Neuro-Oncology (Brain Tumours)
Every year approximately 5,000 people in the United Kingdom are diagnosed as having a primary brain tumour. Anyone can be affected by brain tumours. Some children are born with tumours and tumours can occur at any age throughout life.
Benign brain tumours stay in the part of the brain where they started and don’t spread into other areas of the brain.
Primary brain tumours are tumours that start in the brain and have not spread from somewhere else in the body. Malignant primary brain tumours are most likely to cause problems by spreading into the normal brain tissue around them and causing pressure and damage to the surrounding areas of the brain.
A secondary brain tumour is a tumour caused by cancer cells from a cancer eslewhere in the body spreading to the brain.
Patients diagnosed with a brain tumour will be able to discuss the type of tumour they have with their consultant.
Please note that this section details services provided to adult patients of Belfast Trust. Please follow the link for information on Children’s Cancers.
There are many different types of brain tumours. They are usually named after the type of brain cell from which they have developed. This section gives brief details about some of the main types of brain tumours:
These tumours develop from the supporting cells of the brain known as glial cells. They are named after the type of cell from which they arose. The glioma group can be broadly sub-categorised into:
- Astrocytomas: The most common type of brain tumour found in adults and are thought to develop from astrocyte cells.
- Oligodendrogliomas: Develop from the oligodendrocyte cells which produce the ‘insulation’ covering of nerve cells(the myelin sheath).
- Mixed Gliomas: Mixed gilomas are made up of more than one type of cell, eg. Oligo-astrocytoma are a type of mixed giloma that are made up of astrocytes and oligodendrocytes.
- Ependymomas: Develop from the ependymal cells which line the ventricles (fluid spaces) of the brain and the central canal of the spinal cord. These tumours can spread to other parts of the brain and spinal cord.
Not all Gliomas are of the same severity and they are graded based on their biological ‘aggressiveness’.
Other types of brain tumour
- Medulloblastomas: These develop in the cerebellum at the back of the brain but may spread to other parts of the brain. They are rare in adults but are one of the most common malignant brain tumours seen in children.
- Metastases to the brain: Brain metasteses are the most common brain tumour seen clinically in the UK. Approximately one quarter of cancer patients will develop brain metastases. Patients with cancer who develop neurological symptoms should consult their oncologist or GP at the earliest opportunity as treatment options may be greater with earlier detection.
- Meningioma: These develop from the meninges, a layer of cells covering the central nervous system. They are usually slow growing and can occur over the brain or spinal cord. Most are benign and will not spread from the area in which they originated.
- Acoustic Neuroma (Vestibular Schwannoma): These develop from the Vestibular nerve which is responsible for balance control. These tumours typically present with hearing loss and tinnitus. This type of tumour is usually found in adults and is more common in people with the genetic condition called neurofibromatosis
- Pituitary Tumours: The pituitary gland produces hormones that control and regulate the other hormone producing glands of the body. Most pituitary tumours are benign and can present with hormonal abnormalities and/or visual symptoms.
- Lymphoma: A lymphoma is a maligant tumour of the immune system which can arise primariy within the brain or or more commonly from a source elsewhere in the body.
- Pineal Tumours: Tumours developing in the pineal region of the brain are rare and tend to occur more often in children and young adults. A wide range of tumour types may develop in this region and blood and cerebrospinal fluid markers may help in the diagnosis.
Other types of tumour exist but are rare.
If a brain tumour is suspected, patients will be referred to the regional Neuro Oncology specialist surgical unit at the Royal Victoria Hospital or the Northern Ireland Cancer Centre by their GP or local hospital.
The Regional Neuro Oncology Service provides services for the diagnosis and treatment of brain tumours and spinal neurological tumours.
The Regional Neuro oncology Multidisciplinary Team Meeting
The Regional Neuro-oncology Multidisciplinary Meeting is held on Friday afternoon in the Royal Victoria Hospital Belfast. Members of the team come together to discuss patients referred from across NI who have had investigations for a suspected brain or spinal tumour.
The team discuss results from your recent investigations and this will help the Neuro-oncology team make decisions regarding your treatment plan.
