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Health condition · Clinically reviewed

Brain tumor, modern imaging, molecular testing and a specialist neuro-oncology plan.

A patient-friendly guide to primary CNS tumours in the UK, from meningioma and pituitary adenoma through to glioblastoma and paediatric medulloblastoma.

Note on spelling. This page uses the US spelling "brain tumor" for readers searching that variant. The clinical content follows UK practice and uses the British spelling "tumour" throughout. For the primary UK page, see brain tumours.

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A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against NICE, NHS England, WHO CNS 2021 and peer-reviewed neuro-oncology sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK practice including vorasidenib for IDH-mutant gliomas, TTFields, proton beam and molecular tumour profiling.

Key facts

Brain tumor at a glance.

The essentials, in plain English. What primary CNS tumours are, how they are classified in 2026, and how they are treated in the UK today.

  • What it is

    Primary CNS tumours arising from brain, meninges, pituitary, cranial nerves or embryonal cells. Very different from secondary brain metastases.

  • Types

    Gliomas, meningiomas, pituitary adenomas, vestibular schwannomas, medulloblastomas, ependymomas, germ cell tumours, CNS lymphoma and more.

  • WHO CNS 2021

    The current classification integrates histology with molecular markers (IDH, 1p/19q, MGMT, H3K27, BRAF) to guide treatment and prognosis.

  • Presentation

    Headache with red-flag features, new-onset seizures, focal deficit, cognitive change, cranial neuropathy or endocrine disturbance.

  • Assessment

    MRI brain with gadolinium (plus advanced sequences), biopsy with molecular profiling, and staging MRI spine where indicated.

  • Management

    Multidisciplinary neuro-oncology care combining maximum safe surgery, radiotherapy, systemic therapy and targeted agents.

Types of brain tumor

Many different tumours, grouped by cell of origin.

The WHO CNS 2021 classification integrates traditional histology with molecular markers to give each tumour a clearer identity and prognosis.

  • Gliomas

    Astrocytoma grades 1 to 4 (see our dedicated astrocytoma guide), oligodendroglioma (1p/19q codeleted, IDH-mutant) and ependymoma.

  • Glioblastoma

    WHO grade 4 IDH-wildtype astrocytoma. The most aggressive primary brain tumour in adults, with a median survival of around 15 months.

  • Meningioma

    Arising from the meningeal coverings. Grade 1 (benign) is most common; grades 2 (atypical) and 3 (anaplastic) are rarer and more aggressive.

  • Pituitary adenoma

    Functioning (prolactinoma, acromegaly, Cushing disease, TSH-secreting) or non-functioning, sometimes causing visual loss or hypopituitarism.

  • Vestibular schwannoma

    Also known as acoustic neuroma. Presents with unilateral sensorineural hearing loss, tinnitus and balance disturbance.

  • Medulloblastoma

    A paediatric posterior fossa embryonal tumour, subdivided into WNT, SHH, Group 3 and Group 4 molecular groups.

  • Ependymoma

    Arising from ependymal cells of the ventricles or spinal cord, occurring in both children and adults.

  • Craniopharyngioma

    A benign but locally invasive suprasellar tumour that can compress the optic chiasm and disrupt pituitary function.

  • Haemangioblastoma

    A vascular tumour of the posterior fossa, often linked to von Hippel-Lindau (VHL) disease.

  • Germ cell tumours

    Rare pineal or suprasellar tumours in children and young adults, sometimes secreting tumour markers such as AFP and beta-hCG.

  • CNS lymphoma

    Primary CNS lymphoma is typically a diffuse large B-cell lymphoma treated with high-dose methotrexate-based regimens.

  • ATRT and brain metastases

    Atypical teratoid rhabdoid tumour has its own dedicated guide. Secondary brain metastases from other cancers are covered separately.

How the diagnosis is made

From first symptom to a clear MDT plan.

The steps a UK neuro-oncology team will normally follow, in order, so you know what to expect and why each investigation matters.

  1. 01

    Assessing

    Neurological assessment

    A structured history and examination looking at headache pattern, seizures, focal signs, cranial nerves, cognition and papilloedema.

  2. 02

    Assessing

    MRI brain with gadolinium

    The primary imaging test. Advanced sequences (perfusion, spectroscopy, DTI and functional MRI) help characterise the lesion and plan surgery.

  3. 03

    Assessing

    Staging MRI whole spine

    Added for medulloblastoma, ependymoma and germ cell tumours to look for leptomeningeal spread before treatment starts.

  4. 04

    Confirming

    PET-CT and specialist imaging

    Selective use to help distinguish primary tumour from metastasis or radionecrosis, and to complete staging where relevant.

  5. 05

    Confirming

    Biopsy and molecular profiling

    Tissue diagnosis with IDH, MGMT, 1p/19q, ATRX, TERT, EGFR, H3K27 and BRAF testing under the WHO CNS 2021 framework.

  6. 06

    Confirming

    Endocrine and ophthalmic workup

    Full pituitary hormone profile for sellar lesions, plus formal visual fields where the optic pathway may be involved.

