Glossary of Brain Tumour Terms
16,000 people diagnosed with a brain tumour every year
Glossary of Brain Tumour Terms
A term used to describe a number of different types of tumour, meaning that at this stage the tumour is formed of cancer cells that are dividing rapidly and have little or no resemblance to normal cells.
A protein produced by the immune system to recognise and attach itself to an antigen that identifies something such as a virus, bacteria or cancer cell as “not self” and therefore potentially a threat. The antibody then either neutralises or destroys the cell that has been identified.
An antigen is a substance that is recognised by antibodies as being ‘non-self” and therefore posing a potential threat to our health, hence stimulating an immune response.
The process that enables our bodies to destroy cells that are faulty or at the end of their natural life cycle.
Association of Medical Research Charities (AMRC)
This is a coalition of UK research funding charities. There 140 member charities, who together spend over £1.4 billion a year on research here in the UK. In order to join the AMRC, a charity has to demonstrate transparency by the use of peer-review on all research applications, as well as publishing a research strategy. Research funded by an AMRC member attracts an additional 26% of its value to cover the cost of University overheads and this is funded by the Charity Research Support Fund.
This term is usually used to describe a low-grade tumour which grows slowly and is unlikely to invade into the surrounding brain tissue.
Biopsy for brain tumours
A biopsy is a form of neurosurgery in which a hollow needle is passed into the brain tumour in order to take small samples from various areas within that tumour. The samples are then sent for analysis in order to determine a precise diagnosis.
For full genetic profiling freshly frozen tissue samples are crucial, although paraffin embedded samples (the more traditional, less expensive way to preserve brain tissue) provides enough information to make a diagnosis that is detailed enough to guide the planning of treatment currently available on the NHS in the UK.
Because it is so sensitive, the brain needs to be protected from toxic factors which may be present in the blood. So, a specific membrane called the blood-brain barrier surrounds the blood vessels within the brain to prevent the passage of these agents into the brain. However, it can also prevent certain drugs from entering the brain and this is why some drugs, which have been developed for other tumours, are ineffective for the treatment of brain tumours.
There is one cannabis-based drug, Sativex, which is licensed for the alleviation of spasticity in people with multiple sclerosis. The active ingredients, which are derived from the cannabis plant, are called cannabinoids. These compounds are also contained in cannabis oil, although usually at a much lower concentration. Some people have used cannabis oil as a potential treatment for their brain tumour, although there is no evidence that it is of benefit. Because cannabis oil is available to purchase without prescription, primarily over the internet, it is not considered as a medicinal product. Therefore, the quantity and nature of the cannabinoids present may vary and there is no quality control process to monitor the contents.
Cerebral spinal fluid
The fluid that surrounds and protects the brain and spinal cord.
The tissues in the ventricles that actually make cerebral spinal fluid.
The use of drugs to treat cancer is referred to as chemotherapy. These drugs act to halt the growth of the tumour cells, or to kill them. While there are many different types of drugs available, the majority of these can’t be used for the
treatment of brain tumours because they can’t cross the blood-brain barrier to get to the site of the tumour. The most common drug used for the treatment of brain tumours is temozolomide.
DCVax® are personalised immunotherapy treatments for solid tumour cancers developed by a company called Northwest Biotherapeutics. DCVax®-L is the name of vaccine developed for treating glioblastoma (GBM), the most common and aggressive brain tumour in adults.
How does DCVax®-L work?
Cancer cells are capable of ‘fooling’ the immune system so that they can grow and spread undetected by the body’s natural defence system in a process known as immunosuppression.
DCVax®-L works by training the cells of a patient’s immune system to recognise their tumour, enabling the immune system to then identify and attack tumour cells helping to reduce tumour size and hamper progression.
In order to do this, DCVax®-L takes a 2-3g sample of the tumour and exposes this to the patient’s own immune cells that have been isolated from a blood sample. The cells then learn to recognise unique characteristics of the tumour cells, such as proteins and receptors, also known as antigens. The trained immune cells are then injected back into the patient where they pass on this new information to more cells within the immune system to attack the cancerous cells together.
What does the treatment entail?
The process of creating a batch of newly trained immune cells takes 8 days. The cells are then frozen in individual doses, stored centrally and delivered to the physician when required.
