If your doctor suspects you may have a brain or spinal cord tumour, they 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 type of diagnostic tests as adults, however young children may require a general anaesthetic for some of the tests.
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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 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 (computerised tomography) scan 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. Rarely, more serious reactions occur, such as breathing difficulties or low blood pressure.
- You will lie 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 (magnetic resonance imaging) uses magnetic waves to create detailed cross-sectional pictures of organs in your brain and spine.
- 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.
- You may be injected with a dye that highlights the organs in your body.
- You will lie on an examination table inside a large metal tube that is open at both ends.
- The test is painless, but some people find the noise of the machine distressing. You will usually be offered headphones or earplugs.
- 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.
- The scan takes 30–90 minutes, and you will be able to go home afterwards.
You may also have some of the tests below, which show how quickly or aggressively a tumour is growing (the grade). If your doctor suggests any of these tests, you can ask for a more detailed explanation of the procedures and any follow-up care.
MRS (magnetic resonance spectroscopy) scan – This 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 (tracts). This can be useful in planning treatment for gliomas.
MR perfusion scan – This shows the amount of blood flow to various parts of the brain. It can also distinguish between active tumour and treatment effects.
SPET or SPECT (single photon emission computerised tomography) scan – This 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 (positron emission tomography) scan – You will be 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.