Brain tumour

A guide for patients and carers

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Possible treatments for brain tumour

There are different treatment options for brain tumours and specific treatment pathways will differ for each individual. Your medical team will discuss your best treatment options with you.

Brain tumours can be serious and life-threatening. It is not always possible to treat them successfully.

Steroids

Steroids are used to reduce the swelling around the tumour. This helps to relieve headaches and reduce the levels of physical disability the tumour might cause (for example, physical weakness or numbness). It also makes surgery much safer and easier. Steroids might therefore be given in the early stages and later stages of treatment. Dexamethasone is the name of the steroid most commonly used to treat brain tumours.

Possible side effects of steroids

Side effects of steroids might occur after several weeks of treatment and can include weight gain, acne, stretch marks, muscle weakness, diabetes, sleep disturbance, hunger and feelings of elation. For most people, these side effects go when the steroids are stopped.

Steroid tablets can irritate the lining of the stomach and increase the likelihood of getting stomach ulcers. You might be given anti-ulcer drugs to reduce the risk. You might also be given an antacid drug either in liquid or tablet form.

Craniotomy (surgery)

A craniotomy is an operation to open the head in order to expose the brain. The word craniotomy means making a hole (-otomy) in the skull (cranium). The operation is carried out by a neurosurgeon who specialises in surgery of the brain and spine.

The aim of a craniotomy is to remove the tumour entirely without damaging the surrounding brain tissue. While this is often possible for benign tumours, it is rarely possible for malignant tumours as they invade the surrounding brain tissue which must be left behind to avoid causing serious disability. In most cases of malignant tumours, the neurosurgeon removes as much of the tumour as they judge to be safe.

The operation is carried out under a general anaesthetic which means you will be asleep throughout and will not feel anything. A small horseshoe-shaped area of your hair is shaved over the point at which the tumour can be reached. An incision (cut) is made in the scalp, a skin flap is peeled back, burr holes are drilled in the skull, and then a piece of bone (“bone flap”) is cut out like a trap-door to reveal the brain and tumour underneath.

The surgeon then removes as much of the tumour as possible. This is known as debulking. A piece of it is sent to a pathologist to establish what sort of tumour it is. The operation serves two functions: first, to obtain some of the tumour to be examined by a pathologist (like a biopsy), and second, as a surgical treatment for the tumour by removing as much of it from the brain as can be done safely.

The bone flap is replaced and the scalp is stitched together. The bone flap is usually fixed into place with small metal screws to prevent movement and encourage better healing.
Craniotomy incision and replacement of the bone flap

Craniotomy incision and replacement of the bone flap

Possible problems after a craniotomy

People might experience various problems after a craniotomy. These potential problems depend to an extent on which area of the head was operated on.

You might have a stiff jaw and difficulty opening your mouth, swelling and bruising to your face, pain and discomfort as the wound on your head heals, and headaches after your operation. It might also feel like the bone flap is moving or clicking. Although this feels strange, it is not dangerous. The bone flap is not loose. It is secured when it is replaced and will heal back into place.

(You might be interested in reading our fact sheet on craniotomy for further information.)

Other surgery

Sometimes, certain types of brain tumour are located in a position which makes them easier to reach and remove with surgery through a person’s nose rather than with a craniotomy. Pituitary tumours and adenomas are sometimes approached with surgery through the nose.

Some people might also require other surgical procedures. These might include the insertion of a device called a shunt to drain any fluid from the brain or to remove fluid from within a tumour cyst.

(You might be interested in reading our fact sheet on hydrocephalus and shunts for further information.)

Radiotherapy

Radiotherapy is often used after surgery, most commonly for the treatment of malignant tumours. Occasionally, radiotherapy will also be used to treat benign tumours. If you have had surgery, you will be given time to recover before starting your radiotherapy treatment.

