About brain tumours

What is a brain or spinal cord tumour?

A brain or spinal cord tumour starts when abnormal cells grow and form a mass or lump. The tumour may be benign or malignant, but both types can be serious and may need urgent treatment. Brain and spinal cord tumours are also called central nervous system or CNS tumours.

How common are they?

Every year an estimated 1900 malignant brain tumours are diagnosed in Australia. They are more common in men than women. Malignant brain tumours can affect people of any age. About 110 children (aged 0–14) are diagnosed with a malignant brain tumour each year.

Benign brain and spinal cord tumours are more common than malignant tumours. The risk of being diagnosed with a brain tumour increases with age.

What is a tumour?

A tumour is an abnormal growth of cells. Cells are the body’s building blocks – they make up tissues and organs. The body constantly makes new cells to help us grow, replace worn-out tissue and heal injuries.

Normally, cells multiply and die in an orderly way, so that each new cell replaces one lost. Sometimes, however, cells become abnormal and keep growing. In solid cancers, such as a brain tumour, the abnormal cells form a mass or lump called a tumour.

How are brain tumours classified?

Brain tumours are often classified as benign or malignant. What it means to have a benign or malignant brain tumour is usually different to what it may mean to have one in another part of the body.

Benign tumours

Many benign brain tumours grow slowly and are less likely to spread or grow back (if all of the tumour can be successfully removed). But a benign tumour may still affect how the brain works. This can be life-threatening and need urgent treatment. Sometimes a benign tumour can change over time and become malignant or more aggressive.

Malignant tumours

A malignant brain tumour may be called brain cancer. Some malignant brain tumours can grow relatively slowly, while others grow rapidly (see Grading tumours). They are considered life-threatening because they may grow larger, spread within the brain or to the spinal cord, or come back after initial treatment.

Primary cancer

A cancer that starts in the brain is called primary brain cancer. It may spread to other parts of the nervous system. Unlike other malignant tumours that have the potential to spread throughout the body, primary brain cancers usually do not spread outside the brain and spinal cord.

Secondary cancer

Sometimes cancer starts in another part of the body and then travels through the bloodstream or lymphatic system to the brain. This is known as a secondary cancer or metastasis. The cancers most likely to spread to the brain are melanoma, lung, breast, kidney and bowel. A metastasis keeps the name of the original cancer. For example, bowel cancer that has spread to the brain is still called metastatic bowel cancer, even though the person may be having symptoms because cancer is in the brain.

What types of tumours are there?

The brain is made up of different types of tissues and cells, which can develop into different types of tumours. There are more than 40 main types of primary brain and spinal cord tumours. They can start in any part of the brain or spinal cord. Tumours are grouped together based on the type of cell they start in and how the cells are likely to behave (based on their genetic make-up). These groups include glioma and non-glioma tumours. Gliomas are the most common type of malignant brain tumour.

Common types of primary brain tumours

Glioma tumours

These tumours start in the glial (neuroglia) cells of the brain.

Astrocytoma

• starts in glial cells called astrocytes
• may be benign or malignant

Glioblastoma

• type of malignant astrocytoma
• may develop from a slow-growing astrocytoma
• makes up more than half of all gliomas
• common in both adults and children

Oligodendroglioma

• starts in glial cells called oligodendrocytes
• more common in younger adults
• malignant, but may be slow or fast growing

Ependymoma

• starts in glial cells called ependymal cells
• more common in children than adults
• may be benign or malignant

Non-glioma tumours

These tumours start in other types of cells found in the brain.

Meningioma

• starts in the membranes (meninges) covering the brain and spinal cord
• most common primary brain tumour, usually benign and slow growing

Medulloblastoma

• starts in the cerebellum; malignant tumour
• more common in children; rare in adults

Pituitary tumour

• starts in the pituitary gland
• usually benign

Schwannoma

• starts in Schwann cells, which surround nerves in the brain and spinal cord
• usually benign
• includes vestibular schwannomas (sometimes called acoustic neuromas)

The brain and spinal cord

The brain and spinal cord make up the central nervous system (CNS). This CNS controls how the mind and body works.

The brain

The brain receives and interprets information carried to it by nerves from the sensory organs that control taste, smell, touch, sight and hearing. It also sends messages through nerves to the muscles and organs. The brain controls arm and leg movement and sensations, memory and other thinking skills, personality and behaviour, and balance and coordination. The main parts of the brain are the cerebrum, the cerebellum and the brain stem (see diagram).

