Migraine & Headache Australia

Brain Tumour / Cancer

Reviewed by Dr Brindha Shivalingam, Director of Neurosurgery, The Chris O’Brien Lifehouse, Sydney.
brain-surgeon.com.au
mylifehouse.org.au

What is brain cancer?

There are numerous types of brain tumours and they all behave differently and so require different combinations of treatment.

Symptoms

Brain tumours can cause many different symptoms, including (but not exclusively):

  • Seizures (fits)
  • Headaches
  • Loss of use of your arm or leg
  • Inability to speak
  • Decreased vision, double vision
  • Confusion
  • Sometimes brain tumours can be found incidentally on scans performed for unrelated symptoms.

Commonly Occurring Brain Tumours

Gliomas

Gliomas are primary brain tumours. They arise from the supporting cells of the brain. The two main types of gliomas are Astrocytomas and Oligodendrogliomas. Rarer types are Ependymomas and Choroid plexus tumours.

We do not know what causes these tumours. Radiation exposure can give rise to these tumours. However, the vast majority of patients who have gliomas have never had significant radiation exposure. There is some debate at present about the effect of mobile phones. We do not have firm evidence for this and the current thinking is that there is no link.

Some people with certain genetic conditions also develop gliomas.

Gliomas are graded by the WHO ( World Health Organisation) from 1-4. The grade gives us an idea of how quickly it is growing and spreading, and so also helps guide treatment.

  • Grade 1 is considered benign.
  • Grade 2 is also called “low grade” and implies a slow growth rate. However, a grade 2 tumour can subsequently progress to become a grade 3 or 4.
  • Grade 3 and 4 tumours are considered malignant and rapidly growing.
  • The grade 4, also called Glioblastoma, is the most aggressive type.

Treatment and Outlook

Apart from a grade 1 tumour, which can be cured with surgery, the other grade tumours do not have a cure at present. Treatment generally involves a combination of surgery, radiotherapy and chemotherapy which are all aimed at slowing down the growth and spread of these tumours. Many clinical trials are now becoming available for the trial of novel treatments.

Outlook (with treatment):

  • Grade 1 – Excellent. Potentially curable
  • Grade 2 – Good. Long-term survival over many years.
  • Grade 3 – Guarded. Long-term survival over a few years.
  • Grade 4 – Poor. Average survival around 16-18 months.

Meningiomas

Meningiomas are benign, slow-growing tumours that arise from the lining of the brain called the Dura. Some of them can grow more rapidly or become malignant.

At this point in time, we have no known cause. However, certain previous radiation to the head increases the risk of formation of these tumours. They are also more common in women and so may respond to female hormones.

They can arise anywhere within the skull and spine. As they arise from the membrane that contains the brain and spine, they are on the surface and press on the brain or spine. Rarely, they can arise within the ventricles (fluid cavities)

Treatment

Treatment for meningiomas depends on various factors, such as the size, location, symptoms, age and general condition of the patient.

Treatment options are:

  • Watch and wait
  • Surgery alone
  • Surgery and radiation
  • Radiation alone

Outlook

Meningiomas are graded by the WHO (World Health Organisation) to give us a guide as to how quickly they grow.

  • Grade I – 90% of meningiomas. These are very slow-growing and on average grow 1-2mm per year. Excellent prognosis. Often cured with just surgery alone.
  • Grade II – 8%. Also called atypical meningiomas. More rapidly growing and greater tendency to recur after surgery. Guarded prognosis.
  • Grade III – 2%. Also called malignant meningioma. Rapidly growing and invades brain and can also spread throughout the brain and elsewhere. Poor prognosis.

Pituitary Tumours

Pituitary tumours are benign, slow-growing tumours called adenomas. They arise from the pituitary gland, which is the hormone control centre of the brain and is located at the base of the brain.

These tumours sometimes produce an excess of hormone and so are called functional tumours. The most common syndromes caused by hormone excess are Prolactinoma, Cushing’s Disease, and Acromegaly.

Non-functional tumours often grow to quite a large size and cause symptoms relating to vision as they exert pressure on the optic nerves.

Treatment

Before surgery, all patients need to see an endocrinologist (hormone specialist) and have their vision formally assessed. Most pituitary tumours then require surgery and occasionally drug treatment or radiotherapy. Prolactinomas are usually treated with drugs. Surgery is generally performed endoscopically via the nose.

Outlook

Generally good as these are benign tumours.

Brain Metastases

Malignant tumours that arise elsewhere in the body may secondarily seed in the brain.

Malignant tumours shed cells that can enter the bloodstream. At any one time, a quarter of our total blood volume is in the brain. This makes the brain a common site for secondary brain tumours. There may be only one tumour in the brain or many.

In Australia, we have a very high incidence of melanoma and so there is a high incidence of metastatic melanoma to the brain. Other cancers that seed in the brain are breast, lung and colon.

Treatment

Treatment of brain metastases is complicated and discussion is needed between various specialists to determine the best course of action. This is called a Multi Disciplinary Team (MDT) approach. Treatment generally involves a combination of surgery, radiotherapy and drug treatment. The drug treatment is different for different cancers.

At present, there are a growing number of treatments available and also clinical trials, which have resulted in a much improved prognosis for many cancers.

What to expect

Below is a flow chart of what may happen to patients when they are diagnosed with a brain tumour.

Recent Research

2024 – A new therapeutic approach for glioblastoma – Dr Briony Gliddon – Read more >

2023 – Nanoparticles for Treatment of Brain Cancer – A/Prof Amarali Popat – Read more >

2022 – Repurposing FDA-Approved drugs for the treatment of glioblastoma – Dr Stanley Stylii – Read more >

Further Information and Support

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Reviewed by Dr Brindha Shivalingam, Director of Neurosurgery, The Chris O’Brien Lifehouse.

brain-surgeon.com.au

mylifehouse.org.au

DISCLAIMER: The information provided is designed to support, not replace, the relationship that exists between a patient / site visitor and his / her existing health care professionals.

Brain FoundationThe Brain Foundation is dedicated to funding the next generation of Australian research into brain disorders, diseases, and injuries, with the ultimate goal of advancing diagnoses, treatments, and patient outcomes.

There is no cure without research.