This section on brain tumours is for teenagers and young adults.
A team of specialists will plan your treatment. They will talk to you about the best treatment for you.
It's normal to have a combination of treatments, so you may be seen by different doctors, such as:
- a neurosurgeon, who specialises in brain operations
- a neurologist, who treats brain conditions
- a cancer specialist (oncologist), who treats brain tumours with radiotherapy and chemotherapy
You’ll usually see a specialist nurse who looks after people with conditions affecting the brain, or a specialist nurse for teenagers or young adults with cancer. If you have radiotherapy (X-ray treatment) you will be given this treatment by a radiographer.
There are different types of brain tumours, so treatment won’t be the same for everyone. Your doctors look at the type of brain tumour you have, its size and where it is in the brain before deciding on the best treatment for you.
The main treatments for brain tumours are:
- surgery – an operation to remove all, or as much as possible, of the tumour
- radiotherapy – uses high-energy x-rays to treat cancer cells
- chemotherapy – uses anti-cancer drugs to destroy cancer cells
Your specialist doctor and nurse will explain your treatment and answer any questions you have. It’s important you understand what’s involved. You’ll probably need some time to talk it through with your family.
Medicines you may need to take
You might need to take these medicines for a while to reduce or control the symptoms of the brain tumour:
- steroids, which can reduce swelling or inflammation in the brain and help with symptoms
- anticonvulsant medicines that help prevent fits (seizures)
Surgery for brain tumours
Your surgeon will usually try to remove all, or as much as possible, of the tumour. Before the operation, they will talk to you about what’s involved and the benefits and risks of the operation. It’s important you understand all this, so ask all the questions you want to.
You’ll usually be in hospital for a week, sometimes longer. Your doctor or nurse will tell you what to expect before and after the operation as it can be different for everyone.
Before the operation you’ll probably need to have some of your hair shaved off. This is done in the anaesthetic room. You may prefer to have all your hair shaved off. You can cover up with a wig or hat while it grows back.
For some types of brain tumours, particularly low-grade gliomas, your surgeon might suggest doing an operation while you are awake. This is called an 'awake craniotomy'. If you need this, you will be given plenty of medication to make sure it doesn't hurt.
Sometimes surgery is not needed, or it’s not possible to remove the tumour. Your specialist may think that another treatment would be better for you. They will discuss this with you and you can ask any questions to help you understand your options.
What happens after the operation?
After the operation you are monitored very closely for the first 12 to 24 hours. At first you might be attached to a machine called a ventilator that helps you breathe. Your nurse or doctor will tell you if this is likely to happen.
Your head might be bandaged and you’ll have a tube draining any extra blood that’s collected around the wound into a plastic bottle. You may also have another tube draining extra cerebrospinal fluid (fluid that surrounds the brain). This is to make sure you don’t get too much pressure building up inside your brain. Your doctor will remove these tubes as soon as it’s safe, usually after a couple of days.
You’ll have a drip to give you fluids until you’re eating and drinking again. There may be some swelling and bruising around your face and eyes. This will settle down after a few days.
When you wake up you might have a headache. You’ll be given painkillers regularly until this eases off. Tell your nurse or doctor if you’re in pain so that they can give you something stronger.
Radiotherapy for brain tumours
Radiotherapy uses high-energy X-rays to treat cancer cells. It can be used:
- after the operation to treat any cells that may have been left behind
- instead of an operation when a brain tumour doesn’t need to be or can’t be removed
- if a brain tumour comes back after surgery
For some brain tumours, it’s normal to treat your spinal cord (the nerves that go from your brain to your body) as well as your brain. Your doctor will tell you if this is the case.
Types of radiotherapy
There are 3 types of radiotherapy that are used to treat brain tumours:
- photon radiotherapy (given at your local hospital)
- proton radiotherapy (until 2018/2019 this is given in Switzerland or America)
- stereotactic radiosurgery/radiotherapy (given at specialist hospitals in the UK)
Your doctor will discuss with you which treatment would be best.
You’ll have your treatment in the radiotherapy department of the hospital. It’s usually given Monday to Friday, with a rest at the weekend. The number of treatments you have will depend on your situation, but it can last from 1 day to 7 weeks.
You will have to wear a mask or shell to keep your head as still as possible during radiotherapy treatment. This makes sure treatment is delivered to the exact area each time. Your mask is made before your treatment is planned. You’ll be able to see and breathe properly, but it might feel a bit tight. You only have to wear it for a few minutes at a time. Most people find they get used to it pretty quickly. Let your nurse or radiographer know if you’re worried about this.
The treatment only takes a few minutes. It isn’t painful, but you need to lie very still. You’ll be on your own in the room but you can talk to the radiographer through an intercom. In some hospitals you can have music playing while you have your treatment.
The side effects you might have will depend on the type of radiotherapy you’re having and how long it lasts for. Your doctor and specialist nurse will tell you more about what to expect. Always let them know about any side effects you’re having. There’s usually something they can do to make things easier.
Your hair in the treatment area will start to thin and fall out shortly after your treatment starts. Your doctor or nurse can show you where you will lose your hair.
Losing your hair can be scary and really upsetting. There are lots of ways to cover up with hats, bandannas, baseball caps, scarves, or wigs until it grows back. Getting a shorter haircut before it starts to fall out sometimes makes it a little easier to cope with.
