What is a pineal region tumour?

Pineal region tumours are a type of brain tumour. They start in or around the pineal gland in the centre of the brain.

Brain - cross section

The pineal gland produces a hormone called melatonin. Melatonin helps control sleep patterns.

Pineal tumours do not usually spread to other parts of the body. But they may cause problems by continuing to grow and pressing on surrounding tissue.

This information is about pineal region tumours in adults. For more information about brain tumours in children, contact the Children’s Cancer and Leukaemia Group.

Types of pineal region tumour

Different types of tumour can start in the pineal region.

Germ cell tumour

The most common type of pineal region tumour is a germ cell tumour. Germ cell tumours usually start in the ovaries or testicles. But they can also start in other parts of the body, including the pineal region in the brain.

Germ cell pineal region tumours are more common in children, teenagers and young people. They are more common in males than females.

Germ cell tumours can grow quickly but they usually respond very well to treatment.

There are two main groups:

  • germinomas
  • non-germinomatous tumours – these include embryonal carcinoma, yolk sac tumours, choriocarcinoma and teratomas.

Pineal gland tumours

These tumours develop from the pineal gland itself. There are three types:

  • Pineocytomas grow slowly and are low-grade (benign).
  • Pineal parenchymal tumours of intermediate differentiation usually grow slowly and are low-grade, but can spread to the spine. Differentiation describes how different the tumour cells are to normal cells. Intermediate is between ‘not very different’ and ‘very different’.
  • Pineoblastomas grow more quickly and are high-grade (malignant).

Other types of tumour

These include:

  • astrocytomas – these start in the main supporting cells (glial cells) in or around the pineal gland
  • meningiomas – these start in the cells of the membrane that surrounds the brain and spinal cord (meninges).

Symptoms of a pineal region tumour

As a tumour grows, it can press on or grow into nearby areas of the brain. This can cause symptoms because it stops that part of the brain from working normally. Symptoms can also happen because the tumour causes a build-up of pressure inside the skull. This is called raised intracranial pressure.

Raised intracranial pressure is usually caused by a build-up of cerebrospinal fluid (CSF). Pineal tumours sometimes block the flow of CSF in the brain. This is called hydrocephalus.

Symptoms can depend on the size and position of the tumour and how slowly or quickly it grows. They may develop suddenly or slowly over months or even years. Some people might not have any symptoms. Instead, the tumour may be found during tests for something else.

Common symptoms include:

  • headaches
  • sickness (vomiting)
  • problems with eyesight, such as difficulty looking upwards, focusing on close objects or double vision.

Other possible symptoms include:

  • problems with movement and balance
  • difficulty walking or walking awkwardly.

Germ cell tumours in the pineal region may sometimes also affect the pituitary gland. This is a small, oval-shaped gland that produces different hormones. Hormones control certain processes in our body, such as growth. Germ cell tumours may delay puberty in teenagers, or cause other hormonal imbalances.

We have more information about possible symptoms of a brain tumour.

Causes of pineal region tumour

The cause of these tumours is unknown, but research is being done to find out more.

We have more information about risk factors and causes of brain tumours.

Diagnosis of a pineal region tumour

Your doctors need to find out as much as possible about the tumour so they can plan your treatment.

You will have:

  • a brain MRI scan or sometimes a CT scan to find out the exact position and size of the tumour.

You may also have:

Your doctor may also:

  • check your reflexes and the power and feeling in your arms and legs
  • shine a light at the back of your eye to check if there is swelling
  • ask you some questions to check your reasoning and memory
  • arrange for you to have blood tests to check your general health and to see how well your kidneys and liver are working.

If there are signs that the pituitary gland is affected, you will also usually have blood tests to check your hormone levels.

Some germ cell tumours make chemicals called tumour markers. A sample of your blood or CSF may be tested for these. The main tumour markers made by germ cell tumours are:

  • AFP (alpha-fetoprotein)
  • hCG (human chorionic gonadotrophin).

Getting support

Being diagnosed with a brain tumour can make you feel shocked, frightened, angry or upset. There is no right or wrong way to feel. Talking about your feelings can often help.

You may also want to get support from a brain tumour charity, such as:

How diagnosis affects your right to drive

Most people diagnosed with a brain tumour will not be allowed to drive for a time after their diagnosis. Your doctor, surgeon or specialist nurse will tell you if this applies to you. 

If you have a driving licence, you must tell the licensing agency you have been diagnosed with a brain tumour.

You could be fined if you do not tell them. You could also be prosecuted if you have an accident.

Grading of pineal region tumours

Your doctor may talk about the grade of a tumour. The grade of a tumour describes how abnormal the cells look under a microscope. This can help your doctor understand how quickly a tumour might grow. They can use this information to help them plan your treatment.

