Brain Cancer (cont.)

Medical Author:

Charles Patrick Davis, MD, PhD

Charles Patrick Davis, MD, PhD

Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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If findings of a medical interview and physical examination suggest to the health-care provider that a person may have a problem in the brain or brain stem, additional tests may be done.

• Many people will have a CT scan of the brain, especially if the person is seen emergently.
• This test is like an X-ray but shows more detail in three dimensions.
• Usually, a harmless dye is injected into the bloodstream to highlight abnormalities on the scan.

People with brain cancer often have other medical problems; therefore, routine laboratory tests may be performed.

• These include analysis of blood, electrolytes, liver function tests, and a blood coagulation profile.
• If the person has mental-status change as the main symptom, blood or urine tests may be done to rule out drug use.

The standard way of evaluating the nature and extent of a brain tumor is an MRI scan (note that many hospitals do not have MRI scanners).

• This is because MRI has a higher sensitivity for detecting the presence and characteristics of a tumor. Specifically, the relationship of the tumor to the surrounding brain, the brain coverings, cerebrospinal fluid spaces, and vascular structures is assessed to come up with a provisional diagnosis of the nature of the tumor.
• Currently, however, many institutions that do have MRI scanners still use the CT scan as a screening test for tumors.

If CT or MRI scans indicate the presence of a brain tumor, the person will be referred to a specialist in brain surgery (a neurosurgeon). If one is available in the area, the person may also be referred to a specialist in the chemotherapeutic treatment of brain tumors (a neuro-oncologist).

A word of caution to readers; while radiologic examinations of the brain usually are excellent tests, they are not without any risks. People that "doctor shop" or frequent emergency centers with the main complaint of "headache" often obtain multiple brain scans in close succession. This may put the individuals at increased risk of radiation damage to cells. Patients are urged to have a primary medical caregiver to help coordinate all tests to avoid overexposure to radiation from diagnostic testing.

The next step in diagnosis is confirmation that the person has cancer in the brain. A small sample of the tumor (a biopsy) is taken to identify the type of tumor and the grade of the tumor.

• The most widely used technique for obtaining a biopsy is a surgical procedure called a craniotomy. The skull is opened, usually with the intention of removing the whole tumor if possible. A biopsy is then taken from the tumor.
• If the surgeon is unable to remove the entire tumor, a small piece of the tumor is removed.
• In some cases, it is possible to collect a biopsy without opening the skull. The exact location of the tumor in the brain is determined stereotactically, that is, by using CT or MRI scans while the head is held still in a frame. A small hole is then made in the skull and a needle guided through the hole to the tumor. The needle collects the biopsy and is removed. This technique is called stereotaxis, or stereotactic biopsy. This process does not treat the tumor and is generally reserved for situations in which the tumor is either inaccessible or is thought to be sensitive to radiation therapy (such as CNS lymphoma or pineal germ cell tumor).
• The biopsy is examined under a microscope by a pathologist (a physician who specializes in diagnosing diseases by looking at cells and tissues) and usually assigned a NCI grade.