Introduction

A malignant brain tumour is a fast-growing cancer that spreads to other areas of the brain and spine.

Generally, brain tumours are graded from 1 to 4, according to their behaviour, such as how fast they grow and how likely they are to grow back after treatment. A malignant brain tumour is either grade 3 or 4, whereas grade 1 or 2 tumours are usually classed as benign or non-cancerous. 

Most malignant tumours are secondary cancers, which means they started in another part of the body and spread to the brain. Primary brain tumours are those that started in the brain.

These pages focus on high-grade brain tumours. For information about grade 1 or 2 tumours, read our pages on low-grade (benign) brain tumours.

Signs and symptoms

The symptoms of a malignant brain tumour depend on how big it is and where it is in the brain.

Common symptoms include:

  • severe, persistent headaches
  • seizures (fits)
  • persistent nausea, vomiting and drowsiness
  • mental or behavioural changes, such as memory problems or changes in personality
  • progressive weakness or paralysis on one side of the body, vision problems, or speech problems

See your GP if you have persistent symptoms of a brain tumour. While it's unlikely to be a tumour, it's best to be sure by getting a proper diagnosis.

Read more about the symptoms of malignant brain tumours and diagnosing malignant brain tumours.

Types of malignant tumours

Most malignant brain tumours develop from the glial tissue, which supports the brain's nerve cells. These tumours are known as gliomas.

Gliomas can be separated further, depending on the cells they developed from. For example:

  • an astrocytoma develops from cells thought to provide the brain's framework
  • an oligodendroglioma develops from the cells that produce the fatty covering of nerves
  • an ependymoma develops from the cells that line the cavities in the brain

It's also possible to have a malignant tumour that's a mixture of these types or developed in a different part of the brain.

Who is affected

Brain tumours can affect people of any age, including children, although they tend to be more common in older adults.

Around 5,000 people are diagnosed with a primary malignant brain tumour in the UK each year. Many others are diagnosed with secondary tumours.

The exact cause of primary malignant brain tumours is unknown, although it's thought that certain genetic conditions and previous radiotherapy treatment to the head may increase the risk of one developing.

Read more about the causes of malignant brain tumours.

How malignant brain tumours are treated

A primary malignant brain tumour needs to be treated as soon as possible, because it can spread and damage other parts of the brain and spinal cord.

Surgery will usually need to be carried out to remove as much of the tumour as possible. This may be followed by radiotherapy and/or chemotherapy to kill any cancerous cells left behind and reduce the chances of the tumour regrowing.

However, malignant tumours will often eventually return after treatment. If this happens, or if you have a secondary tumour, a cure isn't usually possible and treatment can instead be used to improve symptoms and prolong life.

Read more about treating malignant brain tumours.

Living with a brain tumour

Living with a brain tumour is not easy. You may feel worried and anxious about what's going to happen to you and your family. This is perfectly normal.

It can help to seek accurate medical information about your specific tumour and its treatment, make sure you're closely involved in decisions about your care, and ask your care team about anything you're not sure about.

You can read more about living with a brain tumour on The Brain Tumour Charity's website.

Your doctor may be able to refer you to a counsellor if you want to talk about the emotional aspects of diagnosis and treatment. There are also many organisations and helplines that can help, such as The Brain Tumour Charity and Brain Tumour Research.

Support for carers

Being a carer is not an easy role. When you are busy responding to the needs of others, it can deplete your reserves of emotional and physical energy, and make it easy for you to forget your own health and mental wellbeing.

Research on carers’ health shows that high numbers of carers suffer health effects through caring. If you are trying to combine caring with a paid job or looking after a family, this can cause even more stress.

However, neglecting your own health doesn't work in the long term. If you're caring for someone else, it’s important to look after yourself and get as much help as possible. It's in your best interests and those of the person you are caring for.

For more information on the support available to you and benefits you may be entitled to, visit Care Information Scotland.

Recovery and outlook

The outcome for malignant primary brain tumours depends on a number of things, such as the type and location of the tumour, your age, and how ill you were when diagnosed.

Overall, around 40% of people live at least a year, about 19% live at least five years, and around 14% live at least 10 years.

If treatment is successful, you may still be left with some persistent problems, such as seizures, walking difficulties, or speech problems. You may need supportive treatment to help you recover from or adapt to these problems.

You'll also need regular follow-up appointments to check if the tumour has started to come back.

