Diagnosing a brain tumour

Sunday 1 May, 2016

Download PDF Order FREE booklet

On this page: Physical examination | CT scan | MRI scan | Further tests | Grading brain and spinal cord tumours | Prognosis | Which health professionals will I see? | Key points


Many people diagnosed with a brain or spinal cord tumour first consult their general practitioner (GP) because they are feeling unwell. Occasionally a brain tumour will be diagnosed during a scan for something unrelated, such as a head injury. Some people have sudden symptoms (such as loss of consciousness, a severe headache or a seizure) and go directly to the hospital’s emergency department.

The doctor will take your medical history and ask about your symptoms. After that, you will have a physical examination. You may then be referred to have one or more scans/tests to confirm a diagnosis of a brain or spinal cord tumour.

Children have the same types of diagnostic tests as adults, however young children may require a general anaesthetic for some of the tests.

Physical examination

Your doctor will assess your nervous system to check how different parts of your brain and body are working, including your speech, hearing, vision and movement.

This is called a neurological examination and may cover:

  • checking your reflexes (e.g. knee jerks)
  • testing the strength in your limb muscles
  • walking, to show your balance and coordination
  • testing sensations (e.g. your ability to feel pinpricks)
  • brain exercises, such as simple arithmetic or memory tests.

The doctor may also test eye and pupil movements, and may look into your eyes using an instrument called an ophthalmoscope. This allows the doctor to see your optic nerve, which sends visual information from the eyes to the brain. Swelling of the optic nerve can be an early sign of raised pressure in the skull.

CT scan

A CT (computerised tomography) scan is a procedure that uses x-ray beams to take pictures of the inside of your body. Unlike a standard x-ray, which takes a single picture, a CT scan uses a computer to compile many cross-sectional pictures of areas of your body.

A contrast dye may be injected into your veins. This injection will help make the scan pictures clearer. It may make you feel flushed and hot for a few minutes. Rarely, more serious reactions occur, such as breathing difficulties or low blood pressure.

You will be asked to lie still on a table while the CT scanner, which is large and round like a doughnut, slowly rotates around you. It may take about 30 minutes to prepare for the scan, but the actual test is painless and takes less than 10 minutes. You will be able to go home when the scan is complete.

The dye that is injected into your veins before a CT or MRI scan may contain iodine, and may affect your kidneys. Before your scan, tell your doctor if you have any allergies. You may need to have blood tests to check your kidney function.

MRI scan

An MRI (magnetic resonance imaging) scan uses magnetic waves to create detailed cross-sectional pictures of organs in your brain and spine. You should let your medical team know if you have a pacemaker or another iron-based metallic object in your body, because the scan may damage these devices.

For an MRI, you may be injected with a dye that highlights the organs in your body. You will then lie on an examination table inside a large metal tube that is open at both ends.

The test is painless, but the noise of the machine can be a source of distress. In addition, some people feel anxious or claustrophobic lying in such a confined space.

If you think you may become distressed, mention it beforehand to your medical team. You may be given medicine to help you relax or you might be able to bring someone into the room with you for support. You will usually be offered headphones or earplugs.

The MRI scan takes 30–90 minutes and you will be able to go home afterwards.

"I found the MRI confronting, going into the cylinder head first and having to hold my breath. But now when I have this scan during check-ups, I count to myself. This helps me feel more in control." - Robyn

Further tests

You may also have some of the tests below, which show how quickly or aggressively a tumour is growing (the grade - see below). If your doctor suggests any of these tests, you can ask for a more detailed explanation of the procedures and any follow-up care.

MRS scan

An MRS (magnetic resonance spectroscopy) scan can be done at the same time as a standard MRI. It detects the chemical make-up of the brain, which may be changed by a brain tumour.

MR tractography

An advanced imaging technique that may enable visualisation of the message pathways (tracts) within the brain e.g. the visual pathway (tracts). This can be useful in planning treatment for gliomas.

MR perfusion scan

Another advanced imaging technique that shows the amount of blood flow to various parts of the brain. This scan also be used to distinguish between active tumour and treatment effects.

SPET or SPECT scan

A SPET or SPECT (single photon emission computerised tomography) scan takes 3D pictures of your body to assess blood flow in the brain. A small amount of radioactive fluid is injected into your body, which is then scanned with a gamma camera. A brain tumour may have higher blood flow than the rest of the brain.

PET scan

In a PET (positron emission tomography) scan you are injected with a radioactive tracer solution. This is absorbed by cancer cells at a faster rate than normal cells and highlights the active cells.

Lumbar puncture

A needle is inserted into the spinal column to collect cerebrospinal fluid to see if cancer cells or abnormal substances, such as blood or proteins, are present. Also called a spinal tap.

Surgical biopsy

If scans show an abnormality that looks like a tumour, some or all of the tissue may be removed for examination (biopsy). In some cases, the neurosurgeon makes a small opening in the skull and inserts a needle to take a sample. In other cases, the neurosurgeon removes a larger part of the skull to get to the tumour.

Grading brain and spinal cord tumours

The grade describes the rate at which tumours grow and the likeliness or ability to spread into nearby tissue. Most brain and spinal cord tumours don’t spread in the body. However, your medical team may need to do other tests to check if the cancer has spread (e.g. CT or MRI scans, or checking the cerebrospinal fluid).