A patient will have 6 intradermal (into the skin) injections in their upper arm over the course of one year. They will then have two injections a year for maintenance after that.
The vaccination protocol takes place alongside current standard of care for GBM patients, which in the UK consists of surgical removal of the tumour followed by radiotherapy and chemotherapy (temozolomide).
What are the treatment outcomes for DCVax®?
Published in the phase III trial results of DCVax®-L on 17th Nov 2022, the median overall survival for a newly diagnosed GBM patient treated with the vaccine was 19.3 months from randomisation in the trial (22.4 months from their initial surgery). For a patient receiving standard care only, the median survival was 16.5 months.
In addition, 13% of patients treated with the vaccine survived at least 5 years from diagnosis, compared to 5.7% in the standard of care only group.
Response to the vaccine differs for different GBM tumour types, however. For instance, patients with a GBM type which has a methylated MGMT gene that were treated with the vaccine survived on average 30.2 months from randomisation in the trial (33 months from surgery) compared to 21.3 months for the standard of care only group.
Are there any side effects from the treatment?
The vast majority of patients treated with the vaccine reported no side-effects.
Is DCVax®-L available to patients on the NHS?
No, DCVax®-L is an emerging treatment that has recently published its results from a final phase 3 clinical trial. It is not currently available on the NHS
This refers to the removal of at least part of a tumour by surgery so that there is less tumour present for subsequent treatment by chemotherapy or radiotherapy.
Diffuse Brain Tumour
A diffuse brain tumour is one that does not have a clear boundary, instead infiltrating healthy brain tissue, spreading between and around surrounding brain cells.
DNA stands for deoxyribonucleic acid. It contains the genetic information that provides the instructions for our body to make proteins with a huge range of different functions.
Grade 3 — the tumour cells grow quickly, are likely to spread into nearby tissue, and the tumour cells look very different from normal cells.
Grade 4 — the tumour grows and spreads very quickly. These tumours can be difficult to treat and not be removable by surgery, depending on the size, location within the brain and the extent to which they have invaded the surrounding tissue.
This is the study of the cells and tissues under a microscope. It involves the preparation of a thin slice of tumour tissue using a specialised cutting device and placing it on a glass microscope slide. This can then be examined in order to obtain specific information about a tumour such as its type and grade.
Reduces the immune system response, making it less effective.
Although tumours are different to normal cells and should be identified as “foreign” by our immune system, they use specific mechanisms to prevent this from happening and essentially puts the immune cells near the tumour into hibernation. Immunotherapy refers to the reawakening of the immune system in order to allow it to attack the tumour cells. There are two main approaches being used. One stimulates the cells into action, and these drugs are called checkpoint inhibitors. An example of this is the drug nivolumab which has undergone clinical trials which were unsuccessful. However, other trials using similar drugs are in the planning stage. The second is to use a vaccination approach. This involves the generation of a part of the surface of the tumour that can be injected into the body to produce antibodies which can attack the tumour cells.
Soluble aspirin forms a suspension and appears as a cloudy solution rather than fully dissolving in water. Because it is not fully soluble, only a small amount will cross the blood-brain barrier to enter into the brain. By combining aspirin with another compound which itself has no action in the brain, researchers have developed a truly soluble form of the drug which is more likely to enter the brain. Initial studies using brain tumour cells grown in the lab suggest that this form of aspirin may kill the cells and trials are currently being planned to see whether this effect can be seen in the brain itself.
Grade 1 — the tumour grows slowly and rarely spreads into nearby tissues. Depending on its location, it should be possible to remove the entire tumour by surgery.
Grade 2 — the tumour grows slowly, but may spread into nearby tissue and the tumour may regrow at some stage following surgery. Some tumours may develop to form a higher-grade tumour.
Lysed tumour cells
Lysed tumour cells have had their cell membrane broken so that their contents have spilled out, resulting in the death of the tumour cells.
These are high grade tumours where the cells are growing rapidly and are actively invading neighbouring brain tissue.
Metastatic brain tumour
One that has developed from a type of cancer that began in another part of the body and then spread to the brain through the blood stream or lymphatic system.
