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Treatment for brain cancer
The aim of treatment may be to remove the tumour completely, slow its growth, or relieve symptoms by shrinking the tumour and reducing swelling. Your choice of treatment will depend on:
- the type, size, grade, location and genetic make-up of the tumour
- your age, medical history and general state of health
- the types of symptoms you have.
For a benign tumour, surgery may be the only treatment needed.
For a malignant brain or spinal cord tumour, treatment can include surgery, radiation therapy and chemotherapy, which may be used alone or together. Medicines, such as steroids or anticonvulsants (anti-seizure medicines), may be given to reduce symptoms.
You may be able to access new or modified treatments through a clinical trial.
Surgery in the brain or spinal cord is called neurosurgery. You may have surgery to:
- remove the whole tumour (total resection)
- remove part of the tumour (partial resection or debulking)
- help diagnose a brain tumour (biopsy).
Partial resection or debulking may be considered because the tumour is widespread, near major blood vessels or near other important parts of the brain or spinal cord. A partial resection may help reduce the pressure on your brain, which will improve some of the symptoms.
Sometimes a tumour cannot be safely removed because it is too close to certain parts of the brain and surgery would cause blindness or partial paralysis. This is called an inoperable or unresectable tumour. Your doctor will talk to you about other ways of easing symptoms.
What to expect before surgery
The different scans used to diagnose a brain tumour (such as CT, MRI or PET scans) are often done again to plan surgery.
The surgeon needs to know where the most important areas of the brain are to make sure these are not damaged during the operation. A type of MRI scan called a functional MRI (fMRI) shows the exact areas of the brain that are used as you speak or move. These parts of the brain are also found with brain mapping. A tiny electrode is placed on the outside layer of the brain during surgery and stimulated with a low dose of electrical current.
Tell your doctor about any blood-thinning or other medicines you are taking. Some medicines interfere with the anaesthetic used during the operation, so you may need to stop taking them for a while. If you smoke, it is important to stop before surgery. Continuing to smoke can increase the risk of complications.
Having surgery to the brain can sound frightening and it is natural to feel anxious beforehand. Talk to your treatment team about your concerns or call Cancer Council 13 11 20 for support.
Types of surgery
Different types of operations may be used for brain and spinal cord tumours.
Removing a brain tumour (craniotomy) – This is the most common type of brain tumour operation. A craniotomy removes all or part of the tumour (total or partial resection) and may be done under a general anaesthetic. The surgeon cuts an area of bone from your skull to access the brain. The tumour is then taken out, and the bone is put back. The surgeon holds the piece of skull in place with small plates and screws.
If you have a high-grade glioma, you may be given a solution to drink before surgery that makes the tumour glow under ultraviolet light. This may help the surgeon remove as much of the tumour as possible, while avoiding normal brain tissue.
Awake craniotomy – This operation may be recommended if the tumour is near parts of the brain that control speech or movement. All or part of the operation is done with the person awake (conscious) but relaxed, so they can speak, move and respond.
The surgeon asks you to speak or move parts of your body to identify and avoid damaging those parts of the brain. An electrode is also used to stimulate and pinpoint important areas of the brain.
You may be worried that an awake craniotomy will be painful, but the brain itself does not feel pain and local anaesthetic is used to numb surrounding tissues.
Removing a pituitary tumour (endoscopic transsphenoidal surgery) – The most common surgery for tumours near the base of the brain (e.g. pituitary gland tumours) is called endoscopic transsphenoidal surgery. To remove the tumour, the surgeon inserts a long, thin tube with a light and camera (endoscope) through the nose and into the skull at the base of the brain. An ear, nose and throat (ENT) surgeon may assist with this type of surgery. You will be given a general anaesthetic for this operation.
Removing a spinal cord tumour (laminectomy) – The most common surgery for spinal cord tumours is called a laminectomy. In this procedure, the surgeon makes an opening through the skin, muscle and a vertebra in the spinal column to remove the tumour that is affecting the spinal cord. A laminectomy is usually performed under general anaesthetic.
