Diagnosis
If a person has symptoms that suggest a brain tumor, the doctor
may perform one or more of the following procedures:
Physical exam—The doctor checks general signs of health.
Neurologic exam—The
doctor checks for alertness, muscle strength, coordination, reflexes, and
response to pain. The doctor also examines the eyes to look for swelling
caused by a tumor pressing on the nerve that connects the
eye and brain.
CT scan—An x-ray
machine linked to a computer takes a series of detailed pictures of the
head. The patient may receive an injection of a special dye so the brain
shows up clearly in the pictures. The pictures can show tumors in the brain.
MRI—A powerful magnet
linked to a computer makes detailed pictures of areas inside the body.
These pictures are viewed on a monitor and can also be printed. Sometimes a
special dye is injected to help show differences in the tissues of the brain.
The pictures can show a tumor or other problem in the brain.
The doctor may ask for other tests:
Angiogram—Dye
injected into the bloodstream flows into the blood vessels in the brain
to make them show up on an x-ray. If a tumor is present, the doctor may
be able to see it on the x-ray.
Skull x-ray—Some types of brain tumors cause calcium
deposits in the brain or changes in the bones of the skull.
With an x-ray, the doctor can check for these changes.
Spinal tap—The
doctor may remove a sample of cerebrospinal fluid (the fluid that fills
the spaces in and around the brain and spinal cord). This procedure is
performed with local
anesthesia. The doctor uses a long,
thin needle to remove fluid from the spinal column. A spinal tap takes
about 30 minutes. The patient must lie flat for several hours afterward
to keep from getting a headache. A laboratory
checks the fluid for cancer cells or other signs of problems.
Myelogram—This
is an x-ray of the spine. A spinal tap is performed to inject a special
dye into the cerebrospinal fluid. The patient is tilted to allow the dye
to mix with the fluid. This test helps the doctor detect a tumor in
the spinal cord.
Biopsy—The removal
of tissue to look for tumor cells is called a biopsy. A pathologist looks
at the cells under a microscope to check for abnormal cells.
A biopsy can show cancer, tissue changes that may lead to cancer, and
other conditions. A biopsy is the only
sure way to diagnose a brain tumor.
Surgeons can obtain tissue
to look for tumor cells in three ways:
Needle biopsy—The
surgeon makes a small incision in
the scalp and drills a small hole into the skull. This is called a
burr hole. The doctor passes
a needle through the burr hole and removes a sample of tissue from the
brain tumor.
Stereotactic
biopsy—An imaging
device, such as CT or MRI, guides the needle through the burr hole to the
location of the tumor. The surgeon withdraws a sample of tissue
with the needle.
Biopsy at the same time as treatment—Sometimes the surgeon
takes a tissue sample when the patient has
surgery to remove the tumor.
Sometimes a biopsy is not possible. If the tumor is in the brain stem
or certain other areas, the surgeon may not be able to remove tissue from
the tumor without damaging normal brain tissue.
The doctor uses MRI, CT, or other imaging tests instead.
A person who needs a biopsy may want to ask the doctor
the following questions:
Why do I need a biopsy? How will the biopsy affect my treatment plan?
What kind of biopsy will I have?
How long will it take? Will I be awake? Will
it hurt?
What are the chances of infection or bleeding
after the biopsy? Are there any
other risks?
How soon will I know the results?
If I do have a brain tumor, who will talk to me
about treatment? When?
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