Diagnosing & Staging

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Diagnosing and Grading Adult Brain Tumors

As with most diseases, successful treatment of brain tumors begins with early detection and an accurate diagnosis. Based on your symptoms, the specialists at the Florida Hospital Brain and Spinal Cancer Program may recommend additional testing. These tests can be as basic as a physical exam to state-of-the-art diagnostics that can identify even the smallest tumor in the brain.

Following are the tests doctors at the Florida Hospital Brain and Spinal Cancer Program may utilize to determine the presence and extent of adult brain tumors:

• Physical exam and history: As a first step, your primary physician or doctor at the Florida Hospital Brain and Spinal Cancer Program may begin with a general exam. This includes checking your general health and signs of disease or anything else that appears out of the ordinary. The doctor may also ask in-depth questions about your personal health habits, past exposure to risk factors, or family history to determine if additional testing is required.
• Neurological exam: As part of your basic exam, your doctor may perform a neurological exam as well. This involves a series of questions and tests to check how your brain, spinal cord and nerves are functioning. Tests include your mental awareness, coordination, ability to walk and the overall state of your muscles, senses and reflexes.
• Visual field exam: Vision issues can be one of the first indicators of a problem in the brain. A vision test checks central and peripheral vision. Any loss of vision may be a sign that a tumor has either damaged or pressed on parts of the brain that affect eyesight.
• Tumor markers test: Blood, urine, spinal fluid or a tissue sample are examined to measure the amounts of certain substances that have been released into the blood by organs, tissues or tumor cells in the body. When substances linked to specific types of tumors are found in increased levels, they are known as tumor markers.
• Gene testing: Changes in a specific chromosome can be used to detect the presence of certain types of brain tumors. This lab test uses a blood or tissue sample to identify these changes.
• Cytologic analysis: Doctors at the Florida Hospital Brain and Spinal Cancer Program insert a small needle into the spinal column to collect a small amount of cerebrospinal fluid. This fluid is then viewed under a microscope by one of our pathologists to check for signs of cancer.
• CT scan: Three-dimensional images are made of the region using computerized x-rays. A dye is first injected into a vein or swallowed to help organs and tissues show up more clearly.
• MRI (Magnetic Resonance Imaging): An MRI uses magnetism, radio waves and a computer to generate images of the brain and spinal cord. Imagining specialists at the Florida Hospital Brain and Spinal Cancer Program begin by injecting gadolinium into a vein. This substance collects around the cancer cells so they appear brighter in the imaging. A procedure called a magnetic resonance spectroscopy (MRS) may also be performed during the MRI to diagnose the chemical composition of the tumors.
• SPECT scan (Single Proton Emission Computed Tomography scan): Using a special camera linked to a computer, the SPECT scan makes a three-dimensional picture of your brain. To enhance the imaging, a radioactive substance is added to your bloodstream. Areas with increased blood flow and more chemical reactions show where the cancer is growing.

If doctors at the Florida Hospital Brain and Spinal Cancer Program believe a brain tumor is present, they may recommend that a biopsy be performed. In a biopsy, a small window in the skull is created and a needle is used to remove a tissue sample. This tissue is viewed by a pathologist under a microscope who can then determine the presence of a tumor, if it is cancerous, and the type and grade.

Based on the results of these examinations and tests, your doctor will discuss treatment options with you if a tumor has been found, which can include surgery, radiation therapy and chemotherapy.

Grading Adult Brain Tumors

As most people today think of it, there is no standardized staging system for brain tumors in adults. Instead, doctors and pathologists work together to grade the tumor. A grade is given based on the way the tumor cells look under a microscope. Pathologists determine the tumor's growth rate, blood supply, presence of a dead cell center, invasive potential and similarity to normal cells.

Grade I - The tumor is slow growing and the cells look a lot like normal cells. The tumor rarely spreads to nearby tissues and there's a high probability that the entire tumor can be successfully removed during surgery.

Grade II - The tumor is growing slowly, but it may spread to nearby tissue and can come back. Some tumors may later become a higher grade tumor.

Grade III - The tumor grows quickly and is likely to spread into nearby tissue. The tumor cells look different from normal cells.

Grade IV - The tumor is growing and spreading very quickly and the cells no longer look like normal cells. Areas of dead cells may be present in the tumor. Grade IV tumors are much harder to treat and cure than lower grade tumors.

Tumors that begin in the brain may spread to other sections or even the spinal cord, but they rarely spread to other parts of the body. The treatment of brain tumors is based on the type of cells the tumor began in, its location in the central nervous system, and the grade of the tumor.