A brain tumor is an abnormal mass of tissue in which some cells grow and multiply uncontrollably, apparently unregulated by the mechanisms that control normal cells. The growth of a tumor takes up space within the skull and interferes with normal brain activity. A tumor can cause damage by increasing pressure in the brain, by shifting the brain or pushing against the skull, and by invading and damaging nerves and healthy brain tissue. The location of a brain tumor influences the type of symptoms that occur. This is because different functions are controlled by different parts of the brain.

Brain tumors rarely metastasize (spread) to other parts of the body outside of the central nervous system (CNS). The CNS includes the brain and spinal cord.

Some tumor types are more common in children than in adults. When childhood brain tumors occur in adults, they often occur in a different part of the brain than in children. Although most primary tumors attack member of both sexes with equal frequency, some, such as meningiomas, occur more frequently in women, while others, such as medulloblastomas, more commonly afflict boys and young men.

The prognosis for brain tumor patients is as individual as the patients themselves. Your doctors will help you understand the possible consequences of your specific tumor.

For more information about brain tumor types, see chapter 4 of The Essential Guide to Brain Tumors.

The most common symptoms include headaches, which can be most severe in the morning; nausea or vomiting, which can be most severe in the morning; seizures or convulsions; difficulty thinking, speaking, or finding words; personality changes; weakness or paralysis in one part or one side of the body; loss of balance; vision changes; confusion and disorientation; and memory loss. Different parts of the brain control different functions, so symptoms will vary depending on the tumor’s location.

While these are the most common symptoms of a brain tumor, they can also indicate other medical problems. If you are having any of these symptoms, it is important to see your doctor and get a definitive diagnosis.

For more information about symptoms, see chapter 2 of The Essential Guide to Brain Tumors.

Primary brain tumors originate in the brain itself. Primary brain tumors do not spread from the brain to other parts of the body, except in rare cases. Pathologists classify primary brain tumors into two groups: glial tumors (gliomas), and non-glial tumors. Gliomas are composed of glial cells, which include astrocytes, oligodendrocytes, ependymal cells, Schwann cells, microglia, and satellite cells. Non-glial tumors develop on or in structures within the brain such as nerves, blood vessels, and glands.

Metastatic or secondary brain tumors begin as cancer in another part of the body. Some of the cancer cells may be carried to the brain by the blood or may spread from adjacent tissue. The site where the cancerous cells originated is referred to as the primary cancer. Metastatic brain tumors are often referred to as brain metastases or lesions. Metastatic brain tumors are the most common brain tumors. Because people are surviving primary cancers for longer periods of time, there has been an increase in metastatic lesions.

For more information about brain metastases, see Understanding Brain Metastases: A Guide for Patient and Caregiver.

Benign brain tumors are slow-growing tumors that can be removed or destroyed if in an accessible location. Malignant tumors (brain cancer) are rapidly growing tumors that invade or infiltrate and destroy normal brain tissue. No one is certain why, but some benign brain tumors may change over time to become malignant.

Tumors are graded to indicate how quickly they are growing. Today, most medical institutions use the World Health Organization (WHO) classification system to identify brain tumors. The WHO classifies brain tumors by cell origin and how the cells behave, from the least aggressive (benign) to the most aggressive (malignant). Some tumor types are assigned a grade, which signifies the rate of growth. There are variations in grading systems, depending on the tumor type. The classification and grade of an individual tumor help predict its likely behavior.

The distinction between benign and malignant can be ambiguous. Some benign tumors can be as dangerous as malignant ones if in a dangerous or inaccessible location, such as the brain stem. Conversely, some malignant tumors can be cured.

Although they may fall into a specific classification or category, brain tumors are specific to each individual. Brain tumors have vastly different characteristics and patterns of growth due to the molecular makeup of the individual tumor.

For more information about brain tumor types, see chapter 4 of The Essential Guide to Brain Tumors.

When a tumor is in remission or is stable, it means the tumor cells have entered a phase in which they generally have stopped growing or multiplying. This may or may not mean that these tumor cells will never grow again. In some cases, the tumor has actually been destroyed and the area it occupied in the brain is composed only of dead tissue, called necrosis. In other circumstances, tumor cells remain alive or viable, and retain the capacity to grow actively again, meaning that the tumor may recur at a later date.

Recurrent tumors grow back after being removed or stabilized. Recurrence commonly occurs in the same area as the original tumor, but may develop in another part of the brain or spinal cord. Both benign and malignant brain tumors can recur after initial treatment.

