Survival rates are a way to get a general idea of the outlook (prognosis) for people with a certain type of tumor. They tell you what portion of people with the same type of tumor are still alive a certain amount of time (usually 5 years) after they were diagnosed. They can’t tell you how long you will live, but they may help give you a better understanding about how likely it is that your treatment will be successful.

What is a 5-year survival rate?

The 5-year survival rate is the percentage of people who live at least 5 years after being diagnosed. For example, a 5-year survival rate of 70% means that an estimated 70 out of 100 people who have that type of tumor are still alive 5 years after being diagnosed. Keep in mind, however, that many of these people live much longer than 5 years.

Relative survival rates (like the numbers below) are a more accurate way to estimate the effect of cancer on survival. These rates compare people with cancer to people in the overall population. For example, if the 5-year relative survival rate for a specific type of tumor is 70%, it would mean that people who have that type of tumor are, on average, about 70% as likely as people who don’t have that tumor to live for at least 5 years after being diagnosed.

But remember, the 5-year relative survival rates are estimates – your outlook can vary based on a number of factors specific to you.

Survival rates don’t tell the whole story

Survival rates are often based on previous outcomes of large numbers of people who had the disease, but they can’t predict what will happen in any particular person’s case. There are some limitations to remember:

• Thesenumbers are among the most current available. But to get 5-year survival rates, doctors have to look at people who were treated at least 5 years ago. As treatments are improving over time, people who are now being diagnosed with brain or spinal cord tumors may have a better outlook than these statistics show.
• The outlook for people with brain or spinal cord tumors varies by the type of tumor and the person’s age. But many other factors can also affect a person’s outlook, such as their age and overall health, where the tumor is located, and how well the tumor responds to treatment. The outlook for each person is specific to their circumstances.

Your doctor can tell you how these numbers may apply to you, as he or she is familiar with your situation.

Survival rates for more common adult brain and spinal cord tumors

The numbers in the table come from the Central Brain Tumor Registry of the United States (CBTRUS) and are based on people who were treated between 2000 and 2014. As can be seen below, survival rates for brain and spinal cord tumors can vary widely by age, with younger people tending to have having better outlooks than older people. The survival rates for those 65 or older are generally lower than the rates for the ages listed below.

These numbers are for some of the more common types of brain and spinal cord tumors. Numbers are not readily available for all types of tumors, often because they are rare or are hard to classify.

Remember, these survival rates are only estimates – they can’t predict what will happen to any individual. If you find these statistics are confusing and you have more questions, talk to your doctor to better understand your specific situation.

Research is always going on in the area of brain and spinal cord tumors. Scientists and doctors are looking for causes and ways to prevent these tumors, better tests to help characterize these tumors, and better ways to trea them.

Lab tests of brain tumors

In recent years, researchers have found some changes in genes, chromosomes, and proteins inside brain tumor cells that can be used to help predict a person's outlook (prognsosi) or help guide treatment. Some examples of changes that can now be tested for include:  

• IDH1 or IDH2 gene mutations
• Chromosomal 1p19q co-deletions
• MGMT promoter methylation

For more on the use of these tests, see Tests for Brain and Spinal Cord Tumors in Adults.

Researchers are looking for other changes in tumor cells that might help guide treatment.

Imaging and surgery techniques

Recent advances have made surgery for brain tumors much safer and more successful. Some of these newer techniques include:

• Magnetic resonance spectroscopy (MRS) and magnetic resonance spectroscopic imaging (MRSI). In this approach, described in Tests for Brain and Spinal Cord Tumors in Adults), specially processed MRS information is used to make a map of important chemicals involved in tumor metabolism. MRSI can help surgeons direct their biopsies to the most abnormal areas in the tumor. It can also help doctors direct radiation to the right areas and evaluate the effects of chemotherapy or targeted therapy.
• Diffusion tensor imaging (DTI), also known as tractography. This is a type of MRI test that can show the major pathways (tracts) of white matter in the brain. This information can be used by surgeons to help avoid these important parts of the brain when removing tumors.
• Fluorescence-guided surgery. For this approach, the patient drinks a special fluorescent dye a few hours before surgery. The dye is taken up by some tumors, which then glow when the surgeon looks at it under special lighting from the operating microscope. This lets the surgeon better separate tumor from normal brain tissue. Researchers are now looking to improve on the dyes currently in use.
• Newer surgical approaches for some types of tumors. For example, a newer approach to treat some tumors near the pituitary gland is to use a 3-D endoscope, a thin tube with a tiny video camera lens at the tip that allows the surgeon to see the small area around the tumor in 3 dimensions. The surgeon passes the endoscope through a small hole made in the back of the nose to operate through the nasal passages, limiting the potential damage to the brain. A similar technique can be used for some tumors in the ventricles, where an endoscope is inserted through a small opening in the skull near the hairline. The use of this technique is limited by the tumor’s size, shape, and position.

Radiation therapy

Some newer types of external radiation therapy let doctors deliver radiation more precisely to the tumor, which helps spare normal brain tissue. Techniques such as 3-dimensional conformal radiation therapy (3D-CRT), intensity modulated radiation therapy (IMRT), and proton beam therapy are described in Radiation Therapy for Adult Brain and Spinal Cord Tumors.

Newer methods of treatment planning are also being studied. For example, image-guided radiation therapy (IGRT) uses a CT scan done just before each treatment to better guide the radiation to its target.

Chemotherapy

Along with developing and testing new chemotherapy drugs, many researchers are testing new ways to get chemotherapy to the brain tumor.

