Types of brain tumour

Primary brain tumours arise from the cells present within the normal brain. The tumour cells grow in an abnormal, uncontrolled way.

Tumours can start to grow in any part of the brain and will cause different symptoms depending on their site.

Primary brain tumours can either be cancerous (malignant) or non-cancerous (benign).

All primary brain tumours are graded according to the World Health Organisation (WHO) classification system (2016). The tumour grade reflects features such as how quickly the tumour is growing:

• Tumours that grow more slowly are called low grade (grade1 or 2). Some low grade tumours are benign, but can still cause problems as they interfere with the surrounding brain and its functions. Some don’t come back after treatment, but others will and require further treatments. Treatmens include surgery, radiotherapy and sometimes, chemotherapy.
• Tumours that grow more quickly are called high grade (grade 3 or 4). These tumours are malignant brain cancers. Unlike other types of cancer, they rarely spread (metastasise) to other parts of the body. High grade brain tumours often need further treatment such as radiotherapy and chemotherapy after surgery.

Primary brain tumours are relatively rare, but the number of people being diagnosed in the UK is increasing. One possible reason for this increase is that advances in scanning technology may be detecting more brain tumours.

Depending on the area of the brain affected by the tumour, patients can have very different problems, such as issues with movement, speech, thinking skills, or vision. If you experience difficulties in any of these areas you may be seen by one, or more, of our specialist therapy services.

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Secondary brain tumours (metastases) are cancers that have spread to the brain from primary cancers in another part of the body. This is more likely to happen with certain cancers such as lung, breast, bowel, kidney and melanoma (skin cancer). In some people, the brain secondary tumours may be the first sign they have cancer.

You will have several tests to diagnose brain metastases. You may have a brain CT (computerised tomography) and / or MRI (magnetic resonance imaging) scans. Sometimes it may be necessary to have a biopsy to make the diagnosis.

Most treatments for brain metastases are given with the aim of control rather than cure. Your doctor will explain what your treatment involves and what they hope it will achieve.

The UCLH Brain Metastases Service provides localised treatments for secondary brain cancers in fit patients who have controlled or no active cancer outside the brain. The service was the first of its kind in the UK and receives referrals from all over London as well as offering second opinions to patients from other centres in the UK.

Patients are discussed in the weekly neuro-oncology multidisciplinary team (MDT) meeting, and are seen in a weekly clinic at the University College Hospital Macmillan Cancer Centre.

Treatments used include surgery and radiosurgery (such as the Gamma Knife), and other advanced radiotherapy techniques.

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Following treatment, you will be kept under regular surveillance and follow up with both The Brain Metastases Service and your primary cancer oncology team.

Depending on the area of the brain affected by the tumour, patients can have very different problems, such as issues with movement, speech, thinking skills, or vision. If you experience difficulties in any of these areas you may be seen by one, or more, of our specialist therapy services.

• Find out more about therapy services

The pituitary gland is located at the base of the brain, behind the eyes. It produces chemical messengers called hormones. These are produced by the pituitary gland and released into the blood stream. They, in turn, control other glands in the body, including the adrenal glands and thyroid gland, which then control important body functions.

Most pituitary tumours are pituitary adenomas, which are benign, slow-growing tumours that arise from cells in the pituitary gland. Symptoms of the pituitary tumour are generally caused by the tumour producing too much of a certain hormone, by preventing the normal gland from producing enough hormones or by causing pressure on the nerves to the eyes. Increasingly pituitary tumours are found on routine scans for often completely unrelated problems such as headaches.

You will need different tests to assess the size and effects of the tumour, such as eye tests, a CT scan or an MRI scan as well as an assessment of the hormones that the pituitary gland produces. Often, a specialist endocrinologist will see you and assess your hormones before any particular treatment is recommended.

If the pituitary tumour needs treatment, surgery tends to be the first line treatment in most cases. Your neurosurgeon will talk to you about the best treatment option for you, taking into consideration the scan and blood test results.

Most pituitary surgery is undertaken through the nose so you will not have a visible wound after surgery. This is called a transsphenoidal hypophysectomy as it is undertaken via the sphenoid sinus which is an air sinus that sits at the back of your nose. It is done under general anaesthetic. If the tumour is very large, your neurosurgeon might decide that the best option for you is a craniotomy (surgery through your head).

We sometimes suggest treating the pituitary tumour with medication. This is particularly if the pituitary tumour produces too much of a hormone called Prolactin. Some people will need radiotherapy after surgery or instead of surgery. Some people with very small tumours may have a specialised type of targeted radiotherapy called stereotactic radiosurgery.

You might need to take medication if your hormones have been affected either by the tumour or as a result of surgery. This is called hormone replacement.

You can find more detailed pituitary information at the pituitary foundation website www.pituitary.org.uk .

The skull base consists of several bones that form the bottom of the skull underneath the brain and the bony ridge behind the eyes and nose.

Many different kinds of tumours grow in this area and are often not diagnosed until they grow large enough to put pressure on the brain or nerves to the eyes. They can grow deep within the skull and close to critical nerves and blood vessels in the brain, head, neck and spinal cord.

Skull base tumours can originate in the skull base (a primary tumour) or spread there from a cancer elsewhere in the body (metastatic disease).

The majority of tumours which are in the skull base area are benign (non-cancerous) however there are very rare types of tumour which are malignant (cancer).

Tumours in the base of the skull can cause problems with coordination, balance, and speech and swallowing. This might affect dextrous movements in the arms and hands, leg movements during walking, and unsteadiness when sitting or standing. The nerves that supply the face are also located in this area and could be affected.

These difficulties can have an impact on how you move, or how independently you can do daily activities.

If you experience difficulties in any of these areas during your treatment journey you may be seen by one, or more, of our specialist therapy services.