  7. 07

    Planning

    Genetics and MDT planning

    Panel testing for Li-Fraumeni, NF1/2, VHL, tuberous sclerosis and Lynch/Turcot where suspected, then a neuro-oncology MDT plan.

Typical timeline: from urgent MRI to a fully staged, molecularly profiled MDT plan within weeks.

Symptoms

What a brain tumor can look like.

Symptoms depend on where the tumour sits and how quickly it grows. The pattern of change often matters as much as any single symptom.

  • Headache with red flags

    Worse in the morning, waking from sleep, progressively worsening or associated with vomiting. Take these features seriously.

  • New-onset seizures

    A first seizure in an adult, or a change in seizure pattern, warrants urgent MRI to exclude a structural cause.

  • Focal neurological deficit

    Weakness, numbness, speech disturbance, visual loss or new clumsiness on one side of the body.

  • Cognitive and personality change

    Memory decline, altered behaviour, apathy or executive dysfunction, particularly with frontal or temporal tumours.

  • Cranial neuropathy

    Unilateral hearing loss, tinnitus, facial numbness, diplopia or swallowing problems point to skull-base or brainstem involvement.

  • Endocrine and visual features

    Amenorrhoea, galactorrhoea, acromegalic features, Cushingoid change, hypopituitarism or bitemporal hemianopia in pituitary disease.

  • Gait and balance disturbance

    Ataxia, unsteadiness or falls, particularly with posterior fossa lesions such as vestibular schwannoma or medulloblastoma.

  • Red flag - raised intracranial pressure

    Papilloedema, persistent vomiting, reducing consciousness or new hydrocephalus needs same-day neurosurgical assessment.

Treatment

How brain tumors are treated in the UK.

Treatment combines maximum safe surgery, precision radiotherapy, systemic therapy and increasingly targeted agents, all delivered by a specialist neuro-oncology MDT.

  • Maximum safe surgical resection

    The cornerstone for most operable tumours, supported by awake mapping, intraoperative MRI, 5-ALA fluorescence and neuronavigation.

  • External beam radiotherapy

    Conformal or intensity-modulated photon radiotherapy, delivered focally to the tumour bed with margins tailored to histology.

  • Stereotactic radiosurgery

    Gamma Knife or CyberKnife for small, well-defined targets such as vestibular schwannoma, meningioma remnants and selected metastases.

  • Proton beam therapy

    Preferred for many paediatric tumours, skull-base and eloquent-area disease to reduce long-term cognitive, endocrine and second-malignancy risk.

  • Temozolomide chemotherapy

    The alkylating backbone of the Stupp protocol for glioblastoma, given with and after radiotherapy in fit patients.

  • PCV and paediatric regimens

    Procarbazine, CCNU and vincristine for oligodendroglioma, and vincristine plus carboplatin for paediatric low-grade glioma.

  • Targeted molecular therapy

    Vorasidenib for IDH-mutant grade 2 astrocytoma, BRAF/MEK inhibitors for BRAF-mutant glioma, selumetinib for NF1 plexiform disease, everolimus for TSC-SEGA.

  • Tumour Treating Fields (TTFields)

    The Optune wearable device delivers alternating electric fields for adjunctive treatment of newly diagnosed and recurrent glioblastoma.

Tumour-specific pathways

Pituitary adenomas are usually managed by transsphenoidal surgery with medical therapy (cabergoline, somatostatin analogues, pasireotide) and selective radiotherapy. Vestibular schwannomas may be observed, microsurgically resected or treated with radiosurgery.

Recurrent and refractory disease

Bevacizumab is used in recurrent glioblastoma. CAR-T and other immunotherapy trials are emerging for high-grade glioma. Access is often through clinical trials at specialist neuro-oncology centres.

Supportive care

Corticosteroids for oedema, anti-epileptic drugs for seizures, antiemetics, neurorehabilitation, neuropsychology and specialist palliative care all sit alongside disease-modifying treatment.

UK specialist neuro-oncology centres

Care is typically delivered from major regional neurosciences centres, including Queen Square, King’s College Hospital, Addenbrooke’s in Cambridge, Oxford, Bristol, Newcastle, Sheffield, Manchester (Salford and The Christie), Leeds, Birmingham (Queen Elizabeth), Cardiff, Edinburgh and Glasgow.

What this guide is based on

The sources behind every claim on this page.

UK national guidance, WHO classification and peer-reviewed neuro-oncology trials, current at the time of last review.

Key references

Guidelines and trials we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your neuro-oncology MDT knows your specific tumour, imaging and molecular results, and can tell you which parts apply to you. If in doubt, ask them.

  • WHO Classification of Tumours of the Central Nervous System, 5th edition (2021).

  • NICE. Brain tumours (primary) and brain metastases in adults (NG99).

  • NHS England Clinical Commissioning Policy: Stereotactic radiosurgery, proton beam therapy and neuro-oncology services.

  • Stupp R et al. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. NEJM.

  • Mellinghoff IK et al. Vorasidenib in IDH1/2-mutant low-grade glioma (INDIGO). NEJM 2023.

