Brain Tumor – Diagnosis and Treatment
Diagnosis
Tumor Classification and Levels
Specialists use several tests to find out if a person has a brain tumor. One of the most important steps is to identify the type of tumor and how aggressive it is.
After a biopsy, doctors examine tumor cells and assign a level from 1 to 4. This level is called the tumor’s grade.
- Grade 1: Tumors at this level grow very slowly. The cells look a lot like healthy brain cells. Doctors usually call these tumors benign, and removing them often leads to a good outcome.
- Grade 2: These tumors grow a bit faster than grade 1. They may look slightly different than normal cells and could become more aggressive over time.
- Grade 3: These tumors look very different from healthy cells and tend to grow faster. Doctors consider them malignant because they are more likely to invade nearby brain tissue.
- Grade 4: This is the most severe grade. The cells look much different from normal brain tissue, and the tumors grow quickly. These are the most aggressive tumors, such as glioblastomas.
Tumor grades help doctors plan treatment and give patients and families an idea of what to expect.
| Grade | Growth Speed | Appearance Compared to Healthy Cells | Benign or Malignant | Example |
|---|---|---|---|---|
| 1 | Slow | Very similar | Usually Benign | Pilocytic astrocytoma |
| 2 | Slow to Moderate | Somewhat different | Could become Malignant | Diffuse astrocytoma |
| 3 | Fast | Very different | Malignant | Anaplastic astrocytoma |
| 4 | Very Fast | Extremely different | Malignant | Glioblastoma |
Doctors grade tumors based only on how the cells look under a microscope after a biopsy. This grading does not account for how much of the brain or spinal cord is affected, because brain tumors are less likely to spread outside the brain.
Doctors call primary brain tumors high-grade if they are graded as 3 or 4, and low-grade if they are 1 or 2. High-grade tumors usually need more urgent and aggressive treatment.
Testing can also uncover changes in the DNA of the tumor cells. These changes give more clues to the kind of tumor and how doctors should treat it.
Imaging and Testing for Diagnosis and Prognosis
- MRI (Magnetic Resonance Imaging): MRI is often the first and most detailed imaging method used to detect brain tumors. It uses magnetic fields and radio waves to create clear images of the brain. A contrast agent like gadolinium may be injected into a vein to help highlight the tumor and show its boundaries more clearly. Special types of MRI, like perfusion MRI and MR spectroscopy, can reveal how much blood is reaching the tumor and what chemicals are inside it.
- CT Scan (Computed Tomography): CT scans use X-rays to quickly generate images of the brain. They are especially helpful in emergency settings to detect bleeding, swelling, or large masses. Although not as detailed as MRI, CT is faster and more widely available.
- PET Scan (Positron Emission Tomography): PET scans involve a small amount of radioactive material that collects in highly active cells. This test is useful for identifying aggressive tumors, such as glioblastomas, and checking for recurrence or spread. It may not detect slow-growing or benign tumors as effectively.
- Functional MRI (fMRI): This test shows which parts of the brain control important functions like speech or movement. Doctors use fMRI before surgery to avoid damaging critical areas during tumor removal.
- Biopsy: A biopsy is the definitive step in diagnosing brain tumors. A surgeon removes a sample of the tumor, either during surgery or through a stereotactic needle biopsy, which is guided by imaging. Biopsy confirms the tumor type, grade, and genetic profile, all of which are essential for planning treatment.
Table: Diagnostic Tests and Why They Matter
| Test | What It Shows | Role in Prognosis |
|---|---|---|
| MRI (+gadolinium) | Brain structure, tumor size and borders, type | Key for location and surgical planning |
| CT Scan | Quick look at brain; detects bleeding, masses | Used first in emergencies |
| PET Scan | Tumor activity and spread | Shows aggressive tumors |
| Functional MRI | Functions near tumor (speech, movement) | Helps avoid damage during surgery |
| Biopsy | Tumor type, grade, DNA changes | Necessary for final diagnosis |
Treatment
Surgical Procedures
For many people, surgery is the first step to treat a brain tumor. The main aim is to remove as much of the tumor as possible while keeping healthy brain tissue safe. Doctors can sometimes remove the entire tumor, especially if it is away from important brain areas and separate from normal tissue.
In other cases, doctors remove only part of the tumor, which can still help lessen symptoms. Craniotomy is the most common type of surgery. The surgeon removes a piece of the skull temporarily to access the brain.
