Anatomy and tumour types

brainstrust asked Paul Grundy, a consultant neurosurgeon and our Patron, for his take on how the brain is structured and what the consequences would be if damage happened. It is the most complex organ and is the organ about which we know the least. This page is to help give you a better understanding of how the brain is structured.

On this page you will find:

Basic brain anatomy

The brain is a complex structure. It contains millions of nerve cells (neurones) and their processes (axons and dendrites) in a highly organised manner. These are supported by many other cell types (astrocytes, oligodendrocytes, etc). The brain is divided into several regions that have different functions: the cerebrum is the largest area and is the source of conscious activity. It is divided into 2 cerebral hemispheres. The cerebellum is situated beneath the cerebral hemispheres and is connected to the brainstem, which in turn runs into the spinal cord.

Cerebral Hemispheres:

The left and right cerebral hemispheres control functions for the opposite side of the body. In addition, certain important functions (particularly speech and language) are located in only one hemisphere, called the dominant hemisphere. In right-handed patients this is virtually always the left hemisphere and in left-handed patients it may be either hemisphere (but is still often the left).

Each hemisphere is divided into 4 principal lobes (see the diagram) and a hidden small lobe called the insula. The surface of the brain is folded with each crest being termed a gyrus and each groove between them a sulcus. The central sulcus separates the frontal from the parietal lobe and on each side of this sulcus lie the pre-central gyrus (in front) and the post-central gyrus (behind). The pre-central gyrus (motor cortex) is responsible for movement on the opposite side of the body and the post-central gyrus (sensory cortex) is responsible for sensations.

Brainstem:

All nerve fibres connecting the cerebral hemispheres with the cerebellum and spinal cord pass through the brainstem, controlling all functions in the limbs and body. There are also collections of neurones (nuclei) in the brainstem that control many functions in the head and neck, particularly eye movements, facial sensation and movement, swallowing and coughing. Areas within the brainstem also control consciousness, breathing, heart rate and blood pressure. So it’s an important area!

As these vital nerves all lie very close together in the brainstem, even a small area of damage might produce multiple severe deficits.

Here is a description of what we know about the functions of different parts of the brain. However it’s important to understand that each lobe of the brain does not function alone. There are very complex relationships between the lobes of the brain and between the right and left hemispheres. But this does give you further indication of what might be affected by the position of a brain tumour:

Frontal lobe:

  • Personality, behaviour, emotions
  • Judgment, planning, problem solving
  • Motivation, initiation
  • Speech: speaking and writing (Broca’s area)
  • Body movement (motor strip)
  • Intelligence, concentration, self-awareness

Parietal lobe:

  • Interprets language, words
  • Sense of touch, pain, temperature (sensory strip)
  • Interprets signals from vision, hearing, motor, sensory and memory
  • Spatial and visual perception

Occipital lobe:

  • Interprets vision (colour, light, movement)

Temporal lobe:

  • Understanding language (Wernicke’s area)
  • Memory
  • Hearing
  • Sequencing and organisation

Messages within the brain are carried along pathways. Messages can travel from one gyrus to another, from one lobe to another, from one side of the brain to the other, and to structures found deep in the brain (e.g. thalamus, hypothalamus).

Have you built your brain tumour team? Meet all the people that can help with the guide to ‘who’s who on your journey’.

Other brain words you might hear include:

Cranium – just a more interesting word for skull
Skull base – the bones at the bottom of the skull
Blood brain barrier – the mechanism by which the blood vessels of the brain prevent substances in the blood (such as bacteria) from reaching the brain. This is good, but can also work against the patient if vital anticancer drugs need to pass through this.
Glia – most of the brain tissue is composed of glial cells. Most brain tumours originate from glial cells.

Brain tumour types

Basic question – what is a brain tumour?

A brain tumour is a mass of abnormal cells growing in the brain. The cells can come from the brain itself or from its lining (primary brain tumours) or from other places in the body (secondary or metastatic brain tumours). Primary brain tumours can be benign or malignant. Secondary brain tumours are always malignant.

