Diagnosing Brain and Spinal Cord Cancer
- Support Throughout the Diagnostic Process
Our physicians, nurses and support staff are here to advise you, listen to you and calm your fears. Your physicians will explain your diagnosis and compassionately offer suggestions for treatment and care. They’re here for you.
Also available for counsel, support and guidance are nurse coordinators, oncology social workers and a pastoral team. They’ll help you navigate through the system and provide additional assistance, including:
- Social support
- Spiritual guidance
- Emotional support
- Practical advice
- Tips on coping
Call on them. They’re here for you.
At Scott & White, we offer a number of different diagnostic tests to evaluate your brain or spinal cord tumor or tumors. Your physician will discuss which test or tests are best for you.
Some of these tests may be ordered by your primary-care physician and some ordered by a specialist, such as a neurosurgeon.
Getting through the testing and determining the best treatment for brain or spinal cord tumors can be a long and arduous process. Accuracy is paramount.
Scott & White provides the following diagnostic services:
Your physician may ask you a series of questions and have a set of physical tests for you to perform in the exam room.
Some of the questions your doctor may ask you include:
- Mental status tests — reciting the alphabet backwards, stating the current date, naming the current president
- Abstract thinking tests — explaining common sayings, such as “birds of a feather flock together”
- Memory tests — having you detail what you ate yesterday or what chores you completed
Some of the physical tests you may be asked to perform include:
- Balance and coordination tests — balancing with your eyes closed, touching finger to nose with eyes closed
- Sense-of-touch tests — identifying sharp, soft, pointed items
- Facial-muscle tests — smiling, frowning
- Reflex tests — using rubber mallet
- Eye-movement tests — following moving finger; pupil reaction to light
- Vision tests
- Hearing tests
- Smelling tests
A biopsy is a surgical procedure in which a sample of brain tissue is removed. Your neurosurgeon will cut a small hole in your skull and remove a small piece of brain tissue. The tissue sample will be sent to the laboratory for evaluation.
Sometimes a small piece of bone must be removed. This procedure is called an open biopsy, or craniotomy. Your neurosurgeon will replace the piece of bone after the tissue sample is removed.
If your tumor is in a part of your brain that is considered “inoperable,” your neurosurgeon may drill a tiny hole, called a burr hole, in your skull and insert a thin, narrow needle to remove a small sample of tissue from your tumor. The tissue sample will be sent to the laboratory for evaluation.
Stereotactic Needle Biopsy
Your physician may recommend a stereotactic needle biopsy. In this procedure, your neurosurgeon will drill a small hole, called a burr hole, into your skull. Then your physician will insert a thin needle, precisely guided by a CT scan or MRI, to the tumor location to remove a small tissue sample. The sample will be sent to the laboratory for evaluation.
The Wada test is used to determine which hemisphere of your brain is dominant for language. It’s generally used prior to surgery for temporal lobe tumors.
In this procedure, your neuroradiologist will insert a small, thin tube (catheter) into one hemisphere of your brain. Your neuroradiologist will anesthetize one hemisphere of your brain while the other hemisphere stays “awake.” Your neuropsychologist will test the language and memory capacity of the half of your brain that’s awake.
Then the physician team will let the medication wear off, reposition the catheter and repeat the process on the other side.
With these results, your neuropsychologist will be able to determine in which hemisphere your language and memory capacities are located.
Your physician may order a hearing test, called an audiogram, to help determine whether you have certain brain tumors that lie along the nerve that connects your ear to your brain.
To assess whether you might have a tumor at your optic chiasm (where your optic nerves cross in your brain), your physician may order a check of your visual field, called a perimetry exam.
Brain Scans and Imaging Tests
With ever-advancing technology, physicians are better able to see inside your brain to locate and evaluate tumors. They often do so using computer-assisted scans. Here are explanations of the kinds of imaging tests and brain scans offered at Scott & White.
Your physician may order an electroencephalogram (EEG) to detect problems in the electrical activity of your brain. Your brain works by sending tiny electrical impulses. In an EEG, this electrical activity is measured by pasting flat metal disks (electrodes) on your scalp. The electrodes are connected to an amplifier and a computer. Results are read by your physician.
Magnetic Resonance Imaging (MRI) Scan
Magnetic resonance imaging (MRI) scans are the primary way of diagnosing brain and spinal cord tumors.
Our top-of-the-line magnetic resonance imaging (MRI) machines offer exceptional image quality of your brain and spinal cord. With the MRI images, your radiologist will have a clear view of any abnormalities. The results are sent electronically to your physician.
MRI with Contrast Dye
Sometimes your physician will request an MRI with contrast dye. After you have had a regular MRI, you’ll be injected with some contrast dye. You’ll then have a second MRI. The dye will highlight the presence of any tumors.
A highly specialized MRI, this machine incorporates minimally invasive techniques utilizing X-ray fluoroscopy technology to monitor movement inside your brain. This super-fast MRI can reveal your tumor’s use of oxygen. It can also reveal the specific areas of the brain that control memory, movement and speech.
Your physician may order an MRI of your spine to evaluate tumors at or near your spine.
Computed Tomography (CT) Scan
Scott & White has four state-of-the-art, top-of-the-line computed tomography (CT) scanners to evaluate your brain or spinal cord tumor or tumors. CT scanners create three-dimensional pictures of the inside of your head.
The CT machine will circle your head and take detailed pictures of your brain or spinal cord. You may receive an injection of contrast dye and have more images made. The dye will highlight the presence of any tumors.
Using the CT scan, your radiologist will be able to determine the size, shape and place of the tumor. The results are sent electronically to your physician.
