Diagnosing a brain or spinal cord tumour

Friday 30 September, 2011

On this page: Physical examination | CT scan | Further tests | Staging and grading tumours | Prognosis | Which health professionals will I see? | Information reviewed by 

 

Most 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 with sudden symptoms, such as vomiting or loss of consciousness, 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. Based on those results, the doctor will refer you to have one or more scans of the brain and body, and possibly some other tests, to confirm a diagnosis of a brain or spinal cord tumour.

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.

"My doctor thought I had depression but I insisted on a CT scan as I had persistent headaches, felt disorientated and couldn't think clearly. The scan showed that I had a brain tumour." — Richard

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 pictures of areas of your body.

A 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 only takes about 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 scan often contains iodine.
If you are allergic to iodine, fish or dyes, let the person performing the scan know in advance.

MRI scan

An MRI (magnetic resonance imaging) scan uses magnetism and radio waves to build up very detailed cross-section pictures of the body. A dye may be injected into your veins before the scan. As the dye may affect the kidneys, your kidney function will be checked.

You will lie on a table in a metal cylinder, which is a large and powerful magnet. Some people feel anxious lying in the narrow cylinder during the MRI. Let your health care team know if you are claustrophobic. It may help to take a mild sedative, or you can talk through an intercom to the person operating the machine.  In some hospitals you can listen to music to help you relax.

Although the MRI scanner can feel tightly enclosed and noisy,the test is painless and is usually completed in under an hour. You will be able to go home when your scan is over.

People with a pacemaker or other metallic objects in their body will not be able to have an MRI due to the effect of the magnet.

Further tests

You may also have some of the tests listed below. Some tests show how quickly or aggressively a tumour is growing (the grade) or if the cancer has spread (the stage).

If your doctor suggests any of these tests, you can ask for a more detailed explanation of the procedures and any follow-up care. Understanding what will happen may help you feel less anxious.

Magnetic resonance spectroscopy (MRS) scan

This scan can be done at the same time as a standard MRI. An MRS scan shows whether the brain's neurons are working properly.

Single photon emission computerised tomography (SPECT or SPET) scan

After an injection of a small amount of radioactive fluid, your body is scanned with a machine called a gamma camera. The camera takes three-dimensional (3-D) pictures of your body to assess blood flow in the brain.

Positron emission tomography (PET) scan

You are injected with a radioactive glucose solution. This is absorbed by cancer cells at a faster rate than normal cells. The scan shows where these areas of active cancer are.

Lumbar puncture (spinal tap)

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.

Surgical biopsy

If scans show an abnormality that looks like a tumour, your doctor may decide to remove some or all of the tissue for examination (biopsy). In some cases, the neurosurgeon is able to make a small opening in the skull and insert a needle to obtain a sample. In other cases, the neurosurgeon will remove part of the skull to access the tumour.

Blood tests

Blood tests may be done to see whether the levels of different hormones in the body are higher or lower than normal. These changes may be due to certain tumours in the brain.

Grading and staging tumours

Grading and staging tumours helps doctors decide on the best treatment for you.

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. The tumour's rate of growth and likeliness or ability to spread into nearby tissue is also assessed.

Grades 1 and 2

These are the slowest-growing tumours. They are called low-grade tumours.

Grade 3

Tumours grow at a moderate rate.

Grade 4

These are the fastest-growing tumours. They are called high-grade tumours.


Staging shows whether a tumour has spread from its original site, and if so, by how much. The doctor will determine this by doing CT or MRI scans, or by checking the cerebrospinal fluid. However, most CNS tumours don't spread beyond the central nervous system.

Prognosis

Prognosis means the expected outcome of a disease. You will need to discuss your prognosis with your doctor if this is something you would like to know. However, it is not possible for any doctor to predict the exact course of your illness.

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

Test results, the rate and depth of tumour growth, how well you respond to treatment, and other factors such as age, fitness and your medical history are all important factors in assessing your prognosis. In general, the younger you are, the better the prognosis is.

Some brain or spinal cord tumours can come back (recur), but treatment such as surgery or radiotherapy can often relieve symptoms for some time.  

Which health professionals will I see?

Your GP will probably arrange the first tests to assess your symptoms. This can be a worrying and tiring time, especially if you need several tests. You will usually be referred to a neurologist or a neurosurgeon who will arrange further tests and advise you about treatment options.

You will be cared for by a range of health professionals who specialise in different aspects of your treatment. You can ask your doctor or nurse for a referral or access to other services at any time. Your needs may change throughout treatment.

Health Professional 

Role 
Neurologist  Diagnoses and treats diseases of the brain and nervous system 
Neurosurgeon Diagnoses and treats diseases and injuries in the brain and nervous system, and uses surgery to treat them 
Nurses Administer drugs and support you through all stages of your diagnosis and treatment 
Care coordinator Provides assistance and information through all stages of diagnosis and treatment
Medical oncologist Prescribes and coordinates chemotherapy treatment 
Radiation oncologist Prescribes and coordinates radiotherapy treatment 
Dietitian Recommends the best eating plan to follow while you're in treatment and recovery 
Social worker, psychologist and pastoral worker Link you to support services and help with emotional or practical issues 
Neuropsychologist, physiotherapist, speech therapist and occupational therapist Provide rehabilitation services and help with physical issues

Information reviewed by: Prof. Michael Besser AM, Consultant Emeritus in Neurosurgery, Royal Prince Alfred Hospital & The Children's Hospital at Westmead; Lindy Cohn, Helpline, Cancer Council NSW; Laraine Cross, Senior Clinician, Social Work, Calvary Mater Newcastle; Christine and Richard Harris, Christine and Gordon Holding, Consumers; Marina Kastelan, Brain Clinical Nurse Coordinator, North Shore Private Hospital; Lorna O'Brien, Helplline Manager, Cancer Council NSW; and Karen Robinson, Neuro-oncology Care Coordinator, Liverpool Hospital Cancer Therapy Centre.

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