What to expect after surgery
You will be closely monitored for the first 12–24 hours after the operation. You may stay in hospital for 3–10 days. How long you stay in hospital will depend on whether you have any problems or side effects following surgery. You may also require rehabilitation.
Neurological observations – For the first day or two you will be in the intensive care unit or a high dependency unit. Nurses will regularly check your breathing, pulse, blood pressure, temperature, pupil size, and arm and leg strength and function. You will also be asked questions to assess your level of consciousness. These neurological observations check how your brain and body are recovering from surgery.
Spinal cord checks – If you have had an operation on your spinal cord, the nurses will regularly check the movement and sensation in your arms and legs. You may need to lie flat in bed for 2–5 days to allow the wound to heal. A physiotherapist will help you learn how to roll over and how to get out of bed safely, so the wound is not damaged.
Pressure stockings – You will need to wear pressure stockings on your legs to prevent blood clots from forming while you are recovering from surgery. Tell your doctor or nurse if you have pain or swelling in your legs or suddenly have difficulty breathing.
Bandages and bruising – The dressing on your head may vary from a simple bandaid to bandaging that covers your whole head. Some or all of your head may have been shaved. After surgery to certain parts of the head, your face and eyes may be swollen or bruised: this is normal. It is not usually painful and should ease within about a week.
Having a shunt – A build-up of cerebrospinal fluid in the brain is called hydrocephalus. It may occur before surgery as a result of the tumour, but can also happen after surgery. To drain the extra fluid you may have a shunt. The surgeon places one end of a long, thin tube into your brain. A temporary tube (called an external ventricular drain, or EVD) drains fluid into a bag on the outside of the body. A permanent shunt is inserted completely inside your body. It drains into your abdomen and the fluid is absorbed into the bloodstream.
Headaches and nausea – You may have a headache or nausea after the operation. Both can be treated with medicines.
Rehabilitation – The surgery may cause a range of short-term or longer-term side effects. Before you can return home, you may require further treatment known as rehabilitation.
Side effects of surgery
Infection – Although the risk is small, you may develop an infection at the surgical site. This can usually be treated with antibiotics. A small number of people may need surgery to have the wound cleaned out.
Bleeding – This is a rare but serious side effect. You’ll have a CT scan or MRI the day after surgery to check for any bleeding or swelling.
Swelling – Surgery can cause swelling. This swelling increases the pressure inside the skull (intracranial pressure). Your medical team will monitor the swelling and try to reduce it.
Other side effects – You may continue to feel confused and dizzy, and have speech problems, weakness and seizures. You and your family or carers may be surprised that you may feel worse than before the surgery and worry that you aren’t recovering well. These side effects are normal and often improve with time.
In some cases, people recover fully and can gradually return to their usual activities. In other cases, the tumour position or damage to surrounding brain tissue may mean that there are longer term changes to how you speak, move and think.
Rehabilitation – A range of therapies can speed up recovery or show you ways to manage any changes. These therapies are known as rehabilitation. At first, you may have some rehabilitation therapies in the hospital or in a rehabilitation facility. You may be given equipment to use at home. Once you return home, you can continue to access these therapies as an outpatient.
Also known as radiotherapy, radiation therapy uses a controlled dose of radiation to kill or damage cancer cells in the area being treated. Treatment is carefully planned to do as little harm as possible to the healthy body tissue near the cancer, though you may experience side effects afterwards.
Radiation therapy is typically given after surgery and possibly along with chemotherapy. Before you start radiation therapy, a radiation therapist will take measurements of your body and do a CT or MRI scan to work out the precise area to be treated. If you are having radiation therapy for a brain tumour, you will probably need to use a face mask (see below). If you are having radiation therapy for a spinal cord tumour, some small marks may be tattooed on your skin to show the treatment area.
How often you have radiation therapy will depend on the size and type of tumour, but usually it is given once a day, from Monday to Friday, for several weeks. During treatment, you will lie on a table under a machine called a linear accelerator. Each daily treatment will last for about 10–15 minutes. Radiation therapy itself is painless; however, there are some possible side effects of radiation that will be discussed with you.
