Adult papillary meningioma is a rare brain or spinal cord tumor that tends to grow more quickly than typical meningiomas. People with adult papillary meningioma may notice headaches, seizures, weakness, or vision changes, and doctors may see swelling or pressure on scans. It can recur and progress over time, so ongoing follow‑up is important. Treatment usually includes surgery, and radiation is often added to lower the risk of return. Outcomes vary by tumor location and how much is removed, but many people do well with timely care and regular monitoring.
Overview
Adult papillary meningiomaSymptoms
Adult papillary meningioma often causes headaches, seizures, or nausea, plus vision, speech, or balance problems. Some notice weakness, numbness, or personality changes. Symptoms depend on tumor location and may worsen quickly compared with typical meningiomas.
Outlook and prognosis
Adult papillary meningioma tends to behave more aggressively than most meningiomas, with a higher chance of returning after treatment. Outcomes improve with complete surgical removal and carefully planned radiation. Regular MRI follow‑up helps catch recurrences early and guide next steps.
Causes and risk factors
Adult papillary meningioma usually stems from acquired DNA changes in meninges; rarely, it’s tied to inherited NF2. Risk rises after prior cranial radiation, with female hormones, older age, and higher body weight. Many cases have no identifiable cause.
Genetic influences
Genetics play a meaningful role in adult papillary meningioma, though most cases are sporadic. Tumors often show changes in genes that control cell growth, such as NF2 loss or chromosomal alterations. Rare inherited syndromes slightly raise risk, so genetic counseling may help select individuals.
Diagnosis
Doctors start with brain MRI or CT to spot a mass. The diagnosis of adult papillary meningioma is confirmed after surgery or biopsy by pathology, often with immunohistochemistry and molecular markers. They may also review your symptoms and neurologic exam.
Treatment and drugs
Treatment for adult papillary meningioma usually involves surgery to remove as much tumor as safely possible, guided by imaging and careful planning. Radiation therapy often follows to lower the chance of it growing back. Regular MRI follow-up, symptom control, and rehabilitation support round out care.
Symptoms
Early symptoms of adult papillary meningioma often reflect where the tumor sits and how much pressure it places on nearby areas. Symptoms vary from person to person and can change over time. Common issues include headaches, seizures, changes in vision or speech, weakness, balance problems, and shifts in memory, thinking, or mood.
Dull, pressure-like headaches that slowly intensify are common. They may be worse in the morning or when you cough, bend, or strain. With adult papillary meningioma, head pain often builds over weeks to months.
New spells of staring, brief confusion, or shaking can occur. Some people lose awareness for seconds to minutes. In papillary meningioma, seizures may be an early warning when the tumor irritates the brain surface.
Blurry or double vision, dimming, or loss of side vision can develop. Pressure on the pathways that carry visual signals can cause these shifts.
One arm or leg may feel weak, heavy, or tingly. You might drop objects, drag a foot, or feel clumsier on stairs. Symptoms depend on where the tumor presses, including along the brain or, less often, the spine.
How people usually first notice Adult papillary meningioma?
Many people first notice adult papillary meningioma because of new, unexplained headaches, seizures, or changes in vision, speech, or balance that build over weeks to months. Some also experience subtle personality or memory changes, weakness or numbness on one side, or hearing problems, which prompts a visit to a doctor; imaging like MRI or CT then reveals a brain or spinal tumor. Because papillary meningioma can grow more quickly than typical meningiomas, these first signs of adult papillary meningioma often appear sooner and feel more disruptive than slow, longstanding symptoms.
Types of Adult papillary meningioma
Adult papillary meningioma is a rare brain or spinal tumor variant that tends to behave more aggressively than typical meningiomas. Clinicians often describe them in these categories: histologic variant (papillary pattern) and location, which together shape symptoms and risks. People may notice different sets of symptoms depending on their situation. When reading about types of adult papillary meningioma, you’ll mostly see distinctions based on where the tumor grows and how much papillary (finger-like) architecture is present—this helps explain differences in early symptoms of adult papillary meningioma.
Cerebral hemisphere
Headache, seizures, or gradual changes in personality or thinking can stand out. Weakness or numbness on one side of the body may develop if nearby motor areas are pressed. Vision or language issues can occur when the tumor is near those centers.
