Prognosis and Duration
Primary brain tumours
There are around 100 different types of brain tumour and prognosis is highly variable between them. For this reason guidance on award duration is provided by tumour diagnosis in the table below. In order to use the table the correct histological diagnosis must be known. This information is most likely to be available from the Clinical Nurse Specialist, treating neurosurgeon, treating neuro-oncologist or the GP. Accurate information on impairment is most likely to be available from the Clinical Nurse Specialist or GP.
For many tumours awards are recommended for one year in the presence of neurological deficits if needs are identified. This is because function may improve significantly over time especially with neurorehabiliation. For example a person may learn how to walk again or their personality may substantially return to normal. Review at one year assesses residual impairment once neurorehabilitation is complete. Once recovery is complete needs may be absent or reduced. In cases where disease progresses despite treatment needs are likely to increase.
Recurrent brain tumours
If needs are identified indefinite awards are recommended.
Types of adult brain tumours with information on prognosis.
See WHO classification of brain tumours. Grade of tumour indicates whether a tumour is benign or malignant and if malignant how aggressively it will behave.
| Name of brain tumour | Features |
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Astrocytic tumours There are several different types of astrocytoma. This type of tumour occurs more frequently in people who have had radiation treatment to the head. |
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Pilocytic astrocytoma (WHO grade 1) |
This is a slow growing type of tumour that has a good prognosis, it is often curable. The main treatment is surgery very occasionally followed by radiation therapy. If needs are identified 1 year time limited awards are recommended. Recovery is expected in the typical case. |
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Diffuse astrocytoma/low-grade diffuse astrocytoma (WHO grade 2) including 3 different subtypes:
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These tumours typically affect young adults and are treatable. The mean survival time after surgical treatment is 6-8 years. If needs are identified 1 year time limited awards are recommended, if needs persist on review indefinite awards are recommended. It is recognised that gemistocytic astrocytomas have a worse prognosis and are treated like anaplastic astrocytomas. |
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Anaplastic or malignant astrocytoma (WHO grade 3) |
Typically affects people around the age of 40 . These tumours can be treatable but not curable. Typically they progress to glioblastoma which is a higher grade tumour within about 2 years. The main treatment is surgery followed by radiation therapy. Young people whose initial treatment successfully removes all of the tumour are most likely to do well; although removal of all the tumour with clear margins is unusual. If needs are identified 1 year time limited awards are recommended, if needs persist on review indefinite awards are recommended. |
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Glioblastoma/ malignant glioma/glioblastoma multiforme (WHO grade 4) includes 3 different sub-types:
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This is the commonest type of brain tumour – around 20% of all brain tumours. It is one of the most aggressive human cancers and median survival is less than one year. 2 year survival is 5-10%.Radiotherapy can prolong median survival from 14 weeks to 38 weeks but may not reverse any disabilities. Rapidly progressive disability is likely, needs are likely. Indefinite awards with routine review are recommended in all cases. |
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Pleomorphic xanthoastrocytoma |
Is very rare it usually affects young adults. Recurrence free survival rates of 71% at 5 years and 61% at 10 years are reported. If needs are identified 1 year time limited awards are recommended. Recovery can be expected in the typical case. |
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Subependymal giant cell astrocytoma (SEGA) (WHO grade 1) |
Very slow growing treatable tumour that mainly affects people with tuberous sclerosis (a rare genetic disorder). If needs are identified 1 year time limited awards are recommended. Recovery is expected in the typical case, however there may be ongoing needs unrelated to the brain tumour in this group. |
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Oligodendroglial tumours: there are two types of this tumour see below – this group has a median postoperative survival time of 3 to 10 years. This type of tumour is likely to be treated with radiotherapy or chemotherapy and survival is good if response to treatment is complete. |
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Oligodendroglioma (low grade, WHO grade 2)) |
Well differentiated tumour that often responds well to treatment, recovery is possible in the typical case. If needs are identified 1 year time limited awards are recommended, if needs persist on review indefinite awards are recommended. |
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Anaplastic oligodendroglioma (WHO grade 3). |
Poorly differentiated tumour with a worse outcome than low grade oligodendroglioma. If needs are identified 1 year time limited awards are recommended, if needs persist on review indefinite awards are recommended. |
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Mixed gliomas |
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Oligoastrocytoma (low grade, WHO grade 2) |
Median survival time with treatment of 6 years. If needs are identified 1 year time limited awards are recommended, if needs persist on review indefinite awards are recommended. |
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Anaplastic Oligoastrocytoma (WHO grade 3) |
These are high grade tumours with outcomes similar to other malignant astrocytomas. If needs are identified 1 year time limited awards are recommended, if needs persist on review indefinite awards are recommended. |
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Ependymal tumours |
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Myxopapillary ependymoma (WHO grade 1) |
Commonly affects people aged between 30 and 40. Commonly affects the lower end of the spinal cord – survival is excellent. recovery is expected in the typical case. If needs are identified 1 year time limited awards are recommended, if needs persist on review indefinite awards are recommended. |
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Subependymoma (WHO grade 1) |
Usually affects middle aged and elderly men – usually cured by surgery. Recovery is expected. Needs unlikely. If needs are identified 1 year time limited awards are recommended |
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Ependymoma (WHO grade 2) |
