Brain and spinal cord tumours (all types)
Brain and spinal cord tumours range from slow-growing meningiomas and low-grade gliomas to glioblastoma, the commonest malignant brain tumour in adults, and a distinct set of childhood tumours such as medulloblastoma and diffuse midline glioma. Molecular markers now define them, and treatment is surgery, radiotherapy and, for some, drugs chosen by those markers.
Overview
Tumours of the brain and spinal cord are classified by the WHO by cell type and, since 2016 and more so in 2021, by molecular markers such as IDH mutation, 1p/19q codeletion, H3 K27 alteration and MGMT methylation. In adults the main groups are gliomas (from IDH-mutant low-grade astrocytomas and oligodendrogliomas to IDH-wildtype glioblastoma), meningiomas, pituitary tumours and primary CNS lymphoma; in children, medulloblastoma, ependymoma, low-grade gliomas, diffuse midline glioma and rare embryonal tumours dominate. Surgery as complete as function allows, radiotherapy and temozolomide remain the backbone; targeted drugs such as vorasidenib for IDH-mutant glioma and BRAF and MEK inhibitors for BRAF-altered paediatric glioma are the first molecular therapies to change practice. The blood-brain barrier and the impossibility of wide margins make these among the hardest cancers to treat, which is why the subtype pages give the detail.
State of the art
Anatomy and lymph node drainage
Gliomas infiltrate along white matter and can cross the corpus callosum, medulloblastoma sits in the cerebellum, and CNS lymphoma favours deep periventricular tissue; none spread through lymph nodes.
- Frontal lobe (glioblastoma commonest)Glioblastoma (IDH-wildtype)
- Temporal lobe
- Corpus callosum (butterfly glioma)
- Lower-grade IDH-mutant gliomaIDH-mutant astrocytoma and oligodendroglioma
- Cerebellum (medulloblastoma)Medulloblastoma
- Brainstem (diffuse midline glioma)Diffuse midline glioma (DIPG)
- Ventricles and ependymal lining (ependymoma)Ependymoma
- Sella and pituitary (pituitary tumours, craniopharyngioma)Craniopharyngioma
- Deep periventricular tissue (CNS lymphoma)Primary CNS lymphoma
No conventional lymphatics: gliomas spread along white matter tracts and, rarely, through cerebrospinal fluid; medulloblastoma can seed the spine.
Same organ: Glioma & glioblastoma, Primary CNS lymphoma, Medulloblastoma, Paediatric low-grade glioma, Diffuse midline glioma, H3 K27-altered (including DIPG), Atypical teratoid/rhabdoid tumour (ATRT), Ependymoma, Craniopharyngioma, Pituitary tumours (pituitary neuroendocrine tumours) and pituitary carcinoma
Show survival figures (1)
Averages across everyone diagnosed, often years ago. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
- About 308,000 new cases and 251,000 deaths worldwide in 2020 (GLOBOCAN) for brain and central nervous system cancers; the leading cause of cancer death in children in many high-income countries.
- AI in radiologyEstablished
- cfDNA fragmentomicsEstablished
- Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood)Standard of care
- DNA methylation profilingEstablished
- HCC surveillance in cirrhosis (ultrasound + AFP)Standard of care
- High-risk pancreatic surveillance (CAPS / PRECEDE)Established
- A 28-day national pathway for people with a positive multi-cancer blood test
- A breath test to rule out cancer in people with vague symptoms
- A cancer blood test for older people arriving at A&E with unexplained symptoms
- A legislated, publicly reported 28-day standard from urgent referral to diagnosis
- A live national dashboard of stage at diagnosis as the scorecard for early detection
- A single 'cancer check at 60' appointment bundling all screening tests
Background: Alpha-fetoprotein (AFP), Barrett's oesophagus, CA 19-9, Early detection, Faecal immunochemical test (FIT). Also on OnCo: Symptoms and red flags · Early detection roadmap.
Cases by country
No country-level case numbers. This cancer is not mapped to a GLOBOCAN site.
Maximal safe resection, radiotherapy with concurrent and adjuvant temozolomide (Stupp regimen), tumour-treating fields as an option. See the glioblastoma page.
