Watch and wait

For some low grade, slow growing tumours that are unlikely to spread, a 'watch and wait' approach may be used. This means closely monitoring your condition without giving any treatment unless symptoms develop, or worsen, or your scan changes.

The most common types of brain tumours to receive a watch and wait approach are newly diagnosed low grade gliomas (grade 1 or 2 astrocytomas, grade 2 oligodendrogliomas) and grade 1 meningiomas.

Why is 'watch and wait' used?

For tumours that are typically slow growing, unlikely to spread and may not cause any, or only a few, symptoms for many years, a 'watch and wait' approach may be used 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 accident', for example, following a scan given for a head injury

• tumours in which the symptoms are such that you feel able to live with without them badly affecting your quality of life, for example, seizures that are being well-controlled by anti-epilepsy drugs

• the tumour is growing in an area that is difficult to operate on and possible treatments will cause more harm than doing nothing

• you did not want to have surgery or other treatments.

'Watch and wait' 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 'watch and wait' work?

If on 'watch and wait', you will see your specialist for regular check ups/MRI scans every 3, 6 or 12 months. You might begin treatment if:

• there is a marked increase in tumour size

• you develop symptoms, or worsening of symptoms, that badly affect your quality of life - for example, uncontrollable seizures

• the tumour becomes a higher grade

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

Emotional impact of '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 very long, leaving you feeling isolated.

Some things that can help include:

• learning more about your tumour and the support that is available

• learning more about available treatment options before you have to make any decisions about how you want to proceed

• asking your health team for advice about when to contact a healthcare professional with regard to new or changing symptoms

• asking how far apart your appointments will be, so you know what to expect and whether there is a named contact

• keeping your own files of every appointment and what was discussed

• speaking to others in the same situation

Some people feel more secure by wearing a medic-alert bracelet in case of accidents or seizures.

Getting a second opinion

If you are uncertain about the decision to watch and wait, you can ask your consultant or health team for a second or further opinion, either on the NHS or privately.

Although there is not a legal right to have a second opinion a healthcare professional will rarely refuse to refer for one. They will not be offended and your care will not be affected.

Advantages:

• if both doctors are in agreement, you will feel more confident about their decision

Disadvantages:

• delay to treatment

• it may be upsetting to hear the same information

• you may find it difficult to decide which treatment to have, if something different is suggested.

Page last reviewed: 06/2014
Next review due: 06/2017