What are brain tumours?
A brain tumour is a collection of brain cells that have grown out of control. Our body is made up of billions of cells that can only be seen under a microscope. Normally, cells only divide to replace old and worn out cells. A brain tumour develops when something inside a cell goes wrong, making the cell carry on dividing until it forms a lump or a tumour.

Tumours that start in the brain are called primary brain tumours. This is different from cancers that have spread to the brain from somewhere else in the body. These are called secondary brain cancers or brain metastases. The information on this page is about primary brain tumours.
The brain is made of different tissues and cells which can develop into different types of tumours. There are over 130 different types of brain tumours.
Cancerous or non-cancerous brain tumours
Generally, brain tumours can be benign (non-cancerous) or malignant (cancerous).
Benign brain tumours
Benign tumours usually grow slowly. They are less likely to come back after treatment or to spread to other parts of the brain. Your doctor might refer to some benign brain tumours as low grade.
Malignant brain tumours
Malignant brain tumours grow faster than benign tumours. They are more likely to come back after treatment and to spread to other parts of the brain. Your doctor might refer to malignant brain tumours as high grade.
The brain and spinal cord
The brain and the spinal cord make up the central nervous system (CNS). The CNS is made up of different types of cells and tissues. Brain tumours are usually named after the cell or tissue they started in. Brain tumours can start anywhere in the brain. They cause different symptoms depending on their position in the brain. Tumours can also start in the spinal cord.
Who gets it
Brain tumours are more common in older people. Almost 25 out of every 100 people (almost 25%) diagnosed with a brain or spinal cord tumour at the aged of 75 or older.

Brain and spinal cord

The central nervous system (CNS)
The CNS is made up of the brain and the spinal cord. The brain controls everything we do, from how we think to how we behave. It sends electrical messages to the rest of our body along nerve fibres. The nerve fibres run out of the brain and join together to make up the spinal cord. The spinal cord has bundles of long nerve fibres that carry signals to and from the brain, to all parts of the body. These long nerve fibres are called peripheral nerves.

The brain
The brain is protected by the skull. The main areas of the brain include the:
1) cerebrum (also called the Forebrain)
2) cerebellum (also called the Hindbrain)
3) brainstem

The cerebrum
The cerebrum is the largest part of the brain and is divided into two halves, the right and left central hemispheres. Each half is divided into 4 areas (lobes):
1) frontal lobe
2) parietal lobe
3) temporal lobe
4) occipital lobe
The cerebrum is responsible for planned movement such as walking and talking. It is also responsible for our:
1) thinking
2) memory
3) emotions
4) senses

Frontal lobe
The frontal lobe is important for:
1) speaking
2) planning 3) problem solving
4) starting some movements
5) processing emotions
6) part of your personality and character
Temporal lobe
The temporal lobe is where you process sounds and where memories are stored. It is also responsible for processing language.
Parietal lobe
The parietal lobe recognises objects in the world and stores that knowledge. It's where you receive and process:
1) touch
2) pressure
3) pain

Occipital lobe
This Occipital lobe processes what you can see.
The cerebellum
The cerebellum is at the back of the brain. It controls our balance and posture. It is also involved with timing and coordination of movement.

The brainstem
The brainstem is the lower part of the brain that connects with the spinal cord. It controls functions that we don't usually think about. They include:
1) breathing
2) sneezing and coughing
3) swallowing
4) our heartbeat and blood pressure
The main areas of the brainstem include:
the midbrain - this connects the cerebrum with the lower part of the brain and the spinal cord
the pons - which connects the cerebellum with the higher part of the brain and the spinal cord
the medulla oblongata - which controls important functions such as breathing

The spinal cord
The spinal cord is a long bundle of nerves that stretch from the brain to the lower part of the back. It sends messages to and from the brain to the different parts of the body. The spinal cord is protected by the bones of the spine.These are called vertebrae. The brain and the spinal cord are made up of different types of cells and tissues.

Glial cells
Glial cells are the supporting cells of the brain and the spinal cord. The most common type of brain tumours start in glial cells. These are called gliomas. There are 3 types of glial cells:
1) astrocytes – tumours that start in these cells are called astrocytoma or glioblastoma
2) oligodendrocytes – tumours that start in these cells are called oligodendrogliomas
3) ependymal cells – tumours that start in these cells are called ependymomas

Neurons
Neurons are also called nerve cells. They are specialised cells that control everything we do. Our brain and spinal cord are made up of billions of neurons.

