After diagnosis, the medical team should discuss a range of treatment options. It is important to consider the following questions about:
- Likely outcomes
- Expected timeframes (e.g. how long will treatment last; how often)
- Possible side effects
- Risks and benefits of the treatment
A doctor may also invite you to take part in a clinical trial.
It is important to always let your medical team know about any potential complementary or alternative therapies you are thinking about using too. Some therapies interact with medical treatments.
It is okay to take a little time to read and decide what is best for the person and the people they care about.
Treatment Overview
Here we’ll look at an overview of treatments for high-grade gliomas. More information about some of these treatments is available by clicking the Fact Sheet link after the treatment description. Treatment options vary depending upon the type and size of the tumour, where it is located in the brain and the general health and age of the person with the tumour.
Treatments may be used at different stages to:
- prolong a person’s life;
- relieve various symptoms and;
- help to improve the quality of life.
Surgery is the most common treatment for people with high-grade glioma. It is important that surgery is performed by a neurosurgeon with experience in the treatment of brain tumours.
Radiation therapy (also called radiotherapy) may be given to you with or without chemotherapy. Fact Sheet
Chemotherapy may be given to you after surgery in combination with Radiation Therapy and/or following Radiation therapy. Fact Sheet
Palliative care may not focus on treating the tumour itself, but is provided in order to ease symptoms causing pain and discomfort and to improve quality of life. Palliative care can be used in conjunction with the other forms of treatment (i.e. surgery, chemotherapy, radiation therapy). Fact Sheet
Medications that May be Used During the Course of your Treatment
The following medications may be used alongside the main treatment for a brain tumour.
- Dexamethasone is a corticosteroid that can sometimes help to reduce the swelling in the brain around the tumour. Fact Sheet
- Antinausea or antiemetic medications can help to prevent or reduce nausea that may be experienced as part of the brain tumour treatment. Fact Sheet
- Anticonvulsant medications help to reduce the risk of seizures/fits. Use of some of these medications needs to be closely monitored. Fact Sheet
- Constipation treatment is called aperients or laxatives, but there are other things that help relieve constipation, as well as medications. Fact Sheet
Side Effects and How to Treat Them
Headaches or pressure symptoms in the head
Headaches can be caused during radiation therapy due to increased swelling around the brain near the tumour. These are monitored closely by the radiation treating team and may require corticosteroid medication (e.g. dexamethasone) during treatment to help reduce the brain swelling and the related symptoms this causes.
Nausea and/or vomiting
Nausea and vomiting can be side effects of chemotherapy and/or radiotherapy treatment for brain cancer. These side effects can be managed using medications which are readily available in Australia and which are commonly prescribed by the oncologist when a person starts their treatment.
They can be well controlled with prescribed medications if necessary.
If your friend or relative is experiencing nausea and/or vomiting which are not controlled by prescribed medications, contact the oncology nurse or the oncology clinic for further instructions. If they are unable to eat or drink, or if you feel that they are becoming dehydrated, the treating medical team should be contacted immediately.
Constipation
So medications which are part of treatment for brain tumours, particularly some anti-nausea medications, can cause constipation. Fact Sheet.
Skin and Hair Changes During Treatment
People with brain tumours can experience a number of skin or hair problems.
These can be due to:
- Radiotherapy
- Chemotherapy
- Anticonvulsant medications
- Other medications used for people with brain tumours and their potential side effects
Skin and Hair Changes During Treatment as a Result of Radiotherapy
Almost everyone who is treated with radiotherapy for a brain tumour will lose a patch of hair over the area of treatment that relates to the tumour location about halfway through the radiotherapy treatment course. Hair re-growth usually occur but can take a number of months. Almost everyone who is treated with radiotherapy for a brain tumour will lose hair over the area of treatment. This may cause permanent hair loss or at least thinning of hair in some areas. In most cases, hair will grow back but the person you are caring for may continue to experience hair thinning. People with longer hair can disguise with a headband or hairstyle, and those with shorter hair may choose to shave their heads.
Areas treated by radiotherapy can also become mild to moderately red during and shortly after treatment completion. Mild skin reactions (mild redness & dryness) can be helped by a fragrance-free moisturiser (e.g. sorbolene).
Areas treated by radiotherapy can be darker or more pigmented in the long term, and may also be sun-sensitive and should be protected from the sun.
Skin and Hair Changes During Treatment as a Result of Chemotherapy
There are a number of reasons why people on chemotherapy may develop skin problems. It is always important to tell your doctor or cancer nurse coordinator if the person taking chemotherapy develops a rash.
- Allergic reactions are uncommon but can happen. Allergic rashes might be red, raised, and itchy.
- A low platelet count can cause tiny red dots from bleeding under the skin, or red marks where scratches or bumps have occurred. This may be seen in between chemotherapy cycles and should always be brought to medical attention.
- People on chemotherapy can develop sun-sensitive skin or red itchy scaly bumps in areas of the body which have been exposed to the sun.
- Hair loss is not usual for most chemotherapy used in brain cancers.
Anticonvulsant medicines can cause skin rashes in some people. If a rash occurs in a person taking anticonvulsant medicine, they should tell their doctor. Even if someone has been on an anticonvulsant medication for some time, a new rash may become obvious when the person stops or reduces dexamethasone (steroid) treatment.
Some older anticonvulsant medications may also cause increased hairiness or development of facial hair in women. Talk to the doctor if your friend or relative is bothered by this.
Other Potential Side Effects of Medications
Any medication has the potential to cause an allergic reaction.
- Dexamethasone (a steroid) taken for a period of time can cause longer term side effects including immune suppression, skin thinning, easy bruising in areas which are scratched or bumped, diabetes, thrush, weight changes as well as sleep and mood disturbances. It is important for the treating medical team to help monitor these side effects if dexamethasone is indicated long term
- Avastin® (bevacizumab) can cause easy bruising or bleeding in the skin, or even boils or skin abscesses occasionally. Early medical attention is needed if a boil develops on Avastin®
- Blood thinners (e.g. Clexane®,Fragmin®,Warfarin®) can also cause easy bruising or bleeding in the skin.
- Antibiotics can cause a rash from an allergic or hypersensitivity reaction
It is important to determine the cause of a rash. Sometimes the doctor might need to stop some of the medications to figure out what might be the cause of the rash before they reintroduce them. Of course, it is also possible for someone with a brain tumour to develop another unrelated problem. The doctor may wish to order some further tests to rule out other problems if there is no other clear cause of a skin problem.
Fatigue
Fatigue, or physical tiredness (rather than sleepiness) is a common problem for people with brain tumours, particularly if they are on combined chemotherapy and radiotherapy, or chemotherapy alone. During radiotherapy, daily visits to the hospital can be particularly tiring. Fatigue in people with brain tumours range from mild to moderately severe. As a carer, you may also experience fatigue, and some of these tips will be helpful for both you and the person you are caring for. People with fatigue can experience:
- Muscle weakness or heaviness of limbs
- Difficulty concentrating
- Sleep disturbance
- Feeling unrested after sleep
- Emotional distress
- Difficulty participating in everyday activities
Unfortunately, there is no ‘magic pill’ to help combat fatigue. Doctors may check that there is no additional reason for your friend or relative to feel tired, such as anaemia or poor thyroid function, but in most people these tests do not show any problems.