Brain tumours

In almost all cases, experts don't know what causes a primary brain tumour. There are some things that may increase your risk of developing a brain tumour, and these are called risk factors.

Remember that having a risk factor doesn't mean you'll get a brain tumour. Only a small number of people develop one because of one of these risk factors.

Macmillan Cancer Support have more information about the possible different risk factors of a brain tumour.

Many people find out they have a brain tumour when they go to hospital after a seizure (fit) or other sudden symptoms. Others go to see their doctor about symptoms.

If your doctor thinks you may have a brain tumour, they'll arrange a brain scan. Or they may send you straight to a neurologist, a doctor who specialises in brain disorders.

You may already have 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 a brain MRI scan as well.

The MRI scan matters a great deal, because it gives much more detailed information about brain tumours. The doctors use that information to guide them when they plan your treatment.

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

These scans can help find out more about where the tumour sits and how close it is to normal brain structures. They may also tell the doctors more about the type of tumour and how active it is.

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

Some people can't have an MRI scan, for example if they have a pacemaker that can't go into an MRI scanner. If that's you, your doctor will talk it through with you.

You may also have some other tests and scans.

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

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

A CT scan of the brain gives a three-dimensional (3D) picture of the inside of your head. The test only takes a few minutes and it doesn't hurt.

You may be given an injection of a dye into a vein in your arm. This dye is called contrast, and it helps show certain areas of the brain more clearly.

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. The scan 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, though you'll be given earplugs or headphones.

Some people worry about feeling claustrophobic (fearful of small spaces) in the scanner. If that worries you, tell the staff in the scanning department. They can help you 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 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)

You may be offered a PET scan, which uses a low dose of radiation to check how active the cells are in different parts of your body. Sometimes it's given together with a CT or MRI scan, and then it's called a PET-CT or PET-MRI. This combined scan can give more detailed information about cancer, or about abnormal areas that have shown up on x-rays, CT scans or MRI scans.

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

A SPECT scan is a test much like a PET scan. It looks at how blood flows through the brain, and also at how certain parts of the brain tissue are working.

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

A blood test can't diagnose a brain tumour. But some types of tumour release certain hormones or chemicals into the blood, so 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. These may include checking your:

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

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

Brain tumours can be treated with surgery, radiotherapy and chemotherapy. Some people have a combination of these.

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 causes few or no symptoms, your doctor may suggest active monitoring, also called surveillance or watch and wait. You have regular scans to check for any growth or changes.

Doctors keep a careful eye on your scans and symptoms, and they start treatment if it's needed. So with active monitoring, you don't have treatment straight away.

Some people need to start treatment quickly, for example when the tumour is growing faster and is high-grade.

If you need treatment, you may be offered surgery to try to remove all of the tumour, or as much of it as possible. Sometimes all of it can't be removed. Taking out part of the tumour can still help.

Radiotherapy or chemotherapy may be offered after surgery.

Radiotherapy can be given in different ways. Sometimes it's given as a single high dose, and 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, with or without chemotherapy. Some people have chemotherapy alone as their main treatment.

You may also need support managing your symptoms during treatment and for a while afterwards. Drugs called anti-convulsants can help reduce the risk of seizures. Steroids may be needed to reduce swelling around the tumour.

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

Macmillan Cancer Support has more information about brain tumour treatments.

Once your treatment for a brain tumour has finished, you'll usually have regular check-ups and scans. How often you have them depends on your own 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.

As you recover from treatment for a brain tumour, you may have to get used to some changes. They can come from the treatment you've had, or from the tumour itself.

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

Your doctor or nurse may refer you to a neurological rehabilitation (neuro-rehab) service. From there, you may be referred on to a physiotherapist, a speech and language therapist or an occupational therapist, and the service can also offer emotional support.

You may also want to read more about:

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

Following diagnosis and treatment for a brain tumour, most people won't be allowed to drive for a period of time. If you drive, talk to your doctor about how your brain tumour and its treatment affect your right to drive.

If you have a driving licence, you must tell the licensing 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.