CT scans are also used to determine whether your cancer has spread to other parts of your body, such as your lymph nodes, lungs and liver.
A dynamic computed tomography is a CT scan that measures the contrast dye flowing in your brain as soon as it enters your body from the IV. This allows your physician to see the blood vessels surrounding your tumor more clearly.
With this highly specialized imaging machine, two opposing energy tubes take scans of your brain at a much faster rate, thereby reducing your exposure to radiation.
Magnetic Resonance Spectroscopy (MRS)
A highly specialized, cutting-edge imaging machine, the magnetic resonance spectroscopy (MRS) unit takes images that reveal how your brain functions rather than the size or shape of your tumor.
The MRS is helpful in evaluating gliomas and in determining whether the tumor is cancerous.
Positron Emission Tomography (PET) Scan
Your physician may order a scan of your brain or spinal cord using our cutting-edge positron emission tomography (PET) scanner. PET scans are generally used to assess the grade or stage of your tumor. They’re also used to determine the difference between new tumor cells, cells destroyed by radiation and scar tissue.
With a PET scan, radioactive tracers are injected into the tumor area. Scanners then record photons emitted by the tracers. A computer reassembles the image into a readable picture to determine the presence of tumors. The results are sent electronically to your physician.
Single Photon Emission Computerized Tomography (SPECT)
Your physician may order a single photon emission computerized tomography (SPECT) scan to evaluate your tumor. It’s usually used in addition to other imaging tests.
Similar to the Positron Emission Tomography (PET) scan, radioactive tracers are placed in the brain. Their movement is recorded.
Your physician may order a chest X-ray to check whether you have cancer in your lungs. Many brain tumors originate in areas of your body other than the brain.
With a cerebral angiogram, your nuclear radiologist will inject a special dye into the blood vessels around your tumor. The dye helps detail the arteries in the brain. A series of X-rays will be taken.
Lumbar Puncture (Spinal Tap)
Generally used as a test to confirm a diagnosis of certain brain tumors, a lumbar puncture, or spinal tap, is a test used to check for cancer cells in your cerebrospinal fluid (CSF). The CSF is the special liquid that surrounds your brain and spinal cord.
With a lumbar puncture, you’ll lie down on your side with your legs pulled up to your chest. Your physician will numb the lower part of your back and then insert a small, hollow needle to withdraw a small sample of your CSF.
The fluid sample will be sent to the laboratory to check for blood, cancer cells or tumor markers. The results will be sent to your physician.
Lumbar punctures are helpful in diagnosing the following:
- Primary CNS lymphoma
- Pineal region tumors
- Meningeal tumors
They’re also useful in staging tumors and in helping your Integrated Care Team determine the best treatment choices for you.
If your physician suspects you may have a tumor on your spine, he or she may order a myelogram. To have a myelogram, you’ll first have a lumbar puncture, which will include a special dye. Your physician will inject the dye into your CSF. The dye will highlight any tumors along your spinal cord.
A myelogram is also used to check whether your cancer has spread (metastasized) to your CSF, your spinal cord or other parts of your brain.
Similar to an EEG, the evoked-potentials test uses small metal plates, called electrodes, to measure the electrical activity of the nerves in your brain. It’s used to detect a benign brain tumor called acoustic schwannoma.
This test is also used to guide your neurosurgeon during the surgical removal of tumors that surround critical nerves in the brain.
Blood Tests & Urine Tests
Your physician may order blood and urine tests to check whether your kidneys and liver are functioning properly, particularly if you have been ill for a while or are undergoing chemotherapy. They’re also often ordered prior to surgery.
Your physician may request a neuropsychological evaluation. Neuropsychological evaluations are typically ordered to assist your physician team in determining whether your brain is functioning at expected levels.
Your neuropsychologist will evaluate several areas of cognitive function. He or she will look for particular patterns between these areas to help determine areas of deficit in order to recommend therapies to circumvent decline.
Some of the areas your neuropsychologist will evaluate include:
- General intellectual ability
- Ability to pay attention
- Language skills
- Problem solving and reasoning ability
- Functional abilities (everyday living skills)
- Mood and personality
Generally, your neuropsychologist will evaluate you prior to any procedures, such as surgery, radiation therapy or chemotherapy, in order to get a baseline evaluation. With baseline scores, any improvements or decline after treatments can be monitored more effectively.
Benefits of a Neuropsychological Evaluation
Based on the results of your neuropsychological evaluation — both before and after treatment — we can recommend medications or treatments, and techniques to help you deal with the complications of the particular deficits you have. We can also suggest techniques to circumvent the cognitive deficit or various therapies to help you adjust to it.
Moreover, your scores will also help you and your family members know which abilities you are able to do independently and which things you may need help with.
Another benefit of your neuropsychological exam is to identify and evaluate your emotional status after your diagnosis. If your neuropsychologist finds that you have anxiety, depression or any other mental health issue — either due to the brain or spinal cord tumor or from some other cause, you will be referred to the proper therapy and appropriate treatment.
The neuropsychological exam will also help determine if your brain tumor is located in an eloquent area of your brain. Eloquent areas are areas that are critical to cognitive function, such as speech, comprehension and memory. When a tumor is located in an eloquent area, your neuropsychologist will help ascertain the risk of removing the tumor or operating in that area.
Your neuropsychologist will follow you as you receive treatment at Scott & White. He or she will test you every six months to a year, depending on what kind of treatment you have and your symptoms.
During this time, your neuropsychologist, as part of your Integrated Care Team, will note your progress and make recommendations for treatment, rehabilitation or circumvention therapy. The goal of continuing neuropsychological treatment is to facilitate and maximize your cognitive function.