Brain Tumors

About 17,000 people are diagnosed with cancer that began in or next to the brain every year in the United States. These are called primary brain cancers. Another 100,000 people are diagnosed with cancer in the brain or spinal cord that spread (metastasized) from another place in the body. These are called secondary brain cancers.

Most types of brain tumors are slightly more common in men than women. Meningiomas are more common in women.

Growth Causes Problems

Some brain tumors grow slowly and may become quite large before causing symptoms. Others may grow quickly and cause a sudden onset of symptoms. While most types of primary brain cancer may spread within the brain, it is rare for a primary brain tumor to spread outside the brain. Because the skull is rigid, providing no room for the tumor to expand, brain tumors may press on parts of the brain that control movement, speech, sight or other vital functions.

Even when brain tumors are benign (not cancer), they can cause serious problems. Although non-cancerous brain tumors usually grow slower than cancerous brain tumors, they may damage and press against normal brain tissue or the spine as they grow spinal cord as they grow, potentially causing symptoms.

Brain Has Crucial Roles

Emotions, thought, speech, vision, hearing, movement and many more important parts of everyday life begin in the brain. The brain sends messages throughout the body via the spinal cord and cranial nerves in the head. The network of the brain and spinal cord is called the central nervous system (CNS). Tumors can develop in the spinal cord and cranial nerves.

The hard, bony skull protects the brain, and the bones (vertebrae) of the spine protect the spinal cord. A liquid called cerebrospinal fluid surrounds both the brain and the spinal cord.

The brain has four main parts:

Cerebrum: The outer and largest part of the brain. The cerebrum has two halves that are called hemispheres. Each hemisphere has four lobes: frontal, parietal, temporal and occipital. The cerebrum is responsible for:

• Emotions
• Reasoning
• Language
• Movement of muscles
• Senses of seeing, hearing, smelling, touch
• Perception of pain

Basal ganglia: These are found deeper inside the brain. They play a part in muscle movement.

Cerebellum: This section is at the back of the brain. It helps control and coordinate movement, such as walking and swallowing.

Brainstem: The brain stem is at the base of the brain. Its nerve fibers carry messages between the cerebrum and the rest of the body. This small area is very important and even plays a part in breathing and heartbeat.

Primary Brain Tumor Types

Brain tumors are classified by the types of cells within the tumor. Each type of brain tumor grows and is treated in a different way.

Craniopharyngioma

Craniopharyngiomas are non-cancerous, slow growing tumors located near the pituitary gland. Craniopharyngioma appears primarily in children and middle-age adults. The tumor itself can be part solid and part fluid-filled cyst. Symptoms can include vision changes and slow growth caused by the tumor’s impact on the pituitary gland. These tumors primarily require treatment with specialized surgery and possibly radiation after surgery. 

Dermoid cysts and epidermoid tumors

Dermoid cysts and epidermoid tumors are benign growths that arise from epithelial cells, which form the outer layer of the body and line certain organs and glands. They can develop in various parts of the body, including the central nervous system. Both are slow growing, and are often not noticed for decades. They are treated by surgical removal. 

Glioma

Gliomas are a class of primary brain tumors. They are some of the fastest-growing brain tumors. The different types of gliomas include:

• Astrocytoma: Astrocytomas spread throughout the brain and mix with healthy tissue, making them difficult to treat. There are several types of astrocytoma:
  • Low-grade astrocytomas: These include grade I pilocytic astrocytoma and grade II diffuse astrocytoma. Grade I astrocytomas are rarely seen in adults.
  • Anaplastic astrocytoma: Grade III astrocytomas are known as anaplastic astrocytoma. These tumors are aggressive, high-grade cancers.
  • Glioblastoma: Grade IV astrocytomas are called glioblastoma or GBM. Glioblastoma is the most common malignant (cancerous) adult brain tumor and one of the fastest-growing tumors of the central nervous system. 
• Ependymoma: Ependymomas arise from ependymal cells, which line the ventricles of the brain and the center of the spinal cord. The ventricles are chambers in the brain that produce and transport cerebrospinal fluid, which surrounds and protects the brain. Ependymomas may be found in the brain or the spine. Ependymomas are more commonly seen in children and are rare in adults.
• Oligodendroglioma: Oligodendroglioma is generally slow growing. It can be diagnosed as a grade II or grade III tumor. 