Parasagittal/falx
Leg weakness, trouble walking, or balance changes are common when the midline motor pathways are affected. Some notice urinary urgency or incontinence as pressure builds. Seizures can occur but may be less prominent than limb weakness.
Skull base
Double vision, facial numbness, or hearing changes may arise from pressure on cranial nerves. People may develop swallowing difficulty or hoarseness if lower nerves are involved. Headache and facial pain can accompany slow but steady growth.
Intraventricular
Headache, nausea, or vomiting can result from blocked cerebrospinal fluid flow and rising pressure. Blurry vision or brief vision dimming may occur with pressure spikes. Some experience confusion or sleepiness when pressure increases.
Spinal canal
Back pain that worsens with coughing or straining is common. Numbness, tingling, or weakness in the legs can progress, sometimes with bowel or bladder changes. Symptoms often depend on whether the tumor presses the cord or nerve roots.
Papillary-dominant histology
Tumors with a strong papillary pattern tend to grow and recur more quickly. Symptoms may escalate faster between visits, and follow-up imaging is often closer together. Discuss how this variant affects your monitoring plan.
What genetics can tell you about symptoms
Certain genetic changes, like alterations in the NF2 gene or chromosome 22, can lead to faster-growing papillary meningiomas that cause headaches, seizures, or weakness by pressing on nearby brain tissue. Tumors with TERT promoter or BAP1 mutations may behave more aggressively, raising recurrence risk.
Causes and risk factors
Risk for adult papillary meningioma rises most clearly after radiation therapy to the head. Many ask about early symptoms of adult papillary meningioma, yet its causes usually trace to gene changes that make cells grow when they should not. A small number inherit higher risk through neurofibromatosis type 2, but most cases are not inherited. Some risks are modifiable (things you can change), others are non-modifiable (things you can’t). Examples include prior head radiation and age as non-modifiable risks, while higher body weight and some hormone therapies may raise overall meningioma risk.
Environmental and biological risk factors
Understanding what can raise the chance of adult papillary meningioma helps you and your care team focus on what can be monitored or reduced. Doctors often group risks into internal (biological) and external (environmental). Risk factors do not predict early symptoms of adult papillary meningioma, but they offer context for when to seek prompt evaluation.
Exposure to ionizing radiation, especially to the head or brain, is the strongest well-established environmental risk. This includes prior medical radiation therapy or high-dose accidental exposure, with effects that may appear many years later. This risk applies to meningiomas broadly and can include adult papillary meningioma.
Meningiomas occur more often in women, pointing to a role for estrogen and progesterone. Hormone shifts, such as during pregnancy or perimenopause, may modestly influence risk. Evidence focuses on meningiomas overall, but the same biology can be relevant here.
Long-term use of certain high-dose progestin medicines has been linked to a higher chance of meningioma in safety reviews. Risk appears related to cumulative dose and may lessen after the medication is stopped. These findings are for meningiomas overall and may include adult papillary meningioma.
Risk of meningioma generally increases with age, while papillary patterns can appear in younger adults than classic types. Adult papillary meningioma can occur across a wide adult age range. Age is a background factor rather than a direct cause.
Genetic risk factors
For many, the story of adult papillary meningioma involves changes in tumor genes that push cells to grow faster and come back sooner. When people ask about the genetic causes of adult papillary meningioma, they’re usually talking about DNA changes inside the tumor itself and, less often, inherited traits that raise risk. Some risk factors are inherited through our genes. Testing the tumor for key markers can help estimate behavior and guide follow‑up plans.
NF2 gene changes: Many adult papillary meningiomas show inactivation of the NF2 gene on chromosome 22 or loss of 22q. This removes a natural brake on cell growth and is a common driver in meningioma.
Chromosome 1p/14q loss: Loss of parts of chromosomes 1p and 14q is frequent in high‑grade meningiomas. In adult papillary meningioma, these losses often track with a higher chance of recurrence.
TERT promoter mutation: Changes in the TERT promoter can switch telomerase back on, helping tumor cells keep dividing. When found in adult papillary meningioma, they point to more aggressive behavior and quicker return after treatment.
CDKN2A/B deletion: Homozygous deletion of CDKN2A or CDKN2B removes key cell‑cycle brakes. In meningiomas, this is considered a marker of grade 3 biology with faster growth and higher recurrence risk.