A molecular marker, also known as a genetic marker, is a fragment of DNA that is related to a particular area on the genome. Your genome contains all of the genetic information needed to build and maintain your body. Because they are specific to certain areas, molecular markers can be used to identify the position on your genome of a specific genetic mutation that gives rise to a mutated protein and hence a particular characteristic or behaviour. For example, will a particular type of brain tumour grow slowly or aggressively, and will it respond well to certain drugs.
Molecular markers are identified using biochemical analysis (genetic profiling) of a brain tumour sample removed during surgery (biopsy). The genetic profile of a brain tumour can then be used to diagnose the exact type and sometimes guide certain treatments that have been shown to benefit tumours that carry the same molecular marker.
Insulates the neurons in the brain in order to ensure that electrical impulses are carried safely and effectively.
A doctor who specialises in the prevention, diagnosis and treatment of cancer is called an oncologist. Those who focus on the treatment of brain tumours are referred to as a neuro-oncologist.
An ophthalmologist a medically qualified doctor who has undergone specialist training in the diagnosis and treatment of eye conditions, and is usually also qualified as an eye surgeon. If an ophthalmologist discovers a brain tumour during an eye examination, they can provide a referral to a neurosurgeon.
An optometrist prescribes and fits glasses and contact lenses, and is trained to understand the mechanisms of the eye, including health conditions such as a brain tumour that may present itself with symptoms affecting sight. If an optometrist discovers symptoms that indicate a brain tumour, a GP can provide a referral to a neurologist or a neurosurgeon for further investigation.
This is a new type of therapy called “Tumour Treating Fields”. It involves the placing of electrodes onto a person’s shaved skull which are then kept in place by a skin-tight cap. These are connected to a battery which is carried around for 18 hours per day. While the results look promising, further research is required in order to understand who would benefit from the treatment. The high cost makes it unlikely to be available on the NHS in near future.
This describes the study of various aspects of a disease including its cause, mechanisms of development, the structural alterations of cells and the consequences of the changes that are observed. It is mostly concerned with analyzing specific changes that have been identified as markers of a disease. A clinical pathologist will use a number of different techniques, including histology, in order to make a diagnosis and this will provide information on what treatment should be used. A pathologist works in close collaboration with clinical staff including oncologists.
It is vital that Brain Tumour Research only funds the highest quality research. Following submission, we send all funding applications to world experts in the specific field and ask them to examine the research proposals in detail. We will only fund research which has received the highest quality reviews from the experts.
Short chains of amino acids, which become classed as proteins once they join together to form longer chains.
Peripheral nervous system
The peripheral nervous system connects the central nervous system (CNS) that lies inside the brain and spinal cord, to other organs.
Peripheral nerves are the 12 cranial nerves (that originate from the brain and brainstem), the nerves in the spine and the autonomic nerves. Autonomic nerves control automatic functions of the body such as regulating the muscles that control heartbeat, the muscles that line blood vessels (hence supporting blood flow around the body), and the functions of glands.
Proton beam therapy
This is a new form of radiotherapy which uses a specific form of radiation called proton beams. It is considered to be more accurate than existing radiotherapy with less damage to the tissue surrounding the tumour.
This is also referred to as radiation therapy and is a treatment using radiation as part of cancer treatment to control or kill tumour cells. It can be administered along with chemotherapy in certain forms of cancer. However, further research is required to identify which types of brain tumour will respond best to this form of therapy.
Surgery to remove part or all of a brain tumour.
RNA stands for ribonucleic acid. RNA’s main role is to act as a messenger, copying the instructions contained within the DNA of our cells in order to then use those instructions to make proteins. However, in some viruses, RNA itself carries the genetic blueprint for the organism.
Spinal cord central canal
A fluid-filled space down the centre of the spinal cord.
Types of brain tumours
There are many different types of brain tumours – the WHO have listed over 120 in their 2016 guidelines. The type of tumour depends on its location within the brain, the cells from which it originated, the pathology and its genetic make-up. This will also influence the shape and size of the tumour as well as its growth rate. Tumours can be classified as low-grade or high-grade, depending upon their nature.
T cells protect the body from infections (and cancer) by specifically recognising anything ‘non-self’, such as viruses and bacteria, and killing infected cells. T cells can also recognise and eliminate tumour cells, because tumour cells make many mutated proteins, which are seen by T cells as “non-self”. Activation of an anti-tumour T cell response is the ultimate goal of immunotherapy.
The fluid-filled spaces of the brain.