Treating primary brain tumours

Doctors treat different types of brain tumours in different ways. The main treatments are: 

  • surgery, which is an operation to remove some or all of the tumour
  • radiotherapy, which uses high-energy rays or particles to treat tumour cells 
  • chemotherapy, which uses anti-cancer drugs to treat tumour cells.

A team of specialists will plan your treatment. Your treatment will depend on the type and grade of brain tumour and where it is in the brain. Your doctor may talk to you about having your treatment as part of a clinical trial.

Before, during or after your main treatments for a brain tumour, you may have symptoms. These can be difficult to cope with, but they can usually be controlled using: 

  • Steroids – drugs that do not treat the tumour itself, but help improve symptoms and make you feel better.
  • Anti-convulsants – drugs that help prevent seizures (fits).
  • A shunt – a long, thin tube put into the brain during surgery. This may reduce pressure caused by a brain tumour. 

You may need extra support to recover from side effects or changes that the tumour or treatment has caused. This is sometimes called neuro-rehabilitation.

Treatment for primary brain tumours

This section is for teenagers and young adults. It is about treating tumours that start in the brain (primary brain tumours). We have more information about cancer that spreads to the brain from somewhere else in the body (brain metastases).


Planning your treatment

Doctors treat different types of brain tumours in different ways. The main treatments are:

  • surgery, which is an operation to remove some or all of the tumour
  • radiotherapy, which uses high-energy rays or particles to treat tumour cells
  • chemotherapy, which uses anti-cancer drugs to treat tumour cells.

Some people do not need treatment straight away. Instead, they have active monitoring. This involves having regular scans to check the tumour and seeing their doctor regularly at a clinic. If their scan results or symptoms show the tumour is growing, they start treatment.

For some tumours, the treatment is surgery, radiotherapy or chemotherapy on its own. But most people have a combination of these treatments. You may also need other treatments to control symptoms before, during or after your main treatments.

A team of specialists will plan your treatment. Your team may include:

  • a neurosurgeon – a doctor who specialises in brain operations
  • a neurologist – a doctor who treats brain conditions
  • a paediatric or medical oncologist – a doctor who treats brain tumours with chemotherapy
  • a clinical oncologist – a doctor who treats brain tumours with radiotherapy and chemotherapy
  • a specialist nurse who looks after people with conditions affecting the brain
  • a specialist nurse for teenagers or young adults with cancer
  • a radiographer, who gives radiotherapy treatment.

Your treatment will depend on the type and grade of brain tumour and where it is in the brain. Your doctor and nurse will explain your treatment and answer any questions you have. It is important that you understand what to expect. You may need some time to talk about it with your family.

Clinical trials

Doctors are working all the time to:

  • improve treatments
  • reduce the side effects of treatment.

They do this through research called clinical trials. Your doctor may talk to you about having your treatment as part of a clinical trial. We have more information about clinical trials. It is written for people of all ages, not just teenagers and young people.


Treating symptoms of brain tumours

You may have symptoms before, during or after your main treatments for a brain tumour. These can be difficult to cope with, but they can usually be controlled. Most people have drugs called steroids as part of their treatment. You may also have anti-convulsant drugs to prevent seizures (fits). Some people need a small operation to place a shunt in the body. This is a device that reduces pressure inside the skull. We have more information about shunts further down the page.

Steroids

Steroids help reduce the swelling that often surrounds a brain tumour. They do not treat the tumour itself. But they can improve symptoms and make you feel better. You will often have steroids before, during and after your main treatment.

It is important to take steroids as your doctor tells you. You should not suddenly stop taking them.

Steroids can cause the following side effects:

  • Indigestion. Take your tablets with food and tell your doctor if you have tummy pain. They may prescribe drugs to help or prevent this.
  • Increased appetite and weight gain. If you are worried about gaining weight, talk to your doctor or nurse.
  • Difficulty sleeping. Taking your tablets in the morning may help you sleep better.
  • Feeling restless or agitated. Let your doctor know if this is a problem.
  • Raised blood sugar levels. You will have regular blood or urine (pee) tests to check this. Let your doctor know if you become very thirsty, pass lots of urine or feel unwell.

Taking higher doses of steroids for a longer time may cause more side effects. For example, you may be more likely to get an infection. Or your muscles may get weaker, especially at the tops of your arms and legs. You may need medication to keep your bones strong. Your doctor or nurse can give you more information.

Side effects can be hard to cope with, especially with everything else you have to deal with. Remember, the side effects will gradually get better when you stop taking steroids.

