ConditionCancer
Brain Cancer (Malignant Brain Tumor)
Brain cancer is a malignant tumor that starts in the brain (primary brain cancer) or spreads there from cancer elsewhere (brain metastases). The most common primary brain cancer in adults is glioblastoma. Symptoms depend on the tumor's location and include new or changing headaches, seizures, weakness, speech or vision problems, and personality changes. Diagnosis uses MRI and a biopsy. Treatment combines surgery, radiation and chemotherapy, and the outlook varies widely by type, grade and genetic features.
Also called: Malignant brain tumor, primary brain cancer, brain neoplasm, glioma
At a glance
- What it is
- A malignant tumor in the brain, either primary or spread from another cancer.
- Most common types
- Brain metastases overall. Glioblastoma is the most common primary brain cancer in adults. Medulloblastoma and gliomas in children.
- Key symptoms
- New headache pattern, seizures, weakness, speech or vision changes, personality change.
- Diagnosis
- MRI with contrast, biopsy with molecular testing.
- Treatment
- Surgery, radiotherapy, chemotherapy (temozolomide), targeted therapy, tumor treating fields.
When to get help
Call 911 or go to the ER
- A first seizure, or a seizure lasting more than 5 minutes
- Sudden severe headache, sudden weakness, loss of speech or vision, or confusion: call 911
- Headache with repeated vomiting and increasing drowsiness
See a doctor within a day or two
- Headaches that are new, progressively worse over weeks, worse lying down or on waking, especially with vomiting
- Gradual weakness or numbness on one side, or new difficulty finding words
- Personality or behavior changes noticed by others over weeks
- New neurological symptoms in someone with a history of cancer
Book a routine appointment
- Persistent changes in vision, hearing or balance
- Hormonal changes such as new milk discharge or loss of periods with headaches
Types of brain cancer
Primary brain tumors
Primary brain tumors start in brain tissue or its coverings. Not all are cancerous: meningiomas, the most common primary brain tumors, are usually benign. The World Health Organization grades tumors 1 to 4 by how aggressive they are, now combined with genetic markers.
| Type | Who | Behavior |
|---|---|---|
| Glioblastoma (IDH-wildtype, grade 4) | Adults, median age about 65 | Most common and most aggressive primary brain cancer |
| Astrocytoma, IDH-mutant (grades 2 to 4) | Younger adults, 20s to 40s | Slower growing, can progress |
| Oligodendroglioma (grades 2 to 3) | Adults 30s to 50s | Often responsive to treatment, better outlook |
| Primary CNS lymphoma | Older adults, people with weak immune systems | Treated mainly with chemotherapy |
| Medulloblastoma | Children | Fast growing, often curable with treatment |
| Ependymoma | Children and adults | Varies by location |
| Meningioma | Adults, more women | Usually benign. A minority are atypical or malignant |
See brain tumor for benign and malignant tumors together, and benign brain tumors.
Brain metastases
Brain metastases are far more common than primary brain cancer. They are cancers that have spread from elsewhere, most often lung cancer, breast cancer, melanoma, kidney cancer and colorectal cancer. They are often multiple. Treatment differs from primary brain cancer.
Symptoms
Symptoms arise from the tumor pressing on or invading brain tissue, and from swelling and raised pressure inside the skull.
General symptoms
- headaches: new, persistent or changing in pattern, often worse in the morning, when lying down, or with coughing and straining, sometimes with vomiting
- seizures: the first sign in many people with lower-grade gliomas
- nausea and vomiting
- drowsiness and fatigue
- confusion and memory problems
Symptoms by location
| Area | Possible symptoms |
|---|---|
| Frontal lobe | Personality change, apathy, disinhibition, weakness on one side, speech problems |
| Temporal lobe | Memory problems, seizures with strange smells or déjà vu, language difficulty |
| Parietal lobe | Numbness, difficulty with spatial tasks, neglect of one side |
| Occipital lobe | Vision loss on one side |
| Cerebellum | Unsteadiness, clumsiness, nausea |
| Brainstem | Double vision, swallowing and speech problems, facial weakness |
| Pituitary region | Hormone changes, vision loss to the sides |
Most headaches are not caused by brain tumors. Headaches alone, without other neurological symptoms, are rarely due to cancer.
Causes and risk factors
The cause of most brain cancers is unknown. Known risk factors are:
- ionizing radiation to the head, such as radiotherapy in childhood
- inherited syndromes: neurofibromatosis types 1 and 2, Li-Fraumeni syndrome, tuberous sclerosis, Lynch syndrome, Turcot syndrome and others
- weakened immune system, for primary CNS lymphoma
- age: glioblastoma risk rises with age
- a family history of glioma
Cell phones, head injuries and diet have not been shown to cause brain cancer in large studies.
