Brain tumor – diagnosis

If it’s suspected that you have a brain tumor, your doctor may recommend a number of tests and procedures, including:

• A neurological exam. A neurological exam may include, among other things, checking your vision, hearing, balance, coordination, strength and reflexes. Difficulty in one or more areas may provide clues about the part of your brain that could be affected by a brain tumor.
• Imaging tests. Magnetic resonance imaging (MRI) is commonly used to help diagnose brain tumors. In some cases a dye may be injected through a vein in your arm during your MRI study. A number of specialized MRI scan components — including functional MRI, perfusion MRI and magnetic resonance spectroscopy — may help your doctor evaluate the tumor and plan treatment.
• Tests to find cancer in other parts of your body. If it’s suspected that your brain tumor may be a result of cancer that has spread from another area of your body, your doctor may recommend tests and procedures to determine where the cancer originated. One example might be a CT or PET scan to look for signs of lung cancer.
• Collecting and testing a sample of abnormal tissue (biopsy). A biopsy can be performed as part of an operation to remove the brain tumor, or a biopsy can be performed using a needle. A stereotactic needle biopsy may be done for brain tumors in hard to reach areas or very sensitive areas within your brain that might be damaged by a more extensive operation. Your neurosurgeon drills a small hole into your skull. A thin needle is then inserted through the hole. Tissue is removed using the needle, which is frequently guided by CT or MRI scanning. The biopsy sample is then viewed under a microscope to determine if it is cancerous or benign. Sophisticated laboratory tests can give your doctor clues about your prognosis and your treatment options.

At Mayo Clinic, teams of experts use all of these diagnostic techniques, in addition to advanced imaging technology such as a high-powered (7-tesla) MRI scanner and magnetic resonance elastography (MRE). MRE tests the softness of a tumor so that a neurosurgeon can plan how best to remove it. This technology was developed by a Mayo Clinic physician-scientist.

The Mayo Clinic brain tumor team also uses molecular diagnostics, an individualized medicine approach that analyzes the DNA of a tumor. This type of genetic testing helps doctors predict which treatment options will work on specific brain tumor types.

The comprehensive, precise diagnostic methods of Mayo Clinic’s brain tumor team enables your neurosurgeon to plan your operation exactly and reduce the risk of needing follow-up surgery.

Treatment

Treatment for a brain tumor depends on the type, size and location of the tumor, as well as your overall health and your preferences.

Surgery

If the brain tumor is located in a place that makes it accessible for an operation, your surgeon will work to remove as much of the brain tumor as possible.

In some cases, tumors are small and easy to separate from surrounding brain tissue, which makes complete surgical removal possible. In other cases, tumors can’t be separated from surrounding tissue or they’re located near sensitive areas in your brain, making surgery risky. In these situations your doctor removes as much of the tumor as is safe.

Even removing a portion of the brain tumor may help reduce your signs and symptoms.

Surgery to remove a brain tumor carries risks, such as infection and bleeding. Other risks may depend on the part of your brain where your tumor is located. For instance, surgery on a tumor near nerves that connect to your eyes may carry a risk of vision loss.

Mayo Clinic neurosurgeons are experts in awake brain surgery. The procedure, offered at very few medical centers in the country, is used to help certain people who’ve been told they have an inoperable brain tumor. The surgical team is able to remove the tumor safely with minimized risk of serious complications.

At Mayo Clinic, neurosurgeons are also experts in minimally invasive techniques. People who undergo brain tumor surgery with these advanced approaches often experience reduced hospital stays, shorter recovery times and a lower expected mortality rate. Many people who undergo brain tumor surgery at Mayo Clinic leave the hospital in one or two days. Neurosurgeons are able to do these precise and complicated surgeries because they work with specialists in brain imaging (neuroradiologists) and use advanced surgical navigation and mapping equipment. They are able to visualize exactly where the tumor is and the surgical path to it.

Radiation therapy

Radiation therapy uses high-energy beams, such as X-rays or protons, to kill tumor cells. Radiation therapy can come from a machine outside your body (external beam radiation), or, in very rare cases, radiation can be placed inside your body close to your brain tumor (brachytherapy).

