New patients who may have a brain tumor:

THE FIRST STEP IN THE PROCESS IS TO ESTABLISH A DIAGNOSIS.

In order to do this, we recommend obtaining an image or picture of the brain.

Brain Imaging:
The first step in the process for patients suspected of having a brain tumor is to obtain an MRI scan of the brain.  An MRI provides a clear picture of the problem.  An MRI scan is better than a CAT scan at looking at the anatomy of the brain.  A CAT scan is most useful for looking at the bone and MRI is better at looking at the soft tissues of the brain itself.  The MRI scan gives us an excellent picture of the tumor – we know where it is in the brain and what type of tumor it might be.  However, the MRI is usually not diagnostic – meaning that it tells us within a certain probability what it might be.

THE NEXT STEP AFTER BRAIN IMAGING IS TO SEE A SPECIALIST.

Specialists in brain tumors:
If you are suspected of having a brain tumor, you should be referred to someone who specializes in brain tumors.  Seeking an opinion from a specialist is the next step in the process.  This is easy to arrange.  While a general medical oncologist may take care of patients with brain cancer, it is very important to see someone who specializes specifically in the field of brain cancer.  There are two main groups of doctors who are specialists in brain tumors: neuro-oncologists and neurosurgical oncologists. neuro-oncologists are specialists who focus on treating patients with brain cancer and are often the “captains of the ship” in taking care of patients with brain cancer.  They make recommendations about what type of treatment would be best including surgery, chemotherapy or radiation.  They also often coordinate clinical trials for patients with brain cancer.  Neurosurgical oncologists specialize in the surgical treatment of patients with brain cancer.  If you are suspected of having a brain tumor you might be referred to either type of doctor.  At Vanderbilt, our neuro-oncologists and neurosurgeons work closely together to make recommendations for individual patients. If a patient does not need surgery, the neuro-oncologist will treat and follow the patient.  If a patient needs a surgical procedure, the neurosurgeon will be involved first.

THE NEXT STEP IS TO DEVELOP A TREATMENT PLAN.

Once the brain imaging is completed and a diagnosis of a brain tumor is suspected the patient will meet with a specialist and develop a treatment plan.  This is usually done in the outpatient clinic setting.  Your doctor will go over the brain imaging scans with you, discuss the findings on the MRI scans and formulate a plan.  The treatment plan will vary depending on the type of tumor found on the brain imaging.  In some cases, the plan may be to proceed with a surgical procedure to establish a diagnosis.  In others, additional tests or studies may be needed.  The purpose of the consultation is to develop a plan and to answer all of your questions.

If the treatment plan includes surgery:
For some patients, the treatment plan will involve a surgical procedure.  Prior to surgery, patients meet with the neurosurgeon to go over the films and discuss the surgical treatment plan.  During this meeting, you and your surgeon will discuss why surgery is recommended and what are the risks and benefits of the surgery.  A date for the surgery is set and arrangements made to have a careful pre-operative medical evaluation.

Hospital stay for surgery:
Patients who are undergoing surgery for their tumors are usually admitted to the hospital the day of surgery.  Often, a planning MRI scan will be obtained the night before, and removable markers will be placed to allow the surgeons to use image guided surgery to precisely localize the tumor during surgery.  Every operation is different and your surgeon will discuss with you how long the surgery may take.  Families often wait in the surgical waiting room at Vanderbilt. Family members are updated frequently during the surgery by the OR staff.

Neurosurgical Intensive Care Unit:
Patients undergoing brain surgery are carefully monitored after surgery, usually in the Neurosurgical Intensive Care Unit.  The Neuro ICU is an intensive care unit, staffed by dedicated neuro-intensivists, doctors who are specially trained in treating patients with neurological diseases.  Patients are evaluated closely by a nursing staff that has special training in caring for neurosurgical patients.  In order to make sure that patients have the highest level of skilled care in the ICU, visitation is regulated and you should discuss this with the ICU nursing staff.

Transfer from the ICU and discharge from the hospital:
After an appropriate period of careful monitoring, patients are transferred out of the ICU to the regular Neurosurgical floor.  Here patients will be monitored and often physical and occupational therapists will carry out an evaluation prior to discharge.  Patients will often have an MRI scan within 24 hours of their surgery.  This scan will serve as an important baseline scan when comparing future MRI scans.  Planning for discharge begins very early in the hospital course, with clinical social workers and case managers assigned to each patient in order to ensure a smooth transition out of the hospital.  A plan is put in place and before discharge, family and patients will go over the plan for their follow up care including medications, follow up appointments, and discharge do’s and don’ts.

Establishing a diagnosis:
Pathology: Once a tumor has been removed, it is studied very carefully by a neuropathologist.  A neuropathologist is a specialist in the diagnosis of brain tumors. Typically, it takes several days for the pathologists to study the tumor and generate a formal diagnosis.  Once the diagnosis is known, the treating neurosurgeon or neuro-oncologist will go over the diagnosis with the patient and his or her family and discuss the next steps.

After surgery: Tumor Board review.
After surgery, patients are given follow up appointments with their neurosurgeon and when appropriate, may be referred to a neuro-oncologist or radiation oncologist for further evaluation and treatment.  At Vanderbilt, every patient’s case is reviewed at the Neuro-Oncology Tumor Board.  The Tumor Board is a regular meeting of clinicians including neuro-oncologists, neurosurgeons, radiation oncologists, pathologists, nursing and support staff.  This interdisciplinary group meets weekly to go over specific patients to develop an individualized treatment plan.

Once a diagnosis is known: A new treatment plan will be developed.
Different tumors require different treatments including chemotherapy and or radiation therapy.  The type of treatment depends directly on the type of tumor.  Most all patients with brain tumors continue to be followed with some form of brain imaging – MRI – at regular intervals.  Patients are followed closely by either the neuro-oncologist or neurosurgeon.

Patients with a known diagnosis of a brain tumor: Second opinion.
May be searching for different information than patients who are newly diagnosed. Because there are so many different types of brain tumors, with many different treatment options, it is often very important for patients to have a second opinion.  The first step is to set up a consultation with a neuro-oncologist or neurosurgeon.  During this consultation, experts in treating brain cancer will review your history, brain imaging, and pathology and help to formulate a treatment plan.

THE NEXT STEP IS TO CONSIDER VARIOUS TREATMENT OPTIONS.

Brain tumors are treated differently, depending on their cell type and location in the brain. Standard ways to treat brain tumors involve surgery, chemotherapy, and possibly radiation. For each of these treatments, there are also often multiple options available.  For example, there are many different types of chemotherapy drugs for treating brain tumors.  There are many factors (such as the cell type of the tumor) that go into selecting the right one.  Some tumors are very sensitive to chemotherapy and others are not.  In a similar fashion, some tumors are very sensitive to radiation, while others are not.  As with chemotherapy, there are often different ways of delivering radiation and it is important to discuss these options with an expert in radiation oncology.  For example, focused radiation – or stereotactic radiosurgery – may be very useful for certain tumors, and in other cases, the doses of radiation are best delivered in smaller fractions, spread out over several weeks.

Clinical Trials:
Some patients with certain brain tumors may be eligible to participate in a clinical trial to evaluate a new way to treat brain tumors.  There are many such clinical trials available in major academic medical centers throughout the country.  Clinical trials are very important in helping to determine if a newer therapy is safe and effective in treating a brain tumor.

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