Wearing a face mask
You’ll need to wear a plastic face mask during radiation therapy to the brain. This is known as an immobilisation mask. It will help keep your head still and make sure the radiation is directed to the same area during each session. It’s made especially for you and fixed to the table. The mask is made of a tight-fitting mesh, but you will wear it for only about 10 minutes at a time. You can see and breathe through the mask, but it may feel strange at first. Let the radiation therapist know if wearing the mask makes you feel anxious, as this can be managed with medicines.
Stereotactic radiosurgery (SRS)
Stereotactic radiosurgery (SRS) is a specialised type of radiation therapy, not a type of surgery, and no cuts are made in the skull. It is used to treat some brain tumours. A specialised radiation machine is used to give very precisely targeted radiation to the tumour. This means the tumour gets a high dose of radiation while the surrounding healthy brain tissue gets very little. SRS is not suitable for all brain tumours. It may be offered when neurosurgery is not possible or as an alternative to neurosurgery. It is most commonly used for metastatic cancers that have spread to the brain from another part of the body. It is also used for some meningiomas, pituitary tumours and schwannomas, and is occasionally used for gliomas that have come back after other treatment.
Often, only 1–5 doses of SRS are needed. A treatment session may last between 15 minutes and two hours, depending on the type of radiosurgery given, and you will need to wear a face mask or a frame during the treatment. You will usually be able to go home afterwards.
Stereotactic radiation therapy (SRT)
A stereotactic radiosurgery machine may also be used to deliver a longer course of radiation, particularly for benign brain tumours. This is called stereotactic radiation therapy. The treatment is given as multiple small daily doses.
This uses protons rather than x-ray beams. Protons are tiny parts of atoms with a positive charge. Proton therapy is useful when the cancer is near sensitive areas, such as the brain, eyes and spinal cord. It is not yet available in Australia (as at mid 2020), but there is funding in special cases to allow Australians to travel overseas for treatment.
Radiation therapy is usually combined with chemotherapy to treat glioblastomas (grade 4 tumours). This is called chemoradiation, and is better at treating brain tumours than radiation therapy alone.
Side effects of radiation therapy
Radiation therapy side effects generally occur in the treatment area and are usually temporary, but some may last for a few months or years, or be permanent.
The side effects vary depending on whether the tumour is in the brain or spinal cord. They may include:
- nausea – often occurs several hours after treatment
- headaches – often occur during the course of treatment
- tiredness or fatigue – worse at the end of treatment; can continue to build after treatment, but usually improves over a month or so
- dry, itchy, red, sore or flaky skin – may occur in the treatment area, usually happens at the end of treatment and lasts one to two weeks before going away
- hair loss – may occur in the brain tumour treatment area and may be permanent
- dulled hearing – may occur if fluid builds up in the middle ear and may be permanent.
Side effects specific for spinal cord tumours include swallowing problems (dysphagia) and diarrhoea. Both are temporary.
If any side effects develop, talk to your radiation oncology team.
A small number of adults who have had radiation therapy to the brain have side effects that appear months or years after treatment. These are called late effects and can include symptoms such as poor memory, confusion and headaches. The problems that might develop depend on the part of the brain that was treated.
High-dose radiation to the pituitary gland can cause it to produce too much or too little of particular hormones. This can affect body temperature, growth, sleep, weight and appetite. The hormone levels in your pituitary gland will be monitored during treatment.
Chemotherapy is the use of drugs to treat cancer. The drugs travel through the bloodstream and damage or destroy rapidly dividing cells (cells that grow quickly) such as cancer cells, while causing the least possible damage to healthy cells.
You may have chemotherapy after surgery and possibly with radiation therapy (chemoradiation).
The brain has a protection system known as the blood–brain barrier, which helps protect the brain from substances in the blood, such as germs or chemicals, that may injure the brain. Only certain types of chemotherapy drugs can get through this barrier.
