Doctors use many tests to find, or diagnose, a brain tumor and learn the type of brain
tumor. They also do tests to find out if it has spread to another part of the body from where
it started. This is called metastasis and is rare for a primary brain tumor. Doctors may also
do tests to learn which treatments could work best.
For most types of tumors, taking a sample of the possible tumor is the only sure way for
the doctor to know if an area of the body has a tumor. This may be done in a procedure
called a biopsy or by removing part or all of the tumor with surgery. In a biopsy, the doctor
takes a small sample of tissue for testing in a laboratory. If this is not possible, the doctor
may suggest other tests that will help make a diagnosis.
How a brain tumor is diagnosed
Imaging tests can help doctors find out if the tumor is a primary brain tumor or if it is
cancer that has spread to the brain from elsewhere in the body. Imaging tests show
pictures of the inside of the body. Your doctor may consider these factors when choosing a
diagnostic test:
• The type of tumor suspected
• Your signs and symptoms
• Your age and general health
• The results of earlier medical tests
Most brain tumors are diagnosed after symptoms appear. Often a brain tumor is first
diagnosed by an internist or a neurologist. An internist is a doctor who specializes in
treating adults. A neurologist is a doctor who specializes in problems with the brain and
central nervous system (CNS).
In addition to asking the patient for a detailed medical history and doing a physical
examination, the doctor may recommend the tests described below. These tests are to
help find out the presence, and sometimes the type or grade, of a brain tumor.
In general, diagnosing a brain tumor usually begins with magnetic resonance imaging
(MRI). Once MRI shows that there is a tumor in the brain, the most common way to
determine the type of brain tumor is to look at the results from a sample of tissue after a
biopsy or surgery. These tests and procedures are described below in more detail.
• MRI. An MRI produces detailed images of the inside of the body using
magnetic fields, not x-rays. MRI can be used to measure the tumor’s size. A
special dye called a contrast medium is given before the scan to create a
clearer picture. This dye can be injected into a patient’s vein. MRIs create
more detailed pictures than computed tomography (CT) scans (see below)
and are the preferred way to diagnose a brain tumor. The MRI may be of the
brain, spinal cord, or both, depending on the type of tumor suspected and the
likelihood that it will spread in the CNS. There are different types of MRI. The
results of a neuro-examination, done by the internist or neurologist, helps
determine which type of MRI to use.
o Intravenous (IV) gadolinium-enhanced MRI is typically used to
help create a clearer picture of a brain tumor. This is when a
patient first has a regular MRI and afterwards is given a special
type of contrast medium called gadolinium through an IV. Then,
a second MRI is done to get another series of pictures using
the dye.
o An MRI technique called "diffusion weighted imaging" helps
show the cellular structure of the brain. Another technique
called "perfusion imaging" shows how much blood is reaching
the tumor. These methods may help doctors predict how well
treatment will work.
o A spinal MRI may be used to diagnose a tumor on or near the
spine.
o A functional MRI (fMRI) provides information about the location
of specific areas of the brain that are responsible for muscle
movement and speech. During the fMRI examination, the
patient is asked to do certain tasks that cause changes in the
brain and can be seen on the fMRI image. This test is used to
help plan surgery, so the surgeon can avoid damaging the
functional parts of the brain while removing the tumor.
o Magnetic resonance spectroscopy (MRS) is a test using an
MRI that provides information on the chemical composition of
the brain. It can help tell the difference between any dead
tissue caused by previous radiation treatments and new tumor
cells in the brain.
• Tissue sampling/biopsy/surgical removal of a tumor. A sample of the
tumor’s tissue is usually needed to make a final diagnosis. During biopsy, a
small amount of tissue is removed for examination under a microscope.
Biopsy is the only way to make a definite diagnosis of a brain tumor, even if
other tests can suggest that cancer is present. A pathologist then analyzes
the sample(s). A pathologist is a doctor who specializes in interpreting
laboratory tests and evaluating cells, tissues, and organs to diagnose
disease. A biopsy can be done as part of surgery to remove the entire tumor.
