Brain tumour treatment depends on what type of tumour it is, where it sits, and whether it started in the brain or spread there from another cancer. For a primary brain tumour, MRI and tissue testing help determine whether surgery, radiation, medicines, or monitoring should come first. For brain metastases, treatment also depends on the original cancer and how well it is controlled elsewhere in the body. [1–5]
By Dr Raman Narang, Consultant Medical & Hemato-Oncologist, New Delhi
A small tumour near an area that controls speech can present a different surgical decision from a larger tumour elsewhere in the brain. A person with a known lung or breast cancer and a new brain lesion may need a different approach again. If you are seeking brain tumour treatment in Delhi, ask what the MRI can establish, whether tissue is needed, and which decision needs to be made first. This guide focuses on adult brain tumours. Children with brain tumours need assessment through a paediatric neuro-oncology pathway.
1. What symptoms can a brain tumour cause?
Symptoms depend on the tumour’s location, how quickly it is growing, and whether it causes swelling or pressure. Possible symptoms include a first seizure, a new or progressively worsening headache, weakness or numbness on one side of the body, changes in speech or vision, difficulty with balance, or changes in memory or behaviour. Family members sometimes notice problems with speech, coordination, or day-to-day tasks before the person affected does. [1]
These symptoms have several possible causes. A persistent or changing symptom warrants medical assessment. A first seizure, sudden weakness or difficulty speaking, or a new reduction in alertness requires emergency evaluation.Sudden neurological symptoms can also occur with a stroke and need immediate attention. [1]
2. How are brain tumours classified?
Primary brain tumours start in the brain or nearby structures. Some are malignant. Others grow slowly and may still cause problems because of their location. Brain metastases are deposits from a cancer that started elsewhere, such as the lung, breast, or skin. The distinction matters because the two groups use different treatment pathways. [1, 2, 5]
| Tumour type | What the diagnosis means for treatment |
|---|---|
| Astrocytoma, IDH-mutant | An adult-type diffuse glioma graded from CNS WHO grade 2 to 4. Grade, symptoms, and how much tumour remains after surgery help guide further treatment. |
| Oligodendroglioma | Defined by an IDH mutation and 1p/19q codeletion. It can be grade 2 or 3. This diagnosis has a distinct treatment pathway. |
| Glioblastoma, IDH-wildtype | A CNS WHO grade 4 adult-type diffuse glioma. Treatment planning usually involves a discussion about surgery or biopsy, followed by radiation and drug treatment when appropriate. |
| Meningioma | Starts in the coverings around the brain or spinal cord. Some can be monitored, while others need surgery or radiation according to grade, growth, location, and symptoms. |
| Primary central nervous system lymphoma | A lymphoma involving the brain or other parts of the central nervous system. A biopsy usually establishes the diagnosis, and treatment generally relies on lymphoma-directed medicines. |
| Brain metastases | Cancer that has spread to the brain from another organ. The original cancer type, number and size of lesions, symptoms, and available medicines guide treatment. |
Grade and stage answer different questions. For adult diffuse gliomas, the CNS WHO grade describes the tumour’s biological behaviour within its type. A grade 4 glioma is a high-grade primary brain tumour. When a lung or breast cancer spreads to the brain, the finding is described as metastatic disease from that original cancer. [1, 2, 5]
3. How is a brain tumour diagnosed, and which molecular tests matter?
Contrast-enhanced brain MRI is usually the main test for defining a suspected tumour. It shows the tumour’s location, swelling, and relationship to structures involved in functions such as movement, speech, or vision. If a metastasis is suspected, scans of other parts of the body may help establish the origin and extent of disease. A CT scan may be the first test in an emergency. [1, 5]
For many suspected primary brain tumours, tissue is obtained through surgical removal or a stereotactic biopsy, which uses imaging to guide a needle to the lesion. The choice depends on whether removing tumour would help and how safely the area can be reached. Some lesions with characteristic imaging findings, such as selected asymptomatic meningiomas, can be monitored without an immediate biopsy. [1–3]
| Finding on the report | How it helps guide care |
|---|---|
| IDH mutation status | Helps classify adult diffuse gliomas and can affect treatment selection. |
| 1p/19q codeletion | Together with an IDH mutation, establishes the diagnosis of oligodendroglioma. |
| MGMT promoter methylation | In glioblastoma, helps estimate the likelihood of benefit from temozolomide. It can be especially useful when choosing a regimen for an older or frail patient. |
Ask for the integrated diagnosis. This is the final name that brings together the microscope findings, molecular results, and CNS WHO grade. If a result is pending, ask whether it could change the next treatment. [2–4]
4. How are primary brain tumours treated?
For many gliomas, the first step is maximal safe resection. The neurosurgeon aims to remove as much tumour as possible while protecting neurological function. For some tumours, a biopsy is the safer first step. Surgery may also relieve pressure, but diffuse gliomas can extend microscopically beyond what can be seen on the scan or removed in an operation. The pathology and postoperative MRI help guide what comes next. [1, 3, 4]
- Lower-grade IDH-mutant glioma. Some patients can begin with scheduled MRI surveillance after surgery. Others benefit from radiotherapy followed by chemotherapy, with the regimen guided by subtype and risk. In selected patients with grade 2 IDH-mutant glioma after surgery, vorasidenib may be discussed when radiation and chemotherapy can be deferred. The applicable Indian prescribing indication and access should be checked. [3, 4]
- Glioblastoma. For many adults who are fit for combined treatment, the usual approach after surgery or biopsy is radiotherapy with temozolomide, followed by further temozolomide. For older or frailer patients, the team may discuss a shorter radiation course, combined treatment, or a single treatment based on fitness, MGMT status, and preferences. [1, 3]
- Suspected primary CNS lymphoma. A biopsy is usually the first procedure. Treatment commonly uses a high-dose methotrexate–based regimen, with further treatment selected according to response and fitness. If steroids are being considered before biopsy, their timing should be coordinated with the treating team, since they can make lymphoma harder to confirm on tissue. [6]
If a glioma appears to grow again after treatment, the team reviews symptoms, the original diagnosis, and serial MRI scans. Changes after radiotherapy can resemble tumour growth. In selected cases, additional imaging or another operation can clarify the finding or help guide treatment. [1, 3]