Hemangioblastoma

These slow-growing tumors develop from the cells of blood vessels. A hemangioblastoma typically forms in the brainstem and cerebellum, but can appear in other locations, including the retina. About a quarter of cases are associated with von Hippel Lindau disease, a genetic condition that is tied to the development of multiple types of tumors and cancers. 

Medulloblastoma

Medulloblastoma is the most common pediatric malignant brain tumor, with about 500 children diagnosed a year in the United States. In adults, medulloblastoma is a rare tumor, with about 200 diagnoses each year. Learn more on our medulloblastoma page.

Meningioma

Meningioma is the most common primary brain tumor. These tumors develop from cells in the meninges, the protective layer of tissue surrounding the brain and spinal cord. Most are benign and slow growing. Some, though, are malignant and aggressive.  Surgery is usually the first treatment for meningiomas that grow and cause symptoms. 

Pineal Gland Tumors

The pineal gland is located deep in the brain and makes the sleep regulating hormone melatonin. Tumors of the pineal gland can be benign or malignant. Pineal tumors include pineocytoma and pineoblastoma.

Pituitary Tumors

Pituitary tumors, also called pituitary adenomas, are usually benign (non-cancerous) growths on the pituitary gland. The pituitary gland is a key part of the endocrine system, which controls the growth and development. Learn more on our pituitary tumor page. 

Sarcoma

Sarcomas are broad category of tumors that form in bones and the body’s soft tissues, including cartilage, fat, and muscle. Soft tissue sarcomas are more common than bone sarcomas. Bone sarcoma types include Ewing’s sarcoma and osteosarcoma. Some gliomas have sarcoma-like characteristics and are called gliosarcomas. Gliosarcomas behave aggressively similar to glioblastomas.

Sarcomas may also be found in the spine or skull base, including chordoma. Chordomas are rare sarcoma tumors that grow in the base of the skull and bones of the spine. Doctors believe they develop from the leftover cells that served as the framework for the skull base and spine when the patient was a developing embryo. When chordomas form in the skull, they can push into the brain and cause many of the same symptoms as brain tumors, including headaches, dizziness and confusion. Chordomas can involve multiple critical nerves and arteries, making them difficult to treat. Treatment may require the use of specialized surgery, radiation therapy and/or chemotherapy. 

Primary Brain Tumor Risk Factors

Anything that increases your chance of getting a brain tumor is a risk factor. Research is ongoing into the causes and risk factors of brain tumors. While no definite risk factors have been found for brain tumors, some factors may put you at increased risk, including:

• Prior radiation exposure to the brain, often as treatment for another cancer
• Family history of certain conditions including:
  • Neurofibromatosis type 1 and type 2
  • Tuberous sclerosis
  • von Hippel-Lindau disease
  • Li-Fraumeni syndrome

Some types of brain tumors may be passed down from one generation to the next, if you have a family history of the conditions listed above. Genetic counseling may be right for you. Learn more about the risk to you and your family on our genetic testing page. 

Brain tumor symptoms depend on the area of the brain affected. Brain tumors can:

• Invade and destroy brain tissue
• Put pressure on nearby tissue
• Take up space and increase pressure within the skull (intracranial pressure)
• Cause fluids to accumulate in the brain
• Block normal circulation of cerebrospinal fluid through the spaces within the brain
• Cause bleeding
  

Brain tumor symptoms vary from person to person. They may include:

