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The term brain tumour refers to an intracranial tumour affecting the brain, meninges, pituitary gland, pineal gland, cranial nerves and/or skull.
In 2015, brain tumours accounted for three percent of total cancers, however, their incidence has been rising.
In adults, the highest incidence occurs in those aged between 85 – 89 years old.
The five-year survival for standard-risk patients is approximately 70%.
Glioma is an umbrella term for a variety of different tumour subtypes. These include astrocytomas, glioblastoma multiforme (GBM), pilocytic astrocytoma (PCA), ependymomas and oligodendrogliomas.
Gliomas account for 50% of primary brain tumours in adults and they are more common in men and in industrial countries. The exception is PCA, which is the commonest benign tumour in children.
The mean age of onset is 55 and they account for 20% of all intracranial tumours. All gliomas metastasise via the cerebrospinal fluid.
Clinical features include:
Focal neurological deficit including visual loss
Cranial nerve dysfunction
Relevant investigations include:
MRI with gadolinium contrast
For all gliomas, complete excision of the tumour is often challenging. This is because the margins between the tumour and the brain are rarely clear. Biopsies taken can be used to help make a histological diagnosis.
Carmustine implants can also be inserted; these are alkylating agents, which can help reduce the rate of tumour spread (however, they do carry a risk of serious cerebral oedema).
Targeted radiotherapy can be used to shrink tumours or to destroy any residual tumour cells after excision.
Temozolomide has been shown to increase survival when given alongside surgery and/or radiotherapy.
Overall, the prognosis is poor as gliomas are rarely curable. As an example, GBMs have a mean life expectancy of one year.
PCAs are an exception, with more than 95% of patients surviving five years.
Neurosurgical Clinical Fellow
Dr Chris Jefferies
DN Louis, A Perry, G Reifenberger, A von Deimling, D Figarella-Branger, W KCavenee et al (2016) ‘The 2016 World Health Organization Classification of Tumours of the Central Nervous System: a summary’, Acta Neuropathologica, 131(6), pp. 803-820.
Whittle IR, Smith C, Navoo P, Collie D (2004), Meningiomas, Lancet, 363, pp. 1535-1543.
BMJ Best Practice (2017) Overview of brain tumours BMJ Best Practice. Available from: [LINK]
Cancer Research UK (2018) Brain, other CNS and intracranial tumours incidence statistics’, Cancer Research UK. Available from: [LINK]
National Institute for Health and Care Excellence (2006) ‘Improving outcomes for people with brain and other central nervous system tumours’, NICE guideline (CSG10)
Grant R (2004) ‘Overview: brain tumour diagnosis and management/Royal College of Physicians guidelines’, J Neurol Neurosurg Psychiatry 75(2), pp. 18-23
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