Neuroectodermal cells
These are cells that are left over from the earliest development of the body in the womb. They can be found in different parts of the brain in children and young people. Usually these cells are harmless but rarely they become cancerous.
The most common type of brain tumours that start in neuroectodermal cells are medulloblastomas. They usually start in the back of the brain (cerebellum) and mainly affect children.

Neuroectodermal cells
Meninges are membranes that support and protect the brain and the spinal cord. A clear fluid called cerebrospinal fluid (CSF) travels in the spaces formed by the meninges. The most common type of brain tumour that starts in the meninges is called meningioma.

Fluid around the brain (cerebrospinal fluid)
The brain and spinal cord are surrounded by a clear fluid called cerebrospinal fluid (CSF). It supports and protects the brain and the spinal cord.
Ventricles are spaces inside the brain filled with CSF. They connect with the space in the centre of the spinal cord and the brain membranes (meninges). So the fluid can circulate around and through the brain and spinal cord.
There are 4 ventricles inside the brain:
1) two lateral ventricles – one on each side of the cerebrum
2) the third ventricle
3) the fourth ventricle
Some brain tumours can spread to the CSF. Doctors might take a sample of CSF from your lower back to help diagnose a brain tumour.

Pituitary gland
The pituitary gland makes hormones which are important for your body to function. These affect:
1) growth
2) the chemical processes that happen inside your body (your metabolism)
3) periods and egg production in women
4) sperm production in men.
Different types of tumours can start in the pituitary gland.

Pineal gland
The pineal gland is in the middle of the brain, just behind the brainstem. It makes a hormone called melatonin which controls your sleep patterns.
The blood brain barrier
The blood brain barrier is a natural filter between the blood and the brain which protects the brain from harmful substances. This barrier stops some drugs from reaching the brain. This includes some types of chemotherapy drugs.

Brain Tumour Symptoms
Common symptoms of brain tumours include headaches, feeling or being sick and seizures (fits).
Brain tumours cause symptoms because:
1) they take up space inside the skull when they grow
2) of their position in the brain
The symptoms can develop gradually over some months or even years if the tumour is slow growing. Or quickly over days or weeks if the tumour is fast growing.
Symptoms due to increased pressure
Your skull is made of bone, so there's a fixed amount of space for the brain to take up. If there's a growing tumour, it increases the pressure inside the skull. This is called raised intracranial pressure. It might cause:
Headaches
Headaches are a common symptom of illness. It's unlikely that you have a brain tumour if headaches are your only symptom. But see a doctor if you have headaches:
● with feeling or being sick
● when you didn't have them before
● that wake you up at night
● with eye problems such as seeing flashing lights or blind spots
● that got steadily worse over a period of weeks or months
Seizures (fits)
Seizures happen in up to 8 out of every 10 people (up to 80%) with a brain tumour. You might have some jerking or twitching of your hands, arms or legs. Or your seizure might affect your whole body.
Having a seizure is very frightening. Different illnesses can cause seizures and it is important that you see your doctor immediately or go to A&E if you have one.
Feeling or being sick
You might feel or be sick, especially when you move suddenly. It’s rare for people with a brain tumour to have sickness on its own. You may have sickness with headaches, weakness and problems with your eyes.
Drowsiness or loss of consciousness
You might feel drowsy or even lose consciousness. This might happen because raised intracranial pressure can lower the blood supply to the brain. This can be frightening for you and the people around you.
Problems with your eyes
You might find that your eyesight is getting worse and glasses are not helping. Or your vision comes and goes. You might lose the ability to see out of the corner of your eyes, making you bump into cars or objects on your left or right side. You may also have:
● blurred vision
● floating shapes
● tunnel vision
Personality and behaviour changes
You, or the people around you, might notice that you are confused or that your personality has changed. You may also find it difficult to think normally.
Symptoms due to the position of the tumour
Brain tumours can cause different symptoms depending on where they are in the brain. The main areas of the brain include the cerebrum and the cerebellum. The cerebrum is divided into 4 areas called lobes:
● frontal lobe
● temporal lobe
● parietal lobe
● occipital lobe
There are also other important areas such as:
● brainstem
● spinal cord
● pituitary gland
● pineal gland
Frontal lobe tumour symptoms
The frontal lobe controls movement such as walking and is part of your personality. A tumour in the frontal lobe may cause:
● difficulty walking
● problems with your sight and speech
● weakness on one side of the body
● changes in personality or behaving in a way that you wouldn’t normally
● loss of smell
Temporal lobe tumour symptoms
The temporal lobe is where you process sounds and where you store memories. A tumour in this area may cause:
● short term memory loss
● difficulty with hearing and speaking
● hearing voices in your head
Parietal lobe tumour symptoms
The parietal lobe allows you to recognise objects and stores that knowledge. A tumour in this area may cause:
● difficulty speaking and understanding
● problems with reading or writing
● loss of feeling in one part of the body
Occipital lobe tumour symptoms
The occipital lobe processes what you can see. A tumour located in this area may cause sight problems such as:
● changes in vision
● difficulty to identify the colour and size of objects
Cerebellum tumour symptoms
The cerebellum controls our balance and posture. So a tumour in this area may cause:
● problems with coordination and balance
● dizziness
●sickness
● uncontrolled movements of the eyes such as flickering
Brain stem tumour symptoms
The brain stem controls important body functions such as breathing. A tumour in this area may cause:
● difficulty swallowing and speaking
● unsteadiness and difficulty walking
● double vision
Spinal cord tumour symptoms
The spinal cord is a long bundle of nerves that stretches from the brain to the lower part of the back. A tumour in the spinal cord may cause pain and numbness or weakness in different parts of the body. You may also lose control of your bladder or bowel.
Pituitary gland tumour symptoms
The pituitary gland makes hormones that are important for your body to function. A tumour in this area of the brain can cause:
● weight gain
● infertility
● mood changes
● high blood pressure
● high blood sugar levels (diabetes)
● leakage of milk from the breasts when you're not breastfeeding
Pineal gland tumour symptoms
The pineal gland makes a hormone called melatonin. Tumours in this area can cause:
● headaches
● sickness
● tiredness
● double vision
● unsteadiness when walking