Radiotherapy treatment is given by a radiotherapist who will also be an oncologist (a doctor who specialises in cancer). It is likely that your oncologist will have a specific interest in tumours of the central nervous system (the brain and spinal cord) and will work closely with the neurosurgeon who performed the surgery as part of your treatment. They will explain the radiotherapy treatment to you, discuss the treatment with you, and talk through any worries or concerns you might have.

Radiotherapy will not always be available at the hospital where you have your surgery but there is always a close link between the hospitals providing your treatment.

Radiotherapy uses X-rays and gamma rays to damage or destroy the tumour. The effect on the tumour is to slow its growth and lengthen the time before it regrows. In some circumstances, radiotherapy can cure the tumour.

The treatment is painless and involves lying on a specially-designed table for a few minutes. You will be fitted for a special mask that you will wear over your face during the treatment. Some people find the mask uncomfortable.

A typical pattern is to receive six weeks of daily radiotherapy (Monday to Friday), usually as an outpatient. Some people might receive a shorter course of the treatment.

Occasionally, radiotherapy might be administered by inserting implants into the tumour (brachytherapy). This form of the treatment is uncommon and only appropriate for a small number of people. Your doctors will discuss this treatment with you if they think it could be useful in your case.

Possible side effects of radiotherapy

Common side effects of radiotherapy are a temporary worsening of the symptoms and inflammation of the skin which might lead to temporary hair loss. For most people, their hair grows back in the first few months following the treatment. The hair might not be as strong as it was before and it might be patchy or thin. Until an adequate covering of hair has grown back you should avoid strong sunlight or wear a hat. Occasionally, hair loss is permanent.

Most people feel tired towards the end of their course of radiotherapy. The level of tiredness varies for individuals and can depend on the particular area of the brain being treated. Some people might be able to manage their usual everyday activities and only experience mild tiredness. Others might experience severe problems with tiredness. It is important that people do not expect too much of themselves during this time and try not to become too frustrated by their tiredness.

Radiosurgery (gamma knife)

Radiosurgery is a technique for treating brain tumours which is only available in a few specialised neurological centres in the UK.

The two main methods of carrying out radiosurgery are by gamma knife and by modified linear accelerator (linac). Both methods use a high energy dose of radiation that can be focused on a very precise point within the brain.

The linac uses only one beam of high energy radiation which arcs around a single point, treating that specific area but not affecting the surrounding tissue. The gamma knife uses hundreds of energy beams which combine to form a high energy point at their focus, each individual beam being too weak on its own to damage any healthy brain tissue in its path.

Unlike radiotherapy, which might require several sessions over weeks and months, radiosurgery is completed in one session and does not usually require an overnight stay. People are able to return to their normal routine immediately after the treatment without experiencing any of the side effects of craniotomy or radiotherapy.

Radiosurgery is thought to be suited to deep-rooted tumours within the brain which might be difficult to reach without damaging the surrounding healthy brain tissue using other methods of treatment. It is not commonly used to treat gliomas or metastases (secondary tumours).

Radiosurgery is not appropriate for everyone and your doctor will discuss your best treatment options with you.

Chemotherapy

Chemotherapy is the use of drugs to destroy tumour cells in a way that is similar to the use of antibiotics to kill bacteria.

There are different types of chemotherapy. Some are taken by mouth and others are given via a drip into a vein. Chemotherapy is usually prescribed by an oncologist who has expertise in both radiation and chemotherapy. The consultant in charge of giving chemotherapy will be happy to discuss it with you if you are referred to them for treatment by your neurosurgeon.

Possible side effects of radiotherapy

The possible side effects of chemotherapy vary considerably depending on the particular drug used. They include nausea (feeling sick), tiredness, hair loss, and a reduced resistance to infection. You should discuss these possible side effects with the specialist providing your treatment.

Some of the newer chemotherapy drugs such as Temozolomide produce lower levels of side effects and are often very well tolerated by people. They are available as pills so people can take them at home and do not need to be in hospital.