Many chemotherapy drugs are limited in their effectiveness because the tightly controlled openings in the brain capillaries, sometimes referred to as the blood-brain barrier, prevents the drugs from getting from the bloodstream to the brain. Researchers are now trying to modify some of these drugs by putting them in tiny droplets of fat (liposomes) or attaching them to molecules that normally cross the blood-brain barrier, to help them work better. This is an area of active research and clinical trials.

Other new treatment strategies

Researchers are also testing some newer approaches to treatment that may help doctors target tumors more precisely. This could lead to treatments that work better and cause fewer side effects. Several of these treatments are still being studied.

Tumor vaccines

Several vaccines are being tested against brain tumor cells. Unlike vaccines against infections, these vaccines are meant to help treat the disease instead of prevent it. The goal of the vaccines is to stimulate the body’s immune system to attack the brain tumor.

Early study results of vaccines to help treat glioblastoma have shown promise, but more research is needed to determine how well they work. Researchers are also looking at combining vaccines with other treatments that could boost the immune response against tumor cells. At this time, brain tumor vaccines are available only through clinical trials.

Angiogenesis inhibitors

Tumors need to create new blood vessels (a process called angiogenesis) to keep their cells nourished. New drugs that attack these blood vessels are used to help treat some cancers. One of these drugs, bevacizumab (Avastin, Mvasi), has been approved by the FDA to treat recurrent glioblastomas because it has been shown to slow the growth of some tumors.

Other drugs that impair blood vessel growth, such as sorafenib (Nexavar) and trebananib, are being studied and are available through clinical trials.

Growth factor inhibitors

Tumor cells are often very sensitive to proteins called growth factors, which help them grow and divide. Newer drugs target some of these growth factors, which may slow the growth of tumor cells or even cause them to die. Several of these targeted drugs are already used for other types of cancer, and some are being studied to see if they will work for brain tumors as well.

Brain and spinal cord tumors are usually found because of signs or symptoms a person is having. If a tumor is suspected, tests will be needed to confirm the diagnosis.

Medical history and physical exam

If signs or symptoms suggest you might have a brain or spinal cord tumor, your doctor will get a complete medical history, focusing on your symptoms and when they began. The doctor will also do a neurologic exam to check your brain and spinal cord function. This exam tests reflexes, muscle strength, vision, eye and mouth movement, coordination, balance, alertness, and other functions.

If the results of the exam are abnormal, your doctor may refer you to a neurologist (a doctor who specializes in medical treatment of nervous system diseases) or a neurosurgeon (a doctor who specializes in surgical treatment of nervous system diseases), who will do a more detailed neurologic exam or other tests.

Imaging tests

Your doctor may order one or more imaging tests. These tests use x-rays, strong magnets, or radioactive substances to create pictures of the brain and spinal cord. The pictures may be looked at by doctors specializing in this field (neurosurgeons, neurologists, and neuroradiologists) as well as by your primary doctor.

Magnetic resonance imaging (MRI) and computed tomography (CT) scans are used most often to look for brain diseases. These scans will show a brain tumor, if one is present, in almost all cases. Doctors can often also get an idea about what type of tumor it might be, based on how it looks on the scan and where it is in the brain.

Magnetic resonance imaging (MRI) scan

MRI scans are very good for looking at the brain and spinal cord and are considered the best way to look for tumors in these areas. The images they provide are usually more detailed than those from CT scans (described below). But they do not image the bones of the skull as well as CT scans and therefore may not show the effects of tumors on the skull.

MRI scans use radio waves and strong magnets (instead of x-rays) to make pictures. A contrast material called gadolinium may be injected into a vein before the scan to help see details better.

Special types of MRI can be useful in some situations:

Magnetic resonance angiography (MRA) and magnetic resonance venography (MRV): These special types of MRI may be used to look at the blood vessels in the brain. This can be very useful before surgery to help the surgeon plan an operation.

Magnetic resonance spectroscopy (MRS): This test can be done as part of an MRI. It measures biochemical changes in an area of the brain (displayed in graph-like results called spectra, although basic images can also be created). By comparing the results for a tumor to that of normal brain tissue, it can sometimes help determine the type of tumor (or how quickly it is likely to grow), although a biopsy of the tumor is often still needed to get an accurate diagnosis. MRS can also be used after treatment to help determine if an area that still looks abnormal on another test is remaining tumor or if it is more likely to be scar tissue.

Magnetic resonance perfusion: For this test, also known as perfusion MRI, a contrast dye is injected quickly into a vein. A special type of MR image is then obtained to look at the amount of blood going through different parts of the brain and tumor. Tumors often have a bigger blood supply than normal areas of the brain. A faster growing tumor may need more blood.

Perfusion MRI can give doctors an idea of the best place to take a biopsy. It can also be used after treatment to help determine if an area that still looks abnormal is remaining tumor or if it is more likely to be scar tissue.

Functional MRI (fMRI): This test looks for tiny blood flow changes in an active part of the brain. It can be used to determine what part of the brain handles a function such as speech, thought, sensation, or movement. Doctors can use this to help determine which parts of the brain to avoid when planning surgery or radiation therapy.

This test is similar to a standard MRI, except that you will be asked to do specific tasks (such as answering simple questions or moving your fingers) while the scans are being done.

Computed tomography (CT) scan

A CT scan uses x-rays to make detailed cross-sectional images of your brain and spinal cord (or other parts of the body). Unlike a regular x-ray, a CT scan creates detailed images of the soft tissues in the body.

