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Brain & Central Nervous System Cancer

The brain and spinal cord together are known as the central nervous system
This information should not be used for self-diagnosis or in place of a qualified physician’s care.

Reviewed Dec 2016

The basics

Guidelines for treating this cancer have been developed by the Neuro-Oncology Tumour Group.

For health professional information on treating this cancer, please see our Cancer Management Guidelines (Neuro-Oncology).

Brain tumours in children often behave very differently from those in adults. Children with brain and CNS tumours are treated by pediatric oncologists at the BC Children’s Hospital.

The BC Cancer Agency produces Headlines: a newsletter for brain tumour patients.

Brain and spinal cord tumours have many more specific names. See the 'Diagnosis and staging' tab for types and stages of brain tumours.

The brain and spinal cord together are known as the central nervous system:

  • The adult brain weighs about three pounds, and is tightly enclosed by the skull.
  • It is a complex organ composed of nerve cells (neurons) and supporting tissues (glia).
  • The brain has four main parts: the meninges which are the membranes that enclose the brain, the cerebrum which is the largest part of the brain and is split into two hemispheres, the cerebellum which is the back part of the brain, located under the cerebral hemispheres, and the brain stem which connects to the spinal cord.
  • The brain controls everything that goes on in our bodies: our senses, thought, reasoning, memory, emotion, movement, breathing etc. It is also the seat of our personality and behaviour.
  • The spinal cord is a thin tube of nerve tissue that extends down the back from the brain into the pelvis. It is protected by bony vertebrae.
  • The spinal cord transmits nerve signals back and forth between the brain and the rest of the body.

What causes it and who gets it?

Listed below are some of the known risk factors for this cancer. Not all of the risk factors below may cause this cancer, but they may be contributing factors.

  • The brain is a frequent site for the spread of cancer (metastasis) from other sites in the body (e.g. breast, lung, melanoma, and colon). When cancer has spread to the brain, the tumour is considered to be a secondary, or metastatic tumour.
  • Tumours that start in the brain tissue first (primary brain tumours) can strike at any age, although most brain tumours are found in young children and adults after age 40.
  • Glioblastoma and meningioma are the two most common brain tumours found in adults.
  • Primary brain tumours are the most common solid tumour in children, accounting for 25% of all pediatric cancers.
  • Primary brain tumours may be benign (non-cancerous, generally slow-growing) or malignant (cancerous, fast-growing).
  • Primary brain tumours rarely spread to other parts of the body.
  • Exposing the head to ionizing radiation is a risk factor for brain tumours. Therapeutic ionizing radiation includes radiation therapy, CT scans or X-rays.
  • Radiation therapy to the head region (given to treat other cancers) increases the risk of a later brain tumour. Despite this, the benefit of the radiation therapy far outweighs the risk of developing of subsequent brain tumours.
  • Inherited genetic conditions such as neurofibromatosis types 1 and 2, Li Fraumeni syndrome, tuberous sclerosis are associated with increased risks of certain types of brain tumours.
  • Occupational exposure to benzene, petroleum products, vinyl chloride and other chemicals may raise risk.
  • Cell phones give off radiofrequency signals, but these have not been conclusively shown to increase the risk of brain tumours. More research needs to be done on the long term use of cell phone technology before true risks can be determined.
  • Brain tumours accounted for 1.38% of cancers diagnosed in all age groups in BC in 2008.
  • Statistics

Can I help to prevent it?

Most primary brain tumours have no known cause.

Secondary brain tumours from lung cancer are strongly related to tobacco use. If you smoke, quit. If you chew tobacco, stop. This will reduce your risk, even after years of use.

Screening for this cancer

No effective screening program exists for this cancer yet.

Signs and symptoms

Many of the common symptoms of brain tumours could also be symptoms of other conditions. Consult a doctor for any of the following symptoms:

  • Headaches that don’t respond to usual headache remedies; often worse in the morning
  • Seizures
  • Nausea and vomiting
  • Vision changes, double vision, loss of vision
  • Unusual or sudden changes in activity level, personality or behaviour
  • Unusual drowsiness
  • Walking or balance or fine motor problems
Diagnosis & staging

Diagnosis

These are tests that may be used to diagnose this type of cancer.

  • Full medical history and physical examination
  • Neurological examination
  • MRI enhanced with Gadolinium-DTPA
  • CT scan
  • X-ray, particularly for investigation of the spine
  • Lumbar puncture
  • Angiography
  • Biopsy is required for definitive diagnosis

For more information on tests used to diagnose cancer, see our Recommended Websites, Diagnostic Tests section.

Types and Stages

Primary brain tumours are sorted into specific types according to the type of brain cell involved and the tumour behaviour (rate of growth), using the World Health Organization classification system. Some types of brain tumour, mostly gliomas, are assigned a grade based on the appearance of the tumour cells and their rate of growth. Brain tumours may contain several grades of cells. A tumour is given the grade of the most malignant cell found.

  • Grade I are the slowest growing, and may be completely removed by surgery. The cells appear almost normal. 
  • Grade 1 tumours generally have the best prognosis and may be considered benign. 
  • Grade II grow slightly faster and may invade surrounding tissue. These tumours may recur after surgery. 
  • Grade III fast-growing and are classed as malignant. They do invade surrounding tissue, and frequently recur after removal. 
  • Grade IV are the most malignant. They grow rapidly. Cell appearance is very different from normal cells, and they invade aggressively into surrounding tissue.