Low-grade pineal region tumour

Most pineal region tumours are low-grade. This means that they grow slowly. They are sometimes called benign tumours. Low-grade pineal tumours do not usually spread to other parts of the brain or spine. But they may cause problems by continuing to grow and pressing on nearby tissues.

High-grade pineal region tumour

Some pineal tumours are high-grade. This means that they grow more quickly. High-grade pineal tumours are also called malignant or cancerous tumours. They can grow into nearby tissues. They can also spread lower down the spinal cord or brain. Pineal tumours do not usually spread to other parts of the body. But they may cause problems by continuing to grow and pressing on surrounding tissue.

We have more information about grading brain tumours.

Treatment for pineal region tumour

The main treatments for pineal region tumours include surgery, radiotherapy and sometimes chemotherapy. Your treatment depends mainly on the type of pineal region tumour you have. It also depends on:

  • the size and position of the tumour
  • the grade
  • the symptoms you have.

A team of specialists will plan your treatment. Your specialist doctor and nurse will explain the aims of your treatment and what it involves. They will talk to you about the benefits and disadvantages of different treatment types. They will also explain the risks and side effects.

You may be given a choice of treatment options. You will have time to talk about this with your hospital team before you make any treatment decisions.

You will need to give permission (consent) for the hospital staff to give you the treatment. Ask any questions about anything you do not understand or feel worried about. Tell your specialist if you need more information or more time to decide on a treatment.

Surgery

Surgery is often the main treatment for pineal region tumours.

Before having surgery to remove the tumour, you might need to have a build-up of cerebrospinal fluid (hydrocephalus) drained. This relieves any pressure in the brain. When the pressure has been relieved, you may have surgery to remove your tumour. Your surgeon will explain your operation and what to expect.

Radiotherapy and chemotherapy

Radiotherapy and chemotherapy may be used after surgery, depending on the type of tumour and how much of it has been removed. Radiotherapy uses high-energy rays to destroy the tumour cells. Chemotherapy uses anti-cancer drugs to destroy the tumour cells.

Radiotherapy and chemotherapy are very effective in treating some germ cell tumours, so surgery may not always be needed.

Radiotherapy may be used:

  • as the main treatment
  • as the main treatment, if surgery is not possible
  • after surgery, if the tumour cannot be completely removed
  • after surgery, to reduce the risk of the tumour coming back
  • to treat the spinal cord, if there are signs the tumour has spread to the spine
  • with chemotherapy, to treat some pineal region tumours.

A type of radiotherapy called stereotactic radiotherapy (SRT) can sometimes be used to treat pineal region tumours.

Chemotherapy is often used to treat germ cell tumours. It is also sometimes used to treat other types of pineal region tumours. This may be as part of a clinical trial. Your doctor will explain whether chemotherapy might be suitable.

Side effects of treatment for a pineal region tumour

Your specialist doctor or nurse will explain your treatment and possible side effects. Some treatments can cause side effects that do not get better. These are called long-term effects. You may also get side effects that start months or years later. These are called late effects.

We have more information about coping:

Treatment for symptoms of a pineal region tumour

You may need treatment for symptoms before you have any treatment for the tumour. You may also need your symptoms managed during your main treatment, or for a while after it has finished.

You may have treatment to reduce pressure inside the skull. This can improve symptoms and may help you feel better.

You may have:

  • drugs called steroids to reduce swelling around the tumour
  • an operation that helps create a new channel for the fluid to drain away – this is called an endoscopic third ventriculostomy (ETV)
  • surgery to place a long, thin tube, called a shunt – this lets some of the fluid drain from the brain to another area of the body, to reduce pressure inside the skull
  • drugs called anti-convulsants to prevent seizures.

Sometimes a brain tumour cannot be removed or controlled anymore. If this happens you can still have treatment for any symptoms. You will have supportive care (sometimes called palliative care) from a specialist doctor or nurse who is an expert at managing symptoms.

We have more information about coping with advanced cancer.

Clinical trials

Clinical trials are medical research trials involving people. Doctors may use clinical trials to test new treatments, find new drugs, or improve the way treatments are given.

Because these tumours are rare, there may not always be a relevant clinical trial happening. If there is, your doctor or nurse may ask you to think about taking part.

They will give you information about the clinical trial so that you understand what it means to take part. If you decide not to take part in a trial, your specialist doctor and nurse will respect your decision. You do not have to give a reason for not taking part. Your decision will not change your care. Your doctor will give you the standard treatment for the type of tumour you have.

We have more information about clinical trials.

After treatment for a pineal region tumour

After your treatment has finished, you will have regular check-ups, tests and scans.

Some side effects can start months or years after treatment has finished. You can use your follow-up appointments to talk about these side effects, or about any other worries or problems you have.

Many people find they get very anxious before appointments. This is natural. It may help to get support from family, friends or a specialist nurse.

Reviewed: 01 October 2019
Reviewed: 01/10/2019
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Next review: 01 April 2022
Next review: 01/04/2022