Risks and causes of brain tumours
Your risk of developing cancer depends on many things including your age, genetics, lifestyle and environmental factors. Anything that can increase your risk is called a risk factor.
The risk factors for developing a brain tumour include getting older and family history. But having a risk factor doesn’t mean that you will definitely develop a brain tumour.
Age
Brain tumours can start at any age. But as we get older our risk of developing most cancers, including brain tumours, increases. The risk of brain tumours is greatest in those aged between 85 and 89 years.
Overweight and obesity
Being overweight or obese increases the risk of some cancer types, including a type of brain tumour called meningioma. About 2 out of 100 brain tumours (2%) diagnosed That are caused by being overweight or obese. Try to keep a healthy weight by keeping physically active and eating a healthy, balanced diet.
Medical radiation (ionising radiation)
Ionising radiation is a type of radiation used by some medical scans, such as x-rays and CT scans. These scans are important to help diagnose many illnesses, including cancer.
Less than 1 out of every 100 brain tumours (less than 1%) diagnosed that are caused by ionising radiation. Most cases happen in people who have received radiation from previous radiotherapy treatments, rather than from x-rays and CT scans.
The risks of radiation from medical scans are very low. Your doctors and dentist will keep your exposure to radiation as low as possible. They will only do x-rays and CT scans when they are necessary.
Family history and genetic conditions
Your risk is higher than other people in the general population if you have a close relative who has had a brain tumour. A close relative is a parent, sibling or child. A small proportion of brain tumours are related to known genetic conditions. People who have one of these rare syndromes have an increased risk of getting a brain tumour. These syndromes include:
● neurofibromatosis (NF) type 1 and type 2
● tuberous sclerosis (TSC)
● Li-Fraumeni syndrome
● Von Hippel-Lindau syndrome (VHL)
● Turner syndrome
● Turcot syndrome
● Gorlin syndrome