External beam radiation can focus just on the area of your brain where the tumor is located, or it can be applied to your entire brain (whole-brain radiation). Whole-brain radiation is most often used to treat cancer that spreads to the brain from some other part of the body and forms multiple tumors in the brain.

A newer form of radiation therapy using proton beams is being studied for use in people with brain tumors. For tumors that are very close to sensitive areas of the brain, proton therapy may reduce the risk of side effects associated with radiation. But proton therapy hasn’t proved to be more effective than standard radiation therapy with X-rays.

Side effects of radiation therapy depend on the type and dose of radiation you receive. Common side effects during or immediately following radiation include fatigue, headaches, memory loss and scalp irritation.

Radiosurgery

Stereotactic radiosurgery is not a form of surgery in the traditional sense. Instead, radiosurgery uses multiple beams of radiation to give a highly focused form of radiation treatment to kill the tumor cells in a very small area. Each beam of radiation isn’t particularly powerful, but the point where all the beams meet — at the brain tumor — receives a very large dose of radiation to kill the tumor cells.

There are different types of technology used in radiosurgery to deliver radiation to treat brain tumors, such as a Gamma Knife or linear accelerator.

Radiosurgery is typically done in one treatment, and in most cases you can go home the same day.

Chemotherapy

Chemotherapy uses drugs to kill tumor cells. Chemotherapy drugs can be taken orally in pill form or injected into a vein (intravenously). The chemotherapy drug used most often to treat brain tumors is temozolomide (Temodar), which is taken as a pill. Many other chemotherapy drugs are available and may be used depending on the type of cancer.

Chemotherapy side effects depend on the type and dose of drugs you receive. Chemotherapy can cause nausea, vomiting and hair loss.

Tests of your brain tumor cells can determine whether chemotherapy will be helpful for you. The type of brain tumor you have also is helpful in determining whether to recommend chemotherapy.

Targeted drug therapy

Targeted drug treatments focus on specific abnormalities present within cancer cells. By blocking these abnormalities, targeted drug treatments can cause cancer cells to die.

Targeted therapy drugs are available for certain types of brain tumors, and many more are being studied in clinical trials. Many different forms of targeted therapy are being developed.

Rehabilitation after treatment

Because brain tumors can develop in parts of the brain that control motor skills, speech, vision and thinking, rehabilitation may be a necessary part of recovery. Depending on your needs, your doctor may refer you to:

• Physical therapy to help you regain lost motor skills or muscle strength
• Occupational therapy to help you get back to your normal daily activities, including work, after a brain tumor or other illness
• Speech therapy with specialists in speech difficulties (speech pathologists) to help if you have difficulty speaking
• Tutoring for school-age children to help kids cope with changes in their memory and thinking after a brain tumor

Alternative medicine

Little research has been done on complementary and alternative brain tumor treatments. No alternative treatments have been proved to cure brain tumors. However, complementary treatments may help you cope with the stress of a brain tumor diagnosis.

Some complementary treatments that may help you cope include:

• Acupuncture
• Art therapy
• Exercise
• Meditation
• Music therapy
• Relaxation exercises

Talk with your doctor about your options.

Coping and support

A diagnosis of a brain tumor can be overwhelming and frightening. It can make you feel like you have little control over your health. But you can take steps to cope with the shock and grief that may come after your diagnosis. Consider trying to:

• Learn enough about brain tumors to make decisions about your care. Ask your doctor about your specific type of brain tumor, including your treatment options and, if you like, your prognosis. As you learn more about brain tumors, you may become more confident in making treatment decisions.
• Keep friends and family close. Keeping your close relationships strong will help you deal with your brain tumor. Friends and family can provide the practical support you’ll need, such as helping take care of your house if you’re in the hospital. And they can serve as emotional support when you feel overwhelmed by cancer.
• Find someone to talk with. Find a good listener who is willing to listen to you talk about your hopes and fears. This may be a friend or family member. The concern and understanding of a counselor, medical social worker, clergy member or cancer support group also may be helpful.