Many people diagnosed with a brain or spinal cord tumour first go to see their doctor because they are feeling unwell. Occasionally a brain tumour will be found during a scan for something unrelated, such as a head injury or an optometry appointment. Some people have sudden symptoms and go straight to a hospital.
The doctor will ask you about your symptoms and medical history and will do a physical examination. If your doctor suspects you have a brain or spinal cord tumour, you will be referred for more tests and scans to confirm the diagnosis.
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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)
- brain 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 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.
You are likely to have blood tests to check your overall health. Blood tests can also be used to check whether the tumour is producing unusual levels of hormones, which could mean the pituitary gland is affected.
An MRI (magnetic resonance imaging) scan uses a powerful magnet and a computer to make cross-sectional pictures of your body. It takes 30-45 minutes.
The pictures from an MRI scan are generally more detailed than pictures from a CT scan. You may be injected with a dye (contrast) that highlights any abnormalities in your brain.
The test is painless, but the machine can be noisy, and some people feel anxious or claustrophobic in the tube. You will usually be offered headphones or earplugs and a distress button to press if you are worried at any time.
A CT (computerised tomography) scan uses x-rays to take many pictures of the inside of the body and then compiles them into detailed, cross-sectional pictures.
Contrast may be injected into a vein to help make the scan pictures clearer. It may make you feel hot all over and leave a bitter taste in your mouth. You may also feel the need to pass urine. These side effects usually ease within minutes.
It may take about 30 minutes to prepare for the scan, but the actual test takes only about 10 minutes and is painless.
You may have further tests to estimate how quickly the tumour is growing (the grade) and whether it has spread into nearby tissue. This information helps your doctor plan treatment.
- MRS scan – a specialised type of MRI. It can be done at the same time as a standard MRI. It looks for changes in the chemicals in the brain.
- MR tractography – helps show the message pathways (tracts) within the brain. It can help plan treatment for gliomas.
- MR perfusion scan – shows the amount of blood flowing to various parts of the brain. It can also be used to help identify the type of tumour.
- SPET or SPECT scan – shows blood flow in the brain. Areas with higher blood flow, such as a tumour, will show up brighter on the scan.
- PET scan – you will be injected with a small amount of radioactive solution, which helps cancer cells show up brighter on the scan.
- Lumbar puncture – also called a spinal tap, a lumbar puncture uses a needle to collect a sample of cerebrospinal fluid from the spinal column, which is then checked for cancer cells.
- Surgical biopsy – if scans show an abnormality that looks like a tumour, some or all of the tissue may be removed for examination. In some cases, the neurosurgeon makes a small opening in the skull and inserts a needle to take a sample. In other cases, the biopsy is done during surgery to remove the brain tumour.
- Genetic tests – every kind of cancer, including a brain tumour, changes the genes of the affected cells. These gene faults are not the same thing as genes passed through families. The fault is only in the structure of the tumour cells, not in the normal cells. A pathologist may run special tests on tumour cells to look for these gene changes, which can help your doctors tailor treatment.
The cancer will be given a grade based on how the cancer 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 and grow slowly.
- 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 and grow faster, and are called malignant. They can spread to other parts of the brain and tend to recur, often as a higher grade.
Other types of cancer are given a stage to describe the extent of the cancer in the body. Primary brain and spinal cord tumours are not staged in this way as most don’t spread to other parts of the body.
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, and how well the tumour responds to treatment. Both low-grade and high-grade tumours can 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 come back and may change into a higher-grade tumour. In this case, treatments such as surgery, radiation therapy or chemotherapy may be used to control the growth of the tumour for as long as possible, relieve symptoms and maintain quality of life.
Understanding Brain Tumours
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Expert content reviewers:
A/Prof Andrew Davidson, Neurosurgeon, Macquarie University Hospital, NSW; Dr Lucy Gately, Medical Oncologist, Oncology Clinics Victoria, and Walter and Eliza Hall Institute of Medical Research, VIC; Melissa Harrison, Allied Health Manager and Senior Neurological Physiotherapist, Advance Rehab Centre, NSW; Scott Jones, Consumer; Anne King, Neurology Cancer Nurse Coordinator, Health Department, WA; Dr Toni Lindsay, Senior Clinical Psychologist and Allied Health Manager, Chris O’Brien Lifehouse, NSW; Elissa McVey, Consumer; Caitriona Nienaber, 13 11 20 Consultant, Cancer Council WA; Dr Claire Phillips, Deputy Director, Radiation Oncology, Peter MacCallum Cancer Centre, VIC.
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The information on this webpage was adapted from Understanding Brain Tumours - A guide for people with brain or spinal cord tumours, their families and friends (2020 edition). This webpage was last updated in July 2021.