1-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 healthy 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 multiple 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 5 because of the high risk of damage to their developing brains. Longer term side effects of radiation therapy depend on how much healthy tissue received radiation and include memory and hormonal problems and cognitive (thought process) changes, such as difficulty understanding and performing complex tasks.

Learn more about the basics of radiation therapy.

Chemotherapy

Chemotherapy is the use of drugs to destroy tumor cells, usually by ending the cancer cells’ ability to grow and divide. The goal of chemotherapy can be to destroy tumor cells remaining after surgery, slow a tumor’s growth, or reduce symptoms. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating tumors with medication. Chemotherapy may also be given by a neuro-oncologist.

Systemic chemotherapy gets into the bloodstream to reach tumor 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. It may also be given through a catheter or port, which are used to make IV injections easier.

As explained above, chemotherapy to treat a brain tumor is typically given after surgery and possibly with or after radiation therapy, particularly if the tumor has come back after initial treatment.

A chemotherapy regimen, or schedule, usually consists of a specific number of cycles given over a set period of time. A patient may receive 1 drug at a time or combinations of different drugs given at the same time.

Some drugs are better at going through the blood-brain barrier. These are the drugs often used for a brain tumor.

  • Gliadel wafers are one way to give the drug carmustine. These wafers are placed in the area where the tumor was removed during surgery.

  • For people with glioblastoma and high-grade glioma, the latest standard of care is radiation therapy with daily low-dose temozolomide (Temodar). This is followed by monthly doses of temozolomide after radiation therapy for 6 months to 1 year.

  • A combination of 3 drugs, lomustine (Gleostine), 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 after radiation therapy for a low-grade tumor 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 2 to 3 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 after 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 after 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.

Learn more about the basics of chemotherapy and preparing for treatment. The medications used to treat a brain tumor 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 a tumor’s 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 1 target. To find the most effective treatment, your doctor may run tests to identify the genes, proteins, and other factors in your tumor. This helps doctors 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 the basics of targeted treatments.

For a brain tumor, anti-angiogenesis therapy is a 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, Mvasi) 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.

Alternating electric field therapy (tumor treating fields)

This type of treatment uses a noninvasive portable device that 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. The available device is called Optune.

Alternating electrical field therapy may be an option for people newly diagnosed with glioblastoma or for those with recurrent glioblastoma. Researchers have found that people with recurrent glioblastoma who used the device lived as long as those who received chemotherapy. In addition, they had fewer side effects. Other research shows that patients newly diagnosed with glioblastoma lived longer and were less likely to have the disease worsen when this treatment was used along temozolomide after radiation therapy. This treatment approach is now considered a recommended option for glioblastoma.

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 causes many people to worry that the tumor will come back. It is important to talk with your doctor about the possibility of the tumor returning. Understanding your 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 new cycle of testing will begin again to learn as much as possible about the recurrence. After this testing is done, you and your doctor will talk about your treatment options. Often the treatment plan will include the treatments 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. Options may include:

  • Temozolomide for grade III recurrent tumors

  • Bevacizumab

  • Alternating electric field therapy for patients with recurrent high-grade glioma

There is no single approach to treating a recurrent brain tumor, and your treatment plan will be based on many factors. Whichever treatment plan you choose, palliative care will be important for relieving 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 a recurrent brain tumor 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 a recurrence.

Metastatic cancer

If cancer spreads to the brain or CNS from where it started, doctors call it metastatic cancer or a secondary brain tumor. If this happens, it is a good idea to talk with doctors who have experience in treating it. Doctors can have different opinions about the best standard treatment plan. Also, clinical trials might be an option. Learn more about getting a second opinion before starting treatment, so you are comfortable with your chosen treatment plan.

Your treatment plan may include a combination of surgery, radiation therapy, targeted therapy, and immunotherapy.

Treatment of brain metastases

If cancer spread to the brain from another part of the body, it is called brain metastasis. Brain metastases have traditionally been treated with surgery or radiation therapy. Chemotherapy is not often used because the blood-brain barrier keeps many drugs from reaching the brain. In the past, it was mostly used if radiation therapy did not work. Current options for treating brain metastases include:

  • Surgery. Surgery is generally only an option for patients who have a single are of cancer in the brain. Radiation therapy is often given afterwards.

  • Radiation therapy. Whole-brain radiation therapy (WBRT) is radiation therapy given to the entire brain. Sometimes, doctors can avoid damaging part of the brain called hippocampus. This helps lessen the cognitive side effects linked with radiation therapy. High-dose radiation therapy can be given using stereotactic techniques that focus the radiation only on the tumor in the brain, which can also help lessen the side effects. This method works very well for getting rid of existing tumors, but it may not prevent new tumors from developing.