Grades of brain and spinal cord tumours
The grade of a brain tumour gives doctors an idea of how the tumour might behave. Brain tumours are put into groups according to how quickly they are likely to grow. There are 4 groups, called grade 1 to 4.
Grade 1
The cells look very like normal cells. They are usually slow growing and less likely to spread. Surgery is usually the only treatment you need for a grade 1 brain tumour.
Grade 2
The cells look less like normal cells. They are usually slow growing but can grow into the nearby brain tissue. Grade 2 tumours are more likely to come back after surgery and some can develop into a malignant tumour.
Grade 3
The cells look more abnormal. They can spread to other parts of the brain and the spinal cord. You are more likely to need radiotherapy and chemotherapy after surgery.
Grade 4
The cells look very abnormal. These are the fastest growing tumours. They often come back after treatment and can spread to other parts of the brain and sometimes the spinal cord. You usually have treatment with radiotherapy and chemotherapy.
Benign or malignant
Doctors might refer to some low grade tumours as benign. And high grade tumours as malignant. This grading system generally works well for most tumours. But for some brain tumours, it isn’t as clear as this. For example, a slow growing benign tumour can cause serious symptoms and be life threatening if it's in a particular part of the brain. And some low grade astrocytomas can become malignant over time. Benign tumours are sometimes treated with radiotherapy and chemotherapy. This is to help to control them and reduce the risk of tumour coming back.
Changing from benign to malignant
Some low grade tumours can develop into a malignant tumour. It is called malignant transformation or progression to malignancy. For example, a grade 2 tumour could progress to a grade 3 tumour. Or a grade 3 tumour could change to a grade 4.
Other tests on the cells
Using new techniques, doctors can look at the genes and proteins inside some types of brain tumour cells. These are called biomarker or molecular studies. The results of the biomarker studies help doctors decide the best treatment for some types of brain tumours.
Types of brain tumors
There are over 130 different types of brain tumours. Tumours can start in any part of the brain or spinal cord. They are usually named after the type of cell they develop from. The most common type of brain tumours in adults is called glioblastoma multiforme (GBM). Tumours that start in the brain are called primary brain tumours. Cancer that has spread to the brain from somewhere else in the body is called secondary brain cancer or brain metastases. The common types are Acoustic neuroma, Astrocytoma (children's cancer), Astrocytoma and glioblastoma (GBM), Children's brain tumours, Craniopharyngioma, Embryonal tumours, Ependymoma, Ependymoma (children's cancer), Glioma, Haemangioblastoma, Lymphoma of the brain or spinal cord, Medulloblastoma (children's cancer), Meningioma, Oligodendroglioma, Pineal region tumours, Pituitary tumours, Primary and secondary brain tumours, Spinal cord tumours, Vestibular Schwannoma

You usually start by seeing your doctors if you have symptoms. They examine you and might refer you to a specialist. But some people with a brain tumour have symptoms that are severe and come on quite suddenly.
Seeing your Doctor
You should see your doctor if you notice a change that isn't normal for you or if you have any of the possible signs and symptoms of cancer. Even if you're worried about what the symptom might be, don't delay seeing them. Your worry is unlikely to go away if you don't make an appointment. The symptom might not be due to cancer. But if it is, the earlier it's picked up the higher the chance of successful treatment. You won't be wasting your doctor's time. Try not to be embarrassed. What you tell your Doctor is confidential. Doctors are used to discussing intimate problems and will try to put you at ease.
Referral to a specialist
Your Doctor should arrange for you to see a specialist if you have symptoms that could be due to a brain or spinal cord tumour. Depending on your symptoms and other factors, this might be an urgent referral. Many people worry that a constant headache might mean they have a brain tumour. But it's unlikely that you have a brain tumour if headaches are your only symptom.
Screening
Screening means testing people for early stages of a disease. This is before they have any symptoms. For screening to be useful the tests:
● need to be reliable at picking up cancers
● overall must do more good than harm to people taking part
● must be something that people are willing to do
Screening tests are not perfect and have some risks.
Tests
You have one or more of these tests to diagnose a brain or spinal cord tumour. If you are diagnosed with a brain tumour, you might have further tests to find out how big the tumour is and whether it has spread.

MRI scan
An MRI is a type of scan that creates pictures using magnetism and radio waves. MRI scans produce pictures from angles all around the body and show up soft tissues very clearly. MRI stands for magnetic resonance imaging.They take between 15 and 90 minutes. You usually have an MRI scan to help diagnose a brain or spinal cord tumour. It can help to find where the tumour is and whether it has spread. You may also have some specialised MRI scans. These include:

1) magnetic resonance spectroscopy (MRS) which looks at the chemicals in the tumour
2) perfusion MRI scans that look at the blood flow in different parts of the brain
3) functional MRI scans (fMRI) that can pick up brain activity

During a functional MRI scan, the radiographer will ask you to do certain things such as move your hand, tap your fingers or speak. Some people can't have MRI scans for any reason. For example, you may not be able to have an MRI scan if you have metal fragments in your body. Your doctor might suggest you have a CT scan instead of an MRI scan if this happens.

CT scan
A CT scan is a test that uses x-rays and a computer to create detailed pictures of the inside of your body. It takes pictures from different angles. The computer puts them together to make a 3 dimensional (3D) image. You usually have a CT scan of the brain to help diagnose a brain tumour. It can help to find where the tumour is and whether it has spread. You may also have a CT scan of your tummy (abdomen) and chest to check whether you have cancer anywhere else in your body. This is because in adults, cancer that has spread to the brain from another part of the body (secondary brain cancer) is much more common than cancer that started in the brain (primary brain tumour).

