The types of treatment used for brain tumours

Treatments used

Surgery, radiotherapy or chemotherapy may be used alone or in combination to treat brain tumours. The choice of treatment will also depend on whether it is a primary or secondary brain tumour.

Your doctor will plan your treatment by taking into consideration a number of factors, including the particular tumour and your general health. A team of doctors and other health professionals will plan your care. This is known as a multidisciplinary team and may include:

• a neurosurgeon – a doctor who specialises in operating on the brain or nervous system
• a neurologist – a doctor who specialises in treating illnesses of the brain and nervous system
• a clinical oncologist – a doctor who treats cancer with radiotherapy and chemotherapy

You may also see a specialist nurse who supports people with brain tumours.

Giving your consent

Before you have any treatment your doctor will explain the aims of the treatment to you and you will usually be asked to sign a form saying that you give your permission (consent) for the hospital staff to give it. No medical treatment can be given without your consent, and before you are asked to sign the form you should have been given full information about:

• the type and extent of the treatment you are advised to have
• the advantages and disadvantages of the treatment
• any other types of treatments that may be appropriate
• any significant risks or side effects of the treatment.

If you do not understand what you have been told, let the staff know straight away so that they can explain again. Some cancer treatments are complex, so it is not unusual for people to need repeated explanations.

It is often a good idea to have a friend or relative with you when the treatment is explained, to help you remember the discussion more fully. You may also find it useful to write down a list of questions before you go for your appointment.

Patients often feel that the hospital staff are too busy to answer their questions, but it is important for you to be aware of how the treatment is likely to affect you. The staff should be willing to make time for you to ask questions.

You can always ask for more time to decide about the treatment if you feel that you can’t make a decision when it is first explained to you.

You are also free to choose not to have the treatment. The staff can explain what may happen if you do not have it. It is essential to tell a doctor, or the nurse in charge, so that they can record your decision in your medical notes. You do not have to give a reason for not wanting to have treatment, but it can be helpful to let the staff know your concerns so that they can give you the best advice.

Primary tumours

With most primary brain tumours, surgery is often the first treatment, if the tumour can be removed without causing harm to the surrounding brain tissue. However, certain tumours may not need to be operated on immediately, or at all. Some low-grade gliomas, for example, may be carefully monitored if they are not causing problems, and others may be treated with radiotherapy alone. Rare tumours of the brain, such as germinomas or lymphomas, are sometimes treated without an operation, using radiotherapy and chemotherapy.

Surgery can range from having a biopsy to find out which type of tumour it is, to a major operation where the tumour is completely removed.

If a tumour has not been completely removed, or if there is a chance that abnormal cells may be left behind following surgery, radiotherapy will usually be given after the operation.

When surgery is not possible, or not necessary, radiotherapy, with or without chemotherapy, is used as the main treatment.

Secondary tumours

The treatment of a secondary brain tumour will depend on the type of primary cancer it has spread from, the size and position of the secondary cancer within the brain and whether or not there are other secondary tumours elsewhere in the body.

Steriods, such as dexamethasone, can often control the symptoms of secondary brain tumours. They are usually taken as tablets and are sometimes the only treatment that is needed.

Radiotherapy (usually to the whole head) may sometimes be given to shrink and control the secondary brain tumour.

Occasionally, if there are only one or two very small areas of secondary cancer, it may be possible to remove them with surgery or give a localised form of radiotherapy called radiosurgery. Radiotherapy is sometimes given after an operation.

Chemotherapy or hormonal therapy may also be helpful, depending on the type of primary cancer the tumour has spread from.

With secondary brain tumours the aim of treatment is to improve symptoms and to prolong a good quality of life. At this stage it is not usually possible to cure the cancer or to remove the tumour altogether, but the steriods, chemotherapy or hormonal therapy may extend some people’s lives for some months.

Symptom control treatment

In both primary and secondary brain tumours, treatment for particular symptoms, such as anticonvulsant medicines to prevent epileptic fits and steroids to reduce any inflammation and swelling around the tumour, may be necessary.