Inherited NF2 syndrome: People with NF2‑related schwannomatosis have a much higher lifetime chance of developing multiple meningiomas. Adult papillary meningioma can occur within this syndrome, sometimes at a younger age than sporadic cases.
Other hereditary syndromes: Rare germline changes in genes such as SMARCB1, SMARCE1, or BAP1 can predispose to meningiomas, often linked to specific subtypes. Papillary histology in adults is uncommon in these conditions but has been described.
Lifestyle risk factors
Research on lifestyle risk factors for Adult papillary meningioma is limited, so most insights come from studies of meningioma overall. Evidence points most strongly to body weight, physical activity, and certain hormonal medications as modifiable factors. The points below focus on how lifestyle affects this tumor type, recognizing that data for the papillary subtype are sparse while still addressing the lifestyle risk factors for Adult papillary meningioma.
Higher BMI is consistently associated with a greater risk of developing meningioma, which likely extends to the papillary subtype. Adipose-driven hormones and inflammation may also support tumor growth or recurrence after treatment.
Lower physical activity is linked with higher meningioma risk in population studies. Regular movement helps regulate weight and insulin signaling, which may reduce biological drivers that support papillary meningioma growth.
Long-term or high-dose progestins (for example cyproterone acetate, and some related agents) have been associated with meningioma development and growth. Reviewing contraceptive or hormone therapies with your clinician may reduce exposure that could stimulate papillary meningioma.
Diets rich in added sugars and ultra-processed foods promote weight gain, indirectly increasing meningioma risk. A balanced, calorie-aware pattern that prevents obesity may help limit hormonal and inflammatory pathways relevant to papillary meningioma.
Risk prevention
Day to day, there isn’t a proven way to stop these tumors from forming, but you can lower certain risks and spot problems earlier. Prevention is about lowering risk, not eliminating it completely. Adult papillary meningioma is rare and often aggressive, so timely attention to new neurologic symptoms matters. Focusing on smart imaging choices, genetic counseling when appropriate, and routine check-ins if you’re higher risk can make a difference.
Use imaging only when medically needed and ask if MRI can replace CT when appropriate. If you need X-rays, request shielding and follow recommended intervals to avoid repeat exposures.
If you work around radiation, use shielding, wear your badge/dosimeter, and follow safety training every day. Keeping dose as low as reasonably achievable helps lower lifetime risk.
People with neurofibromatosis type 2 or a strong family history should consider genetic counseling. Regular MRI checks can catch tumors earlier, when treatment options may be broader.
Know early symptoms of adult papillary meningioma, like new seizures, persistent headaches, or changes in vision, speech, or strength. Seek medical care promptly if these appear.
Transmission
Adult papillary meningioma is not contagious and cannot be transferred from one person to another through touch, the air, or bodily fluids. People sometimes ask, “Is Adult papillary meningioma contagious?”—it isn’t, and being around someone with this tumor does not put you at risk. Most cases are not inherited; rarely, a genetic condition such as neurofibromatosis type 2 (NF2) can raise the chance of developing meningiomas, but even then the tumor itself is not passed between people. In short, there is no infectious transmission of Adult papillary meningioma.
When to test your genes
Adult papillary meningioma is rare, so genetic testing is usually considered when tumors appear at a young age, recur, are multiple, or have unusual pathology. Testing the tumor (somatic testing) helps guide treatment; germline testing is considered if there’s a strong family history or multiple nervous system tumors. Ask your care team about testing if your pathology report mentions aggressive features (e.g., papillary pattern), high grade, or specific gene alterations.
Diagnosis
Adult papillary meningioma is usually found after symptoms—like headaches, seizures, or changes in vision or balance—start to disrupt daily life and prompt a brain scan. After reviewing your symptoms, the next step often involves imaging to see where the tumor sits and how it affects nearby structures. The diagnosis of Adult papillary meningioma is confirmed by examining tumor tissue under a microscope. Early and accurate diagnosis can help you plan ahead with confidence.
Your doctor asks about headaches, seizures, vision changes, and how symptoms evolved over time. This helps narrow the list of possible causes and choose the right tests.
Doctors check vision, strength, reflexes, coordination, and memory. Findings point to which brain areas are affected and guide urgent next steps.
This is the main brain scan to show the tumor’s size, location, and relationship to blood vessels and coverings of the brain. Imaging features can suggest meningioma and help plan surgery, but they cannot confirm the papillary subtype.