CT scans are not used as often as MRI scans when looking at brain or spinal cord tumors, but they can be useful in some cases. They may be used if MRI is not an option (such as in people who are very overweight or people who have a fear of enclosed spaces).CT scans also show greater detail of the bone structures near the tumor.

As with MRI, you may get an injection of a contrast dye through an IV (intravenous) line before the scan (although a different dye is used for CT scans). This helps better outline any tumors that are present.

CT angiography (CTA): For this test, you are injected with a contrast material through an IV line while you are in the CT scanner. The scan creates detailed images of the blood vessels in the brain, which can help doctors plan surgery. CT angiography can provide better details of the blood vessels in and around a tumor than MR angiography in some cases.

Positron emission tomography (PET) scan

For a PET scan, you are injected with a slightly radioactive substance (usually a type of sugar known as FDG) which collects mainly in tumor cells. A special camera is then used to create a picture of areas of radioactivity in the body. The picture is not as detailed as a CT or MRI scan, but it can provide helpful information about whether abnormal areas seen on other tests (such as MRIs) are likely to be tumors or not. This test is more likely to be helpful for fast-growing (high-grade tumors) than for slower-growing tumors.

This test is also useful after treatment to help determine if an area that still looks abnormal on an MRI scan is remaining tumor or if it is more likely to be scar tissue. Remaining tumor might show up on the PET scan, while scar tissue will not.

Chest x-ray

A chest x-ray might be done to look for tumors in the lungs if a tumor is found in the brain. This is because in adults, most tumors in the brain actually have started in another organ (most often the lung) and then spread to the brain. This test can be done in a doctor’s office, in an outpatient radiology center, or in a hospital.

Brain or spinal cord tumor biopsy

Imaging tests such as MRI and CT scans may show an abnormal area that is likely to be a brain or spinal cord tumor. But often these scans can’t tell exactly what type of tumor it is. This can only be done by removing some of the tumor tissue in a procedure called a biopsy. A biopsy may be done as a procedure on its own, or it may be part of surgery to treat the tumor.

Sometimes, a tumor may look so much like an astrocytoma on an MRI scan that a biopsy is not needed, especially if the tumor is in a part of the brain that would make it hard to biopsy (such as the brain stem). In rare cases a PET scan or MR spectroscopy may give enough information so that a biopsy is not needed.

The 2 main types of biopsies for brain tumors are:

Stereotactic (needle) biopsy

This type of biopsy may be used if, based on imaging tests, the risks of surgery to remove the tumor might be too high (such as with some tumors in vital areas, those deep within the brain, or other tumors that probably can’t be treated with surgery) but a sample is still needed to make a diagnosis.

The patient may be asleep (under general anesthesia) or awake during the biopsy. If the patient is awake, the neurosurgeon injects a local anesthetic into areas of skin above the skull to numb them. (The skull and brain do not feel pain.)

The biopsy itself can be done in two main ways:

• One approach is to get an MRI or CT, and then use either markers (each about the size of a nickel) placed on different parts of the scalp, or facial and scalp contours, to create a map of the inside of the head. An incision (cut) is then made in the scalp, and a small hole is drilled in the skull. An image-guidance system is then used to direct a hollow needle into the tumor to remove small pieces of tissue.
• In an approach that’s being used less often, a rigid frame is attached to the head. An MRI or CT scan is often used along with the frame to help the neurosurgeon guide a hollow needle into the tumor. This also requires an incision in the scalp and a small hole in the skull.

The removed tissue is sent to a pathologist (a doctor specializing in diagnosis of diseases by lab tests). Sometimes it might need to be looked at by a neuropathologist, a pathologist who specializes in nervous system diseases. The pathologist looks at it under a microscope (and might do other lab tests) to determine if the tumor is benign or malignant (cancerous) and exactly what type of tumor it is.  This is very important in determining a person's prognosis (outlook) and the best course of treatment. A preliminary diagnosis might be available the same day, although it often takes at least a few days to get a final diagnosis.

Surgical or open biopsy (craniotomy)

If imaging tests show the tumor can likely be treated with surgery, the neurosurgeon may not do a needle biopsy. Instead, he or she may do an operation called a craniotomy (described in Surgery for Adult Brain and Spinal Cord Tumors) to remove all or most of the tumor. (Removing most of the tumor is known as debulking.)

For a preliminary diagnosis, small samples of the tumor are looked at right away by the pathologist while the patient is still in the operating room. This can help guide treatment, including whether further surgery should be done at that time. A final diagnosis is made within a few days in most cases.

You can read more about the kinds of tests done on biopsy or tissue samples in Testing Biopsy and Cytology Specimens for Cancer.

Lab tests of biopsy specimens

Finding out which type of tumor someone has is very important in helping to determine their outlook (prognosis) and treatment options. But in recent years, doctors have found that changes in certain genes, chromosomes, or proteins within the cancer cells can also be important. Some tumors are now tested for these types of changes. For example:

• Gliomas that are found to have IDH1 or IDH2 gene mutations tend to have a better outlook than gliomas without these gene mutations.
• Oligodendrogliomas whose cells are missing parts of certain chromosomes (known as a 1p19q co-deletion) are much more likely to be helped by chemotherapy than tumors that do not.
• In high-grade gliomas, MGMT promoter methylation is linked with better outcomes and a higher likelihood of responding to chemotherapy, so it can sometimes be used to help guide treatment. 

Lumbar puncture (spinal tap)

This test is used mainly to look for cancer cells in the cerebrospinal fluid (CSF), the liquid that surrounds the brain and spinal cord. For this test, you lie on your side on a bed or exam table with your knees up near your chest. The doctor first numbs an area in the lower part of the back near the spine. A small, hollow needle is then placed between the bones of the spine to withdraw some of the fluid.