  • Society for Neuro-Oncology (SNO) and European Association of Neuro-Oncology (EANO) guidelines.

Red flags

When brain symptoms need urgent attention.

Many headaches are benign. These are the features that shift the balance towards urgent imaging and specialist review.

  • Raised intracranial pressure

    Morning headache with vomiting, papilloedema and reducing consciousness needs same-day neurosurgical assessment for possible hydrocephalus or mass effect.

  • New focal deficit or first seizure

    Any new focal neurological deficit, or a first seizure in an adult, warrants urgent MRI brain and specialist review.

  • Progressive headache pattern

    Headaches that worsen over weeks, wake the patient from sleep or change in character deserve urgent imaging rather than reassurance.

  • Rapid cognitive or personality change

    A short history of confusion, apathy or behavioural change, especially in older adults, should prompt urgent brain imaging.

  • Unilateral hearing loss or tinnitus

    Asymmetric sensorineural hearing loss needs MRI internal auditory meatuses to exclude vestibular schwannoma.

  • Bitemporal hemianopia

    Loss of both outer visual fields points to chiasmal compression, classically from a pituitary macroadenoma or craniopharyngioma.

  • New endocrine dysfunction

    Sudden amenorrhoea, galactorrhoea, hypopituitarism, acromegalic features or Cushingoid change alongside headache needs pituitary imaging.

  • Posterior fossa signs in a child

    Ataxia, morning vomiting or head tilt in a child needs urgent paediatric neuro-oncology assessment for medulloblastoma or ependymoma.

  • Known cancer with new brain symptoms

    Any new neurological symptom in a patient with a systemic cancer should trigger imaging for brain metastases.

Living with it

A serious diagnosis, supported by a whole team.

Living well with a brain tumour is about the team around you, structured rehabilitation, honest support and careful practical planning.

A quiet reminder

Ask for help early and often.

Specialist nurses, neurorehabilitation teams and brain tumour charities can transform day-to-day life. You do not need to wait for a crisis to reach out.

  1. 01 Team

    A neuro-oncology MDT

    Care sits with a specialist team of neurosurgeons, neuro-oncologists, clinical oncologists, neuroradiologists, neuropathologists and specialist nurses.

  2. 02 Recovery

    Neurorehabilitation matters

    Physiotherapy, occupational therapy, speech and language therapy and neuropsychology all help protect function and independence.

  3. 03 Support

    Charity and peer support

    The Brain Tumour Charity, Brain Tumour Research, the Brain and Spine Foundation and Meningioma UK offer information, grants and peer networks.

  4. 04 Planning

    Anticipate practical needs

    Driving restrictions, work adjustments, welfare benefits and advance care planning all deserve early, honest conversations.

Frequently asked

Everything we get asked about brain tumors.

Quick answers on classification, glioblastoma treatment, proton beam therapy, pituitary care and UK specialist centres.

  • Is a brain tumour always cancer?

    No. Many primary brain tumours, such as WHO grade 1 meningiomas, most pituitary adenomas, vestibular schwannomas and craniopharyngiomas, are benign in behaviour. Some are managed with surveillance alone, others with surgery or focused radiotherapy. Malignant tumours such as glioblastoma sit at the other end of the spectrum and need intensive combined treatment.

  • Why does molecular testing matter so much now?

    The WHO CNS 2021 classification integrates histology with molecular markers such as IDH mutation, 1p/19q codeletion, MGMT methylation, H3K27 and BRAF. These markers change both prognosis and treatment. For example, an IDH-mutant grade 2 astrocytoma may now be offered vorasidenib after surgery, based on the INDIGO trial.

  • What is the Stupp protocol for glioblastoma?

    It is the standard of care for newly diagnosed glioblastoma in fit adults: maximum safe surgical resection followed by six weeks of radiotherapy given with daily temozolomide, then adjuvant temozolomide cycles. TTFields with the Optune device can be added in eligible patients. Median survival remains around fifteen months, but a meaningful minority live considerably longer.

  • When is proton beam therapy used?

    Proton beam therapy is prioritised for many paediatric CNS tumours, for skull-base tumours, and for young adults with tumours near critical structures. Its sharper dose fall-off reduces long-term cognitive, endocrine and second-malignancy risk. NHS England commissions proton therapy at The Christie in Manchester and University College London Hospitals.

  • How is a pituitary adenoma treated?

    It depends on whether the tumour is functioning and whether it causes mass effect. Prolactinomas usually respond to cabergoline or bromocriptine. Acromegaly may be managed with transsphenoidal surgery, somatostatin analogues or radiotherapy. Non-functioning macroadenomas with visual compression are usually removed via a transsphenoidal approach.

  • Where in the UK is specialist neuro-oncology care delivered?

    Specialist neuro-oncology centres include Queen Square (National Hospital for Neurology and Neurosurgery), King’s College Hospital, Addenbrooke’s in Cambridge, Oxford, Bristol, Newcastle, Sheffield, Manchester (Salford and The Christie), Leeds, Birmingham (Queen Elizabeth), Cardiff (UHW), Edinburgh (Western General) and Glasgow (Institute of Neurological Sciences).

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