A brain tumor that has been treated with radiation or chemotherapy may disappear or remain in remission, a state in which the tumor cells stop multiplying. Remission can be temporary or permanent. It is not possible to predict whether or not recurrence will take place. Therefore, after receiving therapy the patient will need to have follow-up appointments indefinitely, usually with MRI imaging, even if the tumor was benign.

Some brain tumors are cancerous and some are not. Malignant tumors are considered cancer. Two of the most common forms of brain cancer are metastatic brain tumors (brain metastases) and glioblastoma multiforme (GBM).

Brain cancer cells mutate and lose their normal form or structure. This is called anaplasia. The degree of anaplasia helps to forecast a tumor's growth potential. The most rapidly growing tumors have the highest degree of anaplasia.

Benign tumors are not considered cancer. Some benign tumors have malignant forms, such as malignant meningiomas. Also, some benign brain tumors later develop into cancer. The reasons for this are unknown.

A brain tumor diagnosis usually involves several steps, which can include a neurological examination, brain scan(s) and/or a biopsy.

A neurological examination is a series of tests to measure the function of the patient's nervous system and physical and mental alertness. If responses to the exam are not normal, the doctor may order a scan or refer the patient to a neurologist or neurosurgeon, who will then order a scan.

A brain scan is a picture of the internal structures in the brain. A specialized machine takes a scan in much the same way a digital camera takes a photograph. Using computer technology, a scan compiles an image of the brain by photographing it from various angles.

Some types of scans use a contrast agent (or contrast dye), which helps the doctor to see the difference between normal and abnormal brain tissue. The contrast agent is injected into a vein and flows into brain tissue. Abnormal or diseased brain tissue absorbs more dye than normal, healthy tissue.

MRI (Magnetic Resonance Imaging) is a scanning device that uses magnetic fields and computers to capture images of the brain on film. It does not use x-rays. It provides pictures from various planes, which permits doctors to create a three-dimensional image of the tumor. The MRI detects signals emitted from normal and abnormal tissue, providing clear images of most tumors.

CT or CAT Scan (Computed Tomography) combines sophisticated x-ray and computer technology. CT can show a combination of soft tissue, bone, and blood vessels. CT images can determine some types of tumors, as well as help detect swelling, bleeding, and bone and tissue calcification. Usually, iodine is the contrast agent used during a CT scan. People who are allergic to iodine should inform their doctor before having a CT scan.

CT is a valuable diagnostic tool and its use has been increasing rapidly. However, CT scans involve exposure to ionizing radiation, which is known to cause cancer. This is a concern for people who have multiple CT scans and for children, because they are more sensitive to radiation than adults. It is wise for people who have had frequent x-ray exams and parents of children who have brain tumors to keep a record of their x-ray history. This information can help doctors make informed decisions and minimize radiation over-exposure.

PET Scan (Positron Emission Tomography) provides a picture of the brain's activity, rather than its structure, by measuring the rate at which a tumor absorbs glucose (a sugar). The patient is injected with deoxyglucose that has been labeled with radioactive markers. The PET scan measures the brain's activity and sends this information to a computer, which creates a live image. Doctors use PET scans to see the difference between scar tissue, recurring tumor cells, and necrosis (cells destroyed by radiation treatment).

Biopsy is a surgical procedure in which a sample of tissue is taken from the tumor site and examined under a microscope. The biopsy will provide information on types of abnormal cells present in the tumor. The purpose of a biopsy is to discover the type and grade of a tumor. A biopsy is the most accurate method of obtaining a diagnosis.

An open biopsy is done during a craniotomy. A craniotomy involves removing a piece of the skull in order to get access to the brain. After the tumor is resected (completely removed) or debulked (partially removed), the bone is usually put back into place. A closed biopsy (also called stereotactic or needle biopsy) may be performed when the tumor is in an area of the brain that is difficult to reach. In a closed biopsy, the neurosurgeon drills a small hole into the skull and passes a narrow, hollow needle into the tumor to remove a sample of tissue.

Once a sample is obtained, a pathologist examines the tissue under a microscope and writes a pathology report containing an analysis of the brain tissue. Sometimes the pathologist may not be able to make an exact diagnosis. This may be because more than one grade of tumor cells exists within the same tumor. In some cases, the tissue may be sent to another institution for additional analysis.

For more information about diagnostic tests, see chapter 2 of The Essential Guide to Brain Tumors.