It usually starts to grow back within 3 months of finishing treatment. Hair may grow back with a slightly different colour and texture and might not be as thick as before.
Although hair loss is usually temporary, for some people it can be permanent. Your specialist will usually be able to tell you if this is likely. This can be hard to deal with and you’ll be given advice and support to help you cope.
You might get some skin changes – a bit like sunburn – in the area being treated, usually after 3 to 4 weeks of treatment. At first it can be dry and itchy. If you’ve got pale skin it might get red. If you’ve got darker skin it can get darker. You should wash and dry the skin gently using non-perfumed soap and use only the moisturiser that the radiographer gives you. The radiographer or specialist nurse will give you advice on looking after your skin.
You may feel really tired towards the end of your treatment and for a few weeks after it has finished. This gradually improves after a few weeks. Try to get plenty of rest. It’s also a good idea to do some gentle exercise if you can, like taking short walks. This helps to give you more energy and keep your muscles toned.
Let your doctor know if this is a problem. They can prescribe anti-sickness medicines to help.
It’s important to tell your doctor if you have headaches. They can prescribe pain relief for you.
During and after treatment, you might find your symptoms get a bit worse before they get better. This can be scary but it’s usually a reaction to the radiotherapy. It doesn’t mean the radiotherapy hasn’t worked or that the tumour has got worse. If it happens, let your doctor or nurse know.
Side effects that happen months or years after treatment has finished are called late (long-term) effects. These depend on the area of the brain treated. They can include patches of hair loss, worse concentration, memory changes and difficulty learning new things, reduced hormones, increased risk of a stroke, and a second tumour.
You’ll be seen regularly for follow-up appointments and your doctors will be checking you for any late effects of treatment. Your doctors will explain more about this to you.
Chemotherapy for brain tumours
Chemotherapy is the use of special anti-cancer drugs to destroy tumour cells. You might have chemotherapy:
- to shrink a tumour to make it easier to remove with surgery
- when it’s 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 (adjuvant chemotherapy)
- when a brain tumour has come back after treatment.
Macmillan has information on the different chemotherapy drugs that can be used, such as:
- lomustine (CCNU)
- cisplatin or carboplatin
- temozolomide (Temodal®)
The information on these drugs is written for people of all ages, not just for young people. There are lots of other drugs that are used and your doctor or nurse can tell you more about this.
You can also call Macmillan's cancer support specialists for more information about chemotherapy drugs.
Chemotherapy can be given as a single drug or in combination with others. They can be given by injection into a vein (intravenously) or as tablets. Occasionally chemotherapy is given directly into the spine (intrathecal chemotherapy) or into the brain through a special device (ommaya reservoir).
Another way of giving chemotherapy is for the surgeon to place a wafer containing chemotherapy in the area of the brain where the tumour was removed during the surgery. As the wafer dissolves, the chemotherapy drug is slowly released into the area of the brain that needs treatment.|
Chemotherapy causes side effects that usually get better when treatment is over.
Being more at risk of an infection
You need to let your doctor or nurse know immediately if you have signs of an infection like feeling hot and shivery. This is because you can become unwell quite quickly while you are on chemotherapy.
This is a common side effect so it’s important to get plenty of rest. Try to balance rest with some gentle exercise like short walks if you can. This helps give you more energy and keeps your muscles toned.
You’ll be given anti-sickness medicines to take regularly. Let your nurse or doctor know if the ones you’re taking aren’t working for you.
If you lose your hair it will usually start to grow back again after your treatment stops.
Some chemotherapy drugs can affect your fertility. Your doctor should discuss this with you before treatment begins.
Your doctor and nurse will tell you more about the side effects to expect depending on the chemotherapy you have. Let your doctor or nurse know about any side effects as there’s often something that can be done to control them.
Supportive treatment for brain tumours
As part of your treatment for a brain tumour you’ll probably be given drugs called steroids. You may also be given some anticonvulsant drugs to prevent fits.
Steroids help reduce the swelling that often surrounds a brain tumour. Although they don’t treat the tumour itself, they can improve symptoms and make you feel better. Steroids are often given before and after surgery, and sometimes during or after radiotherapy and chemotherapy.
It’s important to take steroids as your doctor tells you and not to suddenly stop them. If you take steroids for more than 2 weeks, it’s important to tell your doctor about them if you are unwell (for example an infection) over the next 6 months. This is because you may need an extra course of steroids.
If you take steroids for some time, you may have some temporary side effects. These can include:
- weight gain
- a change in the shape of your face (making it more rounded)
- slightly more risk of getting an infection
- mood changes (feeling ‘hyper’ or overactive or feeling low)
- increase in the sugar level in your blood – your blood or urine may be tested to check for this
Side effects can be hard to cope with, especially with all the other stuff you have to deal with. Remember – the side effects will gradually get better when the steroids are stopped, and in the meantime there are lots of people who can support you.
Tumours in the brain can sometimes cause fits. Anticonvulsant drugs can help prevent them. You might be prescribed these before surgery, or to take on a more long-term basis. Your doctors will tell you about any side effects of these drugs.
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If you're looking for information about brain tumours in people of all ages, read our general brain tumours section.