This fluid is sent to a lab to be looked at for cancer cells. Other tests may be done on the fluid as well.

Lumbar punctures are usually very safe, but doctors have to make sure the test does not result in a large drop in pressure in the fluid, which could possibly cause serious problems. For this reason, imaging tests such as CT or MRI scans are done first.

Lumbar punctures usually aren’t done to diagnose brain tumors, but they may be done to help determine the extent of a tumor by looking for cancer cells in the CSF. They are often used if a tumor has already been diagnosed as a type that can commonly spread through the CSF, such as an ependymoma. Lumbar punctures are particularly important in people with suspected brain lymphomas because often the lymphoma cells spread into the CSF.

Blood and urine tests

These lab tests rarely are part of the actual diagnosis of brain and spinal cord tumors, but they may be done to check how well the liver, kidneys, and some other organs are working. This is especially important before any planned surgery. If you are getting chemotherapy, blood tests will be done routinely to check blood counts and to see if the treatment is affecting other parts of your body.

For most types of cancer, the stage of the cancer -- a measure of how far it has spread -- is one of the most important factors in selecting treatment options and in determining a person's outlook (prognosis).

But tumors of the brain and spinal cord differ in some important ways from cancers in other parts of the body. One of the main reasons other cancers are dangerous is that they can spread throughout the body. Tumors starting in the brain or spinal cord can spread to other parts of the central nervous system, but they almost never spread to other organs. These tumors are dangerous because they can interfere with essential brain functions.

Because tumors in the brain or spinal cord almost never spread to other parts of the body, they do not have a formal staging system like most other cancers. Some of the important factors that help determine a person’s outlook include:

• Their age
• Their functional level (whether the tumor is affecting normal brain functions and everyday activity)
• The type of tumor (such as astrocytoma, ependymoma, etc.)
• The grade of the tumor (how quickly the tumor is likely to grow, based on how the cells look under a microscope)
• If the tumor cells have certain gene mutations or other changes (For example, tumors with a mutation in the IDH1 or IDH2 gene, known as “IDH-mutant” tumors, tend to grow more slowly and have a better outlook than tumors without these mutations.)
• The location and size of the tumor
• How much of the tumor can be removed by surgery (if it can be done)
• Whether or not the tumor has spread through the cerebrospinal fluid to other parts of the brain or spinal cord
• Whether or not tumor cells have spread beyond the central nervous system

If you have a brain or spinal cord tumor, talk to your doctor to learn more about how these and other factors might affect your outlook and treatment options.

Signs and symptoms of brain or spinal cord tumors may occur gradually and become worse over time, or they can happen suddenly, such as with a seizure.

General symptoms

Tumors in any part of the brain might increase the pressure inside the skull (known as intracranial pressure). This can be caused by growth of the tumor itself, swelling in the brain, or blockage of the flow of cerebrospinal fluid. Increased pressure can lead to general symptoms such as:

• Headache
• Nausea
• Vomiting
• Blurred vision
• Balance problems
• Personality or behavior changes
• Seizures
• Drowsiness or even coma

Headaches that tend to get worse over time are a common symptom of brain tumors, occurring in about half of patients. (Of course, most headaches are not caused by tumors.)

As many as half of people with brain tumors will have seizures at some point. The type of seizure may depend on where the tumor is. Sometimes this is the first sign of a brain tumor, but fewer than 1 in 10 first seizures are caused by brain tumors.

Symptoms of tumors in different parts of the central nervous system

Brain and spinal cord tumors often cause problems with the specific functions of the region they develop in. But these symptoms can be caused by any disease in that particular location — they do not always mean a person has a brain or spinal cord tumor.

• Tumors in the parts of the cerebrum (the large, outer part of the brain) that control movement or sensation can cause weakness or numbness of part of the body, often on just one side.
• Tumors in or near the parts of the cerebrum responsible for language can cause problems with speech or even understanding words.
• Tumors in the front part of the cerebrum can sometimes affect thinking, personality, and language.
• If the tumor is in the cerebellum (the lower, back part of the brain that controls coordination), a person might have trouble walking, trouble with precise movements of hands, arms, feet, and legs, problems swallowing or synchronizing eye movements, and changes in speech rhythm.
• Tumors in the back part of the cerebrum, or around the pituitary gland, the optic nerve, or certain other cranial nerves can cause vision problems.
• Tumors in or near other cranial nerves might lead to hearing loss (in one or both ears), balance problems, weakness of some facial muscles, facial numbness or pain, or trouble swallowing.
• Spinal cord tumors can cause numbness, weakness, or lack of coordination in the arms and/or legs (usually on both sides of the body), as well as bladder or bowel problems.

The brain also controls functions of some other organs, including hormone production, so brain tumors can also cause many other symptoms not listed here.

Having one or more of the symptoms above does not necessarily mean that you have a brain or spinal cord tumor. All of these symptoms can have other causes. Still, if you have any of these symptoms, especially if they don’t go away or get worse over time, see your doctor so the cause can be found and treated, if needed.

Surgery on brain and spinal cord tumors may be done to:

• Get a biopsy sample to determine the type of tumor
• Remove the tumor (or as much of it as possible)
• Help prevent or treat symptoms or possible complications from the tumor

Before surgery, be sure you understand the goal of the surgery, as well as its possible benefits and risks.

Surgery to remove the tumor

Most often, the first step in brain tumor treatment is for the neurosurgeon to remove as much of the tumor as is safe without affecting normal brain function.

