If your healthcare professional thinks you might have a brain tumor, you'll need a number of tests and procedures to get a diagnosis. These might include:

• A neurological exam. A neurological exam tests different parts of your brain to see how they're working. This exam may include checking your vision, hearing, balance, coordination, strength and reflexes. If you have trouble in one or more areas, this is a clue for your healthcare professional. A neurological exam doesn't detect a brain tumor. But it helps your healthcare professional understand what part of your brain might be causing your symptoms.
• Head CT scan. A CT scan uses X-rays to make pictures. It's widely available, and results come back quickly. So CT might be the first imaging test that's done if you have headaches or other symptoms that have many possible causes. A CT scan can detect problems in and around your brain. The results give your healthcare professional clues to decide what test to do next. If your healthcare professional thinks your CT scan shows a brain tumor, you might need a brain MRI.

• Brain MRI. MRI, uses strong magnets to create pictures of the inside of the body. MRI is often used to detect brain tumors because it shows the brain more clearly than other imaging tests.

  Often a dye is injected into a vein in the arm before an MRI. The dye makes certain details more clear and makes it easier to see smaller tumors. It can help your healthcare team see the difference between a brain tumor and healthy brain tissue.

  Sometimes you need a special type of MRI to create more-detailed pictures. One example is functional MRI. This special MRI shows which parts of the brain control speaking, moving and other important tasks. This helps your healthcare professional plan surgery and other treatments.

  Another special MRI test is magnetic resonance spectroscopy. This test uses MRI to measure levels of certain chemicals in the tumor cells. Having too much or too little of the chemicals might tell your healthcare team about the kind of brain tumor you have.

  Magnetic resonance perfusion is another special type of MRI. This test uses MRI to measure the amount of blood in different parts of the brain tumor. The parts of the tumor that have a higher amount of blood may be the most active parts of the tumor. Your healthcare team uses this information to plan your treatment.

• PET scan of the brain. A positron emission tomography (PET) scan can detect some brain tumors. A PET scan uses a radioactive tracer that's injected into a vein. The tracer travels through the blood and attaches to brain tumor cells. The tracer makes the tumor cells stand out on the pictures taken by the PET machine. Cells that are dividing and multiplying quickly soak up more of the tracer.

  A PET scan may be most helpful for detecting brain tumors that are growing quickly. Examples include glioblastomas and some oligodendrogliomas. Brain tumors that grow slowly, such as those that aren't cancerous, might not be detected on a PET scan. Not everyone with a brain tumor needs a PET scan. Ask your healthcare professional whether you need a PET scan.

• Collecting a sample of tissue. A brain biopsy is a procedure to remove a sample of brain tumor tissue for testing in a lab. Often a surgeon gets the sample during surgery to remove the brain tumor.

  If surgery isn't possible, a sample might be removed with a needle. Removing a sample of brain tumor tissue with a needle is done with a procedure called stereotactic needle biopsy.

  During this procedure, a small hole is drilled in the skull. A thin needle is inserted through the hole. The needle is used to take a tissue sample. Imaging tests such as CT and MRI are used to plan where the needle will go. You won't feel anything during the biopsy because medicine is used to numb the area. Often you also receive medicine that puts you in a sleeplike state so you're not aware.

  You might have a needle biopsy rather than surgery if your healthcare team is worried that an operation might hurt an important part of your brain. A needle might be needed to remove tissue from a brain tumor if the tumor is in a spot that's hard to reach with surgery.

  Brain biopsy has a risk of complications. Risks include bleeding in the brain and damage to the brain tissue.

• Testing the tissue sample in the lab. The biopsy sample is sent to a lab for testing. Tests can see whether the cells are cancerous or not cancerous. The way the cells look under a microscope can tell your healthcare team how quickly the cells are growing. This is called the brain tumor's grade. Other tests can find out what DNA changes are present in the cells. This helps your healthcare team create your treatment plan.

Brain tumor grade

A brain tumor's grade is assigned when the tumor cells are tested in a lab. The grade tells your healthcare team how quickly the cells are growing and multiplying. The grade is based on how the cells look under a microscope. The grades range from 1 to 4.

A grade 1 brain tumor grows slowly. The cells aren't very different from the healthy cells nearby. As the grade gets higher, the cells undergo changes so that they start to look very different. A grade 4 brain tumor grows very fast. The cells don't look anything like nearby healthy cells.

There are no stages for brain tumors. Other types of cancer have stages. For these other types of cancer, the stage describes how advanced the cancer is and whether it has spread. Brain tumors and brain cancers aren't likely to spread, so they don't have stages.