• Headaches, which are often the first symptom. A headache due to a brain tumor usually becomes more frequent as time passes. It may not get better with over the counter pain medicine and it may come with nausea or vomiting. It can get worse when you lie down, bend over or bear down, such as when you have a bowel movement.
• Seizures. Seizures can take many different forms, such as numbness, tingling, uncontrollable arm and leg movements, difficulty speaking, strange smells or sensations, staring and unresponsive episodes or convulsions.
• Changes in mental function, mood or personality. You may become withdrawn, moody or inefficient at work. You may feel drowsy, confused and unable to think. Depression and anxiety, especially if either develops suddenly, may be an early symptom of a brain tumor. You may become uninhibited or behave in ways you never have before.
• Changes in speech (trouble finding words, talking incoherently, inability to express or understand language)
• Changes in the ability to hear, smell or see, including double or blurred vision
• Loss of balance or coordination
• Change in the ability to feel heat, cold, pressure, a light touch or sharp objects
• Changes in pulse and breathing rates if brain tumor compresses the brain stem

These symptoms do not always mean you have a brain tumor. However, it is important to discuss any symptoms with your doctor, since they may signal other health problems.

If you have a brain tumor, it is important to get the most accurate diagnosis possible. This will help your doctor pinpoint the tumor to give you the most advanced treatment with the least impact on your body.

At MD Anderson, we have the most modern and accurate equipment available to home in on brain tumors and find out exactly how far they may have spread.

Our specialized staff truly sets us apart. The Brain and Spine Center has four renowned neuropathologists who focus only on diagnosing brain and spine tumors. They are an essential part of our team, and their expertise and experience can make a big difference in brain tumor treatment success.

Brain Tumor Diagnostic Tests

If you have symptoms that may signal a brain tumor, your doctor will examine you and ask you questions about your health, your lifestyle and your family history.

One or more of the following tests may be used to find out if you have a brain tumor and if it has spread. These tests also may be used to find out if treatment is working.

Imaging tests, which may include:

• CT (computed tomography) scans
• MRI (magnetic resonance imaging)

Biopsy: While imaging tests may show an area where there may be a brain tumor, doctors need a tissue sample to definitively diagnose a primary brain tumor. Tissue samples are retrieved through a biopsy. Doctors can perform a biopsy by removing a small sample of tissue with a needle or removing all or part of a tumor through surgery. Your neurosurgeon will determine which type of biopsy is best for your tumor.

Lumbar puncture: A small amount of cerebrospinal fluid (clear liquid in and around the brain and spine) is removed with a needle and examined under a microscope. This test may be done if doctors suspect a tumor has spread to the layers of tissue that cover the brain (the meninges) and into the spinal fluid.

Molecular testing: Some primary brain tumors, including some of the most common types of gliomas, are defined by their key molecular features resulting from tumor cell mutations. These features can be used to diagnose a tumor, provide a more accurate prognosis, and enhance the treatment plan. Key mutations include:

• IDH mutation: Grade II and III gliomas are tested for this mutation. In general, IDH-mutated tumors have a better prognosis than tumors without the IDH mutation. Gliomas without the IDH mutation are also known as IDH wildtype.
• 1p/19q co-deletion: This molecular feature is required for an oligodendroglioma diagnosis. It refers to the loss of parts of chromosomes 1 and 19. Unlike the IDH mutation, which only affects one gene, the 1p/19q co-deletion involves a large segment of DNA. This mutation generally indicates that a tumor will be more responsive to chemotherapy.
• MGMT promoter methylation: Testing for the MGMT mutation is required for many brain tumor clinical trials. MGMT is an enzyme that can make cancer cells more resistant to therapy. MGMT tumor methylation generally indicates better prognosis and may indicate better response to chemotherapy.

Brain Tumor Grading

Many cancers are organized by stages, which describe how much a cancer has spread. Primary brain tumors typically do not spread to other parts of the body, so they are not staged.

Instead, most brain tumors are graded on a scale developed by the World Health Organization. Tumor grading classifies tumor cells by how abnormal they look under the microscope and how quickly the tumor is dividing. Grade I tumors are the least aggressive, while grade IV tumors are the most aggressive.

