Where your tumor is, and what that changes

You know roughly where it sits, even if nobody has named it yet. This page turns the place on your scan report into plain words. It says what your team is weighing about it, and what to do when a place carries a warning of its own. If what changed is your sight, it says what that means for driving.

The short version

You may know roughly where it sits before anyone tells you what it is. That is a normal way round, and this page is for that moment.

Where it sits does not name it. A name usually comes from tissue, tested in a lab, and where it sits helps decide whether taking a piece is worth the risk at all.

What where it sits does shape is the plan: whether an operation is offered at all, whether all of it or part of it can come out, and whether the first job is the tumor or the fluid around your brain.

The clearest case where the place itself makes something urgent is the fluid, and when where it sits makes it urgent is that section. It is not the only reason to call anybody, and it says what to do when a place or a type has a warning of its own.

There is no list here of which places are dangerous, and the reason is worth the two minutes.

What "where it is" tells you, and what it does not

A scan gives your team two things at once: a picture, and a place read out of it. The place is the part of the report that reads like directions.

The place is real information and you can hold on to it. It explains a lot about what you have noticed, and it shapes what an operation would involve.

The place is written down in the report on your scan, and when that report comes back is set locally rather than by any rule. Your MRI scan covers that appointment and says so plainly.

The place is not a diagnosis. Many different growths can sit in the same spot, and they are treated differently once they are named. Why the scan cannot say on its own is the fuller answer to why a picture cannot close that gap.

So two people can be told "it is in the brain stem" and be given two different plans. That is not one of them being brushed off. It is the same place holding two different things.

If your team has given you a word for the type, its own page is more use to you than this one. The tumor types we have written about lists them. If they have not, that is an ordinary position to be in during the first week, and the rest of this page is written for you. Where it says "your tumor", read it as "whatever this turns out to be".

And if you are here about your child, read "you" and "your report" as "your child" and "your child's report". The words on a child's scan report are the same words, and that is the part of this page that transfers cleanly.

One part of it needs a warning, and it is the surgery section. Two of the three sources behind it are written about adults, and childhood tumors are not treated the same way. The fluid section is not adult-only, and the signs of it in a baby are different from the signs in an adult. Brain tumors in children has that list, and it is the page to read alongside this one.

Why your team keeps coming back to where it sits

Because it is one of the few things a surgeon can plan from before there is tissue.

A guideline for one common tumor type spells out what that planning weighs. How much can be taken out, it says, is decided by where the tumor is, how firm it is, how big it is, and how close it sits to blood vessels and nerves that matter. Four things at once, and the place is one of them.

What is next to it counts too. A tumor in an open part of the brain with nothing important beside it is a different operation from one the same size wrapped around a big blood vessel. The scan is read for both.

If more than one spot was found, ask about each of them. More than one spot does not by itself say where they started, and that fork changes the whole plan. Did it start in my brain, or somewhere else? is where it goes.

And a place is something you can ask about today. The grade may turn out differently than expected, and the plan may change once there is tissue, but where the scan found it is already known. That is why your team keeps returning to it, and why there is no reason to hold the question back.

The regions, in plain words and in your report's words

Nine places, in the order this site uses elsewhere. Each one gives the plain name first and then the word your scan report is likely to use, because the word on the paper is often the only clue you were handed.

These nine are places in the head. A tumor in or pressing on the spinal cord is a different subject with different rules, including different reasons to call for help, and tumors of the spinal cord is the page for it.

If the word on your report is not one of these nine, that is normal and it does not mean yours is unusual. Reports use finer words than these. Some name a spot inside one of the nine, and some name a line rather than a place: midline, for instance, means at or near the center line, and more than one of the nine sits on that line. Ask which of these nine yours is in, or nearest to. It is a short question and it does not need an appointment of its own.

And some words name a place without naming a type at all. A report or a doctor can hand you an address where you expected the name of a growth. When the word you were given is a place is the section for that, and the word it works through is tectal gliomaglioma: A tumor that starts in the glial cells. Those are the support cells of the brain and spinal cord. Gliomas are given a grade from 1 to 4. The grade says how the tumor is expected to act. See the glossary.

These entries do not list symptoms. That question has a better answer of its own, region by region, and it lives on the page for the first week: what a tumor in each place tends to cause.

The front of your brain

Above and behind your forehead. Your report may call this the frontal lobe. There are two, one on each side, and they are the largest of the four lobes.