Size doesn’t matter… this is true. The size of a brain tumour doesn’t matter nearly so much as where it is located. A large, benign tumour may be easily accessible and therefore easy to remove. Or you can have a pea –sized tumour that is critically placed, and so makes treatment very difficult. However, treatments options are developing all the time and one size doesn’t fit all. Some small tumours, in tricky locations, may be treated by radiosurgery and some large, diffuse tumours crossing the midline of the brain can be difficult to treat with radiation. So each case needs to be reviewed, discussed and options explored. It’s complex!

What causes a brain tumour?

No one knows. If we did, then we would be able to treat them more effectively, or even prevent them occurring at all. Some genetic disorders may mean that some people are predisposed to getting a brain tumour and there is suggestion that some environmental factors may increase our risk. We do know that the incidence of brain tumours is increasing by about 2% a year – and this isn’t down to better diagnostic weaponry.

Classification and grading of brain tumours

All tumours in the brain can pose a threat to health. Benign tumours grow slowly and do not invade tissue, but they may put pressure on areas of the brain and cause problems. Malignant primary brain tumours spread into the healthy tissue and tend to grow more quickly than benign tumours. The World Health Organisation has developed a classification system for brain tumours. Knowing the classification and grade of an individual tumour helps to predict its likely behaviour.

Grading brain tumours

Grade I (low-grade) — the tumour grows slowly, has cells that look a lot like normal cells, and rarely spreads into nearby tissues. It may be possible to remove (resect) the entire tumour by surgery, but tumours in the brain stem cannot be completely resected safely.

Grade II — the tumour grows slowly, but may spread into nearby tissue and may recur (come back). Some tumours may become a higher-grade tumour.

Grade III — the tumour grows quickly, is likely to spread into nearby tissue, and the tumour cells look very different from normal cells.

Grade IV (high-grade) — the tumour grows and spreads very quickly and the cells do not look like normal cells. There may be areas of dead cells in the tumour. Grade IV brain tumours are harder to manage than lower-grade tumours. High- grade tumours can be difficult to treat.

Depending on their make up, tumours can be a mix of grades, so they will be defined by the highest grade.

Classification

Primary brain tumours are named according to the type of cells or the part of the brain in which they begin.

Generally non-malignant tumours

The term ‘generally’ is key here. Sometimes brain tumours are classified as ‘benign’ (we don’t like the word benign as the impact of any brain tumour diagnosis is anything but benign – we would urge you to ask your clinical team to say ‘non-malignant instead) but in some cases they can recur. This is true of meningiomas. There are other implications too. For example, patients with craniopharyngiomas can go on to have hormonal deficits and need life time supplements. Patients with haemangioblastomas who have VHL syndrome are at risk of developing renal cancer.

MeningiomaMeningioma – This tumour arises in the meninges and is relatively common. It usually grows slowly and often shows no symptoms but often can be removed safely with surgery. Sometimes observation is the best approach if there are no symptoms.
Pituitary adenomaPituitary adenoma – this develops in the pituitary gland and is generally benign. Treatment options depend on the type of pituitary tumour, but drug therapy or surgery are the usual routes. Whilst it is a little confusing we would not classify pituitary tumours as brain tumours therefore the best place for support and information on these tumours would be The Pituitary Foundation: www.pituitary.org.uk/
Acoustic neuromaAcoustic neuroma – (also called vestibular schwannoma) – a benign tumour which develops from Schwann cells. These constitute less than 5% of all brain tumours. They can be tricky: if completely removed they usually don’t recur but there can be several complications of surgery, which can include facial weakness, hearing loss, dizziness and headaches.
CraniopharyngiomaCraniopharyngioma – a rare tumour that grows in the region of the optic nerve and hypothalamus. So whilst it is benign it can cause problems and treatment options depend on how much it is impacting on the person.
Pilocytic astrocytomaPilocytic astrocytoma – the most benign type of astrocytoma which occurs primarily in children and adolescents. Treatment depends on position.
Colloid cystColloid cyst – these are curable lesions, which occur almost exclusively in adults and are best treated by surgical removal where possible.
HemangioblastomaHemangioblastoma – a rare benign tumour composed of cells from the lining of the blood vessels. These can usually be removed through surgery.
Epidermoid cystEpidermoid cyst – these are tumours which are really just pieces of skin enclosed in the brain due to a mistake in fetal development. You sometimes hear stories in the press about a foot being found in a brain – this would be an epidermoid cyst. Surgery is usually for first course of action to remove as much as is possible.