  • Targeted therapy. Some types of targeted therapy can easily enter the brain and are able to target specific genetic changes in the tumor. These include:

    • Osimertinib (Tagrisso) for non-small cell lung cancer (NSCLC) that has a genetic change on the EGFR gene

    • Alectinib (Alecensa) for NSCLC with a genetic change on the ALK gene

    • Lapatinib (Tykerb) may be used for HER2-positive breast cancer

    • Dabrafenib (Tafinlar) either by itself or along with trametinib (Mekinist) and vemurafenib (Zelboraf) for melanoma

  • Immunotherapy. Some types of immunotherapy have shown promise in treating brain metastases from lung cancer and melanoma. These include ipilimumab (Yervoy), nivolumab (Opdivo), and pembrolizumab (Keytruda).

Treatment of leptomeningeal metastases

If cancer spreads to the meninges or the CSF, it is called leptomeningeal metastases. People with leptomeningeal metastases may receive chemotherapy given directly into the CSF of the brain. This may be done with a lumbar puncture, called intrathecal chemotherapy. Or it may be given using a catheter with a reservoir, called an Ommaya reservoir. Radiation therapy may also be an option.  

Learn more about cancer that started elsewhere in the body and spread to the brain or CNS by reading about that specific type of cancer.

For most patients, a diagnosis of metastatic cancer 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. It may also be helpful to talk with other patients, including through a support group.

If treatment doesn’t work

Recovery from a brain tumor is not always possible. If the tumor cannot be cured or controlled, the disease may be called advanced or terminal.

This diagnosis is stressful, and for many people, an advanced brain tumor is difficult to discuss. 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 6 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 talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment can make staying at home a workable option 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 in this guide is About Clinical Trials. It offers more information about research studies that are focused on finding better ways to care for people with a brain tumor. You may use the menu to choose a different section to read in this guide.

Brain Tumor - About Clinical Trials

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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. Use the menu to see other pages.

Doctors and scientists are always looking for better ways to care for patients with a brain tumor. To make scientific advances, doctors create research studies involving volunteers, called clinical trials. In fact, every drug that is now approved by the U.S. Food and Drug Administration (FDA) was tested in clinical trials.

What are clinical trials?

Many clinical trials focus on new treatments. Researchers want to learn if a new treatment is safe, effective, and possibly better than the treatment doctors use now. 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 can be some of the first to get a treatment before it is available to the public. However, there are some risks with a clinical trial, including possible side effects and that the new treatment may not work. People are encouraged to talk with their health care team about the pros and cons of joining a specific study.

Some clinical trials study new ways to relieve symptoms and side effects during treatment. Others study ways to manage the late effects that may happen a long time after treatment. Talk with your doctor about clinical trials for symptoms and side effects. There are also clinical trials studying ways to prevent cancer.

Deciding to join a clinical trial

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 a way to contribute to the 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.

Insurance coverage of clinical trials costs differs by location and by study. In some programs, some of the patient’s expenses from participating in the clinical trial are reimbursed. In others, they are not. It is important to talk with the research team and your insurance company first to learn if and how your treatment in a clinical trial will be covered. Learn more about health insurance coverage of clinical trials.

Sometimes people have concerns that, in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill.” Placebos are usually combined with standard treatment in most cancer clinical trials. When a placebo is used in a study, it is done with the full knowledge of the participants. Find out more about placebos in cancer clinical trials.

Patient safety and informed consent

To join a clinical trial, patients must participate in a process known as informed consent. During informed consent, the doctor should:

  • Describe all of the patient’s options, so that the person understands how the new treatment differs from the standard treatment.

  • List all of the risks of the new treatment, which may or may not be different than the risks of standard treatment.

  • 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.

Clinical trials also have certain rules called “eligibility criteria” that help structure the research and keep patients safe. You and the research team will carefully review these criteria together.

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.

Finding a clinical trial

Research through clinical trials is ongoing for all tumor types. For specific topics being studied for brain tumors, learn more in the Latest Research section.

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.

In addition, this website offers free access to a video-based educational program about clinical trials, located outside of this guide.

The next section in this guide is Latest Research. It explains areas of scientific research currently going on for brain tumors. You may use the menu to choose a different section to read in this guide.    

Brain Tumor - Latest Research

Approved by the Cancer.Net Editorial Board, 11/2017

ON THIS PAGE: You will read about the scientific research being done now to learn more about brain tumors and how to treat them. Use the menu to see other pages.