CT can be faster in emergencies and shows bone changes or calcium within the tumor. It complements MRI for surgical planning in Adult papillary meningioma.
Stages of Adult papillary meningioma
Adult papillary meningioma does not have defined progression stages. Instead, its behavior is judged by how the tumor grows and by lab review of tumor tissue, because it doesn’t follow a predictable, step-by-step course like some cancers. Different tests may be suggested to help confirm the diagnosis, often starting with MRI scans and followed by surgery or a biopsy so a pathologist can assign a grade. Follow-up usually involves regular MRI monitoring, since early symptoms of adult papillary meningioma can be subtle or mimic other conditions and imaging shows changes most clearly.
Outlook and prognosis
Looking ahead can feel daunting, but most people with adult papillary meningioma do well when the tumor is found early and treated by a team experienced with meningiomas. This is considered a higher-grade, faster-growing subtype, so it tends to come back more often than typical meningiomas. After surgery and radiation, many return to work and daily routines, though follow-up scans are more frequent to catch any early changes.
Doctors call this the prognosis—a medical word for likely outcomes. In published studies, local recurrence is common within the first few years, especially if surgeons can’t remove all visible tumor. Adding radiation after surgery lowers that risk. Overall survival varies by how completely the tumor is removed, whether it has spread into nearby structures, and how early it’s treated; some reports note five-year survival rates that are lower than for low-grade meningiomas but still meaningful, particularly with aggressive, well-planned care.
Everyone’s journey looks a little different. Early symptoms of adult papillary meningioma—such as new headaches, seizures, or changes in vision or strength—should prompt quick evaluation, since timely treatment can improve long-term control. If the tumor returns, additional surgery, focused radiation, or clinical trials may be options. Talk with your doctor about what your personal outlook might look like.
Long-term effects
For people living with adult papillary meningioma, long-term effects depend on tumor location, size, and how well treatment controls growth. Long-term effects vary widely and can change over time as the brain heals or adapts. Many remember early symptoms of adult papillary meningioma such as new seizures or headaches, but the long-term picture often centers on thinking, movement, and senses. This subtype has a higher chance of coming back or progressing compared with more typical meningiomas, so follow-up is usually long term.
This variant has a higher risk of coming back locally after surgery. Some people need repeat treatments over the years to keep growth under control.
Seizures can continue or reappear, especially if the tumor started in or near the brain’s cortex. Anti-seizure medicines may be needed long term.
Memory, attention, or processing speed may be slower, particularly after large tumors or radiation. Some find multitasking or returning to complex work takes more time.
Ongoing fatigue, anxiety, or low mood can follow treatment and recovery. These changes may wax and wane and often relate to both brain healing and life adjustments.
How is it to live with Adult papillary meningioma?
Living with adult papillary meningioma often means navigating uncertainty while managing symptoms like headaches, seizures, or changes in vision or thinking, along with regular brain scans and follow-up visits. Because this tumor type tends to recur and can behave more aggressively than many other meningiomas, people may go through surgery, radiation, and periods of watchful waiting, planning work and family life around treatment and recovery. Fatigue and mood changes can ripple into daily routines, so pacing, cognitive rest, and clear communication with loved ones and employers help keep life steady. For many, support from family, friends, and care teams—plus practical tools like seizure safety plans and calendars for appointments—makes the path safer and more predictable for everyone involved.
Treatment and drugs
Adult papillary meningioma is treated with surgery first whenever possible, aiming to remove the entire tumor and any involved lining of the brain and spinal cord to lower the chance of it coming back. Because this subtype tends to be more aggressive than typical meningiomas, doctors often add focused radiation therapy after surgery, even when most or all of the tumor appears removed on scans. If surgery can’t safely take out the whole tumor, or if it returns, radiation (including stereotactic radiosurgery) is commonly used to control growth, and imaging follow-up is scheduled closely at first, then spaced out if things stay stable. Medicines that ease symptoms are called supportive or adjunct treatments, and may include anti-seizure drugs, steroids for short-term swelling, and pain control as needed. If standard options don’t control the disease, clinical trials or targeted therapies may be discussed at specialized centers, and your doctor can help weigh the pros and cons of each option.