Malignant tumours and tumours with uncertain behaviour

Hover your mouse over the name to find out more

GliomaGlioma – A catch all term for a range of brain tumours. These tumours arise from glial cells and can be benign or malignant. They usually fall into three types: astrocytomas, oligodendrogliomas and ependymomas.
Astroglial neoplasmAstroglial neoplasm – Neoplasm is another word for tumour.
AstrocytomaAstrocytoma – Rises from star-shaped glial cells called astrocytes. In adults, astrocytomas most often arise in the cerebrum. In children, they occur in the brain stem, the cerebrum, and the cerebellum. A grade III astrocytoma is sometimes called an anaplastic astrocytoma. A grade IV astrocytoma is usually called a glioblastoma multiforme.
Anaplastic astrocytomaAnaplastic astrocytoma – An astrocytoma rises from star-shaped glial cells called astrocytes. In adults, astrocytomas most often arise in the cerebrum. In children, they occur in the brain stem, the cerebrum, and the cerebellum. A grade III astrocytoma is sometimes called an anaplastic astrocytoma. A grade IV astrocytoma is usually called a glioblastoma multiforme.
GlioblastomaGlioblastoma multiforme – often called a GBM4 for ease. These tumours develop in the cerebral hemisphere and spread quickly into the surroundng brain. They can be treated with a range of treatments. The goal with a GBM4 is to relieve the pressure created and to make the surrounding area unfavourable for continued growth.
OligodendrogliomaOligodendroglioma – this rare tumour arises from cells that make the fatty substance that covers and protects nerves. These tumours usually occur in the cerebrum. They grow slowly and usually do not spread into surrounding brain tissue. They are most common in young to middle-aged adults. The best treatment is to remove as much as possible and then treat with further therapies if it begins to grow.
Anaplastic oligodendrogliomaAnaplastic oligodendroglioma – this tumour is more prevalent in adults in midlife. They appear to resist radiation but may respond to chemotherapy.
Mixed gliomasMixed gliomas – These arise from a combination of cells, like a ganglioglioma.
GangliogliomaGanglioglioma – we know this little beastie well. This is what Meg had. It is mixed cell glioma and the best chance of a cure is complete resection. If the tumour grows back then further therapies are recommended.
EpendymomaEpendymoma – the tumour arises from cells that line the ventricles or the central canal of the spinal cord. They are most commonly found in children and young adults. Surgical removal of as much of the tumour as is possible is recommended, followed by radiation to prevent the spread of cells through the spinal column.
LymphomaLymphoma – Tumours of unknown origin which can appear spontaneously or in a patient whose immune system is compromised. They resemble gliomas and are usually treated with radiation and chemotherapy.
MedulloblastomaMedulloblastoma – This tumour usually arises in the cerebellum. It is the most common brain tumour in children, particularly in ages of 5 to 9 years.The more that can be removed the better. Chemotherapy and craniospinal radiation may be used post surgery. A primitive neuroectodermal tumour resembles a medulloblastoma in appearance and has the same treatment options.
Germ cell tumourGerm cell tumours – there are subdivisions of this tricksy tumour. Most are treated with surgery, radiation and chemotherapy. The tumour arises from a germ cell and most germ cell tumors that arise in the brain occur in people younger than 30.
Pineoblastoma/pineocytomaPineoblastoma/pineocytoma – These rare brain tumours (but more common in children) arise in or near the pineal gland. The pineal gland is located between the cerebrum and the cerebellum. Pineal tumours are classified as either pineocytomas (grade II) that grow slowly or pineoblastomas (grade IV) which are more aggressive. Treatment options include surgery followed by radiation and chemotherapy.
Chordoma/chondrosarcomaChordoma/chondrosarcoma – slow growing tumours most often detected in young adults. They rarely mestatasize and rarely cause symptoms. Surgery and radiation are the preferred treatment options.
Choroid-plexus carcinomaChoroid-plexus carcinoma – rare tumours which occur in the ventricles in children. Surgery is the preferred treatment, followed by radiation.