You may also see Broca's area written down. That is a part inside the front of the brain that helps put words together, and in most people it is on the left side.

The side of your brain, near your ear

Your report may call this the temporal lobe. There are two, and they sit at about ear level on each side of your head. Other pages here call the same place the side of the brain near the temple, which is the same spot.

The upper back part of your brain

Your report may call this the parietal lobe, and there are two of these as well. It is the main place where what your body feels gets put together with everything else your brain knows.

The back of your brain

At the very back of your head. Your report may call this the occipital lobe. There are two, and they are where what your eyes send gets turned into seeing.

If sight is what changed for you, that has a section of its own: when what changed is your sight, and it covers driving.

Low at the back, under everything else

Your report may call this the cerebellum. It sits at the back of the brain, underneath the lobes above it.

It may also name the space rather than the part. The posterior fossa is a hollow in the back of the skull that holds the cerebellum, the brain stem and several of the nerves to the face and head.

The stalk the brain sits on

Your report may call this the brain stem, or it may name one of the three parts it is made of instead: the midbrain, the ponspons: A part of the brain stem. The nerve paths for eye movement, hearing, speaking, swallowing and balance pass through it. So do the paths for movement in your arms and legs. See the glossary and the medulla, which a report may print in full as the medulla oblongata. A report may use one of those smaller words instead of the big one, so one that never says "brain stem" can still be about it.

You may have read that nothing can be done here. Do not settle that from a location. Can they just take it out? is where this page takes that question.

Deep in the middle, where the fluid runs

Your report may call these the ventricles. There are four, and it may name which one: the two lateral ventricles, one in each half of the brain, the third ventricle in the center of the brain, and the fourth ventricle.

One word here is worth knowing. The third and fourth ventricles are joined by a long tube called the aqueduct, which a report may print in full as the aqueduct of Sylvius. When where it sits makes it urgent: the fluid is the section about what happens if the flow through there is held up, and it is worth reading if this is your region.

The floor of the skull

Your report may call this the skull base. It is an umbrella word, and it means the whole floor of the skull, the part the brain rests on. That is how Memorial Sloan Kettering puts it, and it is worth knowing the word covers a wide area rather than one spot.

So "skull base" on its own does not tell you much, and the same center says why in almost those words: the term describes where a tumor is, and the tumors found there are not all the same thing. Its list of the ones that grow on that floor includes five we have written about: acoustic neuroma, chordoma, craniopharyngioma, meningioma and pituitary tumor. That last one has its own entry just below.

The useful question is which part of the floor yours is on, and you can put it to your team in those words.

Behind your nose, at the base of your brain

Your report may call this the pituitary, or it may name the small hollow the gland sits in. That hollow has two names on paper: the pituitary fossa and the sella turcica. Anything called sellar is about the same area.

The gland sits behind the bridge of your nose, below the brain. More than one kind of growth turns up there, and four of the ones we have written about are pituitary tumor, craniopharyngioma, meningioma and germ cell tumor in the brain. Each of those pages starts from the beginning, and the tumor types has the rest.

If sight is your question, when what changed is your sight covers it, including what it means for driving.

This region also carries a warning of its own, and when where it sits makes it urgent: the fluid is where that sits. Read it if this is your region.

When the word you were given is a place

Some of the words people are handed name a place rather than a type. Tectal glioma is one of those words, and it is the one this section works through. If yours is a different place-word, the shape of the answer is the same. The word tells your team where to look. It does not tell them what the growth is.

What the word says. Tectal points at the tectum, which is the back part of the midbrain. The midbrain is one of the three parts of the stalk the brain sits on. So the word is an address with glioma attached to it.

What the word does not say. It does not say what the growth is made of. The place is not a diagnosis is the general form of that. In the small group one study followed, the tissue turned out to be a different thing in different people. That study's own words for where this group belongs do not agree with each other.

Where the fluid comes into it. This is a spot where the fluid can be held up. That same study says a blockage, and the pressure it raises, is the usual way this shows itself. Deep in the middle, where the fluid runs is the entry that names the tube the fluid has to pass through. When where it sits makes it urgent: the fluid is the section to read today if this is your word.

What a team often does about it. Here is what a review of how this is managed in children found. Most of these were watched with repeat scans, rather than having the growth removed. That is not the same as nothing being done. The review says patients often need treatment for the fluid. A procedure to get the fluid moving was the most common operation in it. That is the general point the fluid section below makes, arriving here with a name on it.