Surgery alone or combined with radiation therapy may control or cure many tumors, including some low-grade astrocytomas, ependymomas, craniopharyngiomas, gangliogliomas, and meningiomas.

Tumors that tend to spread widely into nearby brain tissue such as anaplastic astrocytomas or glioblastomas cannot be cured by surgery. But surgery can reduce the amount of tumor that needs to be treated by radiation or chemotherapy, which might help these treatments work better. This could help prolong the person’s life even if all of the tumor can’t be removed.

Surgery can also help relieve some of the symptoms caused by brain tumors, particularly those caused by a buildup of pressure within the skull. These can include headaches, nausea, vomiting, and blurred vision. Surgery may also make seizures easier to control with medicines.

Surgery may not be a good option in some situations, such as if the tumor is deep within the brain, if it's in a part of the brain that can’t be removed, such as the brain stem, or if a person can’t have a major operation for other health reasons.

Surgery is not very effective against some types of brain tumors, such as lymphomas, although it may be used to get a biopsy for diagnosis.

Craniotomy

A craniotomy is a surgical opening made in the skull. This is the most common approach for surgery to treat brain tumors. The person may either be under general anesthesia (in a deep sleep) or may be awake for at least part of the procedure (with the surgical area numbed) if brain function needs to be assessed during the operation.

Part of the head might need to be shaved before surgery. The neurosurgeon first makes a cut in the scalp over the skull near the tumor, and folds back the skin. A special type of drill is used to remove the piece of the skull over the tumor.

The opening is typically large enough for the surgeon to insert several instruments and see the parts of the brain needed to operate safely. The surgeon may need to cut into the brain itself to reach the tumor. The surgeon might use MRI or CT scans taken before the surgery (or may use ultrasound once the skull has been opened) to help locate the tumor and its edges.

The surgeon can remove the tumor in different ways depending on how hard or soft it is, and whether it has many or just a few blood vessels:

• One way is to cut it out with a scalpel or special scissors.
• Some tumors are soft and can be removed with suction devices.
• In other cases, a probe attached to an ultrasonic generator can be placed into the tumor to break it up and liquefy it. A small vacuum device is then used to suck it out.

Many devices can help the surgeon see the tumor and surrounding brain tissue. The surgeon often operates while looking at the brain through a special microscope. MRI or CT scans can be done before surgery (or ultrasound can be used once the skull has been opened) to map the area of tumors deep in the brain. In some cases, the surgeon uses intraoperative imaging, in which MRI (or other) images are taken at different times during the operation to show the location of any remaining tumor. This may allow some brain tumors to be resected more safely and extensively.

As much of the tumor is removed as possible without affecting important brain tissue or leaving the patient disabled in any way. The surgeon can use different techniques to lower the risk of removing vital parts of the brain, such as:

• Intraoperative cortical stimulation (cortical mapping): In this approach, the surgeon electrically stimulates parts of the brain in and around the tumor during the operation and monitors the response. This can show if these areas control an important function (and therefore should be avoided).
• Functional MRI: This type of imaging test (described in Tests for Brain and Spinal Cord Tumors in Adults) can be done before surgery to locate a particular function of the brain. This information can be used to identify and preserve that region during the operation.
• Newer techniques: Newer types of MRI, as well as other techniques such as fluorescence-guided surgery, might be helpful in some situations. Some of these are described in What’s New in Adult Brain and Spinal Cord Tumor Research and Treatment?

Once the tumor is removed, the piece of the skull bone is put back in place and fastened with metal screws and plates, wires, or special stitches. (Usually any metal pieces are made from titanium, which allows a person to get follow-up MRIs [and will not set off metal detectors].)

You might have small tube (called a drain) coming out of the incision that allows excess cerebrospinal fluid (CSF) to leave the skull. Other drains may be in place to allow blood that builds up after surgery to drain from under the scalp. The drains are usually removed after a few days. An imaging test such as an MRI or CT scan is typically done 1 to 3 days after the operation to confirm how much of the tumor has been removed. Recovery time in the hospital is usually 4 to 6 days, although this depends on the size and location of the tumor, the patient’s general health, and whether other treatments are given. Healing around the surgery site usually takes several weeks.

Surgery to put in a shunt or ventricular access catheter

If a tumor blocks the flow of the CSF, it can increase pressure inside the skull. This can cause symptoms like headaches, nausea, and drowsiness, and may even be life-threatening.

To drain excess CSF and lower the pressure, the neurosurgeon may put in a silicone tube called a shunt (sometimes referred to as a ventriculoperitoneal or VP shunt). One end of the shunt is placed in a ventricle of the brain (an area filled with CSF) and the other end is placed in the abdomen or, less often, the heart or other areas. The tube runs under the skin of the neck and chest. The flow of CSF is controlled by a valve placed along the tubing.

Shunts may be temporary or permanent. They can be placed before or after the surgery to remove the tumor. Placing a shunt normally takes about an hour. As with any operation, complications might develop, such as bleeding or infection. Strokes are possible as well. Sometimes shunts get clogged and need to be replaced. The hospital stay after shunt procedures is typically 1 to 3 days, depending on the reason it is placed and the patient’s general health.

Surgery may also be used to insert a ventricular access catheter, such as an Ommaya reservoir, to help deliver chemotherapy directly into the CSF. A small incision is made in the scalp, and a small hole is drilled in the skull. A flexible tube is then threaded through the hole until the open end of the tube is in a ventricle, where it reaches the CSF. The other end, which has a dome-shaped reservoir, stays just under the scalp. After the operation, doctors and nurses can use a thin needle to give chemotherapy drugs through the reservoir or to remove CSF from the ventricle for testing.