PET scan
PET scans are a type of test that creates 3 dimensional (3D) pictures of the inside of your body. PET stands for positron emission tomography. You’ll usually have a PET scan in the radiology department as an outpatient. These scanners tend to be only in the major cancer hospitals. So you might have to travel to another hospital to have one. A radiographer operates the scanner. It usually takes between 30 and 60 minutes. PET scans are often combined with CT scans to produce more detailed images. These are called PET-CT scans.

A PET scan can show how body tissues are working, as well as what they look like. It can help to show up a brain tumour by highlighting the areas of the brain where cells are more active than others. You may also have another type of PET scan called SPECT. It stands for single photon emission computed tomography. SPECT is similar to a normal PET scan but it can show how the blood flows in your brain.

Brain angiogram
An angiogram is an x-ray that can show blood vessels. A neuroradiologist injects a dye (contrast medium) and then takes x-ray images of your brain. They look at your brain on the x-ray screen to see:
1) which blood vessels supply the tumour.
2) if the tumour is near any major blood vessel.
This test is also called cerebral angiography.

Biopsy for brain and spinal cord tumours
A biopsy means taking a small tissue sample from your brain and looking at it under a microscope. This helps your doctors decide the best treatment for you.You usually have a biopsy of your brain under general anaesthetic. This means that you will be asleep and won’t feel anything. Having a biopsy sounds like a frightening procedure, but it is quite safe. Doctors who carry out these tests are very skilled specialists. You can share your concerns with your doctor and cancer nurse specialist. They will be able to tell you what will happen.
A biopsy is done by a specialist doctor, called neurosurgeon. You usually have it as part of the operation to remove the brain tumour, but you may also have it on its own.There are different types of biopsies. The difference between them is the way the surgeon does the biopsy. You might have:
1) a biopsy as part of the operation to remove the tumour
2) a needle biopsy
3) an open biopsy
4) a neuroendoscopy

Lumbar puncture
A lumbar puncture is a test to check the fluid that circulates around the brain and spinal cord. This is called the cerebrospinal fluid or CSF. Certain types of brain tumours can spread from the brain to the CSF. So doctors might take some of the CSF to test for tumour cells. They use a needle to take a sample of the CSF from your lower back. Sometimes, the pressure inside the brain and spinal canal (the intracranial pressure) is too high. It might not be safe to do a lumbar puncture if this happens. You normally have this test in the outpatient department under local anaesthetic. This means you are awake but the area is numb.

Neuroendoscopy to take a sample of tissue
Neuroendoscopy is a way of taking samples of tissue from a brain tumour. Doctors take samples of tissue (biopsy) to look at it under a microscope. This helps your doctor decide the best treatment for you. You may also have a neuroendoscopy to:
1) remove fluid from the fluid filled spaces of the brain (ventricles)
2) remove all or part of the brain tumour
You usually have a neuroendoscopy under general anaesthetic. This means that you will be asleep and won’t feel anything. You might have a neuroendoscopy to take samples of tissue from the fluid filled spaces of the brain (ventricles). The ventricles are spaces inside the brain filled with a clear fluid called cerebrospinal fluid (CSF). The CSF supports and protects the brain and the spinal cord. You may also have it to take a sample of tissue from the pineal region. The pineal region is an area in the middle of the brain, just behind the brain stem.

Blood tests
Blood tests can:
1) check your general health, including how well your liver and kidneys are working
2) check numbers of blood cells
3) help diagnose certain brain tumours such as pituitary gland, pineal region and germ cell tumours
Your blood sample is sent to the laboratory. Specialist technicians and doctors look at your sample under a microscope. They can see the different types of cells and can count the different blood cells. They can also test for different kinds of chemicals and proteins in the blood.