Other tests to determine the type of tumour may also be used to predict how a tumour will grow.

Brain and spinal cord tumours are usually given a grade on a scale of 1 to 4. The grade is worked out by looking at the tumour cells and comparing them to normal cells.

Grading
  • Grades 1 and 2 - These are the slowest-growing tumours. They are called low-grade tumours.
  • Grade 3 - Tumours grow at a moderate rate. They are called high-grade tumours.
  • Grade 4 - These are the fastest-growing tumours. They are also called high-grade tumours.

Prognosis

Prognosis means the expected outcome of a disease. You may wish to discuss your prognosis and treatment options with your doctor, but it is not possible for any doctor to predict the exact course of your disease.

There are many factors that may affect your prognosis. These include tumour type, location of the tumour, grade, age, family history and your general health.

Both benign and malignant tumours can be life-threatening, but you may have a better prognosis if the tumour is benign or low-grade, or if a surgeon is able to remove the entire tumour.

Some brain or spinal cord tumours, particularly gliomas, can come back (recur). In this case, treatments such as surgery, radiotherapy or chemotherapy may be used to control the growth of the tumour for as long as possible, relieve symptoms, and improve quality of life.

To determine your prognosis, your doctor will consider:

  • test results
  • the type of cancer you have
  • the rate and depth of tumour growth
  • how well you respond to treatment
  • other factors such as age, fitness and medical history.

See more information about the prognosis of children with brain or spinal cord tumours.

Which health professionals will I see?

If your GP or another doctor suspects you have a brain or spinal cord tumour, they will arrange the first tests to assess your symptoms. You will then be referred to a neurologist, neuro- oncologist or a neurosurgeon, who will examine you and may do more tests and advise you about your treatment options.

You will be cared for by a range of health professionals who specialise in different aspects of your treatment. This is called a multidisciplinary team (MDT). The MDT will probably include some or all of the health professionals listed below.

Health professional
 Role
neurologist
diagnoses and treats diseases of the brain and nervous system, particularly those not requiring surgery
neurosurgeon
diagnoses and surgically treats diseases and injuries of the brain and nervous system
nurses and cancer care coordinators
administer drugs, including chemotherapy, and provide care, information and support throughout your treatment
neuropathologist
pathologist specialising in analysing blood and tissue from the brain and spinal cord
medical oncologist
specialises in diagnosing cancers and treating them using chemotherapy and biological therapies
radiation oncologist
specialist in treating cancers with radiotherapy
dietitian
recommends an eating plan for you to follow while you are in treatment and recovery
social worker, psychologist, neuropsychologist, psychiatrist
help with emotional, spiritual, physical, social or practical and financial issues and link you to support services
physiotherapist, speech therapist and occupational therapist
provide rehabilitation services and help with physical issues

Key points

  • Many people diagnosed with a brain or spinal cord tumour have symptoms caused by the tumour, such as dizziness, headaches or difficulty walking.
  • You will probably have many tests to diagnose the disease.
  • A physical examination checks how different parts of your brain are working.
  • Imaging scans, such as CT and MRI, allow the doctor to see pictures of the inside of the brain.
  • Other scans assess the chemical make-up of the brain, blood flow in the brain, and whether there are active cancer cells in the central nervous system.
  • You may also need a blood test to check hormone levels, and a biopsy, which removes some tissue for examination under a microscope.
  • The tests help doctors diagnose the type of brain or spinal cord tumour you have, as well as its grade and if it has spread. The grade shows how abnormal the cells are and how quickly the tumour is growing.
  • Many people want to know the likely outcome of their disease (prognosis). You will need to discuss this with your doctor, as it depends on many factors.
  • You will see a range of health professionals who specialise in different areas of your treatment. You will usually be referred to a neurologist, neurosurgeon or neuro-oncologist.

Reviewed by: A/Prof Matthew Foote, Associate Professor, University of Queensland and Staff Specialist, Radiation Oncology, Princess Alexandra Hospital, QLD; Dr Jason Papacostas, Neurosurgeon, Mater Private Hospital, QLD; Dr Dianne Clifton, Psychiatrist and Coordinator of Education, Psychosocial Cancer Care and Palliative Care, St Vincent’s Hospital, VIC; A/Prof Georgia Halkett, Assocaite Professor, Senior Research Fellow, School of Nursing and Midwifery, Faculty of Health Sciences, Curtin University, WA; Lawrence Cher, Neurologist and Neuro-oncologist, Olivia Newton John Cancer & Wellness Centre, Austin Hospital, VIC; Kate Brennan, Occupational Therapist, Princess Alexandra Hospital, QLD; Vivien Biggs, Neuro-oncology nurse practitioner, Briz Brain & Spine, QLD; Lindy Cohn, 13 11 20 advisor, Cancer Council NSW, NSW; Ms Dianne Legge, Brain Tumour Support Officer, Cancer Services, Olivia Newton-John Cancer & Wellness Centre, Austin Hospital, VIC; Russ Talbot, consumer, SA.

Updated: 01 May, 2016