"Most" is a word about a group. It is never a prediction about one person, including everywhere this section uses it. What your own team is weighing is a question you can put to them today.

And it is not only a childhood word. Another paper, with adults as well as children in it, reports the same two parts: watch the growth, and deal with the fluid. It also reports that in adults these are more often found by chance. So if you are an adult holding this word, those two parts are usually what a team is working with. Ask your team what is known for yours.

And something this page will not print. No number from any of those papers is on this page. In the review, how often the growth itself was taken out ran from almost never to always, depending on which study was counted. Why there is no list here makes the same kind of case about the whole page.

And do not read an operation out of the word either. Can they just take it out? is where this page keeps the range a team picks from. It says in as many words that a place is not what settles that.

The word is still worth chasing. Ask what it is being called for now is the first step of the path from a place to a name. It works the same way whether or not the word you were handed is a place.

How long before this turns into a plan?

Not on the day of the scan, and that is the honest answer rather than a brush off.

Here is the shape of it. The place is written down first, in the report on the scan. What to do about it comes later, and for a case that is complicated or hard to read it comes out of a meeting where the people who would treat you look at your scans together. Where a piece of the tumor is going to be tested, what it shows usually settles the rest.

So there are usually two conversations rather than one: what we can see, and then what we are going to do. Knowing a second one is coming stops the first one sounding like the whole answer.

This page prints no timings, because they are not this page's to print. Waiting for results owns the wait. It has the figures, where there are honest ones, and it says which parts vary by hospital.

When where it sits makes it urgent: the fluid

A tumor sitting where the fluid has to pass can block it, and a blockage does not wait. That is the whole of this section, and it can matter today.

The fluid around your brain has to pass through some narrow gaps, and a tumor at one of them can hold it up. How a tumor in the brain causes symptoms explains that part in full, and it is on the page for the first week rather than on a page you need a diagnosis to find.

What matters here is what comes next. The American Cancer Society says a blocked flow raises the pressure in the skull, that it can cause headaches, feeling sick to your stomach and drowsiness, and that it can become life-threatening. That is the reason nobody leaves it alone.

And the blockage can be dealt with on its own, without taking the tumor out. There is more than one way to drain the fluid off and bring the pressure down, and none of them is an operation on the tumor itself.

Which means the first operation may be about the fluid rather than the tumor. A drain or a shunt can go in before the operation on the tumor, or after it. In a review of emergencies in this field, doctors describe deciding which to deal with first, the fluid or the tumor, as a real decision they make. So being told "we are going to deal with the pressure first" is not a delay and it is not a change of subject. It is the order of jobs.

Shunts and hydrocephalus is the whole of that subject: what the operation is and what having one is like afterwards. If you already have one, signs a shunt is not working is a stronger list than the general one below, and it is written for you rather than for everybody.

What to do with this today: the list below is the general one for anybody with a tumor in the brain. It says which signs mean an ambulance, which mean calling your team today, and it does not treat those as the same thing. Some places carry rules of their own on top of it, and two of those are just below.

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.

The list above is the general one, and some places have rules of their own. Read the one that applies to you today, while nothing is happening.

If your report says pituitary or sellar, read pituitary tumor once now. A tumor of the gland itself can bleed or lose its blood supply, which brings on a sudden severe headache, and that one is a 911 call rather than a wait for morning. That page has both of its rules in full, and craniopharyngioma has its own version.

If it is in or pressing on your spinal cord, parts of the list above were written for a tumor in the brain, and the signs that matter most for you are different ones. Tumors of the spinal cord sorts them, and it does not treat them all as one kind of urgent.

And those two are not the whole of it. Several tumor types add a rule of their own on their own page, on top of the list above. Wherever you have been given a stronger rule than the one above, the stronger one wins. Over-reacting to a sign costs you a phone call. Under-reacting can cost more than that.

So: start from the list above, take your own type page's rule over it wherever that one is stronger, and if you cannot tell which is yours, tell your team what has changed and let them place it. All of that is easier to read today than on the day you need it.

When what changed is your sight, and what that means for driving

If sight is the thing that changed, this is the section for it. The pathway that carries sight runs a long way through the head, so where a growth sits can change what you see. Driving is the question people ask first, and it is the one this page cannot answer for you.

