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 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 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 is a 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.
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.
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.