There are 5-15 primary brain tumours
per 100,000 population.This accounts for
5-10% of cancers in all age groups and
30-40% of tumours in children.Tumours
may also spread to the brain from distant
sites (secondary tumours).The commonest
tumours which spread to the brain are
lung (44%), breast (10%), kidney (7%)
and bowel (4%). Brain tumours themselves
almost never spread out from the central
Tumours usually present in one of three
ways: headaches (54%), progressive
neurological deficit (68%) or seizures
is related to raised
pressure inside the brain.The classical
description is of early morning headaches
over the forehead, which usually settle
by the afternoon. Many patients also
complain of nausea.
on the site of the tumour. The common
deficits seen are weakness (frontal),
numbness (parietal), speech problems
(temporal), visual problems (temporal,
parietal or occipital) or a change in
personality (frontal). Certain tumours
present in a very specific fashion, i.e.
endocrine problems with a pituitary
occurring for the first time in
an adult must be investigated with an
urgent scan. Seizures vary from classical
grand mal seizures to focal seizures.
An urgent CT or MRI of the brain is
mandatory; CT chest, abdomen and
pelvis where a secondary is suspected.
The treatment of brain tumours depends
on the location, size and extent of the
tumour. Younger patients and those who
are self-caring, have a better outcome
than older patients or those who have
Each patient’s treatment is individually
tailored to his or her needs.The rationale
for surgery may vary from one patient to
another, as may the use of radiotherapy
There are no cures for astrocytomas
(other than some pilocytic tumours);
however, a combination of surgery,
radiotherapy and chemotherapy may
increase survival in some instances.
The aim of any treatment must be to
improve quality of survival.
The role of surgery may be diagnostic
or therapeutic. Some patients may not
be suitable for surgery.The location
and extent of a tumour may make it
unsuitable for a debulking, in which case
a biopsy may be performed to confirm
The options for a biopsy are:
• To locate the tumour using an image
guidance system and to remove a piece.
• Stereotactically locate the tumour and
perform a biopsy using a fixed frame.
Image guidance systems are safe, but
locating a small tumour may be difficult.
Stereotactic biopsy is the safest and most
accurate method in which to biopsy most
brain tumours.The mortality rate is 1% and
the rate of a non-diagnostic sample is <1%.
If the tumour is in a relatively ‘silent’ part of
the brain, or is causing symptoms of raised
pressure, it may be debulked.The aim is to
safely reduce the volume of the tumour. A
craniotomy is performed, either freehand
with image guidance or with the help of
the stereotactic frame.
Tumours spread in such a way that they
cannot be cured by simply removing them.
In some cases, intra-tumoral chemotherapy
may be left in place (gliadel wafer).
All patients MUST be referred for a
neuro-oncological opinion.The neuro-
oncologist will decide on whether
radiotherapy, chemotherapy or palliation
is the most appropriate option.
Mr Sanj Bassi FRCS
(Neuro Surg) – Neurosurgeon, King’s College Hospital
Contact Mr Bassi’s secretary, Michelle Salton:
Tel: +44 (0) 20 7234 2939