Anti-convulsants

Tumours in the brain can sometimes cause seizures (fits). Anti-convulsant drugs (also called anti-epileptics) can help prevent them. Your doctor might give you these to take before surgery, or to take long-term. There are different types and some people may need more than one type. Your doctor will explain the likely side effects of any drugs they give you.

Shunts

Sometimes, brain tumours block the flow of fluid (CSF) around the brain. This means pressure can build up and cause symptoms.

To reduce this pressure, some people have a small operation to place a long, thin tube (called a shunt) in the body. This lets some of the fluid drain from the brain to another area of the body. You cannot see the tube from outside the body. But you may be able to feel the tube under the skin behind your ear.


Surgery for brain tumours

It is natural to feel worried and frightened about having brain surgery. You may have questions such as:

  • Will it change the way my brain works?
  • How will I feel after the operation?
  • Will I have scars?
  • Will the surgeon shave my head?

Your surgeon and specialist nurse will talk to you about the operation and the possible benefits and risks. If there is a risk of damage to the brain during surgery, they will explain how this may affect you. If they need to shave some of your hair, they will explain what to expect.

Make sure you have as much information as you need and ask any questions you have. The more you know about what to expect, the easier it may be to cope. For general information about what happens before and after an operation, see our surgery section.

Biopsy

A biopsy is when the surgeon removes a piece of the tumour. This can then be examined to find out the type of tumour or what treatments are likely to work best.

There are different ways to take a brain biopsy. Sometimes, it is only safe to remove a tiny part of the tumour to look at under the microscope. But often, the surgeon will take a biopsy as part of a larger operation to remove the tumour. Your surgeon will explain what to expect in your situation.

You usually have a biopsy taken under a general anaesthetic. The surgeon uses scans to guide them while taking the biopsy. The scans are taken before or sometimes during the operation.

Sometimes the surgeon does a biopsy while you are awake. They inject some local anaesthetic into the scalp so you don’t feel anything. This can sound scary, but it should not take long. You can talk to the doctors and nurses looking after you while it is happening.

Removing the tumour

Surgery is often the main treatment for brain tumours. Your surgeon tries to remove all of the tumour, or as much as possible.

You usually have a general anaesthetic. For some types of brain tumours, your surgeon might suggest doing an operation while you are awake. This is called an awake craniotomy. It may sound frightening, but people usually cope with it well. Because you are awake, the surgeon can check that the surgery is not affecting your speech and movement.

For an awake craniotomy, you are usually asleep (sedated) for the first part of the surgery. The surgeon uses local anaesthetic injections to numb the scalp. They gently wake you when they are ready to operate on the brain. The brain has no nerve endings, so you should not feel any pain during the operation.

Your surgeon or nurse will tell you what to expect before and after your operation. When you can go home and how quickly you recover will depend on the type of operation you had. Your doctor and nurse will talk to you about preparing to go home. They will arrange any further support you might need.


Radiotherapy for brain tumours

Radiotherapy uses high-energy rays or particles to treat cancer cells. You may have it:

  • after surgery, to treat any cells that may have been left behind
  • instead of surgery, when it is not possible to remove the brain tumour
  • as your main treatment
  • if a brain tumour comes back after surgery.

For some types of tumour, you have radiotherapy to your spinal cord as well as your brain. Your doctor will explain what to expect.

Types of radiotherapy

You may have radiotherapy in several ways for brain tumours. Your doctor will give you more information about your treatment plan. You can read more about having radiotherapy in our radiotherapy section.

Doctors may treat brain tumours with:

  • Standard radiotherapy. You usually have this over several weeks, at your nearest cancer treatment centre.
  • Stereotactic radiosurgery. You have this all at once, on a single day. You may have to travel to another hospital to have this treatment.
  • Proton beam therapy. You sometimes have this to treat certain types of tumour in the brain and spinal cord. At the moment, NHS patients can travel abroad to have proton beam therapy. But during 2018, it may become available in the UK.

When you have radiotherapy, you may need to wear a light-weight mask or head frame. The mask covers your face and the front of your head. The mask or frame helps keep your head and neck still during the treatment. They should not be uncomfortable. But if you feel nervous, tell the nurse or radiographer so they can help.

Usually, each radiotherapy treatment only takes a few minutes. It is not painful, but you need to lie still. You will be on your own in the room, but you can talk to the radiographers. You can talk through an intercom or signal to them during the treatment. They can see and hear you from the next room. You can usually bring music to listen to if you want.

Side effects of radiotherapy

You may have some side effects during radiotherapy. These usually get better over a few weeks or months after your treatment. Your doctor, nurse or radiographer will tell you more about what to expect.

Some people find side effects get worse for a short time after they have finished treatment. This does not mean your treatment isn’t working. It is usually just a normal reaction to the treatment. Always tell your doctor or nurse about any side effects you have. They can usually help make things easier.

