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Active monitoring or Watch and Wait for a brain tumour

For some low grade, slow growing tumours, immediate treatment may not be necessary. Instead, specialists may recommend a ‘Watch and Wait’ approach. This is also known as active monitoring.

Unless your symptoms develop or your scan changes, you may not need treatment straight away and will continue to be closely monitored and receive regular check-ups.

The most common brain tumours to receive a ‘Watch and Wait’ approach are newly diagnosed low grade gliomas, such as  grade 1 or 2 astrocytomas and grade 2 oligodendrogliomas, and grade 1 meningiomas.

On this page, we’ll cover:

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Video of Gideon Burrows discussing active monitoring and living with a low grade brain tumour

Live recording: Living with a low grade tumour

Please watch the recording of our live panel discussion about living with a low grade tumour. The discussion is chaired by Gideon Burrows, who is also living with a low grade tumour.

What is ‘Watch and Wait’ or active monitoring for brain tumours?

Some brain tumours grow slowly and are unlikely to spread. They can cause few or no symptoms for many years.  In these cases, specialists may recommend a ‘Watch and Wait’ or active monitoring approach rather than give treatments that can cause considerable side-effects.

Examples where this might be the case include:

  • Tumours with no symptoms that were discovered by chance e.g. following a scan for a head injury
  • Tumours in which the symptoms are not adversely affecting your quality of life e.g. seizures that are controlled by anti-epilepsy drugs
  • The tumour is growing in an area that’s difficult to operate on and treatment will cause more harm than doing nothing
  • You choose to not have surgery or receive treatment.

Active monitoring is also sometimes used after initial treatment, such as biopsy or debulking surgery where part of the tumour is removed, before giving other treatments that could cause worse side-effects.

How does active monitoring work?

If you’re on ’Watch and Wait’, you’ll see your specialist for regular check-ups/MRI scans. Having MRI (Magnetic Resonance Imaging) scans means that the size and features of your tumour can be very accurately monitored and compared over time. These can vary in frequency, from every few months to every couple of years.

You might begin treatment if:

  • there’s a marked increase in tumour size
  • you develop symptoms, or worsening of symptoms, that badly affect your quality of life
    e.g. uncontrollable seizures
  • the tumour becomes a higher grade (starts growing more quickly).

Depending on your tumour and age, this could take many years, or not happen at all.

I utilised my hobbies, such as running, which helped my mental health and allowed me to de-stress.

Emotional impact of active monitoring, or ‘Watch and Wait’

Being told that you have a brain tumour, but no active treatment will be given until it grows bigger, or becomes more aggressive, can be very frightening. The time between appointments can also seem (or be) long.

People who’ve been put on active monitoring have told us about what they have found to help. These include:

  • learn more about your tumour and the support that’s available – it can make you feel more in control
  • learn more about available treatment options before you have to make any decisions about how you want to proceed
  • ask how far apart your appointments will be – so you know what to expect – and whether there’s a named contact
  • ask your health team for advice about when to contact a healthcare professional with regard to new or changing symptoms
  • keep a notebook in which you can write any questions that you have for your next appointment. Write them down as they come to mind
  • keep your own files of every appointment and what was discussed
  • talk to your family and friends – about the risks and benefits and how you’re feeling
  • speak to others in the same situation – we have several online support communities that you can access from anywhere in the world and at any time. You can ‘meet’ other brain tumour patients and carers and discuss your worries or fears and share ideas
  • consider whether talking to a professional counsellor could help. We run a free counselling service for people affected by a brain tumour.

Tips from our community

“I think people tend to assume I am okay as I on watch and wait. I still get symptoms though and have good and bad days. Sometimes I have to give myself a gentle reminder that it’s ok to not be okay.”

“Initially I really wanted my brain tumour out, but now I just really want it to behave long enough to not need further treatment. It’s a personal choice and is important to talk through all the pros and cons with your consultant.”

“If you are not happy being on watch and wait, you are entitled to ask for a second opinion, just to be sure.”

“I had CBT counselling to help me to manage the anxiety that being on watch and wait gave me. I try to recognise when I am worrying, remind myself that it’s unhelpful and then refocus my mind to something else. Your GP should be able to refer you.”

By joining one of our Online Support Communities, you can get more tips about living with or beyond a brain tumour diagnosis from people who truly understand what you’re going through.

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NICE (2021). Brain tumours (primary) and brain metastases in adults, NICE guideline [NG99]. Nice

Macmillan Cancer Support. Astrocytoma – Active Monitoring section. Macmillan Cancer Support

Jakola et al. (2017). “Surgical resection vs watchful waiting in low‑grade gliomas”, Annals of Oncology, 28(8): 1942–1948; long-term survival data of early vs delayed surgery. PMCpubmed.ncbi.nlm.nih.gov

Practical Neurology (2024). Review of surveillance vs early treatment in low-risk grade 2 gliomas. practicalneurology.comCancer Network

European Low-Grade Glioma Network survey on postoperative management trends. PMC

EANO guidelines on glioma management emphasize judicious use of interventions vs surveillance. Nature

If you have further questions, need to clarify any of the information on this page, or want to find out more about research and clinical trials, please contact our team:

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Brain Tumours: Living Low Grade by Gideon Burrows

The patient guide to living with a slow growing tumour. Read more about his experiences and those of many others as they came to understand their diagnosis and learned how to live low grade.