Diagnosing Brain Tumours

The doctor will ask you about your symptoms and medical history, and do a physical examination. If they suspect you have a brain or spinal cord tumour, you will be referred for more tests and scans to confirm the diagnosis.

Before having scans, tell the doctor if you have any allergies or have had a reaction to dyes or contrast during previous scans. You should also let them know if you have diabetes or kidney disease, or are pregnant or breastfeeding.

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 include:

• 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 light touch or pinpricks)
• thinking exercises, such as simple arithmetic or memory tests.

The doctor may also test your eye and pupil movements, and may look into your eyes using an instrument called an ophthalmoscope.

This allows the doctor to see parts of the eye and its function - including 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 inside the skull.

Blood tests

You are likely to have blood tests to check your overall health. Most brain and spinal cord tumours cannot be found or monitored by a blood test.

However, blood or special urine tests can be used to check whether the tumour is producing unusual levels of hormones, for example, if the pituitary gland is affected.

MRI scan

Your doctor will usually recommend an MRI (magnetic resonance imaging) scan to check for brain tumours and to help plan treatment. An MRI scan uses a powerful magnet and a computer to build up detailed pictures of your body.

Let your doctor or nurse know if you have a pacemaker or any metallic object in your body (e.g. surgical clips after heart or bowel surgery). The magnet can interfere with some pacemakers, but newer pacemakers are often MRI-compatible.

For an MRI, you may be injected with a dye (known as contrast) that highlights any abnormalities in your brain. 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 noisy, narrow machine makes some people feel anxious or claustrophobic. If you think you may get upset, talk to your medical team before you go for the scan.

You may be given medicine to help you relax or be able to bring someone into the room for support. You will have headphones or earplugs and you can press a distress button if you are worried at any time.

An MRI takes 30–45 minutes. The pictures from an MRI scan are generally more detailed than pictures from a CT scan.

CT scan

Many people may have a CT (computerised tomography) scan, or it may be used if you are unable to have an MRI. This scan uses x-rays and a computer to create detailed pictures of the inside of the body.

Sometimes a dye is injected into a vein before the scan to help make the pictures clearer. The contrast may make you feel hot all over, leave a bitter taste in your mouth, and make you feel like you are going to pee, for a couple of minutes.

The CT scanner is a large, open doughnut-shaped machine. You will lie on a table that moves in and out of the scanner. It may take about 30 minutes to prepare for the scan, but the actual test takes only about 10 minutes and is painless.

Grading tumours

The tumour will be given a grade based on how the cells look compared to normal cells. This suggests how quickly the cancer may grow. The grading system most commonly used for brain tumours is from the World Health Organization.

Brain and spinal cord tumours are usually given a grade from 1 to 4.

• Grade 1 – these tumours are low-grade, slow growing and benign.
• Grade 2 – these tumours are low-grade and usually grow slowly. They are more likely to come back after treatment and can develop into a higher-grade tumour.
• Grades 3 and 4 – these tumours are high-grade, faster growing and malignant. They can spread to other parts of the brain and tend to come back after treatment.

Unlike cancers in other parts of the body that are given a stage to show how far they have spread, primary brain and spinal cord tumours are not staged, because most don’t spread to other parts of the body

“My wife Robyn was diagnosed with grade 4 brain cancer when she had just turned 50. After getting a diagnosis like that, you just go into shock for a couple of days, then you start thinking about how things will change, you evaluate your life and what you need to do to help.” Ross

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 anyone to predict the exact course of the disease.

Several factors may affect your prognosis, including:

• the tumour type, location, grade and genetic make-up
• your age, general health and family history
• whether the tumour has damaged the surrounding healthy brain tissue
• how well the tumour responds to treatment.

Both low-grade and high-grade tumours can affect how the brain works and be life-threatening, but the prognosis may be better if the tumour is low grade, or if the surgeon is able to remove the entire tumour.

Some brain or spinal cord tumours, particularly gliomas, can keep growing or come back. They may also change (transform) into a higher grade tumour.

In this case, treatments such as surgery, radiation therapy and/or chemotherapy may be used to control the growth of the tumour for as long as possible, relieve symptoms and maintain quality of life.