You may be given chemotherapy as capsules or tablets that you swallow (orally), or as a liquid through a drip inserted into your vein (intravenously). Temozolomide is the most commonly prescribed chemotherapy drug for the treatment of glioma brain tumours. Temozolomide is given as a capsule that is taken at home. Each treatment session is usually followed by a rest period of a few weeks. You may have chemotherapy for up to six months.
Side effects of chemotherapy
There are many possible side effects of chemotherapy, depending on the type of drugs you are given. Side effects may include:
- nausea or vomiting
- tiredness, fatigue and lack of energy
- increased risk of infection
- loss of appetite
- mouth sores and ulcers
- diarrhoea or constipation
- skin rash
- breathlessness due to low levels of red blood cells (anaemia)
- low levels of platelets (thrombocytopenia), increasing the risk of abnormal bleeding
- damage to ovaries or testicles, which can make you unable to have children naturally (infertile)
- reduction in the production of blood cells in the bone marrow; you may need to have their blood levels monitored regularly through regular blood tests.
It is rare to lose all your hair with the chemotherapy drugs used to treat brain and spinal cord tumours, although in some cases your hair may become thinner or patchy.
Steroids are made naturally in the body, but they can also be produced artificially and used as drugs. Brain tumours and their treatments can both lead to swelling in the brain. Steroids may help to reduce this swelling, and can be given before, during and after surgery and radiation therapy. The most commonly used steroid for people with brain tumours is dexamethasone.
Side effects of steroids
These depend on the dose and the length of treatment. If you are prescribed steroids for a short period, you may experience increased appetite, weight gain, trouble sleeping, restlessness, mood swings, anxiety and, in rare cases, more serious changes to thinking and behaviour. In people with diabetes, steroids can quickly lead to high or unstable blood sugar levels. These short-term side effects can be managed. Eat before taking steroids to reduce the likelihood of the steroids irritating your stomach.
If steroids are taken for several months, they can cause puffy skin (fluid retention or oedema) in the feet, hands or face; high blood pressure; unstable blood sugar levels; diabetes; muscle weakness; and loss of bone density (osteoporosis). You will also be more likely to get infections. Most side effects are temporary, and your doctor may adjust your dose to manage them.
Anticonvulsant medicines may be given to prevent seizures before and after treatments for brain tumours.
An experienced counsellor, psychologist or psychiatrist can help you manage mood swings or behavioural changes. If you or your family are worried about side effects, talk to your doctor or nurse or call Cancer Council 13 11 20.
Palliative treatment helps to improve quality of life by treating the symptoms of cancer without trying to cure the disease. It can be used at any stage of advanced cancer. As well as slowing the spread of cancer, palliative treatment can relieve pain and help other symptoms. Treatment may include surgery, radiation therapy, chemotherapy or other medicines or supplements.
Palliative treatment is one aspect of palliative care, in which a team of health professionals aims to meet your physical, emotional, cultural, spiritual and social needs. Palliative care services can be accessed in the home as well as in a hospital or in residential care.
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This information is reviewed by
This information was last reviewed in May 2020 by the following expert content reviewers: A/Prof Andrew Davidson, Neurosurgeon, Macquarie University Hospital, NSW; Dr Lucy Gately, Medical Oncologist, Oncology Clinics Victoria, and Walter and Eliza Hall Institute of Medical Research, VIC; Melissa Harrison, Allied Health Manager and Senior Neurological Physiotherapist, Advance Rehab Centre, NSW; Scott Jones, Consumer; Anne King, Neurology Cancer Nurse Coordinator, Health Department, WA; Dr Toni Lindsay, Senior Clinical Psychologist and Allied Health Manager, Chris O’Brien Lifehouse, NSW; Elissa McVey, Consumer; Caitriona Nienaber, 13 11 20 Consultant, Cancer Council WA; Dr Claire Phillips, Deputy Director, Radiation Oncology, Peter MacCallum Cancer Centre, VIC.