The surgeon uses special tools, and sometimes lasers, to take out tumor tissue. In some cases, the patient stays awake for part of the procedure, so doctors can check brain function and limit risk.
| Type of Surgery | How It’s Done | Typical Use |
|---|---|---|
| Craniotomy | Skull bone is removed and replaced | Most brain tumors |
| Endoscopic | Thin tube through nose or skull | Deep or pituitary tumors |
| Subtotal Resection | Only part of tumor removed | Tumors near key brain areas |
Endoscopic surgery is another option. The surgeon inserts a thin tube with a camera (called an endoscope) through the nose, sinuses, or a small opening in the skull.
This less invasive method works well for tumors deep in the brain or near the pituitary gland. Neurosurgeons often work with a team including neuropathologists and neuro-oncologists to plan and perform the surgery.
Risks include infection, bleeding, damage to brain tissue, vision or hearing changes, and blood clots. The exact risks depend on where the tumor is.
External Energy Therapy
Radiation therapy uses strong rays to kill brain tumor cells. Doctors may use X-rays or newer methods like proton beams. Usually, radiation comes from outside the body (external beam radiation).
The doctor shapes the beams to focus on the tumor and tries to avoid harming healthy tissue. Treatment is usually scheduled 5 days a week for several weeks.
Sometimes, doctors treat the whole brain if there are many tumors, but usually only the tumor area gets radiation. Proton therapy is especially useful for children or tumors near important brain structures, since it causes less damage to healthy cells.
Focused Beam Therapy
Doctors use stereotactic radiosurgery (SRS) to treat both benign and cancerous brain tumors. This non-invasive method delivers precise, high-dose radiation to the tumor while sparing healthy tissue. It is often used when surgery is too risky or as a follow-up to remove remaining tumor cells.
Main Forms of Radiosurgery
- Gamma Ray-Based Radiosurgery: This method uses many focused gamma rays that intersect precisely at the tumor site. The combined energy targets the tumor while limiting exposure to nearby brain tissue.
- Linear Accelerator Based Radiosurgery (LINAC): In this approach, X-ray beams are shaped and delivered from multiple angles to conform to the tumor’s shape. It is highly adaptable and commonly used for various brain lesions.
- Proton Beam Radiosurgery: This uses proton particles instead of X-rays. Protons release most of their energy directly in the tumor, which may help protect nearby healthy tissue. While still less common, it is considered in select cases where the tumor is near critical brain structures.
Radiosurgery is usually an outpatient treatment, done in one or a few visits. Side effects include tiredness and changes to the scalp, which may be dry, itchy, or sensitive. Hair loss can also occur in the treated area.
Drug Therapy
Chemotherapy uses powerful drugs to target and destroy brain tumor cells. Patients can take these medicines as pills or receive them through a vein (IV infusion).
Sometimes, doctors place the drugs directly into the fluid around the brain during surgery. Chemotherapy can be given alone or with surgery or radiation, especially for some aggressive cancers.
Doctors choose the drugs based on the type of tumor, its grade, and past treatments. The main goal is to slow down or stop tumors from growing.
Possible side effects include hair loss, tiredness, infections, nausea, and a higher risk of bleeding or bruising. Most side effects depend on the drugs used and usually go away after treatment ends.
Precise Medicine Treatments
Targeted therapies treat certain brain tumors by focusing on specific changes in tumor cells. These drugs work differently from traditional chemotherapy. They block signals or chemicals that cancer cells use to grow and divide.
Neuropathologists or neuro-oncologists choose targeted treatments based on test results. Some people need these drugs if their tumors have special gene changes. Not everyone will benefit from targeted therapies.
Doctors may use these medicines alone or with other treatments. Side effects depend on the specific drug and may include skin changes, high blood pressure, stomach problems, or infection risk.
Doctors may recommend targeted therapy if a tumor returns after other treatments or if tests show the tumor has a target for these drugs.
Healing and Life After Therapy
Recovery after treatment is different for everyone. The time needed depends on the treatment type and which part of the brain was involved.
Some people need physical therapy, speech therapy, or help with daily activities if treatment affects movement, talking, or memory. Family, friends, and healthcare teams provide important support during recovery.
Patients often have regular appointments for MRI scans and check-ups to watch for signs of the tumor coming back. Occasional blood tests and visits to specialists may also be needed.
Common areas where help is needed:
- Regaining strength and movement.
- Working on speech and understanding.
Support groups and connecting with others who have had similar experiences can help with emotional recovery.
Suggestions for Recovery
- Attend all follow-up visits.