The team’s decision will be discussed with you either at your next appointment, or be conveyed to the local hospital team or to the GP involved in your care.
You will be involved in the final decision regarding your treatment. Your GP will also be informed of this treatment plan.
Investigations and Diagnosis
At the hospital the doctor will ask patients about their general health and will perform a detailed examination to test the nervous system. This examination may include:
- Basic cognitive tests eg. basic arithmetic, memory tests
- An eye examination
- Hearing tests
- Facial movement and sensation
- Tongue movement
- Power, sensation, coordination and tendon reflexes of arms and legs
Patients may be sent for further tests depending on their particular situation and symptoms. Please click on the links below for further information:
- Brain CT Scan
- Brain MRI (Magnetic Resonance Imaging) Scan
- Blood Tests
- Chest X-Ray
- Others (Lumbar puncture)
If additional tests are required, the specialist centre will organise them.
The Regional Neuro-Oncology Service
The Regional Neuro-Oncology service or Neuro-Oncology Multidisciplinary team (MDT) is made up of professionals who are experts in the diagnosis and treatment of brain and spinal tumours.
The team meet every Friday afternoon in the Royal Victoria Hospital Belfast to discuss patients referred from across NI who have had investigations for a suspected brain or spinal tumour. The team discuss results from each patient’s recent investigations and this will help the Neuro-oncology team make decisions regarding each patient’s treatment plan.
The team’s decision will be discussed with patients either at their next appointment, or be conveyed to the local hospital team or to the GP involved in patient care.
Each patient will be involved in the final decision regarding their treatment. Their GP will also be informed of this treatment plan.
Working in partnership with local charities / research centres
The Regional Neuro Oncology Service has an excellent working relationship with Friends of the Cancer Centre, Macmillan and Brainwave NI charities. Brainwaves also support local brain tumour research based in the CCRCB.
The type of cancer treatment patients will have will depend on the type and stage of their cancer. Every patient diagnosed with a brain tumour or neurological cancer will differ in their stage and symptoms.
Patients may have one treatment type, or in some cases may have a combined cancer treatment consisting of two or more treatments. Please click on the links below for detailed information on the types of treatment:
- Specialist Palliative Care
- Stereotactic Radiotherapy (available via referral to a hospital outside Northern Ireland)
No medical treatment can be given without patient consent. If a patient has agreed to have treatment, they will be asked to sign a form giving their permission for treatment.
If patients would like a second opinion regarding any aspect of their diagnosis, they should contact their Neuro-Oncologist or Neurosurgeon to discuss this further.
We will be happy to provide advice and information regarding second opinions.
The Neuro-Oncology Service will organise follow up reviews for patients following their diagnosis and initial treatment. These are very important ways for surgeons and oncologists to monitor patient progress.
Consultants will check patient progress and if required they will refer patients for further investigations or rediscussion of a patient’s case at MDT. If patients have any problems or notice any new symptoms in between review appointments, they should make their GP, local Macmillan or Hospice nurse or the Neuro- Surgery/Oncology Consultant aware of this. They could also contact the Neuro-Oncology Specialist Nurse as soon as possible.
Oncology Emergency Helpline
Patients on chemotherapy who experience symptoms may also contact the Oncology Emergency helpline
Patients should ensure they are aware of their follow up and review plan following clinic consultation. Patients who have any queries should contact the Neuro-Oncology Specialist Nurse.
Should patients require additional support or referral to local community services, a patient’s GP and disctrict nurse can organise this. However, if they have any queries they should contact the Neuro-Oncology Specialist Nurse.
A list of supportive websites relating to Brain and Spinal Neurological Tumours have been provided below.
Please click on the links to be taken to their websites:
- Macmillan Cancer Support-Brain Tumours
- Brainwave NI
- Action Cancer
- Cancer Focus NI
- Cancer Research UK
- Brain and Spine Foundation
- Brain Tumour Action
- Changing Faces
- Headway – The Brain Injury Assessment
- Epilepsy Action
- Brain Tumour Trust
- Meningioma UK National Helpline
- Pituitary Foundation
- NI Driver and Vehicle Licencing