Brain tumors can start out at a low grade and over time become more aggressive and transform into high grade tumors. They can also start as a high-grade brain tumor without ever being a low-grade tumor. 

Brain tumor grades include: 

• Grade I (low-grade): Grade I tumor cells are nearly identical to healthy cells. These tumors are slow growing and are usually associated with long-term survival.
• Grade II: These tumor cells look slightly different than healthy cells. While they are still considered low-grade, grade II tumors are more aggressive than grade I tumors.  A grade II tumor has the potential to transform to a higher grade tumor.
• Grade III: Grade III tumor cells look abnormal and actively reproduce. Grade III tumors grow faster than grade II tumors and have the potential to transform to a grade IV tumors.
• Grade IV (high-grade): Grade IV tumors are the most aggressive. Tumor cells do not look like normal cells and are actively reproducing and growing. There may be areas of dead cells in the tumor.

Some of the nation’s top experts customize your brain tumor care at MD Anderson. They take a team approach to deliver the most advanced therapies with the fewest possible side effects, keeping a constant eye on your quality of life. They're also actively engaged in clinical research and trials to help develop the next generation of innovative approaches for brain cancer treatment.

These highly trained physicians work together to give individualized care for malignant (cancer) and benign (non-cancer) brain tumors, collaborating and communicating frequently. Your personal team of experts may include renowned neurosurgeons, radiation oncologists and neuro-oncologists, supported by a specially trained staff.

Surgical Expertise

Like all surgeries, brain tumor surgery is most successful when it is performed by a specialist with a great deal of experience in the particular procedure. This is especially true with brain tumors because it is crucial to remove as much of the tumor as possible while leaving intact as much brain function as possible.

MD Anderson neurosurgeons are among the most skilled and recognized in the world. They perform a large number of brain tumor surgeries each year, using the least-invasive and most advanced techniques.

And MD Anderson has the most modern technology available to treat brain tumors, including:

• Brainsuite®
• Gamma Knife
• Proton therapy
  

Our Brain Tumor Treatments

If you are diagnosed with a brain tumor, your doctor will discuss the best options to treat it. This depends on several factors, including the location and type of the cancer and your general health.

Your treatment for a brain tumor will be customized to your particular needs. One or more of the following therapies may be recommended to treat the cancer or help relieve symptoms.

Surgery

Surgery usually is the first treatment for brain tumors. Even when complete removal is not possible surgery may be able to:

• Help reduce the tumor’s size
• Relieve symptoms
• Help doctors decide what other treatments are needed

The most common surgery for brain tumors is craniotomy, which involves opening the skull. Some brain tumors can be removed with little or no damage to the brain. However, many grow in areas that make them difficult or impossible to remove without destroying important parts of the brain.

Brainsuite® iMRI

When a brain tumor is in a challenging location, our neurosurgeons can use this innovative open MRI system that allows them to view the tumor during surgery. This helps them remove as much of the tumor as possible without damaging other parts of the brain. MD Anderson’s Brainsuite is the first in the world of its type.

Radiation Therapy

Radiation therapy may be able to stop or slow the growth of brain tumors that cannot be removed with surgery. It may be used:

• Alone
• With chemotherapy to help the radiation work better or lessen effect on normal parts of the brain
• With targeted therapies to destroy remaining cancer cells
  

New radiation therapy techniques and remarkable skill allow MD Anderson doctors to target brain tumors more precisely, delivering the maximum amount of radiation with the least damage to healthy cells.

MD Anderson uses the most advanced radiation treatment methods, including:

• Gamma Knife radiosurgery, which is not really surgery. It delivers a pinpoint dose of radiation from hundreds of angles.
• Focused radiation therapy, which is aimed directly at the tumor and immediately surrounding area
• Whole-brain radiation therapy, which may be needed if you have two or more brain tumors in different locations
• Intensity-modulated radiotherapy (IMRT), which shapes the radiation beam to the shape of the brain tumor and lessens exposure to the rest of the brain
• Proton therapy

Proton Therapy

The Proton Therapy Center at MD Anderson is one of the largest and most advanced centers in the world. It’s the only proton therapy facility in the country within a comprehensive cancer center.  