Types

Primary Malignant (fast-growing) Tumours of the Brain and Spinal Cord

  • Gliomas are tumours of the glia (supportive tissues). Astrocytes, oligodendrocytes and ependymal cells are different types of glial cells. Gliomas account for 45% of all tumours that start from brain cells (both benign and malignant tumours).
    • Low Grade Astrocytoma – Grades I and II. These tumours grow relatively slowly. They may be present in the brain for many years, before the progression of symptoms leads to diagnosis.
    • High Grade Astrocytoma – Grades III and IV. These are the most malignant brain cancers. More than 50% of all gliomas fall into this category. Glioblastoma multiforme is a Grade IV astrocytoma commonly diagnosed in adults aged 45 and older
    • Ependymomas are tumours that develop in the cells that line the ventricles (the central spaces in the brain that produce and contain the cerebrospinal fluid) and the spinal cord. These tumours are most common in children and in middle-aged adults. They may be benign or malignant. They have a high rate of recurrence. Sixty percent of spinal cord tumours are Ependymomas.
    • Oligodendrogliomas are tumours that start in the white matter of the cerebral hemisphere. They can be further classified as either low-grade or anaplastic. Low-grade oligodendrogliomas tend to be slow-growing, and have a better prognosis than most gliomas. Anaplastic oligodendrogliomas and anaplastic oligoastrocytomas (also known as mixed gliomas) are more aggressive forms.
  • Medulloblastomas are aggressive, primitive neuroectodermal tumours (PNET) that rarely occur in adults, but account for 20-25% of pediatric brain tumours. These tumours may spread to the spinal cord through the cerebrospinal fluid (CSF).

Primary Benign (slow-growing) Tumours of the Brain / CNS

  • Acoustic neuromas (also called acoustic schwannomas) are rare, benign tumours of the nerve leading from the inner ear to the brain. These tumours are seen most often in middle-aged women. The steady growth of the neuroma puts pressure on and deforms adjacent brain structures.
  • Meningiomas are slow-growing tumours of the meninges (membranes) that often cause no symptoms. These are the most common primary brain / CNS tumour.
  • Pituitary adenomas are tumours that occur in the pituitary gland. The pituitary gland is the body's master gland. It produces the hormones that control many body processes such as growth and reproduction.
  • Craniopharyngiomas are rare tumours that affect the pituitary gland and neighbouring area.
  • Pineal gland tumours are rare tumours and may affect the production of melatonin.
  • Neurofibromas occur in cells that support peripheral nerves.
  • Ependymomas can be benign or malignant. Most patients with benign forms do well for a long period of time.

Secondary (Metastatic) Tumours of the Brain / CNS 

  • Metastatic tumours of the brain are the most frequent type of brain tumours.
  • Metastatic carcinomas have spread to the brain from cancer starting elsewhere in the body – often from the lungs, breasts, colon, or from skin melanomas.
  • Leptomeningeal tumours affect the membranes covering the brain and spinal cord and are frequently spread from a primary breast cancer.
  • Metastatic tumours of unknown primary have come to the brain from elsewhere in the body, but despite thorough searching, the point of origin is unknown. Treatment plans for these tumours are difficult to determine.

Treatment

Treatment

Cancer therapies can be highly individualized – your treatment may differ from what is described below.

Surgery

  • Surgery is usually the first line of treatment for brain / CNS tumours.
  • Surgery often requires a craniotomy in which a piece of the skull bone is removed. The bone is replaced at the end of the surgery.
  • A biopsy of the brain tumour is often done during the surgery, so that the correct diagnosis can be made.
  • The goal of surgery is to remove as much tumour as possible without damaging critical areas of the brain.
  • Surgery may also be done to relieve pressure caused by fluid build-up.
  • For benign tumours, if the surgery successfully removes the entire tumour no further treatment may be necessary.

Radiotherapy

  • Radiation therapy may be given after surgery to slow or stop the growth of any remaining tumour cells.
  • External beam radiation is delivered to the tumour site using specialized techniques that direct a precisely focused beam of radiation at a small, defined target in order to minimize irradiation of adjacent tissue. For gliomas, radiation is also directed at a margin surrounding the visible tumour, where microscopic tumours cells are most likely to be present.
  • Examples of these special types of radiotherapy include: Stereotactic Radiation Therapy (SRT), Intensity Modulated Radiation Therapy (IMRT), Three Dimensional Conformal Radiation Therapy (3D-CRT).
  • The radiation therapy dose may be divided into small doses and delivered over the course of several days or weeks.
  • Radiation therapy to the brain may cause short term effects such as fatigue, hair loss, and skin reactions, which generally clear up once the therapy is finished.
  • Radiation to the brain may cause longer term side effects to memory, cognitive functions, and hormone production.
  • The BCCA has more information for patients undergoing radiation to the brain.

Chemotherapy 

  • Chemotherapy may be given after surgery for certain brain tumours, and may accompany radiation therapy.
  • The intent of the chemotherapy may be to slow a tumour’s growth, destroy any tumour cells remaining after surgery, increase the effectiveness of radiotherapy or reduce brain tumour symptoms.
  • Chemotherapy is sometimes used if tumours recur. In these cases the chemotherapy is not given in the hope of curing the cancer, but to reduce symptoms or cause tumour remission.
  • Other drugs are used in the overall treatment. Steroids such as dexamethasone help reduce swelling in the brain from tumours. Anticonvulsant drugs may also be given.

Follow-up after treatment

  • Guidelines for follow-up after treatment are covered on our website where there is more information on primary care and the Follow-up program for brain tumour patients.
  • You will be returned to the care of your family doctor or specialist for regular follow-up. If you do not have a family physician, please discuss this with your BC Cancer Agency oncologist or nurse.
  • Follow-up testing is based on your type of cancer and your individual circumstances.
  • Life after Cancer focuses on the issues that cancer survivors can face.

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