Brain metastases: your cancer in a new place, not a new cancer

A brain metastasis is the cancer you already have, growing in the brain. It keeps the name of where it started, and that name decides the treatment. What the number of spots changes. Which medicines reach the brain. And the question to ask about the covering of the brain.

The short version

A brain metastasis is the cancer you already have, growing in a new place. It is not a second, different cancer, and it is not a brain tumor that started in your brain. It keeps the name of where it started, and that name is what decides your treatment. Breast cancer that reaches the brain is still breast cancer, and is treated with what works for breast cancer. It is the most common kind of brain tumor there is. More people have one of these than have a tumor that started in the brain. This is a serious thing to be told, and this page is not going to pretend otherwise. What it can do is set out what changes the plan: how many spots there are, where they sit, and whether any of your medicines can reach the brain at all. That last one is a question worth asking out loud.

What is a brain metastasis?

It is cancer that started somewhere else and traveled.

Cells break away from the first cancer, move through the blood, and settle in the brain. They keep behaving like the cancer they came from. So what grows in the brain is made of breast cells, or lung cells, or melanoma cells, not of brain cells.

You will hear several words for the same thing. Metastasis is one of them. Brain mets is what most teams say out loud. Secondary brain tumor means the same, and so does secondary. None of them is worse or better than the others. They are just different rooms' habits.

Lung cancer, breast cancer and melanoma are the ones that reach the brain most often. They are not the only ones. If your cancer is not on that short list, this page is still about you, because almost any cancer can do this and the plan is built the same way.

Why it is still called by the other cancer's name

This is the part that confuses nearly everybody, and it is worth a minute.

A cancer is named for where it began. Not for where it has got to. Breast cancer that spreads to the brain is called breast cancer that has spread, and the treatment follows breast cancer. If you are told "it is in your brain now", that is a statement about the address, not about the disease changing into something else.

That is why your paperwork keeps naming the first cancer. It is not an error, and nobody has forgotten to update it.

Does this mean it will keep spreading?

Two different questions get mixed up here, so they are worth separating.

Can a tumor that STARTED in the brain travel out to the rest of the body? That one is not about you. Gliomas answers it, and explains why tumors that start in the brain are given a grade instead of a stage.

Can the cancer you have spread somewhere else again? Yes. It already has once, and that is what the word metastatic means. Nobody can tell you whether or where it will happen again, which is why new symptoms get looked at rather than waited out. That is a hard sentence and it is the true one.

Your report may say stage 4, or advanced, or metastatic. All three are about the first cancer having traveled. They are not a countdown, and they are not a grade.

Where does it grow, and why does it cause these symptoms?

A metastasis can land almost anywhere in the brain, and there is often more than one. What you notice depends on where they are, and there is a map further down this page setting out what each part of the brain does.

One thing about that map works differently here. Landing in more than one place means the symptoms can come from more than one place at once, which is why a list of them can feel like it is describing several different people rather than you.

The size of a spot on your scan is not the whole story. A small one in a busy place can cause more trouble than a larger one somewhere quiet. And the swelling around a spot can cause as much as the spot itself, which is why a medicine that brings swelling down can change how somebody feels within a day.

And why does that cause symptoms at all?

Most people are told what they have long before anyone explains what it is doing. These are the ways a tumor in the brain causes symptoms. They overlap, and most people have more than one going on at once. Which of them apply to you depends on what your tumor is and where it sits.

It takes up room. The skull is a closed box. It cannot stretch. So anything new inside it has to push on something. The tumor and any swelling around it together take up space and press on nearby parts of the brain.

It can make the brain around it swell. This one surprises people, and it is worth understanding. Fluid builds up in the brain tissue near the tumor. That swelling plays a major part in deciding what symptoms you get. Some of what you are feeling may not be the tumor itself. It may be the swelling around it. That is why medicines that bring swelling down can change how somebody feels, without the tumor being any different than it was.

Pressure can build up inside the head. When the pressure inside the skull rises, there is a pattern doctors watch for: headaches that are worse in the morning, feeling sick to your stomach and throwing up, odd eye movements, seizures, and being confused or very drowsy. Not everybody with raised pressure has all of it, and some people have almost none of it. If this pattern is new for you, it is worth a phone call rather than a wait. If you have a shunt, it means getting help right away.

