Brain Tumors in Adults

No one knows what causes brain tumors; there are only a few known risk factors that have been
established by research. Children who receive radiation to the head have a higher risk of developing a
brain tumor as adults, as do people who have certain rare genetic conditions such
as neurofibromatosis or Li-Fraumeni syndrome. But those cases represent a fraction of the approximately
35,000 new primary brain tumors diagnosed each year. Age is also a risk factor -- people over the age of
65 are diagnosed with brain cancer at a rate four times higher than younger people.
A primary brain tumor is one that originates in the brain, and not all primary brain tumors are
cancerous; benign tumors are not aggressive and normally do not spread to surrounding tissues,
although they can be serious and even life threatening.
The National Cancer Institute estimates there will be about 23,380 new cases of brain cancer diagnosed
in 2014.
What Is a Tumor?
A tumor is a mass of tissue that's formed by an accumulation of abnormal cells. Normally, the cells in your
body age, die, and are replaced by new cells. With cancer and other tumors, something disrupts this
cycle. Tumor cells grow, even though the body does not need them, and unlike normal old cells, they
don't die. As this process goes on, the tumor continues to grow as more and more cells are added to the
mass.
Primary brain tumors emerge from the various cells that make up the brain and central nervous
system and are named for the kind of cell in which they first form. The most common types of
adult brain tumors are gliomas and astrocytic tumors. These tumors form from astrocytes and other types
of glial cells, which are cells that help keep nerves healthy.
The second most common type of adult brain tumors are meningeal tumors. These form in the meninges,
the thin layer of tissue that covers the brain and spinal cord.

A brain tumor or intracranial neoplasm occurs when abnormal cells form within the brain.[1] There
are two main types of tumors: malignant or cancerous tumors and benign tumors.[1] Cancerous
tumors can be divided into primary tumors that start within the brain, and secondary tumors that
have spread from somewhere else, known as brain metastasis tumors.[2] All types of brain tumors
may produce symptoms that vary depending on the part of the brain involved. [1] These symptoms
may include headaches, seizures, problem with vision, vomiting, and mental changes.[2][3][1] The
headache is classically worse in the morning and goes away with vomiting. [1] More specific problems
may include difficulty in walking, speaking, and with sensation. [2][4] As the disease
progresses unconsciousness may occur.[4]
The cause of most brain tumors is unknown.[1] Uncommon risk factors include
inherited neurofibromatosis, exposure to vinyl chloride, EpsteinBarr virus, and ionizing radiation.[1][2]
[4]
The evidence for mobile phones is not clear.[4] The most common types of primary tumors in adults
are meningiomas (usually benign), and astrocytomas such as glioblastomas.[2] In children, the most
common type is a malignant medulloblastoma.[4] Diagnosis is usually by medical examination along
with computed tomography or magnetic resonance imaging.[1] This is then often confirmed by
a biopsy.[2] Based on the findings, the tumors are divided into different grades of severity.[2]
Treatment may include some combination of surgery, radiation therapy and chemotherapy.
[2]
Anticonvulsant medication may be needed if seizures occur.
[2]
Dexamethasone and furosemide may be used to decrease swelling around the tumor.[2] Some
tumors grow gradually, requiring only monitoring and possibly needing no further intervention.
[2]
Treatments that use a person's immune system are being studied.[1] Outcome varies considerably

depending on the type of tumor and how far it has spread at diagnosis. [4] Glioblastomas usually have
poor outcomes while meningiomas usually have good outcomes.[4] The average five-year survival
rate for brain cancer in the United States is 33%.[5]
Secondary or metastatic brain tumors are more common than primary brain tumors, [1] with about half
of metastases coming from lung cancer.[1] Primary brain tumors occur in around 250,000 people a
year globally, making up less than 2% of cancers. [4] In children younger than 15, brain tumors are
second only to acute lymphoblastic leukemia as a cause of cancer.[6] In Australia the average
economic cost of a case of brain cancer is $1.9 million, the greatest of any type of cancer.[7]

A brain tumor is a mass or growth of abnormal cells in your brain or close to your brain.
Many different types of brain tumors exist. Some brain tumors are noncancerous
(benign), and some brain tumors are cancerous (malignant). Brain tumors can begin in
your brain (primary brain tumors), or cancer can begin in other parts of your body and
spread to your brain (secondary, or metastatic, brain tumors).
How quickly a brain tumor grows can vary greatly. The growth rate as well as location of
a brain tumor determines how it will affect the function of your nervous system.
Brain tumor treatment options depend on the type of brain tumor you have, as well as
its size and location.

