Diagnosing a brain or spinal cord tumour

Thursday 1 May, 2014

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On this page: Physical examination | CT scan | MRI scanFurther tests | Grading 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 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. If you are allergic to iodine, fish or dyes, or if you have kidney problems, let the person performing the scan know in advance. You may need to have blood tests to check your kidney function. 

"I had a CT scan because I was having persistent, strong headaches, felt disorientated and couldn’t think clearly. The scan showed that I had a brain tumour." – Richard

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 contrast dye may be injected into your veins before the scan.

You will lie on a table in a metal cylinder, which is a large and powerful magnet. Some people feel anxious or claustrophobic lying in the narrow cylinder during the MRI. Let your health care team know if you feel uncomfortable or afraid in confined spaces. It may help to take a mild sedative, or you can talk through an intercom to the person operating the machine. The scan can be paused if necessary.

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 and some 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 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.

Magnetic resonance spectroscopy (MRS) scan – This 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.

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 gamma camera. This takes 3D pictures of your body to assess blood flow in the brain. A brain tumour may have higher blood flow than the rest of 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 and highlights the active cells.

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, 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.

Blood tests – Blood may be taken to check the levels of certain hormones in the body. Changes could be due to a brain tumour. 

Grading tumours

The grade describes the rate at which tumours grow and the likeliness or ability to spread into nearby tissue. Most central nervous system 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).

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 will need to discuss your prognosis and treatment with your doctor, but it is not possible for any doctor to predict the exact course of your disease.

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. In general, the younger you are, the better the prognosis.

Some brain or spinal cord tumours can come back (recur). In this case, treatments such as surgery, radiotherapy or chemotherapy can often relieve symptoms for some time.

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

If you want to know your prognosis, it’s important to talk to your specialist about your situation. 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. 

Which health professionals will I see?

Your general practitioner (GP) will often arrange the first tests to assess your symptoms. If these tests do not rule out cancer, 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 treatment. This multidisciplinary team will probably include some of the people listed below.

Health professional Role
neurologist  diagnoses and treats diseases of the brain and nervous system, particularly those not requiring surgery
neurosurgeon diagnoses and treats diseases and injuries of the brain and nervous system, and uses surgery to treat them
nurses administer drugs, including chemotherapy, and provide care, information and support throughout your treatment
care coordinator supports patients throughout treatment, coordinates referrals and liaises with staff
medical oncologist specialises in diagnosing cancers and treating them using chemotherapy and biological therapies
radiation oncologist prescribes and coordinates the course of radiotherapy
dietitian recommends an eating plan for you to follow while you are in treatment and recovery
social worker, psychologist, neuropsychologist, psychiatrist and pastoral care worker link you to support services and help with emotional, spiritual, physical, social or practical issues
physiotherapist, speech therapist and occupational therapist provide rehabilitation services and help with physical issues

Key points

  • any 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.
  • Scans, such as CT and MRI, allow the doctor to see inside 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 or a neurosurgeon.

Reviewed by: A/Prof Kate Drummond, Neurosurgeon, Divisional Director of Neuroscience and Cancer and Infection Medicine, Director of Junior Surgical Training, The Royal Melbourne Hospital, VIC; Dr Dianne Clifton, Psychiatrist, Psycho-oncologist and Director, Department of Psychosocial Cancer Care at St Vincent’s Hospital, VIC; Dr Anthony Dowling, Medical Oncologist, St Vincent’s Hospital, VIC; Kate Fernandez, Clinical Nurse Coordinator, Central Nervous System Tumours, Women’s and Children’s Hospital, SA; Carmen Heathcote and Yvonne Howlett, Helpline Operators, Cancer Council Queensland, QLD; Dianne Legge, Brain Tumour Support Officer, Cancer Services, Olivia Newton-John Cancer and Wellness Centre, VIC; Scott Nussey, Consumer, SA; Dr Claire Phillips, Radiation Oncologist, Peter MacCallum Cancer Centre, VIC; and Janine Rhodes, Coordinator, Brain Tumour Support Service, Cancer Council Queensland, QLD.

Updated: 01 May, 2014