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 best diagnostic and treatment options 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 that may help diagnose a brain tumor, estimate a patient’s prognosis, and/or predict whether a specific treatment may work.

  • Immunotherapy. Immunotherapy, 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.

  • Oncolytic virus therapy. This therapy uses a virus that infects and destroys tumor cells, sparing healthy brain cells. It is currently being researched as a treatment for brain tumors.

  • Targeted therapy. As outlined in Treatment Options, this type of treatment targets faulty genes or proteins that contribute to a tumor’s 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 glioma. Recent results include the discovery of 3 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 glioma. Precision medicine approaches that target tumor-specific mutations are being explored.

  • Palliative care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current brain tumor treatments 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:

  • Visit the website of the Conquer Cancer Foundation to find out how to help support cancer research. Please note that this link takes you to a separate ASCO website. 

The next section in this guide is Coping with Treatment. It offers some guidance in how to cope with the physical, emotional, and social changes that a brain tumor and its treatment can bring. You may use the menu to choose a different section to read in this guide.

Brain Tumor - Coping with Treatment

Approved by the Cancer.Net Editorial Board, 11/2017

ON THIS PAGE: You will learn more about coping with the physical, emotional, social, and financial effects of a brain tumor and its treatment. This page includes several links outside of this guide to other sections of this website. Use the menu to see other pages.

Every treatment for a brain tumor can cause side effects or changes to your body and how you feel. For many reasons, people don’t experience the same side effects even when they are given the same treatment for the same type of tumor. This can make it hard to predict how you will feel during treatment.

As you prepare to start treatment, it is normal to fear treatment-related side effects. It may help to know that your health care team will work to prevent and relieve side effects. Doctors call this part of treatment “palliative care.” It is an important part of your treatment plan, regardless of your age or the stage of disease.

Coping with physical side effects

Common physical side effects from each treatment option for a brain tumor are described within the Treatment Options section. Learn more about side effects of a brain tumor and its treatment, along with ways to prevent or control them. Changes to your physical health depend on several factors, including the tumor’s location and grade, the length and dose of treatment, and your general health.

Sometimes, physical side effects can last after treatment ends. Doctors call these long-term side effects. They call side effects that occur months or years after treatment late effects. Treating long-term side effects and late effects is an important part of survivorship care. Learn more by reading the Follow-up Care section of this guide or talking with your doctor.

Coping with emotional and social effects

You can have emotional and social effects as well as physical effects after a brain tumor diagnosis. This may include dealing with difficult emotions, such as sadness, anxiety, or anger, or managing your stress level. Sometimes, patients have problems expressing how they feel to their loved ones, or people don’t know what to say in response.

Patients and their families are encouraged to share their feelings with a member of their health care team. You can also find coping strategies for emotional and social effects in a separate section of this website. This section includes many resources for finding support and information to meet your needs.

Coping with financial effects

Treatment for a brain tumor can be expensive. It is often a big source of stress and anxiety for patients and their families. In addition to treatment costs, many people find they have extra, unplanned expenses related to their care. For some people, the high cost stops them from following or completing their treatment plan. This can put their health at risk and may lead to higher costs in the future. Patients and their families are encouraged to talk about financial concerns with a member of their health care team. Learn more about managing financial considerations, in a separate part of this website.

Caring for a loved one with a brain tumor

Family members and friends often play an important role in taking care of a person with a brain tumor. This is called being a caregiver. Caregivers can provide physical, practical, and emotional support to the patient, even if they live far away.

Patients with a brain tumor often need a lot of support at home. Many patients may not be able to do activities important for their care, such as driving to appointments. And some may need modified living arrangements to accommodate physical challenges. This means that caregivers have a range of responsibilities on a daily or as-needed basis. Below are some of the responsibilities caregivers may take care of:

  • Providing support and encouragement

  • Giving medications

  • Helping manage symptoms and side effects of the tumor and treatment

  • Coordinating medical appointments

  • Providing transportation

  • Assisting with meals

  • Helping with household chores

  • Handling insurance and billing issues

  • Anticipating changes in mood, personality, and thinking and knowing how to best cope with these changes

Learn more about caregiving.

Talking with your health care team about side effects

Before starting treatment, talk with your doctor about possible side effects. Ask:
 

  • Which side effects are most likely?

  • When are they are likely to happen?

  • What can we do to prevent or relieve them?

Be sure to tell your health care team about any side effects that happen during treatment and afterward, too. Tell them even if you don’t think the side effects are serious. This discussion should include physical, emotional, and social effects.