Types of blood tests
● Full blood count (FBC)
A full blood count (FBC) measures the number of red cells, white cells and platelets in your blood. 1) Red cells carry oxygen around our bodies. Haemoglobin is the part of the cell that carries oxygen. If you have a low red cell count, your doctor might say you’re anaemic (pronounced a-nee-mic). This can make you feel tired, short of breath and dizzy.
2) White cells fight infections. There are several different types of white cells, including neutrophils and lymphocytes.
3) Platelets help clot the blood. Symptoms of a low platelet count include abnormal bleeding, such as bleeding gums and nosebleeds. There is a range of normal for blood counts. The range of figures quoted as normal varies slightly between laboratories and also differs between men and women.
● Urea and electrolytes
These blood tests show how well your kidneys are working. Waste chemicals called urea and creatinine are produced by the body. Our kidneys remove them from our blood and get rid of them in our urine. Electrolytes are substances such as sodium, potassium, chloride and bicarbonate.
● Liver function tests (LFTs)
Liver function tests (LFTs) check how well your liver is working. LFTs look for levels of enzymes and proteins made by the liver or which are cleared by the liver. They include:
1) alanine aminotransferase (ALT)
2) aspartate aminotransferase (AST)
3) alkaline phosphatase (ALP)
4) gamma-glutamyl transferase (Gamma GT)
They might be raised if you have a blockage in your liver or bile duct, or if you drink a lot of alcohol. LFTs also look at the amount of bilirubin in the blood. This is a chemical in bile. Bilirubin can be raised if you have a problem with your liver or gallbladder. Bilirubin can cause yellowing of your skin and eyes (jaundice). LFTs also measure albumin. This is a protein in the blood that can be low in some types of cancer. You can also have low albumin if you’ve been eating small amounts and are malnourished.
● Chemical markers (LFTs)
Some brain tumours such as pituitary gland, pineal region and germ cell tumours can change the levels of certain hormones and chemicals in your body. You may have blood tests to check for specific hormones and markers to help diagnose a brain tumour.

Physical examination
Your doctor asks about your symptoms, including when they started and whether anything you do makes them better or worse. They will also do a physical examination and test your nervous system. A test of your nervous system is also called a neurological examination.

There are a number of treatments for brain and spinal cord tumours. Your treatment depends on the type of tumour you have, where it is and your general health.

Prehabilitation - Preparing for treatment and life afterwards
When you’re first diagnosed with cancer, you might feel worried and overwhelmed. But there are things you can do to help you feel more in control of your physical and mental health during this time. Research says that focusing on certain lifestyle changes in whatever time you have before treatment starts can help you cope better with its side effects and improve your long term health. In the hospital, preparing for treatment is also called prehabilitation or prehab.
Prehabilitation (prehab) means getting ready for cancer treatment in whatever time you have before it starts. It is a programme of support and advice that some as some hospitals are using. It covers three particular parts of your health:
1) what you're eating and your weight
2) physical activity or exercise
3) mental wellbeing
Stopping smoking and cutting down on alcohol can also help. It helps while you're having treatment, with your recovery, as well as improving your overall health.
Treatment decisions
The main treatments for brain and spinal cord tumours include:
● surgery
● radiotherapy
● chemotherapy
A team of doctors and other professionals will discuss the best treatment and care for you. The treatment you have depends on:
a) your type of brain tumour
b) where the tumour is
c) whether it has spread
d) how abnormal the cells look under a microscope (the grade)
e) whether the tumour cells have certain changes or mutations
f) your general health and level of fitness

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.

Biomarker 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

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.

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.

Living with a brain tumour
It can be difficult to find out that you have a brain tumour. It’s normal to feel angry, sad, upset and shocked. You might worry about what will happen and how you will cope. Getting practical and emotional support can help you cope with your diagnosis and treatment.

Coping with brain tumours
Coping with a brain tumour can be difficult. You may find you have a lot of different feelings. There is help and support available. There are things you can do, people who can help and ways to cope with a diagnosis of brain tumour. Everyone reacts in their own way. Sometimes it's hard to take in the fact that you have cancer at all. Some people find that counselling can help them cope. Counselling can help to reduce stress and improve your quality of life

Finding out about your prognosis
There are lots of different types of brain tumours and the likely outcome varies greatly, depending on the tumour type and how well you are. Some brain tumours grow quickly and are likely to come back despite treatment. But many brain tumours are curable or can be controlled for many years.
Not everyone wants to know if their brain tumour isn't curable and how long they are likely to live (their prognosis). Reading information about survival can be difficult. You can save it to read another time when you feel ready. And it’s okay if you don’t want to read this information at all. Survival statistics can be useful, but cannot tell you exactly what will happen to you. The best person to do this is your doctor. Talk to them or to your clinical nurse specialist if you want to know about your likely prognosis.

Helping yourself
You are more able to cope and make decisions if you have information about your tumour type and its treatment. Information helps you to know what to expect. Taking in information can be difficult at first, especially if you have just been diagnosed. Make a list of questions before you see your doctor. Take someone with you to remind you what you want to ask and help remember the answers.

