Brain Tumors
Diagnosis
To confirm or rule out a suspected brain or spinal cord tumor, the doctor will order imaging studies which may include a CT (computed tomography) scan or an MRI (magnetic resonance imaging) scan. Often, the radiologist who conducts the scan will need to inject a dye through an IV to make certain kinds of tissues stand out better. Both scans require a child to lie still for an extended time, so they may require procedural sedation or general anesthesia.
Sometimes, an experienced brain tumor team can use images to identify what type of tumor is present, but a biopsy, or tissue sample, may also be needed to make the final diagnosis. The neurosurgeons at Children's Hospital Boston also perform biopsies without open surgery by using a neuroendoscope, a small probe which transmits images from deep inside the brain to the operating surgeon, and tiny surgical tools to carry out the surgeon's actions. In addition, stereotactic biopsies, which are performed through a small hole with precise imaging guidance, can also establish a diagnosis. We will use these minimally invasive biopsy techniques whenever possible. However, certain cases will require more extensive surgery to obtain an adequate tissue sample. Often times, biopsies are done at the same time as the removal of the tumor.
Once a pathologist has examined the tissue collected from a biopsy or tumor excision, your child's neurosurgeon and primary neuro-oncologist will have a much better idea of what to expect. Tumors may be labeled benign or malignant, low grade or high-grade (primitive or undifferentiated) depending on the extent to which they invade surrounding tissue and the speed with which they grow. This terminology can be somewhat misleading because a benign, or slow-growing, tumor in an inoperable location can be just as dangerous as a malignant tumor in a more accessible spot. Because almost all brain tumors are potentially life threatening and usually require treatment regardless of whether they are called benign or malignant, we use the terms brain tumor and brain cancer synonymously.