Also, ask how much care you may need at home and with daily tasks during and after treatment. This can help you make a caregiving plan.

The next section in this guide is Follow-up Care. It explains the importance of checkups after treatment for a brain tumor is finished. You may use the menu to choose a different section to read in this guide.  

Brain Tumor - Follow-Up Care

Approved by the Cancer.Net Editorial Board, 11/2017

ON THIS PAGE: You will read about your medical care after treatment for a brain tumor is completed, and why this follow-up care is important. Use the menu to see other pages.

Care for people diagnosed with a brain tumor doesn’t end when active treatment has finished. Your health care team will continue to check to make sure the tumor has not returned, manage any side effects, and monitor your overall health. This is called follow-up care.

Your follow-up care may include regular physical examinations, medical tests, or both. Doctors want to keep track of your recovery in the months and years ahead.

Learn more about the importance of follow-up care.

Watching for recurrence

One goal of follow-up care is to check for a recurrence. A tumor recurs because small areas of tumor cells may remain undetected in the body. Over time, these cells may increase in number until they show up on test results or cause signs or symptoms.

During follow-up care, a doctor familiar with your medical history can give you personalized information about your risk of recurrence. Your doctor will ask specific questions about your health. Some people may have blood tests or imaging tests done as part of regular follow-up care, but testing recommendations depend on several factors including the type and grade of tumor originally diagnosed and the types of treatment given.

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.

The anticipation before having a follow-up test or waiting for test results can add stress to you or a family member. This is sometimes called “scan-xiety.” Learn more about how to cope with this type of stress.

Managing long-term and late side effects

Most people expect to experience side effects when receiving treatment. However, it is often surprising to survivors that some side effects may linger beyond the treatment period. These are called long-term side effects. Other side effects called late effects may develop months or even years afterwards. Long-term and late effects can include both physical and emotional changes.

Talk with your doctor about your risk of developing such side effects based on the type of tumor, your individual treatment plan, and your overall health. If you had a treatment known to cause specific late effects, you may have certain physical examinations, scans, or blood tests to help find and manage them.

As described in previous sections, a brain tumor and its treatment can affect how your brain functions and 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. These tests are 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. Options for rehabilitative therapy include:

  • Speech therapy

  • Occupational therapy

  • Counseling with a social worker

  • Medications to reduce fatigue or enhance memory

The goal of rehabilitation is to help people regain control over many aspects of their lives and remain as independent and productive as possible. Learn more about rehabilitation.

Keeping personal health records

You and your doctor should work together to develop a personalized follow-up care plan. Be sure to discuss any concerns you have about your future physical or emotional health. ASCO offers forms to help create a treatment summary to keep track of the treatment you received and develop a survivorship care plan when treatment is completed.

This is also a good time to decide who will lead your follow-up care. Some survivors continue to see their oncologist, while others transition back to the care of their family doctor or another health care professional. This decision depends on several factors, including the type and grade of tumor, side effects, health insurance rules, and your personal preferences.

If a doctor who was not directly involved in your care will lead your follow-up care, be sure to share your treatment summary and survivorship care plan forms with him or her and with all future health care providers. Details about your treatment are very valuable to the health care professionals who will care for you throughout your lifetime.

The next section in this guide is Survivorship. It describes how to cope with challenges in everyday life after a brain tumor diagnosis. You may use the menu to choose a different section to read in this guide.

Brain Tumor - Survivorship

Approved by the Cancer.Net Editorial Board, 11/2017

ON THIS PAGE: You will read about how to cope with challenges in everyday life after a brain tumor diagnosis. Use the menu to see other pages.

What is survivorship?

The word “survivorship” means different things to different people. Common definitions include:

  • Having no signs of the tumor after finishing treatment.

  • Living with, through, and beyond the diagnosis. According to this definition, survivorship begins at diagnosis and includes people who continue to have treatment over the long term, to either reduce the risk of recurrence or to manage chronic disease.

Survivorship is one of the most complicated parts of having a brain tumor. This is because it is different for everyone.  

Survivors may experience a mixture of strong feelings, including joy, concern, relief, guilt, and fear. Some people say they appreciate life more after the diagnosis and have gained a greater acceptance of themselves. Others become very anxious about their health and uncertain about coping with everyday life.

Survivors may feel some stress when their frequent visits to the health care team end after completing treatment. Often, relationships built with the health care team provide a sense of security during treatment, and people miss this source of support. This may be especially true when new worries and challenges surface over time, such as any late effects of treatment, emotional challenges including fear of recurrence, sexuality and fertility concerns, and financial and workplace issues.