Possible risks and side effects of surgery

Surgery on the brain or spinal cord is a serious operation, and surgeons are very careful to try to limit any problems either during or after surgery. Complications during or after surgery such as bleeding, infections, or reactions to anesthesia are rare, but they can happen.

A major concern after surgery is swelling in the brain. Drugs called corticosteroids are typically given before and for several days after surgery to help lessen this risk.

One of the biggest concerns when removing brain tumors is the possible loss of brain function afterward, which is why doctors are very careful to remove only as much tissue as is safely possible. If problems do arise, it could be right after surgery, or it could be days or even weeks later, so close monitoring for any changes is very important (see Living as a Brain or Spinal Cord Tumor Survivor).

For more information on surgery as a treatment for cancer, see Cancer Surgery.

Chemotherapy (chemo) uses anti-cancer drugs that are usually given into a vein (IV) or taken by mouth. These drugs enter the bloodstream and reach almost all areas of the body. However, many chemo drugs aren't able to enter the brain and reach tumor cells.

For some brain tumors, the drugs can be given directly into the cerebrospinal fluid (CSF, the fluid that bathes the brain and spinal cord), either in the brain or into the spinal canal below the spinal cord. To help with this, a thin tube known as a ventricular access catheter may be inserted through a small hole in the skull and into a ventricle of the brain during a minor operation (see Surgery for Adult Brain and Spinal Cord Tumors).

When might chemotherapy be used?

In general, chemo is used for faster growing brain tumors. Some types of brain tumors, such as medulloblastoma and lymphoma, tend to respond better to chemo than others. Chemo is not as helpful for treating spinal cord tumors, so it is used less often for these tumors.

Chemo is most often used along with other treatments such as surgery and/or radiation therapy. Chemo can also be used by itself, especially for more advanced tumors or for tumors that have come back after other types of treatment.

Which chemo drugs are used to treat brain and spinal cord tumors?

Some of the chemo drugs used to treat brain and spinal cord tumors include:

• Carboplatin
• Carmustine (BCNU)
• Cisplatin
• Cyclophosphamide
• Etoposide
• Irinotecan
• Lomustine (CCNU)
• Methotrexate
• Procarbazine
• Temozolomide
• Vincristine

These drugs can be used alone or in combinations, depending on the type of brain tumor. Doctors give chemo in cycles, with each period of treatment followed by a rest period to give the body time to recover. Each cycle typically lasts for a few weeks.

Carmustine (Gliadel) wafers: These dissolvable wafers contain the chemo drug carmustine (BCNU). After the surgeon removes as much of the brain tumor as is safe during a craniotomy, the wafers can be placed directly on or next to the parts of the tumor that can’t be removed. Unlike IV or oral chemo that reaches all areas of the body, this type of therapy concentrates the drug at the tumor site, producing few side effects in other parts of the body.

Possible side effects of chemotherapy

Chemo drugs can cause side effects. These depend on the type and dose of drugs, and how longtreatment lasts. Common side effects can include:

• Hair loss
• Mouth sores
• Loss of appetite
• Nausea and vomiting
• Diarrhea
• Increased chance of infections (from having too few white blood cells)
• Easy bruising or bleeding (from having too few blood platelets)
• Fatigue (from having too few red blood cells, changes in metabolism, or other factors)

Some of the most effective drugs against brain tumors tend to have fewer of these side effects than other common chemo drugs. Most side effects usually go away after treatment is finished. There are often ways to lessen these side effects. For example, drugs can often help prevent or reduce nausea and vomiting.

Some chemo drugs can also cause other, less common side effects. For example, cisplatin and carboplatin can also cause kidney damage and hearing loss. Your doctor will check your kidney function and hearing if you are getting these drugs. Some of these side effects might last after treatment is stopped.

Be sure to report any side effects while getting chemo to your medical team so that you can be treated promptly. In some cases, the doses of the drugs may need to be reduced or treatment may need to be delayed or stopped to prevent the effects from getting worse.

To learn more, see the Chemotherapy section on our website.

A risk factor is anything that affects your chance of getting a disease such as a brain or spinal cord tumor. Different types of cancer have different risk factors. Some risk factors, like smoking, you can change. Others, like your age or family history, can’t be changed.

But having a risk factor, or even several, does not always mean that a person will get the disease, and many people get tumors without having any known risk factors.

Most brain tumors are not linked with any known risk factors and have no obvious cause. But there are a few factors that can raise the risk of brain tumors.

Radiation exposure

The best known environmental risk factor for brain tumors is radiation exposure, most often from radiation therapy to treat some other condition. For example, before the risks of radiation were known, children with ringworm of the scalp (a fungal infection) were sometimes treated with low-dose radiation therapy, which was later found to increase their risk of brain tumors as they got older.

Today, most radiation-induced brain tumors are caused by radiation to the head given to treat other cancers. They occur most often in people who received radiation to the brain as children as part of their treatment for leukemia. These brain tumors usually develop around 10 to 15 years after the radiation.

Radiation-induced tumors are still fairly rare, but because of the increased risk (as well as the other side effects), radiation therapy is only given to the head after carefully weighing the possible benefits and risks. For most patients with other cancers involving the brain or head, the benefits of radiation therapy far outweigh the risk of developing a brain tumor years later.

The possible risk from exposure to imaging tests that use radiation, such as x-rays or CT scans, is not known for sure. These tests use much lower levels of radiation than those used in radiation treatments, so if there is any increase in risk, it is likely to be very small. But to be safe, most doctors recommend that people (especially children and pregnant women) not get these tests unless they are clearly needed.