The standard treatments for brain tumors are surgery, radiation therapy, and chemotherapy. In general, radiation and chemotherapy treatments are used as secondary or adjuvant treatments for tumors that cannot be managed using only surgery. However, radiation and chemotherapy may be used without surgery if the tumor is inoperable.

When possible, the doctor, patient, and family will discuss a treatment plan based on the type and location of the tumor, the patient’s general health, medical history, and preferences. In treating brain tumors, a multi-disciplinary treatment team, made up of various specialists, is generally considered the preferred approach. Neurosurgeons, neurologists, radiation oncologists, pathologists, and other medical professionals may be part of the treatment team.

The patient often receives medications to manage the brain tumor symptoms before receiving these treatments. Steroids (glucocortico-steroids) may be used to reduce inflammation and control brain swelling (edema). The most common steroids are dexamethasone, prednisone and methylprednisolone. Steroids may be prescribed at diagnosis, or before or after surgery. When the swelling is under control, then the dosage is gradually tapered off.

Steroids can cause both short-term and long-term side effects if taken over a long period of time, or stopped suddenly without being monitored by a doctor. Short-term side effects include insomnia, facial swelling and flushing, increased sweating, increased appetite, moderate abdominal pain, nervousness, personality and mood changes, hoarseness, throat irritation, weight gain, water retention, and thirst. Patients should never stop taking steroids without the doctor’s knowledge. Discuss monitoring and all possible side effects with the doctor.

The goal of surgery, or resection, is to remove the tumor without causing damage to critical neurological functions. When only part of a tumor can be resected, it is possible that the tumor will recur. Therefore, the entire tumor is removed whenever feasible. Debulking attempts to remove as much of a tumor as is possible. It can alleviate symptoms and improve the effectiveness of other therapies, such as radiation therapy and chemotherapy.

A craniotomy is a major operation. Risks and complications of surgery can include bleeding, infection, brain edema, seizures, paralysis, and behavioral or cognitive changes. Some normal brain tissue may be damaged during surgery. This can lead to permanent impairment of the functions related to the injured area of the brain. For a short time after surgery, symptoms may appear to be worse than before surgery. However, most side effects of surgery usually decrease or disappear over time.

Radiation therapy uses high-energy x-rays or other types of ionizing radiation to stop cancer cells from dividing. Radiation therapy may be used when surgery is not advised, for tumors that cannot be completely resected, or after surgery to prevent or delay tumor recurrence. Radiation therapy can stop or slow the growth of inoperable tumors. Use of radiation therapy is avoided in children below the age of three because it damages the developing brain.

Radiation therapy can be delivered by external or internal means. External beam radiation therapy involves linear accelerators and cobalt machines that direct radiation at the tumor from outside the patient’s body. Interstitial radiation therapy (brachytherapy) involves surgically implanting radioactive material directly inside the tumor.

Two of the main types of external beam radiation therapy are conventional and stereotactic radiosurgery (SRS).

Conventional radiation therapy delivers radiation to an entire region of the brain. The radiation is fractionated into many small doses and given over a period of time (usually five to seven weeks, excluding weekends). Depending on the location and size of the tumor(s), the treatment can be either focused or whole brain radiation therapy (WBRT). Focused radiation therapy aims x-rays at the tumor and area surrounding it. WBRT aims radiation at the entire brain. WBRT is used to treat multiple tumors and metastatic brain tumors.

Stereotactic radiosurgery (SRS) delivers a single, high dose of radiation in a one-day session. Several types of machines are used to administer radiosurgery: Gamma Knife, Linac, X-Knife, CyberKnife, and cyclotron. In an SRS procedure, a head frame is attached to the skull to hold the head in position (newer methods of SRS may use a mask instead of a head frame). Then CT or MRI scans are taken. With the aid of computer imaging, the location of the tumor is accurately calculated. The radiation is delivered directly to the tumor, often from several different directions. Size and location of the tumor are important eligibility criteria for SRS.

Radiation therapy can cause both short-term and delayed side effects. Short-term side effects occur during or shortly after radiation treatment. Long-term, or delayed, side effects may occur months or years after treatment. The most common short-term side effects of radiation therapy are fatigue, loss of appetite, nausea, and short-term memory loss (loss of recently-learned information). Most of these symptoms can be treated or in some cases will decrease or disappear after treatment has been completed. Short-term memory loss usually subsides within two months after RT treatment is completed. Brain edema may occur and may be treated with steroids. Skin reactions (rash, redness, or irritation) and hair loss may occur in the area where the radiation is focused.