Get your sight checked before you drive again. Do that first, whatever the rules where you live turn out to say.

Double vision matters here too. If things appear doubled and that has not been corrected, it can make driving unsafe on its own.

What "visual field" means. Your visual field is everything you can see at once while your eyes are still. Losing part of it is not the same as blurriness. A piece of what you would normally see is simply not there.

There is more than one pattern, and which one you have matters. For some people the missing piece is on the same side in both eyes. For others it is the outer edge in both eyes instead. You may hear either one called hemianopia, and that word does not say which. Which one you get depends on where along that pathway the growth presses, so ask your team which one is yours. A smaller missing patch has its own word, scotoma.

This is not a glasses problem, and that part matters. When the pathway itself is affected, new lenses cannot put back what is missing. So reading an eye chart is not proof that your field is whole.

The test for it is a separate test. It maps the whole of what you can see, edge to edge, rather than measuring how sharp the middle is. Your team may call it a field test, or perimetry. Ask for a field test.

Two people missing the same amount can drive very differently. In driving simulator studies, people who had lost the same side in both eyes ranged widely. Some spotted almost no hazards on that side. Others matched drivers who had full vision.

Most of what has been studied is the same-side pattern. If yours is the outer edge in both eyes, or a smaller patch, that does not mean the question is settled. It means it has to be answered for you.

Three things matter. How much is gone. Where in your vision it sits. And how well you learn to sweep your eyes and head toward the side or sides you cannot see. That sweeping can be taught.

So the test does not settle it by itself. A field test says what is missing. It does not say how you drive. That is why being assessed at the wheel is a real option, in a car or in a simulator.

Whether you are allowed to drive is decided where you live, and places differ more than people expect. One state can set a width of vision you have to have. Another state can set none at all. The same eyes, two answers.

Being allowed to drive is not the same as being safe to drive. A place that sets no minimum has not told you that you drive safely. Some people who have lost the same side are assessed as safe to drive, and some are found to steer and react worse.

So your own answer has to come from where you live, and so does when you could drive again. Driving and seizures is where this site puts the driving question. It also has the part nobody plans for: getting to work and to appointments without a car.

One thing that page does not cover. It was written for seizures, and the rule about sight is a separate rule. The state lookup on it is about seizures too. For the sight rule, ask your team or whoever issues your license.

There are people whose whole job this is. An eye doctor measures the field. Ask your team for a referral to an occupational therapist, or to a driving rehabilitation specialist. They can teach the sweeping and set up an assessment at the wheel. Extra mirrors can help.

And it can change in both directions. How much is missing can shift while you are treated. A no now is not always a no later, and a yes gets looked at again. Keep the eye appointments.

Can they just take it out?

This is the question underneath all of it, and there is a real answer, but it is a range rather than a yes or a no.

The American Cancer Society groups the reasons for operating into three. To get a piece of it so it can be named. To take out the tumor, or as much of it as can come out. And to deal with symptoms the tumor is causing. They are not the same operation, and one operation can be for more than one of them. Why am I having one? is the fuller list, with a fourth reason on it and the question to put to your surgeon.

Five things your team can land on. Where the tumor sits is one of the things that decides which.

• All of it comes out. For some types the surgeon can remove the whole thing. For others that is not usually possible, and which group yours is in depends on what it turns out to be.
• As much as is safe comes out. The guideline for one common type says it straight: aiming to get all of it must not cost you how you think or how your body works. What happens in an operation on the brain explains how much came out, what the words in the report mean, and why a partial operation is not a failed one.
• A piece comes out, to find out what it is. For some tumor types surgery is not usually the treatment, and an operation is done only to get tissue. How tissue is taken is that appointment.
• No operation on the tumor. The American Cancer Society gives three examples of when removing it may not be a good option. When it is deep inside the brain. When it is somewhere that cannot be taken out, such as the brain stem. And when somebody cannot have a major operation for other health reasons. Those are examples, not a list of places, and the paragraph below about the brain stem is why that difference matters. Treatment then starts somewhere else, and what it starts with follows what the tumor turns out to be rather than where it sits.
• Nothing yet, and watching instead. Not every tumor is treated when it is found. Watch and wait goes through what is actually being watched, how often, and what happens if it changes.