Family history

Most people with brain tumors do not have a family history of the disease, but in rare cases brain and spinal cord cancers run in families. In general, patients with familial cancer syndromes tend to have many tumors that first occur when they are young. Some of these families have well-defined disorders, such as:

Neurofibromatosis type 1 (NF1)

This genetic disorder, also known as von Recklinghausen disease, is the most common syndrome linked to brain or spinal cord tumors. People with this condition have higher risks of schwannomas, meningiomas, and certain types of gliomas, as well as neurofibromas (benign tumors of peripheral nerves). Changes in the NF1 gene cause this disorder. These changes are inherited from a parent in about half of all cases. In the other half, the NF1 gene changes occur before birth in people whose parents did not have this condition.

Neurofibromatosis type 2 (NF2)

This condition, which is much less common than NF1, is associated with vestibular schwannomas (acoustic neuromas), which almost always occur on both sides of the head. It is also linked with an increased risk of meningiomas or spinal cord ependymomas. Changes in the NF2 gene are usually responsible for neurofibromatosis type 2. Like NF1, the gene changes are inherited in about half of cases. In the other half, they occur before birth in children without a family history.

Tuberous sclerosis

People with this condition may have subependymal giant cell astrocytomas (SEGAs), which are low-grade astrocytomas that develop beneath the ependymal cells of the ventricles. They may also have other benign tumors of the brain, skin, heart, kidneys, and other organs. This condition is caused by changes in either the TSC1 or the TSC2 gene. These gene changes can be inherited from a parent, but most often they develop in people without a family history.

Von Hippel-Lindau disease

People with this condition tend to develop benign or cancerous tumors in different parts of the body, including hemangioblastomas (benign blood vessel tumors) in the brain, spinal cord, or retina, as well as tumors of the inner ear, kidney, adrenal gland, and pancreas. It is caused by changes in the VHL gene. Most often the gene changes are inherited, but in some cases the changes happen before birth in people whose parents don’t have them.

Li-Fraumeni syndrome

People with this condition are at higher risk for developing gliomas, along with breast cancer, soft tissue sarcomas, leukemia, adrenal gland cancer, and certain other types of cancer. It is caused by changes in the TP53 gene.

Other syndromes

Other inherited conditions are also linked with increased risks of certain types of brain and spinal cord tumors, including:

• Gorlin syndrome (basal cell nevus syndrome)
• Turcot syndrome
• Cowden syndrome

Some families may have genetic disorders that are not well recognized or that may even be unique to a particular family.

Having a weakened immune system

People with weakened immune systems have an increased risk of developing lymphomas of the brain or spinal cord (known as primary CNS lymphomas). Lymphomas are cancers of lymphocytes, a type of white blood cell that fights disease. Primary CNS lymphoma is less common than lymphoma that develops outside the brain.

A weakened immune system can be congenital (present at birth), or it can be caused by treatments for other cancers, treatment to prevent rejection of transplanted organs, or diseases such as acquired immunodeficiency syndrome (AIDS).

Factors with uncertain, controversial, or unproven effects on brain tumor risk

Cell phone use

Cell phones give off radiofrequency (RF) rays, a form of energy on the electromagnetic spectrum between FM radio waves and those used in microwave ovens, radar, and satellite stations. Cell phones do not give off ionizing radiation, the type that can cause cancer by damaging the DNA inside cells. Still, there have been concerns that the phones, whose antennae are built-in and therefore are placed close to the head when being used, might somehow raise the risk of brain tumors.

Some studies have suggested a possible increased risk of brain tumors or of vestibular schwannomas (acoustic neuromas) with cell phone use, but most of the larger studies done so far have not found an increased risk, either overall or among specific types of tumors. Still, there are very few studies of long-term use (10 years or more), and cell phones haven’t been around long enough to determine the possible risks of lifetime use. The same is true of any possible higher risks in children, who are increasingly using cell phones. Cell phone technology also continues to change, and it’s not clear how this might affect any risk.

These risks are being studied, but it will probably be many years before firm conclusions can be made. In the meantime, for people concerned about the possible risks, there are ways to lower your exposure, such as using the phone's speaker or an earpiece to move the phone itself away from the head.

For more on this topic, see Cellular Phones. 

Other factors

Other environmental factors such as exposure to vinyl chloride (a chemical used to manufacture plastics), petroleum products, and certain other chemicals have been linked with an increased risk of brain tumors in some studies but not in others.

Exposure to aspartame (a sugar substitute), exposure to electromagnetic fields from power lines and transformers, and infection with certain viruses have been suggested as possible risk factors, but most researchers agree that there is no convincing evidence to link these factors to brain tumors. Research on these and other possible risk factors continues.

The cause of most brain and spinal cord tumors is not fully understood, and there are very few well-established risk factors. But researchers have found some of the changes that occur in normal brain cells that may lead them to form brain tumors.

Normal human cells grow and function based mainly on the information contained in each cell’s DNA. Brain and spinal cord tumors, like other tumors, are caused by changes in the DNA inside cells. DNA is the chemical that makes up our genes, which control how our cells function. We usually look like our parents because they are the source of our DNA. But DNA affects more than how we look.

Some genes control when our cells grow, divide into new cells, and die:

• Certain genes that help cells grow, divide, and stay alive are called oncogenes.
• Genes that help keep cell division under control, or make cells die at the right time, are called tumor suppressor genes.

Cancers can be caused by DNA changes that turn on oncogenes or turn off tumor suppressor genes. These gene changes can be inherited from a parent, but more often they happen during a person’s lifetime.