Sometimes dead tumor cells form a mass in the brain. This is called radiation necrosis. Necrosis may look like a tumor on a scan and can cause similar symptoms (headache, memory loss, seizures, personality changes, and cognitive problems). A biopsy may be required to make a correct diagnosis. Surgery and/or steroids may be necessary to treat necrosis.

Chemotherapy uses chemicals (drugs) that have a toxic effect on tumor cells as they divide. Chemotherapy is usually taken orally or by injection, and may be given alone or in combination with other treatments. Chemotherapy is given in cycles, which consist of “on” and “off” phases – days of treatment followed by periods of time between treatments. Cycles vary depending on the drug or drugs used. Chemotherapy is usually a secondary therapy. It is also used to delay or replace radiation treatment in young children.

A new method to deliver chemotherapy directly to brain tumors is the polymer wafer implant. Biodegradable wafers are saturated with the chemotherapy drug, BCNU. After resection, several wafers are inserted into the tumor cavity and are left there to dissolve over time. In this way, a concentrated dose of BCNU (approximately 100 times higher than that tolerated through IV) is delivered to the tumor site.

Most chemotherapy drugs enter and affect the patient’s entire system. Chemotherapy can cause a range of side effects including fatigue, chills, shortness of breath, nausea, neuropathy (numbness and tingling in the arms or legs), skin reactions, and hair loss.

Side effects are caused when the drugs damage normal cells that are dividing. Reactions can range from mild to severe. All side effects should be reported to the doctor. There are treatments available to alleviate many of these problems. Antiemetics (antinausea drugs) have greatly reduced the nausea chemotherapy patients have experienced in the past. Oncologists or oncology nurses will work with patients to minimize or prevent anticipated side effects. In some cases, the type of chemotherapy drug may be changed.

For more information about brain tumor treatments, see chapter 5 of The Essential Guide to Brain Tumors.

To a large extent, what happens to you depends on the type of tumor you have, its location, the area of the brain involved and the forms of therapy you’ll have. But each patient is different, and these are not the only factors to be considered.

For patients and their families, the brain tumor experience is a journey into an unknown land filled with uncertainty. Through the diagnosis, treatments and follow-up visits, there’s much to learn and cope with physically, emotionally, and spiritually.

The more you and your family know and understand each aspect of your treatment, the less uncertainty remains about what will happen. The confidence you place in yourself and your medical caretakers makes a tremendous difference. Perhaps most important of all is your outlook toward your condition and treatment and your willingness to believe in the power of healing. Brain tumor patients have a right to remain hopeful in the fight against their illness and its aftermath. Hope is a powerful coping strategy that empowers patients to look beyond the moment and into the future.

For more information, see Coping with Your Loved One’s Brain Tumor.

There is no one “best” doctor, but there are issues to consider that can help guide you in choosing the doctor that is best for you. Good communication is key to a good relationship with your doctors. If you ask your questions and get them answered, the experience will be easier for you and your family. If you are not comfortable with your doctor, consider changing doctors.

Getting a second opinion is important if your doctor does not have experience with brain tumors or if you want to confirm your primary physician’s recommendation. Ask your doctor for a referral to a specialist. You can also consult the information in our Treatment Center Database to research different treatment centers, or call NBTF. We can provide you with phone numbers of comprehensive cancer centers and medical centers of excellence specific to brain tumors.

There are many important questions to ask when choosing a treatment center. Does the center have specialists in neurosurgery, neurology, neuro-oncology and radiation oncology? What types of imaging technology is available? How many patients does the medical center diagnose and treat per year? Our fact sheet, Issues to Consider When Choosing a Treatment Center, may be helpful in this process.

Click here for the fact sheet How and Why to Get a Second Opinion.

A family in which one member has a brain tumor is constantly challenged by changing circumstances, and yet must also strive to be caring and supportive throughout the entire process of diagnosis, treatment, and recovery.

Being aware of some of the different ways in which illness may affect you and your loved ones can help in finding the best ways to cope with these changes. People may respond in various ways. Common reactions can include physical symptoms such as fatigue, nervousness, impaired sleep or appetite; emotional reactions such as fear, shock, depression, anger, guilt, mood swings, or crying; cognitive symptoms that may include difficulty concentrating or forgetfulness; and spiritual responses such as searching for meaning, or an increase or decrease in spirituality. These are all normal responses to stress. Recognizing these common issues can guide everyone struggling with the challenges brought about by a brain tumor diagnosis.

