Brain tumours

What causes a brain tumour?

In almost all cases, doctors and researchers don't know exactly what causes a primary brain tumour. Some things may raise a person's chances of developing one. These are called risk factors.

It's important to remember that having a risk factor doesn't mean you will definitely get a brain tumour. Only a small number of people who have one of these risk factors actually go on to develop a brain tumour.

Macmillan Cancer Support has more information about the different possible risk factors for a brain tumour.

Diagnosing brain tumours

Many people are diagnosed with a brain tumour when they go to hospital after having a seizure (fit) or other sudden symptoms. Other people go to see their GP about symptoms.

If your GP thinks you may have a brain tumour, they’ll arrange for you to have a brain scan. Or they may refer you directly to a neurologist. This is a doctor who specialises in brain disorders.

You may have already had a CT scan of your brain. A CT scan can show some changes, like bleeding or swelling in the brain. But you’ll usually need to also have a brain MRI scan.

Having an MRI scan is very important. This is because MRI scans can give much more detailed information about brain tumours. This information helps guide the doctors when planning your treatment.

You may need to have more than 1 type of MRI. If you have had an MRI scan without the injection of dye (contrast), you’ll usually need to have another MRI with dye. The dye helps to show the tumour in more detail.

They can help to find out more about the position of the tumour and how close it is to normal brain structures. They may also be used to find out more about the type and the activity of the tumour.

Some MRI scans provide detailed images of blood vessels in the brain or show how different parts of the brain are working.

If you’re not able to have an MRI scan, for example if you have a pacemaker that can’t go into an MRI scanner, you doctor will discuss this with you.

You may also have some other tests and scans.

At the hospital, you’ll also have a neurological examination. This is a check of your nervous system.

Get Checked Early has more information on what to expect when getting checked.

Tests and scans for brain tumours

Brain CT scan

A CT scan makes a three-dimensional (3D) picture of the brain. The test only takes a few minutes and is painless.

You may have an injection of a dye into a vein in your arm. This is called contrast. It helps show certain areas of the brain more clearly.

Brain MRI scan

An MRI (magnetic resonance imaging) scan uses magnetism to make a detailed picture of the brain. It can also be used to check your spine. It takes about 30 to 60 minutes and doesn’t use any radiation.During the scan, you need to lie very still on a bed inside a cylinder (tube). It’s painless, but lying still for that long can be uncomfortable. The scan is also noisy, but you’ll be given earplugs or headphones.Some people worry about feeling claustrophobic (fearful of small spaces) in the scanner. If you’re worried about this, make sure you tell the staff in the scanning department. They can help you to feel as comfortable as possible and suggest ways to manage your anxiety. This may include listening to music, or using relaxation techniques.

If needed, you may be able to have a sedative tablet to help you relax. Ask your GP or doctor if they can prescribe this before you have the scan.Specialised types of MRI may be used to look at:

• blood vessels (MR angiography)
• chemical activity (MR spectroscopy)
• blood volume (MR perfusion)
• fibre tracts (MR diffusion or tractography)
• specific functional areas (fMRI or functional MRI in the brain)

PET or PET CT scan

You might have a PET scan which uses low-dose radiation to check the activity of cells in different parts of the body. It’s sometimes given together with a CT or MRI scan.

In this case, it’s called a PET-CT or PET-MRI. It can give more detailed information about cancer or abnormal areas seen on x-rays, CT scans or MRI scans.

PET scans aren’t suitable for everyone. Your doctor or specialist nurse can tell you whether they might be helpful for you.

SPECT

This test is similar to a PET scan. It looks at blood flow through the brain. It also looks at how certain brain tissues are working.

You’ll be given an injection of a radioactive substance, usually in your arm. This substance travels in the blood to the brain. The PET scan then takes pictures (scans) of the brain.

Brain biopsy

A biopsy is an operation when a surgeon removes a small part of the tumour to find out what type of brain tumour it is. You may have a biopsy done on its own before having treatment. Or if you’re having surgery to remove tumour, the biopsy will be taken then.

Macmillan Cancer Support have more information about having a brain biopsy.

Biomarker testing (molecular markers)

Most types of brain tumours are tested for gene changes. These are called molecular marker tests or biomarker tests.Molecular markers describe markers, proteins, or changes in the genetic structure of a tumour. The samples are tested for changes in the genes in the tumour cells.

Macmillan Cancer Support have more information about biomarker testing.