It can set off seizures. A tumor and the irritated brain around it can upset the normal electrical activity of that part of the brain. For some people a seizure is the first sign that anything is wrong.

It can block the flow of fluid. The brain makes a fluid that circulates around it and drains away. A tumor sitting in the wrong place can block that flow, so the fluid backs up and the pressure goes up. This is more likely with tumors near the narrow channels the fluid passes through. It can be treated, and the usual treatment is a shunt. That is a thin tube that carries the fluid to another part of the body, where it is absorbed. It is the word your team will use. Shunts and hydrocephalus covers what having one is like, and the signs it has stopped working.

Why your symptoms are the ones you have

The short rule: the symptom tells you where, the scan tells you what. A tumor disturbs whatever job the brain does in that spot, so where it sits decides what you notice.

There is one exception, and it is the fluid. When the flow is blocked, what you notice is the pressure rather than the spot: headaches worse in the morning, throwing up, double vision, and feeling unsteady. Those signs are much the same wherever the blockage sits, so they tell you the pressure is up, not where the tumor is. If that is your pattern, the part above called It can block the flow of fluid is the one about you, and it says what can be done. If the pattern is new, the phone call above applies.

• Front of the brain. Personality, behavior, planning, motivation, and on one side, producing speech.
• Side of the brain, near the temple. Seizures, memory, and understanding what people say.
• Upper back part of the brain. Sensation, knowing where your body is in space, reading, writing and arithmetic.
• Back of the brain. Vision, and losing part of your field of view.
• Cerebellum, low at the back. Balance, coordination and walking.
• Brainstem. Double vision, facial weakness, and trouble swallowing.
• Deep in the middle, near the spaces the fluid runs through. A tumor here can block the flow, so what you notice is often the pressure rising rather than anything that points to the spot.
• The floor of the skull, below and behind the ear. Hearing, balance, and the nerves to the face. So hearing loss or ringing in one ear, dizziness, and numbness or weakness down one side of the face. Your team may call the whole floor of the skull the skull base. This spot is one part of it.
• Behind the eyes, at the base of the brain. Vision, and the hormones that set energy, weight, thirst and periods. In a child, growth and puberty too. Side vision is what usually goes first, so things start disappearing at the edge. Your team may call this the pituitary or the sellar region.

If something on this list matches what you have noticed, it is worth writing down and taking to your next appointment. Your team can tell you whether it fits where your tumor actually is.

This list is about what the place explains. The other half of the question is what the place changes: whether an operation is offered, how much of it can come out, and when the place makes something urgent on its own. Where your tumor is, and what that changes is that half.

What symptoms does it cause?

There is no single list, because it depends on where they are. The ones that turn up across many places are headache, feeling sick to your stomach, a seizure, an arm or leg that feels weak or numb, poor balance, a change in what you can see, and shifts in thinking or mood that the people around you often notice first.

Some metastases are found on a scan before they have caused anything at all. That is common, and it is a better place to start from.

If you have cancer and your legs go weak, or you lose control of your bladder or bowel, that is its own emergency. Cancer can press on the spinal cord as well as on the brain, and the signs are new weakness in the legs, a change in how you walk, numbness around the saddle area, and any new trouble with your bladder or bowel. New weakness or new bladder trouble is a reason to be seen quickly, not to wait for the next appointment. Do not wait for it to get bad first, because the early signs are often vague ones. For you, that means calling your team right away or going to the emergency room, not waiting to see whether it settles. Spinal cord tumors has the rest of it.

When to call for help right now

Some things should not wait for the next appointment.

Call an ambulance for any of these. Call 911, or your local emergency number:

• A first ever seizure.
• A seizure that lasts more than five minutes.
• One seizure right after another, with no waking up in between.
• Someone who cannot be woken.
• Trouble breathing, or someone who seems to be choking.
• Suddenly not being able to speak, move one side, or see.

A seizure like the ones you usually have, that stops on its own, is not an ambulance call. What to do during a seizure draws the line.

Call your team the same day for any of these:

• A headache much worse than usual, or one that wakes you from sleep.
• Throwing up again and again.
• New weakness in the face, an arm or a leg.
• New trouble speaking, or understanding what people say.
• New confusion.
• Sleeping much more than being awake.
• A sudden change in your vision.