Brain tumor patients will often have a primary caregiver, the main person who assists and cares for the patient’s needs. Communication between family members may become more difficult in addressing changes in roles and responsibilities. How a family copes with these changes is affected by the ability to communicate. Families may need to identify outside sources of support to assist with this process.

Identifying individual family members and friends who are committed to helping can provide needed support to the patient and help with difficult transitions. Including others who are looking for a helpful role to play can help form a sense of community and reduce the feeling for caregivers and patients that they are going through this alone. Creating new, flexible solutions to changing circumstances can serve as a way to help cope with the changing nature of the illness. Recognizing that the old way of doing things may no longer be useful can help families to come up with new and innovative ways of dealing with change.

It is difficult to summarize a single approach to coping, because every patient, family and disease is different. But it’s important to recognize how stress is affecting you. If your response to stress feels extreme or persists over time, consider consulting your doctor or a counselor.

These are some of the resources available to help patients and their families cope:

National Brain Tumor Foundation Support Group Listings
800.934.CURE (800.934.2873)

Cancer Care Counseling Line
800.813.HOPE (800.813.4673)
www.cancercare.org

National Family Caregivers Association
800.896.3650
www.nfcacares.org

Well Spouse Foundation
800.838.0879
www.wellspouse.org

Wellness Community
310.453.2300 (National Headquarters)
www.thewellnesscommunity.org

For more information, see Coping with Your Loved One’s Brain Tumor.

NBTF maintains a comprehensive list of brain tumor support groups for patients and their families, with over 200 support groups across the United States and Canada currently listed.

You can post and answer email messages on the NBTF Message Boards. NBTF Message Boards are for brain tumor patients, survivors, family members, caregivers or health professionals dealing with the same tumor types. The brain tumor community can “meet” via the Internet and exchange ideas on treatments and research, as well as to share suggestions and information about the medical and emotional challenges of living with a brain tumor.

NBTF offers the Patient Support Network for patients to connect with other survivors by email or by telephone. The Caregiver Support Network does the same for caregivers. You can also call the Patient Services Department at 800.934.2873 or email nbtf@braintumor.org if you are interested in being connected to another survivor or caregiver. The NBTF support network volunteers offer information, stories, support, and an understanding ear.

In addition, the NBTF National Brain Tumor Caregiver Training Program offers one-day workshops for caregivers at treatment centers around the United States. For upcoming workshops, visit What’s New or call 800.934.2873.

The brain is divided into sections, each of which controls aspects of movement and behavior. A brain tumor can affect different functions depending on where in the brain the tumor is located.

The cerebrum is the largest area of the brain. It has two sections called the right and left hemispheres. The right cerebral hemisphere typically controls the left side of the body, and the left cerebral hemisphere controls the right side of the body. Each hemisphere is further divided into four sections called lobes: the frontal, parietal, temporal and occipital lobes.

The frontal lobes make up the front portion of the cerebral hemispheres. The frontal lobes control many of the brain’s activities including attention, abstract thought, problem solving, reasoning, judgment, initiative, inhibition, memory, parts of speech, moods, major body movements, and bowel and bladder control.

The parietal lobes help us make calculations, read, and write.

The temporal lobes form the lower portion of the cerebral hemispheres. The temporal lobes manage most auditory activities in the brain by translating words into meaning. There is also a small, important section of the temporal lobe that controls the brain’s ability to form long-term memory patterns. The left temporal lobe controls language comprehension in most people. For this reason, the left temporal lobe is considered the dominant lobe.

The occipital lobes are in the back portion of the cerebral hemispheres. The occipital lobes control vision. The right occipital lobe processes what is seen out of the left field of vision, and the left occipital lobe processes what is seen out of the right field of vision.

The brain stem, located at the base of the brain, includes three parts: midbrain, pons, and medulla oblongata. The brain stem contains the 12 cranial nerves, which control hearing, vision, sense of smell, and balance. The brain stem also contains pathways going from the spinal cord to the brain for messages related to movement and the senses. In addition, the brain stem controls involuntary functions, including breathing and heartbeat and our sleep/wake cycle. All functions controlled by the cerebrum pass through the brain stem.

The cerebellum, located behind the brain stem, has many connections to the brain and the spinal cord. The cerebellum is responsible for coordinating muscle groups and controlling small movements and balance.

For more information about the brain, see chapter 1 of The Essential Guide to Brain Tumors.