- Ask for help with physical or emotional challenges.
Eat a healthy diet and get plenty of rest. Keep a list of any side effects or new symptoms to share with your doctor.
Alternative medicine
Complementary treatments help people manage stress after a brain tumor diagnosis.
Some options include:
- Art therapy
- Physical activity
- Meditation
- Music therapy
- Relaxation techniques
These approaches do not cure brain tumors, but they can improve emotional well-being. Patients should talk to their health care providers before starting these methods.
Coping and support
Living with a brain tumor brings many changes. People may have symptoms like headaches, nausea, vomiting, seizures, vision changes, numbness, or trouble with balance or coordination.
Emotional challenges such as worry or sadness can affect daily life.
Ways to manage and find support:
Get Information: Learning about the type of brain tumor and available treatments helps people feel more in control. Reliable websites and medical experts can answer questions about symptoms, side effects, and how the tumor may affect brain function.
Build a Support System: Staying connected with family and friends offers practical and emotional help.
Talk to Professionals: Social workers or counselors from the health care team can listen, give information about resources, and help manage feelings.
Join Support Groups: Meeting others with brain tumors can help reduce isolation. In support groups, people share tips for coping and advice about handling side effects or changes in daily life.
| Symptom/Challenge | Possible Support |
|---|---|
| Headaches, nausea | Medications, talking to provider |
| Seizures | Safety planning, medication help |
| Balance issues | Physical therapy, exercise tips |
| Vision changes | Tips from specialists, adjustments |
| Emotional distress | Support groups, counselors |
Taking small steps, asking questions, and reaching out for help can make daily life feel easier.
Getting Ready for Your Visit
Steps to Take Before Your Appointment
Preparing ahead can make your appointment go smoother and help you remember important details.
Some steps to take:
Check for any special instructions. When you book your appointment, ask if there are things you should avoid before you come in.
Write down all your symptoms. Make a clear list of any problems, even those that do not seem connected to your main concern.
Record key personal background. Note any big life changes, stress, or recent events that may affect your health.
List all medications. Include prescriptions, over-the-counter drugs, vitamins, and herbal supplements.
Bring a support person. A friend or family member can help ask questions and remember what the doctors say.
Prepare questions. Write down what you want to ask, putting the most important questions first.
Here is a table to help organize what to bring:
| Item to Bring | Details |
|---|---|
| Proof of insurance | ID card or authorization info |
| List of symptoms | Dates, frequency, severity |
| List of medications/supplements | Names, doses, times taken |
| Recent test results | Blood tests, imaging, previous reports |
| Personal and family medical history | Major illnesses, surgeries, cancers |
| Written questions | Prioritized, space to take notes |
You may meet several health experts when facing brain tumor symptoms or diagnosis. A neurologist specializes in brain and nerve problems.
Other doctors, such as a medical oncologist or neuro-oncologist, focus on cancer. Sometimes a neurosurgeon will discuss possible surgery. Doctors might order blood tests and scans, depending on your symptoms.
A multidisciplinary team often works together in cancer care. This group of doctors and experts reviews your medical history and plans the best care for you. Being prepared helps you understand your options and take part in making decisions.
Some suggested questions to ask during your visit:
- What type of brain tumor do I have?
- Where exactly is the tumor located?
- How large is the tumor, and how fast is it growing?
- Are more tests needed, such as blood tests or MRI scans?
- What are the recommended treatment options?
- What are the possible side effects or risks?
- Is there a cure available for this type of tumor?
- Who are the members of the treatment team?
- Should care be handled at a specialized center?
- Will insurance cover the suggested treatments?
Tip: Take notes or record the appointment (with permission) to help you remember details later.
What Your Healthcare Team May Ask You
Your doctor and other team members will likely have several questions to guide diagnosis and next steps. Preparing answers ahead of time can help you get the most out of your visit.
Examples of questions your care team might ask:
- When did you notice your first symptoms?
- Are your symptoms present all the time, or do they come and go?
- How bad are your symptoms, and have they changed over time?
- Does anything seem to make the symptoms better or worse?
- Have you experienced any other changes in your daily life or mental function?
- Do you have any family history of brain or nervous system cancers?
If your doctor suggests extra tests, such as imaging or blood tests, they will explain why you need them and what to expect. The care team might also ask about other medical conditions, allergies, or past surgeries to better understand your health.
Remember: Good communication with your medical team builds trust and can improve your care. If you donโt understand something, ask your team to explain it in simpler terms or in writing.