Non-drug treatment
For adult papillary meningioma, non-drug care centers on removing as much tumor as safely possible and carefully controlling any regrowth. Non-drug treatments often lay the foundation for long-term recovery, with surgery and targeted radiation complemented by rehabilitation and supportive care. Plans are tailored to tumor size and location, your symptoms, and overall health. Follow-up typically includes regular scans and day-to-day strategies that help you think, move, and feel better after treatment.
Surgeons aim for maximal safe removal to lower pressure, ease symptoms, and reduce the risk of return. Advanced tools help protect critical brain areas during the operation. Recovery plans often include therapy to rebuild strength and skills.
Focused X‑ray treatments target remaining tumor cells after surgery or when surgery is not possible. This can lower the chance of regrowth in adult papillary meningioma.
A single or few highly focused radiation sessions treat small residual or recurrent spots. It is typically an outpatient procedure with a short recovery.
Proton beams can deliver radiation while limiting dose to nearby healthy brain. This may be useful when the tumor is close to vision, hearing, or memory pathways.
Your genes may have an impact on how drugs work for you
Some drugs used for adult papillary meningioma are processed differently depending on gene variants that affect drug-metabolizing enzymes, transporters, or tumor pathways. Genetic testing can sometimes guide dose, predict side effects, or suggest targeted therapies when actionable mutations are found.
Pharmacological treatments
Medicine is not the mainstay for adult papillary meningioma, but it can help when surgery and radiation aren’t enough or when the tumor comes back. Medicines may control swelling, slow growth, or ease symptoms; they do not treat early symptoms of adult papillary meningioma. Not everyone responds to the same medication in the same way.
This IV medicine targets tumor blood vessels and can reduce swelling and fluid around the tumor. It’s often used for recurrent disease or to control edema-related symptoms like headaches or weakness.
This daily pill blocks multiple growth signals that tumors use to make new blood vessels. It’s considered for recurrent or progressive high-grade meningioma when other options are limited.
This targeted pill slows cell-growth signals in the mTOR pathway. Some centers use it alone or with octreotide for recurrent disease when standard therapies have been tried.
Octreotide or lanreotide may help slow growth in tumors that show somatostatin receptor uptake on imaging. They are generally well tolerated and sometimes paired with other targeted drugs.
Genetic influences
Genetic changes play a role in how adult papillary meningioma starts and behaves, but most cases are not inherited. Family history is one of the strongest clues to a genetic influence. Rarely, an inherited condition called neurofibromatosis type 2 (NF2) raises the chance of multiple meningiomas, and this can include adult papillary meningioma. Much more often, the gene changes happen only in the tumor; in high-grade meningiomas, this can include loss of the NF2 gene or alterations in the TERT region and CDKN2A/B, changes linked with faster growth and a higher chance of coming back. Tumor DNA testing can identify these changes and may help with prognosis and treatment planning, including clinical trials. Because the genetic causes of adult papillary meningioma are varied, two people can have very different experiences even when similar changes are found. If several family members have meningiomas or related features such as early-onset tumors or hearing-nerve tumors typical of NF2, your team may recommend genetic counseling to discuss inherited risk.
Is Adult papillary meningioma genetic?
Genetics play a meaningful role in adult papillary meningioma, though most cases are sporadic. Tumors often show changes in genes that control cell growth, such as NF2 loss or chromosomal alterations. Rare inherited syndromes slightly raise risk, so genetic counseling may help select individuals.
Pharmacogenetics—how genetics influence drug effects
Surgery and radiation guide the core treatment, but genetics can also shape what comes next in adult papillary meningioma. Testing the tumor’s DNA can reveal changes—such as NF2 loss, TERT promoter changes, or CDKN2A/B deletions—that hint at how aggressive it may be and may point toward targeted therapy options or clinical trials. Alongside your medical history and imaging, genetic testing can help doctors match you with treatments being studied and decide how closely to monitor for recurrence. Some medicines considered for difficult-to-treat meningiomas, such as mTOR or multi‑kinase inhibitors, are broken down by liver enzymes that vary from person to person, so genetics can influence drug levels and side effects. These tests rarely give a simple yes-or-no answer, but they can sometimes suggest whether a standard dose needs adjusting and whether extra lab monitoring is a good idea. If you’re offered a trial drug, asking about genetic testing for adult papillary meningioma and any drug–gene considerations can help you understand the goals, dosing plan, and how side effects will be watched.