Blood tests

A blood test can’t diagnose a brain tumour. But some types of tumours release certain hormones or chemicals into the blood. If the tumour is affecting your pituitary gland or pineal gland, you may have blood tests to check for this.You’ll also have blood tests to check your general health. This may include checking your:

• liver and kidney function
• blood cell levels – for example whether you have a low number of red blood cells (anaemia)

Chest X-ray

Some people may have a chest X-ray to check their lungs and their general health.

Grading of brain tumours

The grade of a tumour describes how abnormal the cells look under a microscope. Your doctor will use the information about the grade along with results of molecular markers (biomarkers). This can help them to understand how quickly a tumour may grow, and how best to treat it.

Low-grade tumours usually grow slowly and may not cause symptoms for a long time.

High-grade tumours grow faster than low-grade tumours.

Macmillan Cancer Support have more information about how brain tumours are graded.

How diagnosis affects your right to drive

Following diagnosis and treatment for a brain tumour, most people won’t be allowed to drive for a period of time. If you drive, it’s important to discuss with your doctor how your diagnosis and treatment for a brain tumour affects your right to drive.

If you have a driving licence, you must tell the licencing agency (DVLA or DVA) that you have been diagnosed with a brain tumour.

Macmillan Cancer Support have more information about how a brain tumour may affect your right to drive.

Getting support

Being diagnosed with a brain tumour may cause a range of different emotions. There’s no right or wrong way to feel.

It may help to get support from family, friends or a support organisation.

Macmillan Cancer Support also has further information to support you. You can:

• phone the Macmillan Support Line on 0808 808 00 00
• chat to Macmillan specialists online
• use the Macmillan brain cancer forum – you can talk to others affected by brain tumours, ask questions and share your experience

Other organisations who offer information and support include:

• The Brain Tumour Charity
• Brainstrust
• Brain Tumour Research
• Brain Tumour Support

Don’t include personal information e.g. name, location or any personal health conditions.

Treatments used for brain tumours include surgery, radiotherapy and chemotherapy. You may have a combination of treatments.

Your treatment depends on:

• the size and position of the tumour
• the type and grade of the tumour
• any biomarkers you have
• the symptoms you have

If the tumour is slow-growing (low grade) and with few or no symptoms, your doctor may suggest active monitoring or surveillance. This is sometimes called watch and wait. This is when you have regular scans to check for any growth or changes.

Doctors will monitor your scans and symptoms carefully and start treatment if needed. This means you have active monitoring instead of having treatment straight away.

Some people may need to start treatment quickly, for example if the tumour is growing more quickly and is high-grade.

If you need treatment, you may be offered surgery to try to remove all or as much of the tumour as possible. If it's not possible to remove all of the tumour, removing part of the tumour can still be helpful.

Sometimes radiotherapy or chemotherapy may be offered after surgery.

Radiotherapy can be given in different ways. Sometimes it's given as a single high dose. This is called stereotactic radiosurgery (SRS).

SRS may be used to treat secondary brain tumours (brain metastasis) or small primary brain tumours.

When surgery isn't possible, the main treatment is usually radiotherapy. This could be with or without chemotherapy. Some people may have chemotherapy alone as their main treatment.

You may also need help managing your symptoms during your treatment and for a while afterwards. You may need drugs called anti-convulsants to help reduce the risk of seizures.

You may also need steroids to reduce swelling around the tumour.

Some people may be offered surgery to reduce the pressure inside the skull.

Macmillan Cancer Support have more information about brain tumour treatments.

After brain tumour treatment

After your treatment has finished, you'll usually have regular check-ups and scans. How often you have these depends on your situation, including:

• the type of tumour
• the grade
• if there were any gene changes
• the treatment that you had

Your doctor or nurse can tell you more about this.

These appointments are a good time to talk to your doctor or specialist nurse about any worries or problems you have.

If you notice any new symptoms between check-ups, don't wait for your next appointment. Contact your doctor or specialist nurse for advice.

Coping with changes

As you recover from treatment, you may have to adjust to some changes. These may be caused by the treatment you have had or the tumour.

Your healthcare team includes several professionals who can support you during and after treatment. You may meet them in hospital, at a clinic, or even at your own home.

Your doctor or nurse may refer you to a neurological rehabilitation (neuro-rehab) service. Through this service, you could be connected with a physiotherapist, a speech and language therapist, or an occupational therapist, along with emotional support to help you through this period.

Macmillan Cancer Support also offers more information on:

• coping with changes after brain cancer treatment
• lifestyle and wellbeing after treatment