Every survivor has individual concerns and challenges. With any challenge, a good first step is being able to recognize your fears and talk about them. Effective coping requires:

  • Understanding the challenge you are facing

  • Thinking through solutions

  • Asking for and allowing the support of others

  • Feeling comfortable with the course of action you choose

Whenever possible, participation in a support group with other people diagnosed with brain tumors is highly encouraged. This allows you to talk with people who have had similar first-hand experiences. Other options for finding support include talking with a friend or member of your health care team, individual counseling, or asking for assistance at the learning resource center of the place where you received treatment.

Changing role of caregivers

Family members and friends may also go through periods of transition. A caregiver plays a very important role in supporting a person diagnosed with a brain tumor, providing physical, emotional, and practical care on a daily or as-needed basis. Many caregivers become focused on providing this support, especially if the treatment period lasts for many months or longer.

However, as treatment is completed, the caregiver's role often changes. Eventually, the need for caregiving related to the diagnosis will become much less or come to an end. Caregivers can learn more about adjusting to life after caregiving in this article.

A new perspective on your health

For many people, survivorship serves as a strong motivator to make positive lifestyle changes.

People recovering from a brain tumor are encouraged to follow established guidelines for good health, such as not smoking, limiting alcohol, eating well, and managing stress. Regular physical activity can help rebuild your strength and energy level. Your health care team can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about making healthy lifestyle choices.

It is important to have recommended medical checkups and tests (see Follow-up Care) to take care of your health. Talk with your doctor to develop a survivorship care plan that is best for your needs.

Looking for More Survivorship Resources?

For more information about survivorship, explore these related items. Please note that these links will take you to other sections of Cancer.Net:

  • ASCO Answers Cancer Survivorship Guide: Get this 44-page booklet that helps people transition into life after treatment. It includes blank treatment summary and survivorship care plan forms. The booklet is available as a PDF, so it is easy to print out.

  • Cancer.Net Patient Education Video: View a short video led by an ASCO expert that provides information about what comes next after finishing treatment.

  • Survivorship Resources: Cancer.Net offers an entire area of this website with resources to help survivors, including those in different age groups.

The next section offers Questions to Ask the Health Care Team to help start conversations with your health care team. You may use the menu to choose a different section to read in this guide.  

Brain Tumor - Questions to Ask the Doctor

Approved by the Cancer.Net Editorial Board, 11/2017

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. Use the menu to see other pages.

Talking often with the health care team 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 a digital list and other interactive tools to manage your care.

Questions to ask after getting a diagnosis

  • 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?

  • Do you have reading material that would help me understand my disease?

  • Who will be leading my overall treatment?

  • 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?

  • If I’m worried about managing the costs of medical care, who can help me?

  • Do you know of a local support group for people with brain tumors?

Questions to ask about choosing a treatment and managing side effects

  • What are my treatment options?

  • What clinical trials are available for 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?

  • 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?

  • Whom should I call with questions or problems?

Questions to ask about having surgery

  • What type of surgery will I have?

  • How long will the operation take?

  • How long will I be in the hospital?

  • Can you describe what my recovery from surgery will be like?

  • What are the possible long-term effects of having this surgery?

Questions to ask about having radiation therapy, chemotherapy, or targeted therapy

  • What type of treatment is recommended?

  • What is the goal of this treatment?

  • How long will it take to give this treatment?

  • What side effects can I expect during treatment?

  • What are the possible long-term effects of having this treatment?

  • What can be done to relieve the side effects?

Questions to ask about planning follow-up care

  • What is the chance that the tumor will come back? Should I watch for specific signs or symptoms?

  • What long-term side effects or late effects are possible based on the treatment I received?

  • After treatment, what follow-up tests will I need, and how often will I need them?

  • How do I get a treatment summary and survivorship care plan to keep in my personal records?

  • Who will be leading my follow-up care?

  • What survivorship support services are available to me? To my family?

The next section in this guide is Additional Resources. It offers some more resources on this website beyond this guide that may be helpful to you. You may use the menu to choose a different section to read in this guide.

Brain Tumor - Additional Resources

Approved by the Cancer.Net Editorial Board, 11/2017

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. Use the menu to go back and see other pages.

Cancer.Net includes many other sections about the medical and emotional aspects of a brain tumor 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.

Beyond this guide, here are a few links to help you explore other parts of Cancer.Net:

  • To find a range of information and insights from different voices on timely cancer topics, visit the Cancer.Net Blog.

This is the end of Cancer.Net’s Guide to Brain Tumors. You may use the menu to choose a different section to read in this guide.