Resources used in creating this page:

Patient/carer representative

Consultant Neuropathologist

http://www.nice.org.uk/csgbraincns

The 2007 Revised World Health Organization (WHO) Classification of Tumours of the Central Nervous System: Newly Codified Entities Gregory N. Fuller, Bernd W. Scheithauer

Article first published online: 26 JUN 2007 DOI: 10.1111/j.1750-3639.2007.00084.x

Living with a Brain Tumour (Peter Black) 2006

http://www.cancercouncil.com.au/

Adult brain tumors (2014) available at: http://www.cancer.gov/cancertopics/pdq/treatment/adultbrain/HealthProfessional

Cancer of the Brain and Brain Tumours (2012) available at: http://www.patient.co.uk/health/cancer-of-the-brain-and-brain-tumours

Benign Brain Tumour, NHS Choices (2013), available at: http://www.nhs.uk/conditions/Brain-tumour/Pages/Introduction.aspx

Malignant Brain Tumour, NHS Choices (2013), available at: http://www.nhs.uk/Conditions/brain-tumour-malignant/Pages/Introduction.aspx

Navigating Life with a Brain Tumour, L. Taylor, F. Alyx B. Porter, D. Richard (2013)

Did this information make you feel more resourced, more confident or more in control?

Date published: 17-05-2009
Last edited: 28-02-2018
Due for review: 28-02-2021

sidebar brainbox

Introduction

The Brain Tumour Data Dashboard lets you explore up -to-date, population level data about the brain tumours diagnosed in England between 2013 and 2015. Using the drop down menus on the left you can select different groups of patients to view in the charts below. In these charts the number of patients for every 100 diagnoses is displayed as images of people. Patients have been grouped by date of diagnosis, type of tumour, age, gender, and region in England.

For each group of patients you can explore the different routes to diagnosis, the proportion of those who received chemotherapy or radiotherapy, as well as the survival of the patients within each group. For more information about what these metrics mean please see the glossary.

How to use

  1. Select the year of diagnosis using the drop down menu.
  2. Select your patient group of interest from the four drop down menus in the following order:
    1. Tumour group
    2. Age at diagnosis
    3. Region of England
    4. Gender of patient
  3. To view a second chart to compare different groups of patients, click the ‘compare’ button.The second chart will appear below the first chart.

*Note that the tool is best used on a laptop or tablet rather than a mobile phone*

Unavailable data

Some of the data in these charts is not available.There are two main reasons for this:

  1. How the data has been grouped

If you cannot select a patient group from the drop down menus, the data is unavailable because of how the data has been organised.

Public Health England has grouped the data like a branching tree. The bottom of the tree contains all the patients with brain tumours, and then each branch divides the data by a certain characteristics, like age, or location of tumour. But the data is divided in an order, starting with location of the tumour (endocrine or brain), then by age, region, and gender. Age is at the start because it makes a bigger difference to survival rates and treatment rates than gender or region. Sometimes, after the data has been split by type of tumour and age, there is not enough data to be split again. This is because to protect patient confidentiality groups cannot contain less than 100 patients. Because some groups cannot be split further, you cannot create ‘totals’ for everyone by region or gender. For example, you cannot see results for all ages by region, or all brain tumours by gender. If these totals were calculated and released, it might be possible to identify patients, which is why Public Health England cannot release this data.