Talking to other people
Talking to your friends and relatives about your brain tumour can help and support you. But some people are scared of the emotions this could bring up and won’t want to talk. They might worry that you won't be able to cope with your situation. It can strain relationships if your family or friends don't want to talk. But talking can help increase trust and support between you.
Help your family and friends by letting them know if you would like to talk about what’s happening and how you feel.You might find it easier to talk to someone outside your own friends and family. For example your specialist nurse, or other people in a similar situation to you. You could join a support group, or contact one of the brain tumour charities.

Survival for brain tumours depends on different factors. So no one can tell you exactly how long you will live.These are general statistics based on large groups of people. Remember, they can’t tell you what will happen in your individual case.Your doctor can give you more information about your own prognosis.

What affects survival
Brain tumours are quite rare and there are many different types. Survival depends on many factors.

a) Type of tumour
Different types of brain tumours respond differently to treatment. Some respond better to radiotherapy than others, for example. Some types are likely to spread into the surrounding brain tissue. This may make them difficult to remove with surgery.

b) Grade of the tumour
The grade is one of the most important factors for some types of tumours. But for others, the grade is much less likely to predict how the tumour might behave. Generally, fast growing (high grade) tumours are much more likely to come back after treatment than slow growing (low grade) tumours.

c) Position in the brain
The position of the tumour may affect the type of treatment you might have. For example, surgery is the main treatment for most types of brain tumour. But some parts of the brain are more difficult to operate on than others. These include areas near the nerves that control your sight (optic nerves), the brain stem, spinal cord, or areas close to major blood vessels.
Sometimes the tumour may be in an area where it isn't possible for doctors to operate on. For tumours in these areas, radiotherapy or chemotherapy may be better options for treatment.

d) Size or shape of the brain tumour
Large tumours or those where the edge of the tumour is not clear may be more difficult to remove.

e) Age at diagnosis
The outlook is often better for people younger than 40.

Survival for all types of cancerous (malignant) brain tumour
Generally for people with a cancerous (malignant) brain tumour:
1) 40 out of 100 people (40%) survive their cancer for 1 year or more
2) more than 10 out of 100 people (more than 10%) survive their cancer for 5 years or more

Herbal Medicines for Healing Cancer
Traditional herbal medicine recognized centuries ago that combining many plants delivers far better results than relying on a single plant. This is true both for supporting health and vitality and for treating imbalances and diseases. The multi-component nature inherent in medicinal herbs makes them particularly suitable for managing the multitude of issues that present in complex diseases such as cancer, and offers great potential for synergistic actions, including interactions between botanicals and the relationship of botanicals to conventional cytotoxic drugs such as chemotherapy and targeted agents.

As respect for botanical medicine has grown, numerous herbs, including those traditionally used in Chinese medicine, are being incorporated as remedies for disease management and treatment. Because botanicals contain a variety of organic chemical complexes, they usually act on multiple targets. A potential advantage of phytochemicals is that they may act through multiple pathways, thus reducing the development of resistance by cancer cells. Botanical medicine does not have single effects, nor does it have a high degree of potency, but rather is pleotrophic, having relatively weak (compared to that of drugs) or gentle effects, assisting rather than controlling, and often acting in an amphoteric.

Botanical, as well as natural dietary compounds, have drawn a great deal of attention as potential cancer preventive agents because of their wide margin of safety. Combinations of botanicals and natural dietary compounds are gaining increasing popularity. Botanical preparations include crude herbs, herbal tinctures, fluid extracts, powdered concentrated whole herb extracts, standardized herbal extracts, and herbal isolates. Botanical compounds, even as isolates, differ from drugs in that rather than blocking pathways or receptors, they tend to “take the edge off” just enough to reduce excessive amplification. The result is that there is still plenty of activity for normal response and cellular activity. They are also capable of up-regulating protective pathways, targeting tumor cells, enhancing immune activity, and functioning as selective redox-antioxidants—inducing oxidative damage to cancer cells while protecting the health of normal cells. Botanical compounds also reduce mutagenicity of many of the main players in oncogene and tumor suppressor gene mutation, such as the p53 tumor suppressor gene.

Integrated Botanicals with Conventional Therapies In The Treatment Of Cancer
The tide is shifting in the way we view cancer, and as a result, in the ways cancer is treated, even with conventional drugs. The basis of using multi-drug therapy is the recognition that for each disease process, there is more than one mechanism and gene involved. For example, in pancreatic cancer, in the great majority of cell types there is a global genomic analysis that demonstrates at least 12 partially overlapping processes that are genetically altered.