Proton therapy delivers high radiation doses directly to the brain tumor site, with no damage to nearby healthy tissue. It may be used to treat tumors in very sensitive areas, including in the skull base and along the spine.  

Laser Interstitial Thermal Therapy

Laser interstitial thermal therapy (LITT) is performed by implanting a laser catheter into the tumor and heating it to temperatures high enough to kill the tumor.

The treatment is minimally invasive, often requiring little more than a 2-millimeter incision in the scalp, and takes just a few minutes to perform. Most patients can go home the day after treatment and can quickly return to normal activities.

LITT is currently being used to treat patients with primary and metastatic brain tumors, but can also help patients who do not respond to stereotactic radiosurgery or have radiation necrosis (tissue death caused by radiation treatment).

Chemotherapy

MD Anderson offers the most up-to-date and advanced chemotherapy options for brain tumors. These drugs may be taken orally or by injection. They may be given alone or with other treatments.

Chemotherapy often is not as effective for brain cancer as some other types of cancer. This is because of the blood-brain barrier, small blood vessels in the brain and spinal cord that protect the brain from harmful substances. They also may act as a shield against chemotherapy drugs.

Targeted Therapies

These new drugs target the specific gene changes that cause cancer. MD Anderson is at the forefront of discovering these agents. Many of our brain tumor clinical trials include analysis of the molecular profiles of patients' tumors.

As one of the world's largest cancer research centers, MD Anderson is leading the way in developing and evaluating new approaches to brain cancer diagnosis and treatment. Patients benefit from the most advanced brain tumor research, translated into clinical trials as quickly as possible.

Current treatments for both primary brain tumors and brain metastases (cancer that has spread to the brain from another place in the body) are low in number and short on effectiveness. Because brain tumors contain an unusually diverse mix of cells, our plan of attack is diverse as well.

We’re building on biological therapies developed at MD Anderson, like the Delta-24-RGD virus, and testing methods that use the body’s own cells to deliver these therapies more effectively. With advanced models, we’re also screening existing drugs to find targeted combinations that can penetrate the blood-brain barrier. In the cutting-edge field of immunotherapy, our team is working on approaches using T cells, natural killer cells, signaling pathways and checkpoint inhibitors to unleash the immune system to fight brain cancer.

Existing brain tumor treatments are often toxic, threatening neurological function and quality of life. Our scientists are also investigating regenerative medicine approaches to protect and repair the brain during and after treatment. We aim to find better, safer solutions to treat both primary brain tumors and brain metastases.

Brain Tumor Research Initiatives

Our commitment to brain cancer research is echoed through two major programs:

Glioblastoma Moon Shot
Our ambitious effort to quadruple the five-year survival rate for this aggressive brain cancer, from 10% to 40%, in the next decade.

Brain Cancer SPORE
One of only five such federally-funded grants in the National Cancer Institute's Translational Research Program.

Through unique programs and other pioneering brain tumor research, MD Anderson has:

• Led the initial clinical trials that established temozolomide (Temodar) as the current standard of care for glioblastoma
• Established that surgically removing at least 98% of the tumor improves survival in glioblastoma patients
• Devised unique genetically engineered laboratory models of gliomas to identify cancer drivers and test potential therapies
• Created Delta-24-RGD, a novel cancer-killing virus that has demonstrated significant response in early clinical trials
• Determined how gliomas use a metabolic process known as the “Warburg effect” for cancer growth, laying the groundwork for improved diagnosis and treatment
• Defined molecular signatures of brain tumors and completed a comprehensive genomic analysis of low-grade gliomas, influencing the 2016 World Health Organization (WHO) classification of central nervous system tumors and resulting in more precise diagnosis and treatment planning
• Identified unique drivers of brain metastasis development and illustrated how the central nervous system microenvironment fosters this development
• Demonstrated that brain function is better preserved with radiosurgery than whole brain radiation in patients with brain metastases