Prognosis

Your healthcare team uses all the information from your diagnostic tests to understand your prognosis. Prognosis is the likely outcome of a disease. For cancer, this means the chance of recovery and the chance that the cancer could come back. Things that can influence the prognosis for people with brain tumors include:

• The type of brain tumor.
• How quickly the brain tumor is growing.
• Where the brain tumor is within the brain.
• Which DNA changes are present in the brain tumor cells.
• Whether the brain tumor can be removed completely with surgery.
• Your overall health and well-being.

What is the survival rate for people with brain cancer or a brain tumor?

The average one-year survival rate for all types of brain cancers and brain tumors combined is about 40%. The average five-year survival rate is about 19%, while the 10-year survival rate is 13%.

What is the average life expectancy after brain tumor metastasis?

Cancer can spread from where it started to other parts of the body. When cancer spreads to the brain, it's called brain tumor metastasis.

Life expectancy, how long someone lives after brain tumor metastasis, can be very different from person to person. It depends on where the cancer started and other health factors.

Studies show that life expectancy after a diagnosis of brain tumor metastasis is often between 3 and 12 months. In certain situations, such as when the cancer is limited and treated with a focused type of radiation called stereotactic radiosurgery (SRS), survival may be closer to 12 to 15 months. Living three years or longer is possible but uncommon, occurring in about 5% of people and usually when treatments work very well.

If you'd like to know more about your prognosis, discuss it with your healthcare team.

A diagnosis of a grade 4 brain cancer tumor means that the cancer is very aggressive and advanced. The life expectancy of people with grade 4 brain cancer varies based on many different things. These include the type of cancer you have, your age and overall health.

• The average life expectancy for someone age 65 or older diagnosed with glioblastoma is 6 to 9 months.
• The average life expectancy for someone between the ages of 18 and 44 is 20 months.
• The average life expectancy for someone age 17 or younger is 15 months.

Other types of grade 4 brain cancers and their average life expectancy include:

• Diffuse midline glioma (DMG) — less than one year.
• Anaplastic astrocytoma (grade 3) — 25 months.
• Anaplastic oligodendroglioma (grade 3) — 15 years. About 20 percent of people with anaplastic oligodendroglioma survive five years or less.

What are common causes of death from brain tumors?

There are several different ways brain tumors can cause death. Often, death can occur because the tumor grows in the brain, presses on critical parts of the brain, and prevents the brain from doing its essential tasks. Pressure and swelling can cause death, as can bleeding and infections that happen as a result of brain tumors.

The signs and symptoms of a brain tumor depend on the brain tumor's size and location. Symptoms also might depend on how fast the brain tumor is growing, which is also called the tumor grade.

General signs and symptoms caused by brain tumors may include:

• Headache or pressure in the head that is worse in the morning.
• Headaches that happen more often and seem more severe.
• Headaches that are sometimes described as tension headaches or migraines.
• Nausea or vomiting.
• Eye problems, such as blurry vision, seeing double or losing sight on the sides of your vision.
• Losing feeling or movement in an arm or a leg.
• Trouble with balance.
• Speech problems.
• Feeling very tired.
• Confusion in everyday matters.
• Memory problems.
• Having trouble following simple commands.
• Personality or behavior changes.
• Seizures, especially if there is no history of seizures.
• Hearing problems.
• Dizziness or a sense that the world is spinning, also called vertigo.
• Feeling very hungry and gaining weight.

Noncancerous brain tumors tend to cause symptoms that develop slowly. Brain tumors that aren't cancer also are called benign brain tumors. They might cause subtle symptoms that you don't notice at first. The symptoms might get worse over months or years.

Cancerous brain tumors cause symptoms that get worse quickly. These tumors also are called brain cancers or malignant brain tumors. They cause symptoms that come on suddenly. The symptoms get worse in a matter of days or weeks.

Brain tumor headaches

Headaches are the most common symptom of brain tumors. Headaches happen in about half of people with brain tumors. Headaches can happen if a growing brain tumor presses on healthy cells around it. A brain tumor also can cause swelling in the brain that increases pressure in the head and leads to a headache.

Headache pain caused by brain tumors is often worse when you wake up in the morning. But it can happen at any time. Some people have headaches that wake them from sleep. Brain tumor headaches tend to cause pain that's worse when coughing or straining. People with brain tumors most often report that the headache feels like a tension headache. Some people say the headache feels like a migraine.

Brain tumors in the back of the head might cause a headache with neck pain. If the brain tumor happens in the front of the head, the headache might feel like eye pain or sinus pain.

Brain tumor symptoms by location

The main part of the brain is called the cerebrum. Brain tumors in different parts of the cerebrum might cause different symptoms.

