Stage 4 Brain Cancer

Nov. 14, 2025

This page was reviewed under our medical and editorial policy by Keng Lam, M.D., assistant clinical professor, Department of Medical Oncology & Therapeutics Research, City of Hope^® Cancer Center Duarte.

Staging is a way doctors describe how much cancer there is in the body and where it has spread. But brain cancers are different. Since they usually stay within the brain and rarely spread to other parts of the body, they don’t follow the traditional cancer staging system.

Instead, for primary brain tumors that start in the brain, doctors use a system called grading. Grading helps determine how fast the tumor may grow by looking at the cells under a microscope. Tumors are graded from 1 to 4, with grade 4 being the most advanced.

Most brain tumors diagnosed in adults are not primary — they’re brain cancer metastases, meaning they started in another part of the body and spread to the brain. In these cases, brain cancer staging depends on the original cancer site.

What Is Grade or Stage 4 Brain Cancer?

Some brain tumors grow slowly and stay in one place, while others grow quickly and spread into nearby tissue. Grade 4 tumors are the most aggressive and are considered advanced disease because they tend to grow and spread quickly within the brain or spinal cord.

Tumors are usually graded from 1 to 4 based on how the cells look under a microscope:

Lower grade brain tumors (grade 1 or 2): These tend to grow slowly and are less likely to spread into nearby brain or spinal cord tissue.

Higher grade brain tumors (grade 3 or 4): These grow faster, are more likely to invade nearby tissue and usually require more aggressive treatment.

According to the World Health Organization’s 2021 Classification of Nervous System Tumours, several types of brain tumors can be classified as grade 4, including:

• Glioblastoma
• Astrocytoma
• Diffuse midline glioma with an H3 K27 gene mutation
• Diffuse hemispheric glioma with an H3 G34 gene mutation
• Embryonal tumors

Grade 4 Brain Cancer Symptoms

As brain tumors grow, they can cause different symptoms depending on their size, location in the brain and how fast they’re growing. Some brain tumor symptoms may develop gradually, while others may arise more suddenly.

Common symptoms include:

• Headaches
• Seizures
• Trouble thinking clearly, speaking or finding words
• Changes in personality or behavior
• Weakness, numbness or difficulty moving one part or side of the body
• Trouble with balance or dizziness
• Changes in the senses, like hearing, vision or smell
• Memory loss
• Unexplained nausea or vomiting
• Fatigue or muscle weakness

Other possible symptoms include:

• Abnormal eye movements
• Difficulty swallowing
• Trouble walking
• One side of the face drooping or feeling weak
• Slurred speech
• Loss of appetite or weight loss

If any of these symptoms occur — especially if they’re new, worsening or don’t go away — talk to a doctor right away.

Grade 4 Brain Cancer Treatment

Doctors consider several factors when determining optimal treatment for brain tumors, including tumor type and location, how much it has grown or spread, whether there are specific changes in the tumor’s genes or chromosomes, and a person’s age and overall health.

Treatment options for glioblastomas or grade 4 astrocytomas — the most common malignant brain tumors in adults — include the following:

Surgery to remove as much of the tumor as possible without harming critical areas of the brain is usually the first step in treating grade 4 brain cancer. In the case of glioblastomas, they tend to spread into nearby brain tissue, so they can rarely be removed completely.

Radiation therapy is typically the next step and may be combined with chemotherapy, depending on a person’s overall health. Some people — especially those who are older, have other health concerns, or whose tumor has specific gene changes — might receive just chemo or radiation, but not both.

A combination of radiation and chemotherapy is usually recommended If the tumor can’t be removed with surgery. Temozolomide is the most common chemo for glioblastoma because it reaches the brain and comes in pill form. It’s often given during and after radiation. Other chemo drugs, like carmustine and lomustine, or combinations like PCV (procarbazine, CCNU and vincristine), may also be used to slow the tumor’s growth.

If standard chemo stops working for a grade 4 brain tumor patient, a targeted therapy called bevacizumab may help. Another option is tumor treating fields (TTF), a wearable device (Optune Gio) that uses electrical fields to slow tumor growth.

Clinical trials may offer access to promising new therapies.

Grade 4 Brain Cancer Survival Rate

With brain cancer, doctors estimate a person’s outlook by looking at several key factors, including:

• Age
• How the tumor affects daily function and activity
• Tumor type, size and location
• Whether the tumor cells have certain gene changes
• If surgery is possible and how much of the tumor can be safely removed
• Whether the tumor has spread in or beyond the brain, spinal cord or nervous system

These details help guide treatment and give a clearer picture of what to expect.

The National Brain Tumor Society estimates that the overall relative survival rate for someone with a malignant brain tumor is about 35.7%, but that number isn’t specific to grade 4 tumors.

All glioblastomas are considered to be grade 4, and the American Brain Tumor Association has shared five-year relative survival rates for this brain tumor type. This number describes how someone with that type of cancer lives compared to people without that cancer type.

The five-year relative survival rate for glioblastoma is 5.6% among adults, 27.3% among those ages 15-39 and 19.5% for children 14 or younger.

Patients with grade 4 brain cancer should speak to the care team to get a personalized prognosis based on their cancer subtype, overall health and other factors.