Common side effects of radiotherapy to the brain include:

  • tiredness
  • headaches
  • hair loss
  • skin changes
  • feeling sick.

We have more information about these radiotherapy side effects.

Late effects of radiotherapy

Radiotherapy can sometimes cause side effects months or years later. These are called late effects or long-term side effects. Newer ways of giving radiotherapy help to reduce the chances of late effects as much as possible.

Late effects depend on where the treated area is and the dose of radiotherapy you had. Your specialist doctor or nurse will talk to you about any risk of late effects.

The main late effects of brain tumour treatments are:

  • effects on thinking and memory
  • an increased risk of stroke
  • a small risk of damage to the normal brain
  • risk of a second tumour in later life.

These may sound scary, but for most people the risk of them happening is small. It is important to talk to your doctor about anything you are worried about.

For several years after radiotherapy, you will go to the clinic for regular check-ups. Your doctor will check for late effects so they can manage or treat these as early as possible. They will advise you to follow a healthy lifestyle to help reduce the chances of problems. This includes things like not smoking. They will arrange regular checks of your blood pressure, cholesterol levels and for diabetes. You may also need checks of your hearing, eyesight and hormone levels.

We have more information about the late effects of radiotherapy.

Watch our video about external beam radiotherapy

Consultant Clinical Oncologist Vincent Khoo describes external beam radiotherapy, how it works, and what it involves.

Information about our videos

Watch our video about external beam radiotherapy

Consultant Clinical Oncologist Vincent Khoo describes external beam radiotherapy, how it works, and what it involves.

Information about our videos


Chemotherapy for brain tumours

Chemotherapy uses anti-cancer drugs to treat cancer cells. You might have chemotherapy:

  • to shrink a tumour, to make it easier to remove with surgery
  • when it is not possible to remove the tumour completely with surgery
  • during radiotherapy, to make the tumour more sensitive to radiation
  • after radiotherapy or surgery, to reduce the chance of the tumour coming back
  • when a brain tumour has come back after treatment.

You may have a variety of chemotherapy drugs. We have information about different chemotherapy drugs. It is written for people of all ages, not just for young people.

You usually have chemotherapy for brain tumours by injection into a vein (intravenously). Or you may have tablets. You may have one chemotherapy drug, or two or three drugs in combination.

You may also have chemotherapy:

  • directly into the spine (intrathecal chemotherapy)
  • directly into the brain through a device called an ommaya reservoir
  • directly into the brain during surgery to remove a tumour (called a Gliadel implant).

Side effects of chemotherapy

Different chemotherapy drugs cause different side effects. Some people just have a few side effects, and others have more. Everyone is different.

Most side effects are short-term (temporary), and gradually disappear once treatment stops.

The most common short-term side effects are:

  • risk of getting an infection
  • losing your hair
  • feeling sick
  • tiredness.

Effects on fertility

Some chemotherapy drugs can affect your ability to father a child or get pregnant (fertility). Your doctor or nurse should talk to you about this before you start treatment. If treatment could affect your fertility, you may be able to have treatment to preserve it. We have more information about fertility and fertility preservation.

Chemotherapy

This video provides a brief overview of chemotherapy treatment, how it can be given, how it works and possible side effects.

About our cancer information videos

Chemotherapy

This video provides a brief overview of chemotherapy treatment, how it can be given, how it works and possible side effects.

About our cancer information videos


Support after your treatment

You may need extra support to recover from side effects or changes that the tumour or treatment has caused. This is sometimes called neuro-rehabilitation.

Your doctor or nurse will talk to you about how you are managing to do normal activities or things you enjoy. Let them know if anything is more difficult than usual. They can arrange extra support.

If you need this support after your treatment, your team may include different people depending on what you need.

For example, you may see:

  • A physiotherapist, who can help you improve your strength, balance or co-ordination. They can show you exercises to do and give you advice to help you.
  • A speech and language therapist, who can help if you have problems speaking or communicating clearly. They can also help if you have difficulty eating, drinking, or swallowing. They will give you advice and show you exercises to do.
  • An occupational therapist, who will help you get back to doing everyday tasks. These could include washing, dressing, eating, shopping or managing your money. They may also give you equipment that can help make things easier.
  • A neuro-psychologist, who can help you cope with any changes that affect your thinking, feelings, behaviour or personality.

Your team may help in the early stages of your recovery, or for a while after you finish treatment. You may see them when you are in hospital, as an outpatient in a clinic, or at home.

Our general primary brain tumour section has more information, written for people of all ages. The Children’s Cancer and Leukaemia Group has information about brain tumours in children.

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