Read more about recovering from treatment for a malignant brain tumour.

Symptoms

The symptoms of a malignant brain tumour depend on how big it is and where it is in the brain.

When symptoms do occur, it is because the brain tumour is either putting pressure on the brain or preventing an area of the brain from functioning properly.

Signs of increased pressure on the brain

Common symptoms of increased pressure within the skull include:

  • severe, persistent headaches – which are typically worse in the morning or when bending over or coughing
  • persistent nausea and vomiting
  • drowsiness
  • vision problems – such as blurred vision, floaters and loss of vision that may come and go
  • seizures (fits) – which may affect the whole body or just involve a twitch in one area

Symptoms caused by the position of the tumour

Different areas of the brain control different functions, so the symptoms caused by a brain tumour will depend on where the tumour is located. For example, a tumour affecting:

  • the frontal lobe may cause changes in personality, weakness in one side of the body and loss of smell
  • the temporal lobe may cause forgetfulness, language problems (aphasia) and seizures
  • the parietal lobe may cause aphasia and numbness or weakness in one side of the body
  • the occipital lobe may cause loss of vision on one side
  • the cerebellum may cause a loss of co-ordination, flickering of the eyes, vomiting and a stiff neck
  • the brain stem may cause unsteadiness and difficulty walking, facial weakness, double vision, and difficulty speaking (dysarthria) and swallowing (dysphagia)

When to see your GP

It's important to see a doctor if you develop persistent and worrying symptoms that may be caused by a brain tumour. While it's unlikely that you have a tumour, it's best to be sure by getting a proper diagnosis.

If your GP is unable to identify a more likely cause of your symptoms, they may refer you to a neurologist for further assessment and tests, such as a brain scan.

Read more about diagnosing malignant brain tumours.

Causes

Most malignant brain tumours are caused by a cancer that started somewhere else in the body and spread to the brain, through the bloodstream. These are known as secondary tumours.

Cancers that can spread to the brain include lung cancer, breast cancer, bowel cancer and melanoma skin cancer.

Some primary malignant brain cancers (cancerous tumours that start in the brain) are caused by a previously benign brain tumour becoming cancerous, but usually the exact reason why a primary tumour develops is unknown.

Who's most at risk?

Some of the things that can increase your risk of brain tumours are outlined below.

Age

Brain tumours affect people of all ages, including children, but the risk tends to increase as you get older. Most tumours affect people over 50 years of age.

Family history

People with a family history of brain tumours may be at a slightly increased risk of developing a brain tumour themselves.

Radiotherapy

If your brain is exposed to radiation during radiotherapy, your risk of developing certain types of brain tumour later on is increased.

Genetic conditions

Some genetic conditions can increase your risk of a brain tumour, such as:

  • neurofibromatosis type 1 or neurofibromatosis type 2
  • tuberous sclerosis 
  • Turcot syndrome
  • Li-Fraumeni cancer syndrome
  • von Hippel-Lindau syndrome
  • Gorlin syndrome

Unlike most brain tumours, tumours associated with these conditions tend to develop in childhood or early adulthood.

Can mobile phones cause brain tumours?

There have been reports in the media about a possible connection between brain tumours and the radiofrequency (RF) energy emitted by mobile phones. RF energy produces heat, which can increase body temperature and damage tissue exposed to it.

However, it's thought that the amount of RF energy people are exposed to from mobile phones is too low to produce significant tissue heating or an increase in body temperature.

Research is underway to establish whether RF energy has any long-term health effects, but the balance of evidence currently available suggests that it's unlikely mobile phones cause health problems.

Diagnosis

See your GP if you develop any of the symptoms of a malignant brain tumour, such as a persistent and severe headache.

Your GP will examine you and ask about your symptoms. They may also carry out a simple neurological examination (see below).

If they suspect you may have a tumour, or they are not sure what's causing your symptoms, you'll probably be referred to a neurologist (brain and nerve specialist).

Neurological examination

Your GP or neurologist may carry out a test of your nervous system, called a neurological examination, to look for problems associated with a brain tumour.

This may involve tests of your:

  • hand and limb strength
  • reflexes, such as your knee-jerk reflex
  • hearing and vision
  • skin sensitivity
  • balance and co-ordination
  • memory and mental agility (using simple questions or arithmetic)

A neurologist may also recommend one or more of the tests mentioned below.