If you are having chemotherapy, a fever is its own rule. It means calling your team right away, at any hour, not waiting for the morning. An infection during chemotherapy can get dangerous fast, and it is treatable when it is caught early. The fever rule explains why, and what number your team will give you.

In the weeks after brain surgery, a fever is its own rule too, especially with a stiff neck or a bad headache. What comes after a craniotomy has the rest of that list.

If you have a shunt, the signs it has stopped working are their own rule. For you, everything on the same-day list above is a right-away call instead, and so are a few other signs. Get help right away, at any hour: call your team, or go to the emergency department. Signs a shunt is not working has the full list.

If you are not sure whether to call, call. Nobody on that team minds a phone call that turns out to be nothing.

Same day means today, not the next clinic appointment. Ask your team now for the after-hours number, and put it somewhere you will find it at two in the morning rather than somewhere sensible.

What to do during a seizure has the step-by-step, and getting help now is the short version to keep on a phone.

How do doctors find out it is this?

Nearly always an MRI, with contrast dyecontrast dye: A liquid put into a vein before some scans. It makes certain tissues stand out, which helps show where a tumor is. It does not always show the whole of it. See the glossary. On a scan, metastases look like round spots with a clear edge, frequently more than one, with swelling around them. The pattern is clear enough that a team can often say what they are looking at before anything is taken out.

Sometimes the brain scan is what finds the cancer in the first place. Some people arrive at this page having had no idea they had cancer at all. A scan for headaches, or after a fall, shows something, and the search for where it started begins from there. That is not rare, and usually it means nobody had a reason to look at your brain before now.

If that is you, expect scans of the rest of your body, and blood tests, and probably a sample of tissue. In most people that search finds the starting point, and finds it within a few months. In a smaller number it does not, even after a thorough look. That situation has a name, cancer of unknown primary, and it is a known situation rather than a failure. Treatment does not wait for the answer, and testing the tumor itself can still point to what will work.

MRI scans describes the machine and the appointment. Biopsy covers how tissue is taken, and the pathology report covers what comes back.

What do the words on my report mean?

Paperwork here follows the rules of your first cancer, so it will not look like a report for a tumor that started in the brain. These are the words that come up most.

Metastasis, metastases, mets. One of them, several of them, and the word your team will say out loud.

Solitary or single. One spot in the brain. Multiple means more than one. Teams count them, because the count changes which treatments are on the table.

Mass effectmass effect: The tumor is taking up room and pushing on what is next to it. The skull cannot stretch, so anything that takes up space presses on the brain around it. See the glossary. The tumor is pushing on something rather than just sitting there. It describes the crowding, not the cancer.

Vasogenic edemavasogenic edema: Fluid that leaks out of blood vessels. It leaks into the brain around a tumor. It is the swelling that steroid medicines are given to bring down. See the glossary. Swelling in the brain tissue around a spot. It is treatable and it often improves faster than the tumor does. Steroids covers the medicine used for it and what it is like to take.

Leptomeningeal. The cancer is in the thin coverings and the fluid around the brain rather than in lumps. That is a different situation and it has its own section below.

Stage 4, advanced, metastatic. All three mean the first cancer has traveled. They say nothing about how fast anything is growing.

Who is looking after me now?

Something changes here that is rarely spelled out.

If you already have a cancer team, they are not replaced. The people who treat brain metastases are added to them. A neurosurgeon, a radiation oncologistradiation oncologist: The doctor in charge of radiation treatment. They decide which area is treated, and how the treatment is split up. See the glossary and a neuro-oncologistneuro-oncologist: A doctor who specializes in tumors of the brain and spine. They often lead the brain tumor team. They are a good person to ask who your one named contact is. See the glossary join the conversation, and the plan for your cancer as a whole is still built around the cancer you started with.

If this is all new, your team is being built this week, and it is being built from both ends at once: somebody for the cancer wherever it started, and somebody for the brain. That is disorienting, and it is not a sign that nobody is in charge.

What that means in practice is that you now have more than one team, and more than one clinic, and that is exactly the situation where something gets dropped between two sets of notes.

So ask this, early: who is coordinating? Ask for a name and a number, and ask which team to call about what. It is an ordinary question and it saves a great deal later.

A tumor board is a meeting where specialists look at one person's case together: surgeons, cancer doctors, the lab, and the people who read scans. It tends to happen when a case is complicated or something is hard to read.