Affects young adults. 5 year median survival 57% and 10 year median survival 45%. Can occur in the spine and cause paraplegia that is permanent. Recovery from initial treatment is expected in the typical case. If needs are identified 1 year time limited awards are recommended, if needs persist on review indefinite awards are recommended. |
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Anaplastic ependymoma (WHO grade 3) |
Prognosis is possibly worst in very young people. If needs are identified 1 year time limited awards are recommended, if needs persist on review indefinite awards are recommended. |
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Neuroepithelial tumours of uncertain origin |
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Astroblastoma |
Affects young adults. Very rare. If needs are identified 1 year time limited awards are recommended, if needs persist on review indefinite awards are recommended. |
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Choroid glioma of the third ventricle |
Rare and slow growing but difficult to treat. If needs are identified 1 year time limited awards are recommended, if needs persist on review indefinite awards are recommended. |
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Gliomatosis cerebri |
Rare. Widely infiltrating aggressive tumour with median survival of less than one year. Rapidly progressive disability is likely, needs are likely. Indefinite awards with routine review are recommended in all cases. |
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Neuronal and mixed neuronal-glial tumours |
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Gangliocytoma Ganglioglioma Anaplastic ganglioglioma Dysembryoplastic neuroepithelial tumour Central neurocytoma Cerebellar liponeurocytoma (lipomatous medulloblastoma) |
All of these tumours are very rare. The main treatment is surgery sometimes followed by radiation therapy. If needs are identified 1 year time limited awards are recommended. |
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Embryonal tumours |
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Medulloblastoma |
Affects young adults, 5 year survival is between 50% and 70%. Recovery from initial treatment is expected in the typical case. If needs are identified 1 year time limited awards are recommended, if needs persist on review indefinite awards are recommended. |
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Choroid plexus tumours |
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Choroid plexus papilloma |
Often cured by surgery 5 year survival around 100%. Recovery expected in the typical case. |
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Choroid plexus carcinoma |
2 year survival less than 40%. Recovery from initial treatment can be expected in the typical case. If needs are identified 1 year time limited awards are recommended, if needs persist on review indefinite awards are recommended. |
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Pineal parenchymal tumours |
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Pineocytoma |
Affects young adults. 5 year survival 88%. If needs are identified 1 year time limited awards are recommended. Recovery is expected in the typical case. |
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Pineoblastoma |
5 year survival 58%. Recovery from initial treatment is expected in the typical case. If needs are identified 1 year time limited awards are recommended, if needs persist on review indefinite awards are recommended. |
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Pineal parenchymal tumours of indeterminate differentiation |
Variable outcome. If needs are identified 1 year time limited awards are recommended, if needs persist on review indefinite awards are recommended. |
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Meningeal tumours – these tumours are WHO graded I-III. WHO grade determines prognosis. |
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Meningioma grade I |
Cured by surgery in 80-90% of cases. If needs are identified 1 year time limited awards are recommended. Recovery is expected in the typical case. |
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Meningioma grade II |
Cured by surgery in 60-70% of cases. If needs are identified 1 year time limited awards are recommended. Recovery is expected in the typical case. |
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Meningioma grade III/anaplastic Meningioma |
Median survival of less than 2 years. If needs identified indefinite award with routine review recommended. |
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Haemangiopericytoma |
Responds well to initial treatment but recurs in 90% of cases over 15 years. Recovery from initial treatment is expected in the typical case. If needs are identified 1 year time limited awards are recommended, if needs persist on review indefinite awards are recommended. Indefinite awards recommended on recurrence. |
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Melanocytic lesions |
Poor prognosis. If needs identified indefinite award with routine review recommended. |
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Pituitary tumours |
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Benign adenomas of the pituitary gland |
Around 80% of this group experience resolution of symptoms with treatment. Needs unlikely, recovery expected. Good long term prognosis. Rarely visual field problems will persist after treatment. May require hormone replacement. |
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Carcinomas of the pituitary gland. |
Median survival of around 2 years. If needs identified indefinite award with routine review recommended. |
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Craniopharyngoma |
Good prognosis with combined modality treatment (surgery and radiotherapy). 10 year recurrence free survival of 60-90%. Needs depend on initial deficits (visual, hypothalamic). If needs are identified 1 year time limited awards are recommended, if needs persist on review indefinite awards are recommended. |
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Capillary haemangioblastoma |
Good prognosis. Most commonly occurs in association with a genetic disorder called von Hippel-Lindau disease. Recovery is expected in the typical case, however there may be ongoing needs unrelated to the brain tumour in this group. |
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Schwannoma/neurilemoma/neurinoma |
Usually benign tumour often cured by surgery. If needs are identified 1 year time limited awards are recommended. Recovery is expected in the typical case. |
You may need to consider whether H/R Mob SVI deeming provisions are satisfied. See H/R Mobility Severely Visually Impaired (SVI) deeming provisions.
All information must be taken into account when considering the duration of disabling effects and the duration of disabling effects must be based on the particular circumstances of the individual claimant.
Amended April 2011