Further tests

Other tests you may have to help diagnose a brain tumour include:

If a tumour is suspected, a biopsy (surgical removal of a small piece of tissue) may be taken to establish the type of tumour and the most effective treatment.

Under anaesthetic, a small hole (known as a burr hole) is made in the skull and a very fine needle is used to obtain a sample of tumour tissue. You'll probably need to stay in hospital for a few days afterwards.

Treatment

If you have a malignant brain tumour, you'll usually need surgery to remove as much of it as possible. Radiotherapy and/or chemotherapy may then be used to treat any remaining cancerous tissue.

The aim of this is to remove or destroy as much of the tumour as possible, ideally getting rid of the cancerous cells completely. However, this isn't always possible and most malignant brain tumours will eventually return after treatment.

If your tumour does return after treatment, or you have a secondary brain tumour (where cancer has spread to your brain from another part of your body), a cure isn't usually possible. Treatment can instead be used to control your symptoms and prolong life.

Your treatment plan

There are a number of different treatments for malignant brain tumours, and deciding on what you feel is the best treatment can be confusing.

A group of different specialists called a multidisciplinary team (MDT) will be involved in your care and will recommend what they think is the best treatment option for you, but the final decision will be yours.

Before visiting hospital to discuss your treatment options, you may find it useful to write a list of questions that you'd like to ask. For example, you may want to find out the advantages and disadvantages of particular treatments.

The main treatments used are described below.

Surgery

Surgery will be recommended for most people with a malignant brain tumour. If the size or position of the tumour mean surgery is not possible, one or more of the treatments described below may be recommended instead.

The main operation used to treat people with brain tumours is called a craniotomy. You will be given a general anaesthetic so you are asleep while the procedure is carried out. An area of your scalp will be shaved and a section of the skull is cut out as a flap to reveal the brain and tumour underneath.

The surgeon can then remove as much of the tumour as possible and secure the flap of skull back in place with metal screws.

After surgery, treatment with radiotherapy and/or chemotherapy may be recommended to kill any cancer cells left behind and reduce the risk of the tumour coming back. 

Radiotherapy

Radiotherapy is a treatment where a beam of high-energy radiation is focused on the tumour to kill the cancerous cells. It can be used after surgery or as the main treatment for tumours that are difficult to remove.

Radiotherapy is usually given in several doses (fractions) spread over the course of a week. An entire course of treatment will usually last up to six weeks in total.

Possible side effects of radiotherapy for a brain tumour include nausea, temporary hair loss, tiredness and red, sore skin. Read more about the side effects of radiotherapy.

In a small number of cases, a similar treatment called proton beam therapy may be recommended. However, this is only suitable in very specific cases and currently you'll need to be referred for treatment abroad if your doctor thinks it's appropriate.

Chemotherapy

Chemotherapy is medication used to kill cancerous cells. It may be used alongside radiotherapy or on its own, either to help kill any cancerous cells left behind after surgery or to help relieve your symptoms when a cure is not possible.

Chemotherapy medication for brain tumours can be given in a number of ways, including as:

  • tablets (orally) – temozolomide and procarbazine are given in this way
  • injections into a vein (intravenously) – vincristine is given in this way
  • small, disc-like implants placed in the brain during surgery – carmustine can be given in this way, but is only recommended if 90% or more of the tumour has been removed

The side effects of chemotherapy largely depend on the specific medication you're taking. Common general side effects include tiredness, headaches, temporary hair loss and nausea. Read more about the side effects of chemotherapy.

For more information about some of the treatments used, see the guidelines from the National Institute for Health and Care Excellence (NICE) on carmustine implants to treat gliomas and temozolomide for recurrent malignant glioma.

Radiosurgery

Stereotactic radiosurgery (SRS) is a special type of radiotherapy that's sometimes used to treat brain tumours that can't be safely removed with surgery.

During the treatment, several small beams of radiation are used to very accurately deliver a high dose of radiation to the tumour, usually in a single treatment session. 

As the radiation beams can be aimed very precisely, a high dose of radiation can be delivered to the tumour with minimal damage to the surrounding healthy cells.

This means you're less likely to experience many of the usual side effects of radiotherapy. Recovery tends to be much faster and an overnight stay isn't usually necessary.

However, radiosurgery is currently only available in a few specialised centres across the UK and is only suitable for certain people, based on the characteristics of their tumour.