And the same place can give two different answers. Columbia's neurosurgeons describe this in the brain stem. One kind of tumor there does not spread into the tissue around it, and removing it can be worth doing. Another kind cannot safely be removed, and surgery is not usually recommended at all. Same place, opposite plans, because the tumor is not the same tumor.

Which is why this page ranks no place against another. If one spot can hold both of those answers, a spot on its own was never the answer.

And none of the five is the surgeon giving up. All five are plans, including the one nobody wants to hear. A decision not to operate is a judgment that going in would cost you more than it gave you, and it is made with the years after in view rather than the day itself.

Why there is no list here of which places are dangerous

You have probably looked for one. Every instinct says there should be a table: this spot is fine, that spot is serious. This page does not have one, and the reason is not squeamishness.

Surgeons do not agree on it. A survey of neurosurgeons in twenty-five countries asked them to rate how much different parts of the brain matter. Their answers varied. Most of them said the field needs one agreed definition of that, and only a minority use any of the scales that already exist for it. The authors say plainly that this lack of agreement limits how much that rating can be relied on to describe where a tumor sits.

There is a word for a part of the brain that matters in that sense, and what can go wrong in an operation teaches it, because that is the page where a reader meets it.

The same twelve cases produced different answers. The survey put twelve cases to those surgeons. They differed on how much the spot mattered, on which operation they would do, on whether they would map the brain during it, and on how they would do that mapping. Four separate things, on the same twelve cases.

So a table on this page would be presenting one group's opinion as a fact about your brain. That is not a gap in this site. It is the honest shape of what is known.

What that leaves you with is better than a table anyway. The person who can tell you what your location means is the surgeon looking at your scan. Put the question to them in those words. If their answer is the thing this page cannot give you, that is because it genuinely is theirs to give.

And if two surgeons can weigh the same case differently, wanting a second read of yours follows from that rather than from anything being wrong. Asking somebody else to look goes through how that works, before there is tissue and after.

How to find out what yours is called

A place plus a word is usually enough to find your way around. Here is how to get the word.

• Ask what it is being called for now. Teams often have a working answer before the final one. Ask what is on the scan report and ask them to spell it.
• Ask for a copy of the report on your scan. It is the document the place is written in. Ask how to get one, because hospitals differ on how they hand it over.
• If a piece is taken, the lab result is the name. Your pathology report, part by part goes through the document it arrives in. And if no piece is taken, you get a working answer rather than a confirmed one. Is there a way to find out without one? covers the exceptions it names, and how can they know what it is without a sample? covers the version where nothing is being treated yet. Either way, ask what your team is going on instead, and how sure of it they are.
• Then look it up here. The tumor types is the index, grouped so you can see which family a word belongs to before you read anything.

If the word you were given is not on that list, that is worth knowing rather than worrying about. Some of what people are handed is an address instead of a name, and when the word you were given is a place is the section for that.

Who decides, and how will you hear?

The person who weighs where it sits is a neurosurgeon. They are the one who can look at your scan and say what it means for an operation, and they are the right person to put the question to.

The decision is often not made by one person alone. That is what the meeting above is, and the meeting about your case explains who is in the room and what comes out of it.

Before you leave, get two things: how the answer reaches you, and who to chase. Whether that is a phone call, a letter or the next appointment is a local arrangement, and it differs from hospital to hospital. Ask what to do if nothing arrives, and write down a name.

What to ask your surgeon

• Where exactly is it, and can you show me on the scan?
• What is right next to it that you are thinking about?
• Is an operation on the table, and what would the aim of it be?
• If all of it cannot come out, what decides how much does?
• Is the fluid draining normally, and is that something we need to deal with first?
• Does where it sits change what happens before the operation, like extra scans or being awake for part of it?
• If you are not operating, what are we doing instead, and when?
• Would another surgeon be likely to see this the same way?
• What would make you change this plan?
• Which of my symptoms come from where it sits, and which come from the pressure?

Where to go next

• The tumor types is the way in if you have a word for yours.
• If you have just been told there is something on your scan is the page for the first week, and it is where what a tumor in each place tends to cause is explained.
• What happens in an operation on the brain is the operation itself, start to finish, and the report words that follow it.
• Being awake for part of an operation explains why a team suggests it and what it is like.
• The extra scans before treatment goes through the extra appointments that sometimes come before an operation, and what each one is for.
• Shunts and hydrocephalus is the fluid, in full.
• Waiting for results is the wait between the scan and the plan.