Spinal cord

The spinal cord extends from the brain stem to the lower back. It is made up of nerve tissue that connects the brain to all parts of the body through a network of nerves called the peripheral nervous system. The spinal cord lies in the spinal canal, protected by a series of bones (vertebrae) called the spinal column.

Meninges

These are thin layers of protective tissue (membranes) that cover both the brain and spinal cord.

Cerebrospinal fluid (CSF)

Found inside the skull and spinal column, CSF surrounds the brain and spinal cord and protects them from injury.

Pituitary gland

Found at the base of the brain, the pituitary gland is about the size of a pea. It makes chemical messengers (hormones) and releases them into the blood. These hormones control many body functions, including growth, fertility, metabolism and development.

The central nervous system

The parts of the brain and their functions

The largest part of the brain is the cerebrum. It is divided into 2 halves called hemispheres. Each hemisphere is divided into 4 main areas – the frontal, parietal, occipital and temporal lobes.

The other main parts of the brain are the cerebellum and the brain stem. The cerebellum is found at the back of the head. The brain stem connects the brain to the spinal cord. Each part of the brain controls different bodily functions.

Brain tumours in children

Brain tumours in children often form in different parts of the brain to adults, and may have different treatments and outlook.

Children are more likely to develop gliomas and medulloblastomas – and tumours in the lower or back part of the brain, which control sleep/wake functions, movement and coordination.

Prognosis

In general, children diagnosed with a malignant tumour will have a better outlook than adults. In many children, treatment will cause signs of the cancer to improve.

Because a child’s nervous system is still developing, some children may have physical, behavioural or learning difficulties due to the tumour and/or treatment. These might not show up for several years.

Health professionals to see

Doctors who specialise in treating children with brain and spinal cord tumours are called paediatric oncologists. After 16 years of age, some teenagers may have treatment in an adult ward. Or they may be looked after by an adolescent and young adult multidisciplinary team.

Some hospitals have music, play or art therapists, to help children cope with the side effects of treatment. Most hospitals have occupational therapists, physiotherapists and social workers, and some may have a child life therapist.

Treatment

Talk to your child’s medical team about treatment options, what to expect and your concerns.

Support

The hospital social worker can offer practical and emotional support, and suggest support services.

Cancer Hub can link you to organisations that support families, young adults and children affected by cancer – including Canteen, Camp Quality and Redkite. Call Cancer Hub on 1800 431 312.

For more information, see Talking to kids about cancer or Cancer Council's Explaining Cancer to Kids podcast episode.

Which health professionals will I see?

Your general practitioner (GP) or another doctor will arrange the first tests to assess your symptoms. If these tests do not rule out a tumour, you will usually be referred to a specialist, such as a neurosurgeon or neurologist. The specialist will examine you and arrange further tests.

• neurosurgeon – diagnoses and surgically treats diseases and injuries of the brain and nervous system
• neurologist – diagnoses and treats diseases of the brain and nervous system, particularly those not requiring surgery; helps manage thinking and memory changes and seizures
• radiation oncologist – treats cancer by prescribing and overseeing a course of radiation therapy
• radiation therapist – plans and delivers radiation therapy
• medical oncologist – treats cancer with drug therapies such as chemotherapy and targeted therapy (systemic treatment)
• cancer care coordinator, patient navigator – coordinate your care, liaise with other members of the MDT and support you and your family throughout treatment; a clinical nurse consultant (CNC) or clinical nurse specialist (CNS) may also coordinate your care
• nurse – administers medicines and drug therapies; provides care, information and support throughout treatment
• pathologist, neuropathologist – analyse blood and tissue from the brain and spinal cord
• rehabilitation specialist – recommends and oversees treatment to help you recover movement, mobility and speech after treatment and return to your usual activities
• social worker – links you to support services and helps you with emotional, practical and financial issues
• neuropsychologist – assesses people who have problems in thinking or behaviour caused by illness or injury (particularly to the brain) and manages their rehabilitation
• psychologist, psychiatrist – help you manage your emotional response to diagnosis and treatment
• physiotherapist, occupational therapist – assist with physical and practical problems, including restoring movement and mobility after treatment, and recommending aids, devices and equipment
• speech pathologist, speech therapist – help with communication, swallowing and speech after treatment
• exercise physiologist – prescribes safe and effective exercise to help people with medical conditions restore or improve their overall health, fitness, strength and energy levels
• palliative care specialists and nurses – work closely with the GP and cancer team to help control symptoms and maintain quality of life