• Brain tumors in the front of the brain. The frontal lobes are in the front part of the brain. They control thinking and movement. Frontal lobe brain tumors might cause balance problems and trouble walking. There might be personality changes, such as forgetfulness and lack of interest in usual activities. Sometimes family members notice that the person with the brain tumor seems different.
• Brain tumors in the middle of the brain. The parietal lobes are in the upper middle part of the brain. They help process information about touch, taste, smell, vision and hearing. Parietal lobe brain tumors can cause problems related to the senses. Examples include vision problems and hearing problems.
• Brain tumors in the back of the brain. The occipital lobes are in the back of the brain. They control vision. Occipital lobe brain tumors can cause vision loss.
• Brain tumors in the lower part of the brain. The temporal lobes are on the sides of the brain. They process memories and senses. Temporal lobe brain tumors can cause memory problems. They might cause someone to see, taste or smell something that isn't there. Sometimes the taste or smell is unpleasant or unusual.

When to see a doctor

Make an appointment with your healthcare professional if you have persistent signs and symptoms that worry you.

Brain tumors that begin in the brain

Brain tumors that start as a growth of cells in the brain are called primary brain tumors. They might start right in the brain or in the tissue nearby. Nearby tissue includes the membranes that cover the brain, called meninges. Brain tumors also can happen in nerves, the pituitary gland and the pineal gland.

Brain tumors happen when there are changes in the DNA of the cells in or near the brain. A cell's DNA holds the instructions that tell the cell what to do. The changes tell the cells to grow quickly and continue living when healthy cells would die as part of their natural life cycle. This makes a lot of extra cells in the brain. The cells can form a growth called a tumor. The tumor can grow to invade and destroy healthy tissue.

It's not clear what causes the DNA changes that lead to brain tumors. For many people with brain tumors, the cause is never known. Sometimes parents pass DNA changes to their children. The changes can increase the risk of having a brain tumor. These hereditary brain tumors are rare. If you have a family history of brain tumors, talk about it with your healthcare professional. You might consider meeting with a healthcare professional trained in genetics to understand whether your family history increases your risk of having a brain tumor.

When brain tumors happen in children, they're likely to be primary brain tumors. In adults, brain tumors are more likely to be cancer that started somewhere else and spread to the brain.

Cancer that spreads to the brain

Secondary brain tumors happen when cancer starts somewhere else and spreads to the brain. When cancer spreads, it's called metastatic cancer.

Any cancer can spread to the brain, but common types include:

• Breast cancer.
• Colon cancer.
• Kidney cancer.
• Lung cancer.
• Melanoma.

It's not clear why some cancers spread to the brain and others are more likely to spread to other places.

Secondary brain tumors most often happen in people who have a history of cancer. Rarely, a brain tumor may be the first sign of cancer that began somewhere else in the body.

In most people with primary brain tumors, the cause isn't clear. But there are some factors that may raise the risk.

Risk factors include:

• Age. Brain tumors can happen at any age, but they happen most often in older adults. Some brain tumors mostly affect adults. Some brain tumors happen most often in children.
• Race. Anyone can get a brain tumor. But some types of brain tumors are more common in people of certain races. For example, gliomas are more common in white people. Meningiomas are more common in Black people.

• Exposure to radiation. People who have been exposed to a strong type of radiation called ionizing radiation have an increased risk of brain tumor. This radiation is strong enough to cause DNA changes in the body's cells. The DNA changes can lead to tumors and cancers. Examples of ionizing radiation include radiation therapy used to treat cancer and radiation exposure caused by atomic bombs.

  Low-level radiation from everyday objects isn't linked to brain tumors. Low levels of radiation include the energy that comes from cellphones and radio waves. There is no convincing evidence that using cellphones causes brain tumors. But more research is being done to confirm that there is no link.

• Inherited syndromes that increase the risk of brain tumor. Some DNA changes that increase the risk of brain tumor run in families. Examples include the DNA changes that cause neurofibromatosis 1 and 2, tuberous sclerosis, Lynch syndrome, Li-Fraumeni syndrome, Von Hippel-Lindau disease, familial adenomatous polyposis, Cowden syndrome and Gorlin syndrome.

There's no way to prevent brain tumors. If you get a brain tumor, you didn't do anything to cause it.

People with an increased risk of brain tumor might consider screening tests. Screening isn't brain tumor prevention. But screening might help find a brain tumor when it's small and treatment is more likely to be successful.