Diagnosis
- Neurological examination: strength, sensation, reflexes, coordination, vision and thinking.
- MRI with contrast: the main imaging test, showing the tumor's size, location and features. CT is used in emergencies.
- Advanced MRI (perfusion, spectroscopy) and PET scans in selected cases.
- Biopsy or surgical removal: tissue confirms the diagnosis. Molecular testing (IDH mutation, 1p/19q codeletion, MGMT promoter methylation and others) defines the tumor type and guides treatment.
- Body scans to look for a primary cancer when metastases are suspected.
- Lumbar puncture for some tumors, such as lymphoma and medulloblastoma.
Treatment
Treatment is planned by a multidisciplinary neuro-oncology team.
Surgery
The aim is to remove as much tumor as safely possible. Awake surgery and brain mapping help protect speech and movement areas. Surgery relieves pressure and provides tissue for diagnosis. Tumors in deep or critical areas may only be biopsied.
Radiotherapy
External beam radiation is given to the tumor area, typically over 3 to 6 weeks for glioblastoma. Stereotactic radiosurgery delivers precise high doses to small tumors, especially metastases.
Chemotherapy and other therapies
- Temozolomide: standard chemotherapy for glioblastoma, given with radiation and then for at least 6 months. Tumors with MGMT methylation respond better.
- PCV chemotherapy for oligodendroglioma.
- Targeted therapy: vorasidenib for some IDH-mutant gliomas, BRAF inhibitors for BRAF-mutant tumors.
- Tumor treating fields: a wearable device that delivers electric fields to the scalp, used with temozolomide for glioblastoma.
- Bevacizumab for recurrent glioblastoma to reduce swelling.
- Clinical trials are an important option for many patients.
Symptom control
- steroids (dexamethasone) reduce brain swelling and headaches
- anti-seizure medicines for people who have had seizures
- rehabilitation: physical, occupational and speech therapy
- palliative care alongside treatment to manage symptoms and support quality of life
Outlook
Outlook depends heavily on tumor type, grade, genetic features, age and how much tumor can be removed.
- Glioblastoma has a median survival of about 15 to 20 months with standard treatment, though some people live several years.
- Oligodendrogliomas and IDH-mutant astrocytomas often have survival measured in many years.
- Many childhood brain tumors are curable.
- Brain metastases outcomes depend on the original cancer and its control elsewhere, and are improving with targeted therapies.
Living with brain cancer
Brain cancer can affect thinking, mood and independence. Many people cannot drive for a time after seizures or surgery, following state rules. Families and caregivers often take on significant responsibilities, and caregiver stress is common. Neuro-oncology nurses, social workers, support groups and palliative care teams can help.
Frequently asked questions
What are the first signs of brain cancer?
Early signs include new or changing headaches, often worse in the morning or when lying down, seizures, gradual weakness or numbness on one side, speech or vision changes, and personality or memory changes. These symptoms have many other causes, but new ones should be checked.
What is the most common type of brain cancer?
Cancers that spread to the brain from elsewhere, such as lung or breast cancer, are the most common overall. Among cancers that start in the brain, glioblastoma is the most common in adults. In children, gliomas and medulloblastomas are among the most common.
Can a headache be the only sign of a brain tumor?
It is uncommon. Most brain tumors that cause headaches also cause other symptoms such as vomiting, seizures, weakness, confusion or vision changes. A new, progressive headache, especially after age 50, or one with these features, needs prompt medical assessment.
How is brain cancer treated?
Treatment usually combines surgery to remove as much tumor as safely possible, radiotherapy, and chemotherapy such as temozolomide. Some tumors are treated with targeted drugs. Steroids reduce swelling, and anti-seizure medicines control seizures. Clinical trials offer newer options.
What is the survival rate for brain cancer?
It varies widely by type. Glioblastoma has a median survival of about 15 to 20 months with treatment. Lower-grade gliomas and oligodendrogliomas often allow survival for many years, and many childhood brain tumors are curable. Your care team can explain what applies to your tumor.
Sources
This guide was written from current patient and clinical guidance, including:
- National Cancer Institute: Adult central nervous system tumors treatment (PDQ)
- American Cancer Society: Brain and spinal cord tumors in adults
- National Comprehensive Cancer Network: Guidelines for central nervous system cancers
- World Health Organization: Classification of tumours of the central nervous system (5th edition, 2021)
- American Brain Tumor Association: Brain tumor information
- CBTRUS: Statistical report on primary brain and CNS tumors