You do not go to the meeting. Afterwards, the doctor who knows you best explains what was said.

What they decide is advice, not an order. The choice is still yours. Because you are not in the room, tell your team what matters to you before it happens, so it is taken into account.

How is it usually treated?

There are four things on the table, and which of them applies turns on how many spots there are, where they are, and what your first cancer responds to.

Medicine for the swelling. Often the first thing, and often the fastest to help. It treats the swelling rather than the tumor, and it can lift symptoms quickly. Steroids covers the whole of that.

Surgery. Considered when there are only a few spots, when one of them can be reached safely, and when it is causing trouble by itself. It is also how tissue is taken when nobody yet knows where the cancer began. Brain surgery covers what an operation involves.

Focused radiation. Aimed at the spots rather than at the whole brain. It is the usual choice when there are only a few of them. It can often be given in one visit, or in a small number. Its full name is stereotactic radiosurgerystereotactic radiosurgery: Radiation aimed at a small target, in one visit or a few. There is no cutting, despite the name. See the glossary, and it is not surgery despite that.

Whole-brain radiationwhole-brain radiation: Radiation given to the whole brain, rather than aimed at one spot. It is used when there are too many tumors to aim at one at a time. See the glossary. The whole brain is treated, not only the spots, usually because there are too many to aim at one at a time. Healthy tissue gets the dose as well, so this is a genuine trade-off and not a formality. Radiation therapy sets out what it involves, and it carries a question to ask by name about protecting memory. Read that before the planning appointment rather than after it.

Where the line falls between a few and many is your team's to draw. It has moved over the years, and it depends on the size of the spots and on how the rest of your cancer is doing, so a number from a web page is not your number.

Ask about trials here, not at the end. Clinical trials explains why an early question is a better question.

Is there a medicine that reaches the brain?

This is the section with something in it to actually do. It ends in a question, and the question has a real answer.

Not every cancer medicine gets into the brain. The brain is guarded by a lining that keeps many drugs out, and a drug that has been working well on the rest of your cancer may be doing less inside your head. That is a property of the medicine, not a sign that anything is being done badly.

The ones that do get in tend to be the newer drugs aimed at a specific change in the cancer's genes. Which of those is even possible for you depends on whether your cancer has been tested for that change. Testing is routine for some cancers and not for others, and it is not always repeated once somebody has been on treatment for a while.

So the question to ask, in those words, is: "Has my cancer been tested for a marker with a drug that reaches the brain?"

And there is a second half. The tumor in your brain can carry a different change from the one you started with. If tissue was taken from your brain, it is fair to ask whether that tissue was tested too, and not only the original sample.

What the markers mean explains the testing itself, and targeted drugs explains how that kind of drug works and what being on one asks of you.

None of this means there is a pill for brain metastases. It means there is a question with a real answer, the answer differs from person to person, and nobody will ask it for you.

If the cancer is in the covering rather than in lumps

This is a different thing from the spots described above, and it is worth its own section because it is handled differently and because it is easy to miss.

Your brain and spinal cord float in fluid, inside thin coverings. Cancer cells can settle in those coverings and travel in that fluid instead of forming lumps. Doctors call it leptomeningeal disease, or leptomeningeal metastasis. Breast cancer, lung cancer and melanoma are the ones that do it most often.

The clue is symptoms in several places at once. Rather than one problem you could draw on a map, there are a few: double vision, a drooping or weak face, hearing trouble, a headache with vomiting, and confusion. The nerves that leave the base of the skull are often involved, and they are why a person may have eye, face and hearing trouble together.

Leg weakness and bladder trouble can also come from this, and those two are handled differently. They are in the urgent list above rather than here.

Finding it takes two tests, and both are worth understanding before you have them.

• An MRI of the brain and often the spine.
• A spinal tap, where a small amount of the fluid is taken from your lower back with a needle and the cells in it are looked at.

A clear spinal tap is not an all-clear. The test misses this often enough that a single clear result settles nothing. Doing it again finds cases the first one missed, and a scan can show it when the fluid looks normal, and the fluid can show it when the scan looks normal. The two tests are used together on purpose.

So if your symptoms are still there and you have been told a tap was clear, it is fair to ask whether it should be repeated. That is not arguing with your team. It is the same question they would ask each other, and the guidance they work from says plainly that a negative result does not rule this out.