Inherited gene changes

Researchers have found gene changes that cause some rare inherited syndromes (like neurofibromatosis, tuberous sclerosis, Li-Fraumeni syndrome, and von Hippel-Lindau syndrome) and increase the risk of developing some brain and spinal cord tumors. For example, the Li-Fraumeni syndrome is caused by changes in the TP53 tumor suppressor gene. Normally, this gene prevents cells with damaged DNA from growing. Changes in this gene increase the risk of developing brain tumors (particularly gliomas), as well as some other cancers.

Gene changes acquired during a person's lifetime

Most often, it's not known why people without inherited syndromes develop brain or spinal cord tumors. Most exposures that cause cancer somehow damage DNA. For example, tobacco smoke is a risk factor for lung cancer and several other cancers because it contains chemicals that can damage the genes inside cells. The brain is relatively protected from tobacco smoke and other cancer-causing chemicals that we might breathe in or eat, so these factors are not likely to play a major role in these cancers.

Several different gene changes usually occur in normal cells before they become cancerous. There are many kinds of brain tumors, each of which may have different sets of gene changes. A number of gene changes have been found in different brain tumor types, but there are probably many others that have not yet been found.

Researchers now understand some of the gene changes that occur in different types of brain tumors, but it’s still not clear what causes most of these changes. Some gene changes might be inherited, but most brain and spinal cord tumors are not the result of known inherited syndromes. Other than radiation, no known lifestyle-related or environmental factors are clearly linked to brain tumors. Most gene changes are probably just random events that sometimes happen inside a cell, without having an outside cause.

At this time there are no widely recommended tests to screen for brain and spinal cord tumors. (Screening is testing for cancer in people without any symptoms.) Most brain tumors are found when a person goes to a doctor because of signs or symptoms they are having.

Most often, the outlook for people with brain and spinal cord tumors depends on their age, the type of tumor, and its location, not by how early it is detected. But as with any disease, earlier detection and treatment is likely to be helpful.

People with inherited syndromes

For people with certain inherited syndromes (such as neurofibromatosis or tuberous sclerosis) that put them at higher risk for brain tumors, doctors often recommend frequent physical exams and other tests starting when they are young. In some cases these tests can find tumors when they are still small. Not all tumors related to these syndromes may need to be treated right away, but finding them early might help doctors monitor them so that they can be treated quickly if they begin to grow or cause problems.

It’s important for you to be able to have honest, open discussions with your cancer care team. Ask any question, no matter how small it might seem. Here are some you might want to ask, and be sure to add your own questions as you think of them.

When you're told you have a brain or spinal cord tumor

• What kind of tumor do I have?
• Is the tumor benign or malignant? What does this mean?
• Where in the brain or spinal cord is the tumor? Has it grown into nearby areas?
• Will I need any other tests before we can decide on treatment?
• Will I need to see any other types of doctors?
• If I'm concerned about costs and insurance coverage for my diagnosis and treatment, who can help me?

When deciding on a treatment plan

• How much experience do you have treating this type of tumor?
• What are my treatment choices? What do you recommend? Why?
• Should I get a second opinion? Can you recommend a doctor or cancer center?
• What’s the goal of treatment (cure, prolonging life, relieving symptoms, etc.)?
• Will treatment relieve any of the symptoms I now have?
• What are the possible risks or side effects of treatment? What disabilities might I develop?
• What should I do to be ready for treatment?
• How long will treatment take? What will it be like? Where will it be given?
• What is my expected prognosis (outlook)?

During treatment

Once treatment begins, you’ll need to know what to expect and what to look for. Not all of these questions may apply, but getting answers to the ones that do may be helpful.

• How will we know if the treatment is working?
• Is there anything I can do to help manage side effects?
• What symptoms or side effects should I tell you about right away?
• How can I reach you or someone from your office on nights, holidays, or weekends?
• Are there any limits on what I can do? 
• Can you suggest a mental health professional I can see if I start to feel overwhelmed, depressed, or distressed?

After treatment

• Are there any limits on what I can do?
• What symptoms should I watch for?
• What type of follow-up will I need after treatment?
• How often will I need to have follow-up exams and tests?
• How will we know if the tumor has come back? What should I watch for?
• Where can I find more information and support?

Along with these sample questions, be sure to write down any others you want to ask. For instance, you might want information about recovery times so that you can plan your work or activity schedule. Or you might want to ask about clinical trials that might be right for you.

Keep in mind that doctors aren’t the only ones who can give you information. Other health care professionals, such as nurses and social workers, can answer some of your questions. To learn more about speaking with your health care team, see Talking With Your Doctor.

The American Cancer Society’s estimates for brain and spinal cord tumors in the United States for 2018 include both adults and children.

• About 23,880 malignant tumors of the brain or spinal cord (13,720 in males and 10,160 in females) will be diagnosed. These numbers would be much higher if benign (non-cancer) tumors were also included.
• About 16,830 people (9,490 males and 7,340 females) will die from brain and spinal cord tumors.

Overall, the chance that a person will develop a malignant tumor of the brain or spinal cord in his or her lifetime is less than 1%. The risk for men (about 1 in 143) is slightly higher than that for women (about 1 in 185), although certain types of tumors are more common in women.

Survival rates for brain and spinal cord tumors vary widely, depending on the type of tumor (and other factors). Rates for some of the more common types of brain and spinal cord tumors are discussed in Survival Rates for Selected Adult Brain and Spinal Cord Tumors.

Visit the American Cancer Society’s Cancer Statistics Center for more key statistics.