Or surgery may be done as a separate procedure if completely removing the
tumor is not possible because of its specific location in the brain or a
patient’s overall health.
Your health care team may also recommend other tests to help make a diagnosis or find
out how well treatment is working. Not all tests described here will be used for every
person.
• CT scan. A CT scan takes pictures of the inside of the body using x-rays
taken from different angles. A computer combines these pictures into a
detailed, 3-dimensional image that shows any abnormalities or tumors. A CT
scan can help find bleeding and enlargement of the fluid-filled spaces in the
brain, called ventricles. Changes to bone in the skull can also be seen on a
CT scan, and it can be used to measure a tumor’s size. A CT scan may also
be used if the patient cannot have an MRI; for example, if the person has a
pacemaker for their heart. Sometimes, a contrast medium is given before the
scan to provide better detail on the image. This dye can be injected into a
patient’s vein and/or given as a pill or liquid to swallow.
• Positron emission tomography (PET) or PET-CT scan. A PET scan is a
way to create pictures of organs and tissues inside the body using various
substances, such as sugars or proteins. A PET scan is used at first to find
out more about a tumor while a patient is receiving treatment. It may also be
used if the tumor comes back after treatment. A PET scan is usually
combined with a CT scan (see above), called a PET-CT scan. However, you
may hear your doctor refer to this procedure just as a PET scan. A small
amount of a radioactive substance is injected into the patient’s body. This
substance is taken up by cells that are actively dividing. Because tumor cells
are more likely to be actively dividing, they absorb more of the radioactive
substance. However, the amount of radiation in the substance is too low to
be harmful. A scanner then detects this substance to produce images of the
inside of the body.
• Cerebral arteriogram, also called a cerebral angiogram. A cerebral
arteriogram shows the arteries in the brain. It is an x-ray, or series of x-rays,
of the head. X-rays are taken after a special dye called a contrast medium is
injected into the main arteries of the patient’s head.
• Lumbar puncture or spinal tap. A lumbar puncture looks for cancer cells,
blood, or tumor markers in a sample of cerebrospinal fluid (CSF), which is
removed using a needle. Tumor markers or biomarkers are substances
found in higher-than-normal amounts in the blood, urine, spinal fluid, plasma
or other bodily fluids of people with certain types of tumors. Typically, a local
anesthetic is given to numb the patient’s lower back before the procedure.
• Myelogram. The doctor may recommend a myelogram to find out if the
tumor has spread to the spinal fluid, other parts of the brain, or the spinal
cord. A myelogram uses a dye injected into the CSF that surrounds the
spinal cord. The dye shows up on an x-ray and can outline the spinal cord to
help the doctor look for a tumor. This test is only done occasionally; a lumbar
puncture (see above) is more common.
• Biomarker testing of the tumor. Your doctor may recommend running
laboratory tests on a tumor sample to identify specific genes, proteins, and
other factors, such as tumor markers, unique to the tumor. This may also be
called molecular testing of the tumor. Some biomarkers may help doctors
determine a patient’s prognosis, which is the chance of recovery
(see Grades and Prognostic Factors). Researchers are examining
biomarkers to find ways to diagnose a brain tumor before symptoms begin.
Results of these tests may help determine your treatment options. The
markers most commonly looked at for brain tumors include:
o For oligodendroglioma, the loss of the p-arm of chromosome 1
and the loss of the q-arm of chromosome 19. This is called a
1p/19q codeletion. It is linked to more successful treatment,
particularly with chemotherapy. It can be used to help plan
treatment, especially for anaplastic oligodendroglioma.
o A mutation in the isocitrate dehydrogenase (IDH) gene, which
is found in about 70% to 80% of low-grade gliomas in adults.
Higher-grade tumors can also have IDH gene mutations, which
suggests that these tumors started as lower-grade tumors that
became a higher grade. This mutation is linked with a better
prognosis in both low-grade and high-grade tumors.
o In glioblastoma, whether a gene called methyl guanine methyl
transferase (MGMT) is changed can help the doctor
understand a patient’s prognosis and how well treatment will
work. Its role in determining the benefit of treatment is being
tested in clinical trials.