Brain tumors do not discriminate. Primary brain tumors - those that begin in the brain
and tend to stay in the brain - occur in people of all ages, but they are statistically
more frequent in children and older adults. Metastatic brain tumors - those that begin
as a cancer elsewhere in the body and spread to the brain - are more common in adults
than children.
These numbers address incidence, trends and patterns in the United States only. The
facts and statistics include brain and central nervous system tumors (i.e., spinal cord,
pituitary and pineal gland tumors). We continually update these statistics, as they
become available. This information was last updated in January 2017.
We thank the Central Brain Tumor Registry of the United States (CBTRUS) for their
assistance. These numbers address incidence, trends and patterns in the United States
only. For more information, please visit CBTRUS at www.cbtrus.org.
By the Numbers: Critical Brain Tumor Statistics

 More than 79,000 new cases of primary brain tumors are expected to be
diagnosed this year. This figure includes more than 26,000 primary malignant
and 53,000 non-malignant brain tumors.
There are nearly 700,000 people in the U.S. living with a primary brain and
central nervous system tumor.
This year, nearly 17,000 people will lose their battle with a primary malignant
and central nervous system brain tumor.
Survival after diagnosis with a primary brain tumor varies significantly by age,
histology, molecular markers and tumor behavior.
There are more than 100 histologically distinct types of primary brain and
central nervous system tumors.
Approximately one-third or 32% of brain and CNS tumors are malignant.
Brain Tumor Statistics by Age

The median age at diagnosis for all primary brain tumors is 59 years.
It is estimated that more than 4,800 children and adolescents between the ages
of 0-19 will be diagnosed with a primary brain tumor this year.
Brain tumors are the most common cancer occurring among those age 0-14,
and the leading cause of cancer-related deaths in children (males and females)
age 0-14 (leukemia is the second for both statistics).
Brain and CNS tumors are the third most common cancer occurring among
adolescents and young adults (ages 15-39) and the third most common cause of
cancer death in this age group.

Tumor-Specific Statistics
Meningioma represents 36.6% of all primary brain tumors, making them the
most common primary brain tumor. There will be an estimated 27,110 new
cases in 2017.

 Gliomas, a broad term which includes all tumors arising from the gluey or
supportive tissue of the brain, represent 24.7% of all primary brain tumors and
74.6% of all malignant tumors.
Glioblastoma represent 14.9% of all primary brain tumors, and 55.4% of all
gliomas. Glioblastoma has the highest number of cases of all malignant tumors,
with an estimated 12,390 new cases predicted in 2017.
Astrocytomas, including glioblastoma, represent approximately 75% of all
gliomas.
Nerve sheath tumors (such as acoustic neuromas) represent about 8.2% of all
primary brain tumors.
Pituitary tumors represent nearly 16% of all primary brain tumors and rarely
become malignant. There will be an estimated 14,230 new cases of pituitary
tumors in 2017.
Lymphomas represent 2% of all primary brain tumors.
Oligodendrogliomas represent nearly 2% of all primary brain tumors.
Medulloblastoma/embryonal/primitive tumors represent 1% of all primary
brain tumors.
The most common site for primary brain and CNS tumors (37%) is within the
meninges.

