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Treatment decisions

The main treatments for brain and spinal cord tumours include: 

  • surgery 
  • radiotherapy
  • chemotherapy 

Deciding which treatment you need

A team of doctors and other professionals discuss the best treatment and care for you. They are called a multidisciplinary team (MDT).

The treatment you have depends on:

  • your type of brain tumour
  • where the tumour is
  • whether it has spread
  • how abnormal the cells look under a microscope (the grade)
  • whether the tumour cells have certain changes or mutations
  • your general health and level of fitness

Your MDT will discuss your treatment, its benefits and the possible side effects with you. 

Some hospitals have specialist brain tumour nurses. They go to the MDT meetings. You usually see the nurses more regularly than your surgeon or cancer specialist. They can answer your questions and support you. 

Surgery

Surgery is the main treatment for most brain tumours. You might have surgery to:

  • remove the whole tumour 
  • remove part of the tumour (this is called subtotal resection or debulking) 
  • take a biopsy 
  • drain a build up of fluid on your brain (hydrocephalus)

Our skull is made of bone, so there is a fixed amount of space for the brain to take up. If there is a growing tumour, it takes up space and increases the pressure inside your head. The increased pressure causes some of the symptoms of brain tumours. 

Even if your surgeon doesn't think they can completely remove the brain tumour, they are still likely to try to remove as much as possible. This can help to slow down the progression of the tumour and relieve your symptoms. 

You may not need surgery straight away if you have a very slow growing tumour (low grade) that isn't causing symptoms. Your doctor will monitor you with regular scans.   

Radiotherapy

Radiotherapy uses high energy x-rays to destroy tumour cells. You might have radiotherapy on its own, or after surgery. You usually have radiotherapy to:

  • the tumour and the surrounding area of healthy brain tissue
  • the whole brain
  • the spinal cord

You usually have a type of radiotherapy called external beam radiotherapy. For a small brain tumour, you may have stereotactic or radiosurgery. It targets high doses of radiation to a small area. 

Chemotherapy

Chemotherapy uses anti cancer (cytotoxic) drugs to destroy tumours cells. You might have it:

  • after surgery to lower the chances of the tumour coming back
  • if your brain tumour comes back

You usually have chemotherapy on its own or with radiotherapy. 

Some chemotherapy drugs can't cross the blood brain barrier. This is a natural filter between the blood and the brain which protects the brain from harmful substances. You might have some chemotherapy drugs into the fluid surrounding the brain and spinal cord. This is called intrathecal chemotherapy. 

Tests on your tumour cells

For some types of brain tumours, you might have tests on your tumour cells to help doctors work out which treatment you need. These are called biomarker tests and include checking for proteins such as:

  • IDH
  • 1p/19q
  • MGMT
Ask your doctor whether these tests are helpful in your situation.

Treatment by type of brain tumour

Treatment depends a lot on the type of brain or spinal cord tumour you have. We have information about treatment for the most common types of brain tumours.   

Getting a second opinion

Treatment decisions can be complicated and confusing. You can ask for a second opinion if you would like to get another doctor's view about your treatment. This means going to see another specialist. They will need to see all your test results and x-rays. 

Having a second opinion doesn't usually mean that the new doctor takes over your treatment and care. They discuss with you and your current doctor which is the best treatment approach to take.

If you want to get a second opinion, your doctor will usually be happy to arrange it for you. It can take time to arrange though and it might mean that your treatment is delayed for a while.

It is worth discussing your treatment again with your current specialist first. Once you have heard why they are suggesting particular treatments for you, you might feel that you don't need a second opinion.

It is always a good idea to jot down a few questions before you go to the hospital for an appointment with your specialist. It can be difficult to remember everything you want to ask once you get there. Writing down your questions beforehand can help you to feel more confident during the discussion.

Clinical trials

Your doctor might ask if you’d like to take part in a clinical trial. Doctors and researchers do trials to make existing treatments better and develop new treatments.

Last reviewed: 
10 Apr 2019
  • Brain tumours (primary) and brain metastases in adults
    The National Institute for Health and Care Excellence (NICE), 2018

  • High-grade glioma: ESMO Clinical Practice Guidelines for the diagnosis, treatment and follow up. 
    R Stupp and others
    Annals of Oncology, 2014. Vol 25, Supplement 3, Pages 93-101

  • Overview of brain tumours
    BMJ Best Practice, Last accessed April 2019

  • Primary brain tumours in adults
    S Lapointe, A Perry and N Butowski
    Lancet, 2018. Vol 392, Pages 432-446 

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