Treatment is different here too. It may involve radiation aimed at the places causing trouble, and medicine given in a way that gets into the fluid itself, and which of those applies varies a great deal. Ask what is being aimed at, and what it is expected to do, because the goals are often about symptoms rather than about the scan.

What is treatment actually like, and what is normal afterwards?

Focused radiation is usually short. Often one visit, sometimes a few. Your head is held still, either by a mask or by a light frame pinned to your scalp under local anesthetic. Stereotactic radiosurgery goes through that day hour by hour. Tiredness afterwards is common and it can arrive days later rather than on the day.

Whole-brain radiation runs over more days, and the tiredness builds. Hair loss is usual, and it does grow back. The tiredness can go on for weeks after the last session, and it surprises people who were expecting the end of treatment to feel like an end. Radiation therapy goes through the mask, the weeks, the hair and when it comes back.

If you have surgery, expect a deep tiredness that comes in waves, a sore scar, patchy concentration, and odd sleep for a while.

One more, and it trips people up. You are probably still having treatment for your first cancer at the same time. Two sets of side effects overlap, and it is genuinely hard to tell which is causing what. Say so at the appointment rather than working it out alone. It is useful information, and it changes what your team is able to offer you.

Everyday life: work, driving, seizures and tiredness

Nobody is ready for how tired this is. It is not the same as needing an early night, and it is rarely down to one cause you can point at. Plan around it rather than through it.

A seizure is possible with metastases in some places. Read the steps to take when one happens now rather than later, and living with seizures picks up everything in between. Anti-seizure medicines goes through the medicines, and whether you need one at all.

Whether you can drive is decided where you live, and a seizure changes the answer. No web page can tell you yours, and this one will not try. Driving and seizures points you at the right authority.

Steroids change things while you are on them: sleep, appetite, mood and blood sugar. That is covered on steroids, and it is worth reading because the effects are easy to mistake for the illness.

Trouble with memory, focus and temper is real here, and from the outside it can look like a person being awkward on purpose. Raise it with the team rather than absorbing it at home. It is treatable more often than people expect.

Follow-up scans, and what to do while you wait

You will have brain scans as well as the scans you already have for your first cancer. They are often on different clocks, run by different teams, and the results do not always arrive together.

Ask who is reading the brain scan and who tells you. With two teams involved, this is the most common place for a wait to get longer than it needed to be.

The waiting is the hard part, not the scanner. Follow-up scans covers how scans are compared over time, and what to do with yourself in between.

One thing worth knowing in advance: after radiation, a treated spot can look bigger or brighter on a scan without the cancer having grown. Teams expect this and look at a series of scans rather than one. If a report worries you, ask whether it is being compared with the last one.

It is not only a change on the screen, though. Whatever is causing the spot to look bigger can crowd the brain beside it, and that can make you feel different. Tell somebody at the time rather than saving it for the next scan, because there is usually something to be done about it. When a scan looks worse goes through it.

If it comes back, or changes

New spots can appear in the brain even while the rest of your cancer is quiet, and the reverse happens too. That is the blood-brain lining again, not a sign that treatment failed everywhere.

So a change in the brain does not automatically change your whole plan. It may mean adding something aimed at the brain, and it may mean revisiting whether your systemic medicine is one that gets in. Those are two different questions and it is fair to ask which one is being answered.

If radiation has already been given to an area, that shapes what can be given again. Surgery, more focused radiation, a change of drug and a trial are all still possible options. Which of them is open depends on what has already been done.

Did I let this happen?

Almost everybody asks some version of this, usually in private, and it deserves a plain answer rather than a soft one.

Cancer spreading is something the cancer does. It is not something you did. Whether cells travel, and whether they settle and grow once they get somewhere, depends on the biology of that cancer. It is not a measure of how quickly you got to an appointment.

"I should have gone to the doctor sooner." This is the one that keeps people awake. Even where an earlier diagnosis would have helped the first cancer, it does not follow that it would have stopped this. Cells can leave a cancer long before there is anything to find, and they can also settle years after the first cancer was treated. Neither of those is a timetable you could have beaten.

"I stopped a treatment", or "I took a break." Treatment breaks happen for real reasons, including side effects that were making life unlivable. A break is not a cause, and your team made those decisions with you.