Prognostic factors
To decide on the best treatment for a brain tumor, both the type and grade of the
tumor must be determined. There are several factors that help doctors determine the
appropriate brain tumor treatment plan and determine prognosis:
Tumor histology. As outlined in the Diagnosis section, a sample of the
tumor is removed for analysis. Tumor histology includes the type of tumor,
the grade, and additional molecular features. Together, these factors will
help your doctor understand how the tumor will behave. These factors may
also help determine a patients treatment options.
Grade describes specific features in the tumor that are linked with specific
outcomes. For example, doctors may consider whether the tumor cells are growing

out of control or if there are a lot of dead cells. Tumors with features generally linked
with growing more quickly are given a higher grade. For most tumors, the lower the
grade, the better the prognosis.
Specifically for glial tumors, the grade is determined by its features, as seen under a
microscope, according to the following criteria:
Grade I. This is a separate group of tumors called juvenile
pilocytic astrocytoma (JPA) and subependymoma. These are
noninvasive and slow growing and can often be cured with
surgery.
Grade II. These tumors do not have actively dividing cells or
dead cells in the tumor, called necrosis, but show many
abnormal cells. A grade II tumor can be an astrocytoma,
ependymoma, or oligodendroglioma.
Grade III. These tumors are given a grade based on the cell
type. For example, anaplastic astrocytoma is a grade III tumor
that contains dividing cells but no dead cells. In contrast,
anaplastic oligodendroglioma and anaplastic ependymoma are
grade III tumors that do have dead cells.
Grade IV. A grade IV tumor is usually glioblastoma. Cells in the
tumor are actively dividing. In addition, the tumor has blood
vessel growth and areas of dead tissue.
Age of patient. In adults, the age of the patient and his or her level of
functioning, called functional status (see below) when diagnosed is one of
the best ways to predict a patients prognosis. In general, a younger adult
has a better prognosis.
Extent of tumor residual. Resection is surgery to remove a tumor.
Residual refers to how much of the tumor remains in the body after
surgery. A patients prognosis is better when all of the tumor can be
surgically removed. There are 4 classifications:
Gross total: The entire tumor was removed. However,
microscopic cells may remain.
Subtotal: Large portions of the tumor were removed.
Partial: Only part of the tumor was removed.
Biopsy only: Only a small portion, used for a biopsy, was
removed.
Tumor location. A tumor can form in any part of the brain. Some tumor
locations cause more damage than others, and some tumors are harder to
treat because of their location.

 Functional neurologic status. The doctor will test how well a patient is
able to function and carry out everyday activities by using a functional
assessment scale, such as the Karnofsky Performance Scale (KPS),
outlined below. A higher score indicates a better functional status.
Typically, someone who is better able to walk and care for themselves has
a better prognosis.
100 Normal, no complaints, no evidence of disease
90 Able to carry on normal activity; minor symptoms of disease
80 Normal activity with effort; some symptoms of disease
70 Cares for self; unable to carry on normal activity or active work
60 Requires occasional assistance but is able to care for needs
50 Requires considerable assistance and frequent medical care
40 Disabled: requires special care and assistance
30 Severely disabled; hospitalization is indicated, but death not imminent
20 Very sick, hospitalization necessary; active treatment necessary
10 Moribund, fatal processes progressing rapidly
0 Dead
Metastatic spread. A tumor that starts in the brain or spinal cord, if
cancerous, rarely spreads to other parts of the body in adults, but may
grow within the CNS. For that reason, with few exceptions, tests looking at
the other organs of the body are typically not needed. A tumor that does
spread to other parts of the brain or spinal cord is linked with a poorer
prognosis.
Recurrent tumor. A recurrent tumor is one that has come back after
treatment. If the tumor does return, there will be another round of tests to
learn about the extent of the recurrence. These tests and scans are often
similar to those done at the time of the original diagnosis.
Currently, the factors listed above are the best indicators of a patients prognosis. As
discussed in Diagnosis, researchers are currently looking for biomarkers in the
tumor tissue that could make a brain tumor easier to diagnose and allow for the
staging of an adult brain tumor in the future. Researchers are also looking at other
genetic tests that may predict a patients prognosis. These tools may someday help
doctors predict the chance that a brain tumor will grow, develop more effective
treatments, and more accurately predict prognosis.