• Neurological, vision, and hearing tests. These tests help determine if a
tumor is affecting how the brain functions. An eye examination can detect
changes to the optic nerve, as well as changes to a person’s field of vision.
• Neurocognitive assessment. This consists of a detailed evaluation of all
major functions of the brain, such as storage and retrieval of memory,
expressive and receptive language abilities, calculation, dexterity, and the
overall well-being of the patient. These tests are done by a licensed clinical
neuropsychologist. This specialist will write a formal report to compare with
future evaluations or identify specific problems that can be helped through
treatment.
• Electroencephalography (EEG). An EEG is a noninvasive test in which
electrodes are attached to the outside of a person's head to measure
electrical activity of the brain. It is used to monitor for possible seizures
(see Symptoms and Signs).
• Evoked potentials. Evoked potentials involve the use of electrodes to
measure the electrical activity of nerves and can often detect acoustic
schwannoma, a noncancerous brain tumor. This test can be used as a guide
when removing a tumor that is growing around important nerves.
Test results
After diagnostic tests are done, your doctor will review the test results with you. If the
diagnosis is a brain tumor, additional tests will be done to learn more about the tumor. The
results help the doctor describe the tumor and plan your treatment.
A team of researchers from Yale and the University of Connecticut
(UConn) has developed a nanoparticle-based treatment that targets
multiple culprits in glioblastoma, a particularly aggressive and deadly form
of brain cancer.
The results are published Feb. 8 in Science Advances.
The new treatment uses bioadhesive nanoparticles that adhere to the site
of the tumor and then slowly release the synthesized peptide nucleic acids
that they’re carrying. These peptide nucleic acids target certain
microRNAs — that is, short strands of RNA that play a role in gene
expression. Specifically, they’re directed at a type of overexpressed
microRNA known as “oncomiRs” that lead to the proliferation of cancer
cells and growth of the tumor. When the peptide nucleic acids attach to
the oncomiRs, they stop the tumor-promoting activity.
The laboratories of professors Mark Saltzman of Yale and Raman Bahal of
the University of Connecticut collaborated on the treatment system.
Unlike similar efforts that target only one oncomiR at a time, this
treatment targets two, making its effect on cancer cells stronger, the
researchers say. The test mice who received the treatment lived for a
significantly longer time than the control mice.
“The treatment can knock down both targets at the same time, which
turns out to have a remarkably more powerful result, as we saw with the
increased survival results,” said Saltzman, the Goizueta Foundation
Professor of Biomedical Engineering, Chemical & Environmental
Engineering & Physiology and member of Yale Cancer Center. “These
results are the best I've ever seen in this sort of aggressive brain tumor.”
One challenge in developing the treatment was designing the anti-cancer
agents, known as antimiRs, so that two different ones could fit in a single
nanoparticle.
“We synthesized all these compounds and came up with the idea that you
don't have to target one oncomiR at a time,” said Bahal, associate
professor of pharmaceutics at UConn. “Now we can think about multiple
oncomiR targets.”
For this work, the researchers targeted the oncomiRs known as miR-10b
and miR-21, which are both very common in glioblastoma. Future
treatments, though, can be easily tailored for specific patients. For
instance, if a biopsy of a patient’s tumor produces a profile showing the
proliferation of different oncomiRs, the treatment could be appropriately
altered.
Saltzman calls the treatment “a marriage of two technologies.”
“One is the bioadhesive nanoparticle technology, which we had developed
earlier, and marrying it to this peptide nucleic acid technology that Raman
has perfected,” he said.
Because the treatment is localized to the tumor site, Bahal noted that
both the synthesized nucleic acids and the nanoparticles that deliver them
to the tumor site are nontoxic. Also critical to the treatment’s success is
that the particles and the agent it releases remain at the tumor site for
about 40 days. Conventional site-specific treatments tend to wash away
fairly quickly.