If you have a family history of brain tumor or inherited syndromes that increase the risk of brain tumor, talk about it with your healthcare professional. You might consider meeting with a genetic counselor or other healthcare professional trained in genetics. This person can help you understand your risk and ways to manage it. For example, you might consider brain tumor screening tests. Testing might include an imaging test or a neurological exam to test your vision, hearing, balance, coordination and reflexes.

A brain tumor is a growth of cells in the brain or near it. Brain tumors can happen in or near the brain tissue. Nearby areas where brain tumors can happen include nerves, the pituitary gland, the pineal gland and the membranes that cover the surface of the brain.

Brain tumors can begin in the brain. These are called primary brain tumors. Sometimes, cancer spreads to the brain from other parts of the body. These tumors are secondary brain tumors, also called metastatic brain tumors.

There are many different types of primary brain tumors. Some brain tumors are not cancer. These are called noncancerous brain tumors or benign brain tumors. Noncancerous brain tumors may grow over time and press on the brain tissue. Other brain tumors are brain cancers, also called malignant brain tumors. Brain cancers may grow quickly. The cancer cells can invade and destroy brain tissue.

Brain tumors range in size from very small to very large. Some brain tumors are found when they are very small because they cause symptoms that you notice right away. Other brain tumors grow very large before they're found. Some parts of the brain are less active than others. If a brain tumor starts in a part of the brain that's less active, it might not cause symptoms right away. The brain tumor could become quite large before the tumor is found.

Brain cancers and brain tumors are not classified by stage as some types of cancer are. Brain tumors are graded from 1 to 4 based on a classification system of the World Health Organization (WHO). Grade 1 brain tumors are the least aggressive and grow slowly. Grade 4 brain tumors are the most aggressive and grow quickly. Grade 4 tumors are typically more difficult to treat and have lower survival rates than lower grade tumors.

Brain tumor treatment options depend on the type of brain tumor you have, as well as its size and location. Common treatments include surgery and radiation therapy.

Types

There are many types of brain tumors. The type of brain tumor is based on the kind of cells that make up the tumor. Special lab tests on the tumor cells can give information about the cells. Your healthcare team uses this information to figure out the type of brain tumor.

Some types of brain tumors usually aren't cancerous. These are called noncancerous brain tumors or benign brain tumors. Some types of brain tumors usually are cancerous. These types are called brain cancers or malignant brain tumors. Some brain tumor types can be either benign or malignant.

Benign brain tumors tend to be slow-growing brain tumors. Malignant brain tumors tend to be fast-growing brain tumors.

Types of brain tumors include:

• Gliomas and related brain tumors. Gliomas are growths of cells that start in glial cells. The glial cells surround and support nerve cells in the brain tissue. Types of gliomas and related brain tumors include astrocytoma, glioblastoma, oligodendroglioma and ependymoma. Gliomas can be benign, but most are malignant. Glioblastoma is the most common type of malignant brain tumor.
• Choroid plexus tumors. Choroid plexus tumors start in cells that make the fluid that surrounds the brain and spinal cord. This fluid is called cerebrospinal fluid. Choroid plexus tumors are located in the fluid-filled cavities in the brain, called the ventricles. Choroid plexus tumors can be benign or malignant. Choroid plexus carcinoma is the malignant form of this type of brain tumor. It's more common in children.
• Embryonal tumors. Embryonal tumors begin in cells that are left over from fetal development. The cells, called embryonal cells, stay in the brain after birth. Embryonal tumors are malignant brain tumors that happen most often in babies and young children. The most common type of embryonal tumor is medulloblastoma. These tumors are usually located in the lower back part of the brain, called the cerebellum.
• Germ cell tumors. Germ cell tumors start in reproductive cells, called germ cells, that go on to become sperm and egg cells. Germ cells are mostly in the ovaries and testicles. But sometimes they're in other parts of the body, including the brain. When germ cell tumors happen in the brain, they're often located near the pineal gland, which is located in the center of the brain, or the pituitary gland, which is located near the base of the brain. Germ cell tumors are mostly benign. They're more common in children.
• Pineal tumors. Pineal tumors start in and around the brain's pineal gland. It makes a hormone called melatonin that helps with sleep. Pineal tumors can be benign or malignant. Pineoblastoma is a malignant type of pineal tumor that's most common in children.
• Meningiomas. Meningiomas are brain tumors that start in the membranes around the brain and spinal cord. Meningiomas are usually benign, but sometimes they can be malignant. Meningiomas are the most common type of benign brain tumor.
• Nerve tumors. Nerve tumors are growths that happen in and around nerves. The most common type that happens in the head is acoustic neuroma, also called schwannoma. This benign tumor is located on the main nerve that connects the inner ear to the brain.
• Pituitary tumors. Brain tumors can begin in and around the pituitary gland. Most tumors that happen in and around the pituitary gland are benign. Pituitary tumors happen in the pituitary gland itself. Craniopharyngioma is a type of brain tumor that happens near the pituitary gland.
• Other brain tumors. Many other types of rare tumors can happen in and around the brain. Tumors can start in the muscles, blood vessels and connective tissue around the brain. Tumors can form in the bones of the skull. Malignant brain tumors can start from the germ-fighting immune system cells in the brain. This type of brain cancer is called primary central nervous system lymphoma.