  1. Statistical reasons and data availability

If you can select a patient group from the chart menus, but the chart does not display, the data is unavailable for one of several reasons:

  1. Data is not yet available for the selected year from Public Health England.
  2. Data is not available because the data quality is too poor to release this statistic.
  3. Data is not available as the statistic is not appropriate for this group.
  4. Data is not available because the standard error of the estimate was greater than 20% and so the estimate has been supressed.

Up to date brain tumour data

Brain tumour data may influence the decisions you make about your care. Data also helps you understand the bigger picture, or landscape, in which you find yourself.

Brain tumour data and statistics influence the focus, and work of organisations like brainstrust. The information helps us to understand the scale and impact of the problems we are setting out to solve.

This tool helps you understand the landscape in which you find yourself having been diagnosed with a brain tumour. This landscape can be particularly tricky to navigate as there are many different types of brain tumour, all of which have a different impact.

The information you see represents the most up-to-date, official, population level brain tumour data available for England. Over time we will be adding to the brain tumour data available and publishing reports, with recommendations, as a result of what we learn from this data.

The data behind this content has come from Public Health England’s National Cancer Registration and Analysis Service (NCRAS) and is a direct result of the ‘Get Data Out’ project.

This project provides anonymised population level brain tumour data for public use in the form of standard output tables, accessible here: http://cancerdata.nhs.uk/standardoutput

Incidence

The number or rate (per head of population) of new cases of a disease diagnosed in a given population during a specified time period (usually a calendar year). The crude rate is the total number of cases divided by the mid-year population, usually expressed per 100,000 population.

Malignant

Malignant tumours which grow by invasion into surrounding tissues and have the ability to metastasise to distant sites

Mortality

The number or rate (per head of population) of deaths in a given population during a specified time period (usually a calendar year). The crude rate is the total number of deaths divided by the mid-year population, usually expressed per 100,000 population.

Non-malignant

Not cancerousNon-malignant tumours may grow larger but do not spread to other parts of the body.

Survival

The length of time from the date of diagnosis for a disease, such as cancer, that patients diagnosed with the disease are still alive. In a clinical trial, measuring the survival is one way to see how well a new treatment works. Also called ‘overall survival’ or ‘OS’.

Routes to Diagnosis

Under the ‘Routes to Diagnosis’ tab in the Brain Tumour Data Dashboard, you can explore the ways patients have been diagnosed with brain tumours. There are many ways, or routes, for cancers to be diagnosed in the NHS. A ‘route to diagnosis’ is the series of events between a patient and the healthcare system that leads to a diagnosis of cancer. The routes include:

  1. Two Week Wait

Patients are urgently referred by their GP for suspected cancer via the Two Week Wait system and are seen by a specialist within 2 weeks where they are diagnosed.

  1. GP referral

Diagnosis via a GP referral includes routine and urgent referrals where the patient was not referred under the Two Week Wait system.

  1. Emergency Presentation

Cancers can be diagnosed via emergency situations such as via A&E, emergency GP referral, emergency transfer or emergency admission.

  1. Outpatient

Outpatient cancer diagnoses include diagnoses via an elective route which started with an outpatient appointment that is either a self-referral or consultant to consultant referral. (It does not include those under the Two Week Wait referral system).

  1. Inpatient elective

Diagnosis via an inpatient elective route is where diagnosis occurs after the patient has been admitted into secondary care from a waiting list, or where the admission is booked or planned.

  1. Death Certificate Only

Diagnoses made by Death Certificate Only are made where there is no more information about the cancer diagnosis other than the cancer related death notifications. The date of diagnosis is the same as that of the date of death.

  1. Unknown

For some patients with a cancer diagnosis, there is no relevant data available to understand the route to diagnosis.

 

More information

If any of the statistical terms in this section of the brainstrust website are hard to understand, we recommend looking them up here:

Cancer Research UK’s Cancer Statistics Explained

http://www.cancerresearchuk.org/health-professional/cancer-statistics/cancer-stats-explained/statistics-terminology-explained#heading-Seven

If you are looking for help understanding terms relating specifically to brain tumours, and treatment, then the brainstrust glossary is available here:

https://www.brainstrust.org.uk/advice-glossary.php