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  • How are brain and spinal cord tumours diagnosed?

    Contents

    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. 

    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.

    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.

    Further tests

    You may also have some of the tests below, which show how quickly or aggressively a tumour is growing (the grade). 

    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 (tract). 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.

    This website page was last reviewed and updated October 2017.

    Information last reviewed May 2016 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.

     

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