Surgery, then observation or vorasidenib for grade 2 tumours, radiotherapy and chemotherapy for higher risk.
Risk-adapted surgery, radiotherapy and chemotherapy by subgroup; BRAF and MEK inhibitors for BRAF-altered low-grade glioma. See the medulloblastoma, ependymoma and DIPG pages.
Subtypes & biomarkers
top- Glioblastoma (IDH-wildtype)
- IDH-mutant astrocytoma and oligodendroglioma
- Paediatric low-grade glioma
- Diffuse midline glioma (DIPG)
- Medulloblastoma
- Ependymoma
- Atypical teratoid/rhabdoid tumour
- Craniopharyngioma
- Meningioma
- Primary CNS lymphoma
- Brain metastases (from other cancers)
- IDH1/IDH2 mutation
- 1p/19q codeletion
- MGMT promoter methylation
- H3 K27M alteration
- BRAF V600E and KIAA1549 ::BRAF fusion in paediatric glioma
- Molecular subgroups of medulloblastoma (WNT, SHH, group 3, group 4)
How often this target appears
- 2005Temozolomide chemoradiation becomes the glioblastoma standard
The Stupp trial showed radiotherapy with concurrent and adjuvant temozolomide prolonged survival.
- 2016WHO classification adds molecular markers
IDH mutation, 1p/19q codeletion and H3 K27M began to define brain tumour types alongside microscopy; extended in 2021.
- 2024Vorasidenib approved for IDH-mutant glioma
First targeted drug for grade 2 astrocytoma and oligodendroglioma after surgery (INDIGO trial).
Open problems and what is being done
Drugs rarely cross the blood-brain barrier at useful concentrations.
Diffuse midline glioma remains almost uniformly fatal.
Cognitive late effects of radiotherapy in children.
and how the field plans to fix it →What is being done about thisSide effects and quality of lifeAvailable now- Cardio-oncologyEstablished
- Exercise & lifestyle oncologyEstablished
- Geriatric assessmentEstablished
- IMRT / IGRT (modern external beam)Standard of care
- Oncology nutrition assessment and medical nutrition therapyEstablished
- Proton therapyEstablished
In trialsIdeas and roadmaps- A cheap old tablet to restore appetite
- A coordinated FLASH radiotherapy evidence programme with shared dose-rate standards
- A dedicated programme for cachexia and treatment toxicity research
- A dietitian in every gastrointestinal and head and neck tumour board
- A funded programme of organ-preservation trials to avoid radical surgery
- A lifelong late-effects registry linked to every treatment for adult survivors
Background: CTCAE toxicity grading (grade 3-4 adverse events), De-escalation, escalation and response-adapted therapy, Immune-related adverse events (irAEs), Quality of life, Toxicity grade. Also on OnCo: Side effects by symptom · Immune-related side effects · Toxicity compare · Survivorship planner.
Trials
topTrials recruiting now
Country and place are remembered in this browser only. A postcode is sent to OpenStreetMap's Nominatim service to find coordinates when you press the button; nothing else leaves your device.
Expert centres
topExpert centres
- Robert H. Lurie Comprehensive Cancer Center of Northwestern UniversityChicago, IL, USNCI comprehensivevia Temozolomide
Questions to ask
topQuestions to ask your oncologist about Brain and spinal cord tumours
Newly diagnosed
- What is my exact diagnosis, stage, and grade, and which tests established them?Why: Everything else follows from an accurate stage and subtype.
- Which biomarkers have been tested on my tumour (for example IDH1/IDH2 mutation, 1p/19q codeletion, MGMT promoter methylation, H3 K27M alteration, BRAF V600E and KIAA1549::BRAF fusion in paediatric glioma), and what were the results?Why: These results decide eligibility for targeted therapy, immunotherapy, and trials.
- Which subtype is my cancer, and does that change the recommended treatment?Why: Recognised subtypes for this cancer include Glioblastoma, IDH-mutant astrocytoma and oligodendroglioma, Paediatric low-grade glioma.