Even if you do find the target in regard to the cancer, there are a multitude of “co-conspirators”, and the cancer intellect is continually mutating to gain an edge for strength, control, proliferation and metastasis. The pathways that are altered, both intra and extra cellular, as well as in the membrane in any individual tumor, vary widely such as Glioblastoma multiforme, which is the most common and lethal type of brain cancer using multi-targeted approach. This is why a multi-targeted approach is necessary and the basis for how botanicals can provide a significant advantage.

There is currently a great deal of research worldwide investigating the potential of botanicals in the treatment of cancer. For example, a combination of four herbs: Scutellaria baicalensis, Glycyrrhiza uralensis, Paeonia lactiflora, and Ziziphus jujube, which have a history of use in traditional Chinese medicine for over 1800 years, has been shown to enhance the effectiveness of chemotherapy while decreasing chemotherapy-related toxicities and side effects of anticancer agents in various cancers. decreased the toxicity of abdominal irradiation without protecting tumors and thereby increased the therapeutic ratio.

Botanical Synergy as a Pleotropic Force Against Cancer
One thing to keep in mind is that everything in the body is in flux, in a trophic push-pull responsive state that is modulating and adaptive. The efficacy of most natural medicines lies in the synergy of diverse components rather than a single compound. When an extracellular signaling molecule activates a cell surface receptor, signal transduction occurs. This process involves the numerous actions of cellular messengers. Though different constituents may affect various cellular messengers, the same response may appear in a cell. On the other hand, different agents may regulate the same target, and therefore cooperate in an agonistic, synergistic way.

One example, Chinese coptis root was used for thousands of years for clearing heat as well as purging body fire, resolving phlegm to activate meridians, promoting blood circulation to remove blood stasis, and for removing dampness.The pharmacologically active constituents of coptis consist mainly of alkaloids, including palmatine, berberine, epiberberine, coptisine, and jatrorrhizine, which exhibit anti-hyperglycemic, anti-inflammatory, anti-bacterial and cancer inhibiting activity.

A research concluded that as potential adjuvants to chemotherapy for non small cell lung cancer, coptis extract and berberine increase selective cancer cell reactive oxygen species production, reduce multidrug resistance, and enhance the inhibitory effects of chemotherapeutic agents against cancer cell growth. Both coptis and berberine significantly inhibited cell growth in a dose-dependent manner. Combinations coptis and berberine with chemotherapeutic agents (fluorouracil, camptothecin, and paclitaxel) exhibited a stronger inhibitory effect on cancer cell growth.

Another consideration is that diseases such as cancer have many contributing factors including viral, environmental, behavioral, and metabolic, as well as inherited factors. The evolutionary origin of synergy in natural medicines, such as in traditional Chinese medicine, offers a strategy that not only utilizes whole plants with a multitude of synergistic compounds, but also uses formulations that involve several plants. For instance, polyphenols and terpenoids are two groups of constituents which are contained in many herbal extracts; the former possess a strong binding ability to different molecular structures like proteins or glycoproteins, while the latter have great affinities for cell membranes and therefore, a high potential to permeate through cell walls of the body or bacteria, or perhaps cancer cells.

Combining herbs for medicinal use is a time-honored art and science that has been practiced for thousands of years in the ancient healing traditions of China, India, and many other parts of the world. Advanced traditional medicines consider combining herbs into formulations to be one of the most important and subtle arts of medicinal knowledge. Although the multi-herb formula approach combined with a multi-drug protocol is complex and adds many variables to a treatment protocol, this approach offers the best long-term results for patients.

Herbs and natural dietary for anti-cancer
Traditional Chinese herbs have always been the main axis of adjuvant cancer treatment, and with the help of modern research on herbs medicine anti-cancer, it has become a hot new trend in the world. How herb causes the inhibitory effect of cancer cells and its molecular mechanism and anti-cancer mechanism can be summarized as follows:
1. Induction of apoptosis.
2. Causes gene hypomethylation (DNA hypomethylation).
3. Regulate cell cycle arrest (G2/M arrest).
4. Block the malignant proliferation signaling pathways (Inhibition of signaling pathways).
5. Inhibit cancer cell invasion and reduce angiogenesis (Anti-migration, anti-invasion and anti-angiogenesis).
6. Sensitizing effect of radiotherapy (downregulation of Rad51, G2/M arrest).
7. Inhibition of cancer stem-like cells (Elimination of cancer stem-like cells).
Anti-cancer stem cell drugs mainly target herb medicines/natural substances. At present, at least 50 natural substances are known to have the activity of inhibiting cancer stem cells. Combining them with orthodox treatment can enhance the effect of chemoradiotherapy and prevent cancer metastasis and reissue.