"Somebody missed it." Sometimes there is a real question to ask here, and asking it is allowed. Often there is nothing to find: a scan of your chest does not show your head, and metastases can arrive between two appointments. If you want to know, ask directly: was there anything on my earlier scans? You are entitled to the answer, and hearing it is usually easier than imagining it.

"Could I have passed this on?" Different question, and a real one. A few cancers run in families, and if yours is one of them your relatives may be offered testing. That belongs to the team who treat your first cancer rather than to the brain team, so ask them. And no part of this is catching.

"I did something to deserve it." No. Stress does not cause cancer to spread, diet does not, and neither does attitude. The idea that staying positive changes the outcome puts the blame in the worst possible place, and it is not true.

Going round this at night is normal, and almost nobody says so. Put it to somebody on your team in daylight. They have answered it before, and they would much rather have the conversation than let you keep having it alone.

What might happen over time

For the person caring for someone with this

If you are the one driving to the appointments, keeping track of the pills, and lying awake at night worrying about them, this part is for you.

You are allowed to ask questions. In one study, families said they were afraid of annoying the doctor by asking too much. One of them was told by a doctor to stop playing doctor. Ask anyway. Write your questions down before you go, and bring a notepad. Two people in the room hear more than one.

Ask who your first call is. Care comes from a lot of people at once, and it is easy to end up as the only one holding it together. Ask the team: who do I call first? Some teams have one person whose job this is, often a nurse. Get the name and the number.

Get two numbers, and know which one to use. One for work hours, one for nights and weekends. Then ask what counts as "call us today" and what counts as "call an ambulance" for this tumor, and write the answer down where you can see it. If you are not sure which it is, call. Nobody on that team will mind.

If they have seizures, read about them before you need to. What to do when someone has a seizure is the one to know by heart. Living with seizures is about the rest of the time: what is safe, what to change, and driving.

Ask to be shown anything you are sent home to do. In that same study, families were sent home to change dressings and give medicines with no training at all. That is not fair to you. Before you leave the hospital, ask someone to show you. Then do it once while they watch.

Say what you notice. You may see a change before they do. Changes in thinking, mood and behavior can show up to the people close by first. Telling the team is not going behind their back. It is something the team cannot learn any other way.

Look after yourself, and let people help. Eat, sleep, and keep your own appointments. Take a little of the day back for yourself. When someone asks what they can do, give them a real job: a meal, a ride, an hour with the kids. Most people want to help and do not know how to offer.

You can talk to somebody about all of this today. See where to get help.

Three more, and they come with this situation rather than with tumors in general.

You are dealing with two teams, and you will be the one holding both. Appointments, scans and phone numbers come from more than one place, and nobody on either side sees the whole of it. Keeping one list, in one place, is worth more here than anywhere else. Ask each team who their coordinator is.

Three different things can be behind how they are behaving, and only one of them is the tumor. Flatness, a short temper, broken sleep and confusion come just as easily from a steroid or from the treatment aimed at the first cancer. They are put right in completely different ways. You are usually the only person who knows what changed and when. Bring the dates to the appointment, and say it with them in the room.

People will hear "it has spread" and treat it as the end of the conversation. It is not. There are decisions still being made, and questions still worth asking, and the person you are caring for is still in the middle of their own life. You do not have to correct anybody. You just do not have to agree.

What to ask your team

• Where did this cancer start, and does that change what I am given?
• How many spots are there, and where are they?
• Is surgery, focused radiation or whole-brain radiation being considered, and why that one?
• If whole-brain radiation is planned, can it be planned to protect my memory, and should I be on memantinememantine: A medicine given with whole-brain radiation to help protect thinking and memory. See the glossary?
• Has my cancer been tested for a marker with a drug that reaches the brain?
• If tissue was taken from my brain, was that tissue tested as well?
• Who is coordinating between my cancer team and my brain team?
• Which team do I call about what, and what are the two numbers?
• Am I on a steroid, and how will we get me off it again?
• Could any of this be in the coverings rather than in lumps, and how would we know?
• Is there a trial I should be asking about now rather than later?
• Who reads my brain scans, and how will I hear the result?

Where to get support

• Get help now if you want to talk to a person today.
• Steroids if you have just been started on one.
• Radiation therapy for what treatment is like.
• Clinical trials before you decide a trial is not for you.
• The other tumor pages cover the ones that start in the brain.