Interactions with other conditions
Many living with adult papillary meningioma also manage other neurological or general health conditions, which can shape how symptoms show up day to day and how treatment is planned. Doctors call it a “comorbidity” when two conditions occur together, and one of the most relevant is neurofibromatosis type 2 (NF2), a genetic condition linked to multiple meningiomas, vestibular schwannomas, and spinal tumors that often require coordinated, multi‑specialty care. A history of cancer treated with radiation to the head or neck can raise the chance of radiation‑associated meningiomas later in life, which may coexist with a papillary tumor and affect follow‑up and surgical decisions. Seizure disorders, migraine, or prior stroke can blur early symptoms of adult papillary meningioma, making new headaches, behavior changes, or weakness harder to spot. Blood clot risk is higher in aggressive brain tumors; if someone also has atrial fibrillation, a prior deep vein thrombosis, or needs blood thinners, the team will carefully balance clotting and bleeding risks around surgery and radiation. Hormone‑related factors may influence growth in some meningiomas, so if breast or gynecologic disease is present, clinicians often review current hormone therapies when tailoring the treatment plan.
How genes can cause diseases
Humans have more than 20,000 genes, each carrying out one or a few specific functions in the body. One gene instructs the body to digest lactose from milk, another tells the body how to build strong bones and another prevents the body's cells from beginning to multiply uncontrollably and developing into cancer. As all of these genes combined are the building instructions for our body, a defect in one of these genes can have severe health consequences.
Through decades of genetic research, we know the genetic code of any healthy/functional human gene. We have also identified that in certain positions on a gene, some individuals may have a different genetic letter from the one you have. We call these hotspots "Genetic Variations" or "Variants" in short. In many cases, studies have been able to show that having the genetic letter "G" in the position makes you healthy, but having the letter "A" in the same position disrupts the gene function and causes a disease. Genopedia allows you to view these variants in genes and summarizes all that we know from scientific research, which genetic letters (Genotype) have good or bad consequences on your health or on your traits.
History
Throughout history, people have described sudden changes in behavior, headaches, or weakness that today we’d recognize as signs of a brain or spinal tumor. Families and communities once noticed patterns—an adult who developed seizures in midlife, or trouble with balance that slowly worsened—long before scans could show what was growing inside. Looking back helps explain why some of these tumors were grouped together for years, even when their behavior wasn’t the same.
First described in the medical literature as meningiomas arising from the coverings of the brain and spinal cord, these tumors were long considered mostly slow growing. Over time, descriptions became more precise as pathologists noticed that a small subset looked and behaved differently under the microscope. Among them was what is now called adult papillary meningioma, a rare pattern where the tumor cells form finger-like (papillary) structures. Initially understood only through symptoms, later classifications added details about how these tumors invade nearby tissue and their higher chance of coming back after treatment.
With each decade, improvements in imaging, surgical techniques, and tissue staining sharpened the picture. In the late 20th century, pathologists began separating papillary meningioma from other meningioma types based on its distinctive architecture and clinical course. This distinction mattered in everyday care: people with adult papillary meningioma often needed closer follow-up after surgery and, at times, added treatments such as radiation, because the risk of recurrence was higher than for typical meningiomas.
Advances in genetics also changed the conversation. While many meningiomas share common gene changes, researchers found that higher-grade patterns like papillary meningioma may carry different molecular signals that help explain their faster growth. These findings led to updated grading systems that place papillary meningioma in a more aggressive category, guiding doctors to plan tighter surveillance schedules and discuss options beyond surgery when needed.
In recent decades, awareness has grown that adult papillary meningioma is uncommon but important to recognize early. Case series and registry studies helped outline early symptoms of adult papillary meningioma—new seizures, one-sided weakness, or persistent headaches—and highlighted how outcomes improve when the tumor is removed completely and monitored carefully afterward. Today, multidisciplinary teams use MRI, detailed pathology, and sometimes molecular tests to confirm the diagnosis and tailor care.
Despite evolving definitions, the core lesson from the history of adult papillary meningioma is practical: naming the subtype accurately helps match the treatment plan to the tumor’s behavior. Each step—from early symptom descriptions to modern molecular work—has refined how clinicians counsel adults living with this diagnosis, how often they return for scans, and which therapies they consider if the tumor comes back.