About 13,000 people die from cancerous brain tumors each year. Recent advances in surgical and radiation
treatments have significantly extended average survival times and can reduce the size and progression of malignant
gliomas.
The survival rates in people with brain tumors depend on many different variables:

Type of tumor (such as astrocytoma, oligodendroglioma, or ependymoma)

Location and size of tumor (these factors affect whether or not the tumor can be surgically removed)
Tumor grade
Patient's age
Patient's ability to function
How far the tumor has spread
SURVIVAL RATES

Survival rates for brain tumors vary widely depending on the type of tumor and other factors, including age. Survival
rates tend to be highest for younger patients and decrease with age. Five-year survival rates range from 66% for
children ages 0 - 19 years to 5% for adults age 75 years and older.
Patients with some types of tumors have relatively good survival rates. Five year survival rates for patients with
ependymoma and oligodendroglioma are, respectively, 85% and 81% for people ages 20 - 44, and 69% and 45% for
patients ages 55 - 64. Glioblastoma multiforme has the worst prognosis with 5-year survival rates of only 13% for
people ages 20 - 44, and 1% for patients age 55 - 64.
SPECIFIC EFFECTS OF TUMORS ON FUNCTION

The specific effects of tumors on the brain can cause seizures, mental changes, and mood, personality, and emotional
changes. Tumors may also impair muscle usage in certain body areas, hearing, vision, speech, and other neurologic
complications. Such effects can be devastating to the patient and the caregivers. Numerous treatments are available
that can help alleviate these complications. Patients and family members should discuss these options with their
doctors.
Effects in Children . Advancements in treatment have dramatically increased survival rates for children with brain
tumors. About 75% of children survive at least 5 years after being diagnosed with a brain tumor. Unfortunately, many
childhood brain tumor survivors are at risk for long-term neurological complications.
Children younger than age 7 (and particularly those younger than age 3 years) appear to have the greatest risk for
cognitive problems. These problems may result from the tumor and from treatment (cranial radiation therapy,
chemotherapy that penetrates the blood-brain barrier). Long-term cognitive problems include difficulties with
attention and concentration, memory, mental processing of information, visual perception skills, and problems with
planning, insight, initiative, and organizational competencies. Parents need to make sure that children receive
appropriate supportive services and educational accommodation at their schools.

Survival rates for selected adult brain and spinal cord tumors
Survival rates are a way for doctors and patients to get a general idea of the outlook (prognosis) for
people with a certain type of tumor. Some people want to know the statistics for people in their situation,
while others may not find them helpful, or may even not want to know them. If you do not want to know
the survival rates for adult brain and spinal cord tumors, stop reading here and skip to the next section.
The 5-year survival rate refers to the percentage of people who live at least 5 years after being
diagnosed. Of course, many of these people live much longer than 5 years. Five-year relative survival
rates, such as the numbers below, assume that some people will die of other causes and compare the
observed survival with that expected for people without the tumor. This is a more accurate way to
describe the prognosis for patients with a particular type of tumor.
To get 5-year survival rates, doctors have to look at people who were treated at least 5 years ago.
Although the numbers below are among the most current available, improvements in treatment since then
may result in a better outlook for people now being diagnosed with brain and spinal cord tumors.
The numbers below come from the Central Brain Tumor Registry of the United States (CBTRUS) and are
based on people who were treated between 1995 and 2010. 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.

Type of Tumor

5-Year Relative Survival Rate

Age

20-44

45-54

55-64

Low-grade (diffuse) astrocytoma

65%

43%

21%

Anaplastic astrocytoma

49%

29%

10%

Glioblastoma

17%

6%

4%

Oligodendroglioma

85%

79%

64%

Anaplastic oligodendroglioma

67%

55%

38%

Ependymoma/anaplastic ependymoma

91%

86%

85%

Meningioma

92%

77%

67%

Survival rates are based on previous outcomes of large numbers of people who had the disease, but they
cant predict what will happen in any persons case. The type of tumor is important in estimating a
persons outlook. But many other factors can also affect outlook, such as the location of the tumor and
whether it can be removed with surgery, as well as a persons age and overall health. Even when taking
these other factors into account, survival rates are at best rough estimates. Your doctor is your best
source of information on this, as he or she is familiar with your situation.