Little research has been done on complementary and alternative brain tumor treatments. No alternative treatments have been proven to cure brain tumors. However, complementary treatments may help you cope with the stress of a brain tumor diagnosis.

Some complementary treatments that may help you cope include:

• Art therapy.
• Exercise.
• Meditation.
• Music therapy.
• Relaxation exercises.

Talk with your healthcare team about your options.

Some people say a brain tumor diagnosis feels overwhelming and frightening. It might make you feel like you have little control over your health. It might help to take steps to understand your condition and talk about your feelings. Consider trying to:

• Learn enough about brain tumors to make decisions about your care. Ask your healthcare professional about your specific type of brain tumor. Ask about your treatment options and, if you like, your prognosis. As you learn more about brain tumors, you may feel better about making treatment decisions. Seek out information from reliable sources, such as the American Cancer Society and the National Cancer Institute.
• Keep friends and family close. Keeping your close relationships strong can help you deal with your brain tumor. Friends and family can provide the practical support you'll need, such as helping take care of your home if you're in the hospital. And they can serve as emotional support when you feel overwhelmed by cancer.

• Find someone to talk with. Find a good listener who is willing to hear you talk about your hopes and fears. This may be a friend, family member or clergy member. Ask your healthcare team to suggest a counselor or medical social worker you can talk with.

  Ask your healthcare team about brain tumor support groups in your area. It can be helpful to learn how others in the same situation are coping with complicated medical conditions.

Make an appointment with your usual healthcare professional if you have any symptoms that worry you. If you're diagnosed with a brain tumor, you may be referred to specialists. These might include:

• Doctors who specialize in brain conditions, called neurologists.
• Doctors who use medicine to treat cancer, called medical oncologists.
• Doctors who use radiation to treat cancer, called radiation oncologists.
• Doctors who specialize in nervous system cancers, called neuro-oncologists.
• Surgeons who operate on the brain and nervous system, called neurosurgeons.
• Rehabilitation specialists.
• Healthcare professionals who specialize in helping with memory and thinking problems that can happen in people with brain tumors. These health professionals are called psychologists or behavioral psychologists.

It's a good idea to be prepared for your appointment. Here's some information to help you get ready.

What you can do

• Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Write down key personal information, including any major stresses or recent life changes.
• Make a list of all medicines, vitamins or supplements that you're taking.
• Consider taking a family member or friend along. Sometimes it can be difficult to remember all the information provided during an appointment. Someone who goes with you may remember something that you missed or forgot. That person can help you understand what your healthcare team is telling you.
• Write down questions to ask your healthcare professional.

Your time with your healthcare professional is limited. Prepare a list of questions to help you make the most of your time together. Identify the three questions that are most important to you. List the rest of the questions from most important to least important in case time runs out. For a brain tumor, some basic questions to ask include:

• What type of brain tumor do I have?
• Where is my brain tumor located?
• How large is my brain tumor?
• How aggressive is my brain tumor?
• Is my brain tumor cancerous?
• Will I need additional tests?
• What are my treatment options?
• Can any treatments cure my brain tumor?
• What are the benefits and risks of each treatment?
• Is there one treatment you think is best for me?
• What happens if the first treatment doesn't work?
• What happens if I choose not to have treatment?
• I know that you can't predict the future, but am I likely to survive my brain tumor? What can you tell me about the survival rate of people with this diagnosis?
• Should I see a specialist? What will that cost, and will my insurance cover it?
• Should I seek care at a medical center or hospital that has experience in treating brain tumors?
• Are there brochures or other printed material that I can take with me? What websites do you recommend?
• What will determine whether I should plan for a follow-up visit?

In addition to the questions that you've prepared, don't hesitate to ask other questions that occur to you.

What to expect from your doctor

Your healthcare professional is likely to ask you a number of questions. Being ready to answer them may allow time later to cover other points you want to address. Your healthcare professional may ask:

• When did you first begin experiencing symptoms?
• Do your symptoms happen all the time or do they come and go?
• How severe are your symptoms?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?