Treating symptoms

You may also be given medication to relieve some of the symptoms you may have as a result of your brain tumour.

These may include:

  • anticonvulsants to prevent seizures (fits)
  • corticosteroids to reduce swelling and pressure in the brain
  • painkillers to treat headaches
  • anti-emetics to prevent vomiting

Depending on your circumstances, these medications may be given before, after, or instead of surgery.

Choosing not to have treatment

If your tumour is at an advanced stage or in a difficult place in the brain, a cure may not be possible and treatment may only be able to control the cancer for a period of time. This means you will be getting the side effects of treatment without getting rid of the tumour.

In this situation, it may be difficult to decide whether or not to go ahead with treatment. Talk to your doctor about what will happen if you choose not to be treated, so you can make an informed decision.

If you decide not to have treatment, you will still be given palliative care, which will control your symptoms and make you as comfortable as possible.

Recovery

After being treated for a brain tumour, you may need additional care to monitor and treat any further problems.

Follow-up appointments

Malignant brain tumours often grow back after treatment, so regular follow-up appointments will be recommended to look for signs that this may have happened.

These appointments may include a discussion of any worrying new symptoms you experience, a physical examination, and occasionally a brain scan.

You will usually have follow-up appointments at least every few months to begin with, but they may be needed less frequently over time if no problems develop.

Supportive treatment

Problems caused by a brain tumour don't always resolve as soon as the tumour is removed or treated. For example, some people have persistent weakness, seizures (fits), difficulty walking and speech problems.

In these cases, you may need extra support to help you overcome or adapt to any problems you have. This may include therapies such as:

  • physiotherapy – to help with any movement problems you have
  • occupational therapy – to identify any problems you're having with daily activities and arrange for any equipment or alterations to your home that may help
  • speech therapy – to help you with any communication or swallowing problems

Some people may also need to continue taking medication for seizures for a few months or more after their tumour has been treated or removed.

The National Institute for Health and Care Excellence (NICE) has made recommendations on the standards of care that brain tumour patients should receive. For more information, see the service guidance for improving outcomes for people with brain and other central nervous system tumours.

Driving and travelling

You may not be allowed to drive for a while after you've had a brain tumour. This will depend on things such as the type of brain tumour you had, where it was in the brain, and what symptoms you have.

If you are required to give up your driving licence and notify the DVLA, they will speak to your GP or specialist to determine when you can drive again.

With up-to-date scans and advice from your medical team, you may be allowed to drive again once an agreed period has passed and you have successfully completed a medical test to determine your ability to control a vehicle.

You can find out about brain tumours and driving on the Cancer Research UK website.

Flying is usually possible from three months after treatment.

Sports and activities

After you have been treated for a brain tumour, you must permanently avoid contact sports, such as rugby and boxing. You can start other activities again, with the agreement of your doctor, once you have recovered.

Swimming unsupervised is not recommended for around one year after treatment, as there is a risk you could have an epileptic fit while in the water.

Sex and pregnancy

It's safe to have sex after treatment for a brain tumour.

Women may be advised to avoid becoming pregnant for six months or more after treatment. If you're planning to become pregnant, you should discuss this with your medical team.

Going back to work

You'll usually tire more easily following treatment for a brain tumour.

You may wish to return to work and normal life as soon as possible, but it's probably a good idea to return part-time to begin with and only go back full-time when you feel able to.

If you've experienced seizures, you shouldn't work with machinery or at heights.

Emotional support

A brain tumour is often life-changing. You may feel angry, frightened and emotionally drained. If it will help, your doctor or specialist may be able to refer you to a social worker and counsellor for help with the practical and emotional aspects of your diagnosis.

There are also many organisations that can provide information and support, such as The Brain Tumour Charity and Brain Tumour Research.

Social support

If you have been diagnosed with a brain tumour, your treatment and medical care will probably be the first thing on your mind. But there are other aspects of your life to think about and it is important to know exactly what kind of assistance is available and where you can get it.

If you are finding it hard to cope with day-to-day life, talk about your needs with your doctor or nurse, who will refer you to a social worker. Your social worker will assess exactly the kind of help you need.

Help you may need might include:

  • a care attendant, who can help with housework, dressing and washing, or even just keep you company and give your carer a break
  • a "meals on wheels" service
  • income support, disability living allowance or attendance allowance
  • equipment and adaptations for your home

For more information about what help you might need and how you can access it, visit Care Information Scotland.