5. How are brain metastases treated?
For brain metastases, the team considers the number, size, and location of the lesions, whether they are causing symptoms, and what treatment is available for the original cancer. Symptomatic brain metastases generally need prompt assessment for surgery or radiation, even when medicines can also treat the cancer. [5]
| Treatment | When it may be considered |
|---|---|
| Surgery | A large or accessible lesion is causing pressure, rapid relief is important, or tissue is needed to clarify the diagnosis. |
| Stereotactic radiosurgery or focused stereotactic radiotherapy | Precise radiation can treat selected lesions or the area where a metastasis was removed. The choice depends on factors such as lesion size, location, and total volume. |
| Whole-brain radiotherapy | May be appropriate in selected patients when the extent or distribution of disease makes focused treatment unsuitable. |
| Systemic treatment | Some targeted drugs and other cancer treatments work against brain metastases from specific cancers. In selected patients without symptoms, a multidisciplinary team may consider starting such treatment and monitoring closely before giving radiation. |
Supportive care may include medicines to reduce symptomatic swelling or control seizures, and rehabilitation for difficulties with speech, movement, or daily tasks. [1, 5]
What I look for clinically before recommending treatment
I review the original MRI and ask which symptom or scan finding needs attention first. If there is a tissue diagnosis, I check whether the molecular report is complete enough to guide treatment. If the tumour is close to an area that controls speech or movement, I want the surgical team to explain what can be removed safely and what recovery may involve. For brain metastases, I review the brain and body scans together so the local treatment and the systemic treatment can be planned in sequence.
How the next step is decided
| If the assessment shows… | The next discussion is about… |
|---|---|
| A suspected primary brain tumour without a tissue diagnosis | Whether surgery or a stereotactic biopsy can provide the diagnosis safely |
| An IDH-mutant grade 2 glioma after surgery | MRI surveillance, radiation and chemotherapy, or an IDH-targeted option where appropriate |
| A newly diagnosed glioblastoma | The postoperative radiation and temozolomide plan, adjusted for fitness and MGMT status |
| A brain metastasis causing symptoms or pressure | How quickly surgery or radiation is needed |
| A new MRI change after treatment | Whether the change represents tumour growth or a treatment effect |
What to bring to a brain tumour consultation in Delhi
- Brain MRI or CT reports and the original scan images, including earlier scans for comparison.
- Biopsy or surgical pathology report and details for obtaining the slides or tissue block.
- Molecular reports, including IDH, 1p/19q, and MGMT results where applicable.
- Operation notes, discharge summary, and postoperative MRI, if available.
- Records of previous radiotherapy, medicines, or treatment for a cancer elsewhere in the body.
- A list of current symptoms and medicines, including steroids or anti-seizure medicines and their doses.
Frequently asked questions
Does every brain tumour need surgery?
Some tumours can be monitored, while others need a biopsy, surgery, or another treatment. The location, likely diagnosis, symptoms, and safety of the procedure guide the decision. [1, 3]
What does an IDH mutation mean on a brain tumour report?
It helps classify the glioma and can affect the treatment discussion. The team also needs the exact subtype, grade, and postoperative MRI to interpret what it means in your case. [2–4]
Is stereotactic radiosurgery an operation?
It is a form of focused radiation delivered without a surgical incision. It can treat selected brain metastases, depending on their size and location. [5]
Does a larger area of enhancement on MRI mean the tumour has returned?
Radiation and other treatments can cause MRI changes that resemble growth. The team may compare scans over time, use additional imaging, or consider a biopsy if the answer would change treatment. [1, 3]
Before treatment, ask for the exact diagnosis, the purpose of the next step, and what the team will use to assess response. If speech, movement, or vision is already affected, ask how those functions will be protected during treatment and supported afterward.
This page is for general education. Individual treatment decisions require review of the imaging, pathology, symptoms, and overall health by the treating team.
Clinical references
- National Cancer Institute. Adult Central Nervous System Tumors Treatment (PDQ). Health Professional Version.
- World Health Organization. WHO Classification of Tumours of the Central Nervous System. Fifth edition.
- American Society of Clinical Oncology and Society for Neuro-Oncology. Therapy for Diffuse Astrocytic and Oligodendroglial Tumors in Adults: ASCO–SNO Guideline.
- American Society of Clinical Oncology and Society for Neuro-Oncology. Therapy for Diffuse Astrocytic and Oligodendroglial Tumors in Adults: ASCO–SNO Guideline Rapid Recommendation Update. 2025.
- American Society of Clinical Oncology, Society for Neuro-Oncology, and American Society for Radiation Oncology. Treatment for Brain Metastases: ASCO–SNO–ASTRO Guideline.
- European Association of Neuro-Oncology. EANO Guidelines for Treatment of Primary Central Nervous System Lymphoma.