- Is germline (inherited) genetic testing recommended for me or my family?Why: Inherited variants can change treatment and matter for relatives.
Glioblastoma
- For my situation (glioblastoma), which of the standard options do you recommend and why?Why: Guideline options include: Maximal safe resection, radiotherapy with concurrent and adjuvant temozolomide (Stupp regimen), tumour-treating fields as an option. See the glioblastoma page.
- Am I a candidate for Temozolomide, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
IDH-mutant low-grade glioma
- For my situation (idh-mutant low-grade glioma), which of the standard options do you recommend and why?Why: Guideline options include: Surgery, then observation or vorasidenib for grade 2 tumours, radiotherapy and chemotherapy for higher risk.
- Am I a candidate for Vorasidenib, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
Childhood tumours
- For my situation (childhood tumours), which of the standard options do you recommend and why?Why: Guideline options include: Risk-adapted surgery, radiotherapy and chemotherapy by subgroup; BRAF and MEK inhibitors for BRAF-altered low-grade glioma. See the medulloblastoma, ependymoma and DIPG pages.
- Am I a candidate for Dabrafenib, Trametinib, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
Any stage
- Are there clinical trials I could join, for example of Dordaviprone, Tovorafenib?Why: Trials are how the next standard of care is set; asking early keeps options open.
- Would a second opinion at a high-volume centre change anything, and can you help arrange it?Why: Rare or high-stakes decisions benefit from a centre that treats many similar patients.
- What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?Why: Supportive care improves quality of life and helps patients complete treatment.
- I read that “Drugs rarely cross the blood-brain barrier at useful concentrations”. How does that affect my plan?Why: Open problems are where trials and second opinions matter most.
- I read that “Diffuse midline glioma remains almost uniformly fatal”. How does that affect my plan?Why: Open problems are where trials and second opinions matter most.
Print this page for your appointment (your browser's print command). These prompts are for discussion; your clinical team knows your case.
Direct links plus the targets, companies, and technologies of this cancer's products.
technologies
5targets
3drugs
6companies
5Latest papers
topQuery for this cancer: (TITLE:"Brain and spinal cord tumours" OR ABSTRACT:"Brain and spinal cord tumours" OR TITLE:"all types" OR ABSTRACT:"all types" OR TITLE:"Brain Tumors" OR ABSTRACT:"Brain Tumors" OR TITLE:"Brain tumors" OR ABSTRACT:"Brain tumors" OR TITLE:"CNS tumours" OR ABSTRACT:"CNS tumours" OR TITLE:"Central nervous system tumours" OR ABSTRACT:"Central nervous system tumours") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Brain and spinal cord tumours (all types), not a curated reading list.
Similar pages
not linked directly; found by shared links- CancerSkin cancer (all types)
Shares Dabrafenib, MEK1/2, BRAF and the tag umbrella.
- CancerChildhood cancers (all types)
Shares Tovorafenib, Ependymoma, Atypical teratoid/rhabdoid tumour (ATRT), Diffuse midline glioma, H3 K27-altered (including DIPG) and the tag umbrella.
- JournalBrain tumor pathology
Shares Craniopharyngioma, Ependymoma, Atypical teratoid/rhabdoid tumour (ATRT), Diffuse midline glioma, H3 K27-altered (including DIPG).
- JournalCNS oncology
Shares Craniopharyngioma, Ependymoma, Atypical teratoid/rhabdoid tumour (ATRT), Diffuse midline glioma, H3 K27-altered (including DIPG).
- JournalJournal of neuro-oncology
Shares Craniopharyngioma, Ependymoma, Atypical teratoid/rhabdoid tumour (ATRT), Diffuse midline glioma, H3 K27-altered (including DIPG).
- CancerNon-Hodgkin lymphoma (all types)
Shares Primary CNS lymphoma and the tag umbrella.
- PathwayGlioma (KEGG map)
Shares Dabrafenib, Tovorafenib, Trametinib, Vorasidenib.
- CollectionNational Brain Tumor Society (NBTS)
Shares Dordaviprone, Vorasidenib, Primary CNS lymphoma, Medulloblastoma.