What the diagnosis means
Tumours in the brain and spine are either primary (arising there — gliomas, meningiomas, pituitary tumours, medulloblastoma and others) or secondary (metastases from a cancer elsewhere, such as lung or breast). Symptoms depend on location: headaches, seizures, weakness, speech or vision changes, or personality change. MRI is the key investigation; the diagnosis is confirmed by surgery or biopsy, and modern reports classify gliomas by grade and molecular markers — IDH mutation, 1p/19q co-deletion, MGMT promoter methylation — which predict behaviour and response to treatment.
Not every brain tumour is a cancer: many meningiomas and pituitary tumours are benign and need surgery or observation alone.
Where medical oncology fits
This is a neurosurgery- and radiation-led area. The neurosurgeon removes as much tumour as is safe; the radiation oncologist treats residual or high-grade disease. Medical oncology's role is specific:
- Chemotherapy for gliomas — temozolomide during and after radiation for glioblastoma and many other high-grade gliomas; PCV or temozolomide for oligodendrogliomas — with the molecular markers guiding who benefits most.
- Targeted therapy for the small number of tumours with a treatable alteration (for example BRAF, NTRK), and newer IDH-targeted drugs for some lower-grade gliomas.
- Brain metastases — the systemic treatment of the original cancer (some targeted drugs and immunotherapies reach the brain), coordinated with focused radiation and, sometimes, surgery.
- Supportive treatment — seizure control, steroid use, clot prevention, rehabilitation and symptom control, shared with neurology and palliative care.
What to expect
Temozolomide is a capsule taken at home, daily during radiation and then for five days of each 28-day cycle for around six months; nausea and low blood counts (especially platelets) are monitored with regular tests. Fatigue is common with radiation. Driving restrictions after seizures and practical support at home are discussed early.
Questions to ask
- What exactly is the tumour type, grade and molecular profile?
- Is it benign or malignant, and what is the goal of treatment?
- After surgery, is radiation, chemotherapy, both, or observation recommended?
- What symptoms or side effects should prompt urgent review?
- What rehabilitation and support is available?
Preparing for your consultation
Bring MRI (and CT) images with reports, the surgical/pathology report including molecular markers, details of seizures and current medicines (especially steroids and anti-seizure drugs), and a family member who can describe symptoms you may not notice yourself.