Early diagnosis is not always possible as, despite everything, the brain is characterised by a high degree of functional plasticity and its compensatory mechanisms are individually very variable. A direct consequence of this is that especially in the case of low grade tumours there can be a significant interval of time between the start of tumour growth and the first presentation of symptoms.

Speed and accuracy of primary diagnosis is critical in getting speedy treatment.

Different tumours need different instruments and diagnostic investigations to discover them, in order to choose the best treatment options.

When there is suspicion of a brain lesion, the patient should identify as soon as possible a physician (e.g: GP) who should quickly get a brain scan and refer him to a specialist (Neuro-oncologist) in order to start the diagnostic work-up: time lost in queuing for a scan can be fatal and resources are stretched.

Some scans are difficult to interpret and some tumours are difficult to grade. You need to know the type of tumour and the grade in order to assess the need for urgent action or whether a slower approach is acceptable.

This is easily said but difficult to do because there is strong demand for scarce resources.

Get a second opinion.

The full diagnostic work-up includes:

Complete medical history with physical and neurological examination.

Radiological evaluation: the preferred diagnostic investigation is magnetic resonance imaging without and with contrast enhancement.  The advantages here lie in the vast amount of detail that can be visualised without exposure to ionising radiation.

Disadvantages are:

This cannot be used for those carrying some kind of metal implants even if in most cases is safe, except for a few times. The radiologist should be always informed of any metal or electronic device (pace-maker..)

It can be a very uncomfortable experience for those who are claustrophobic, in this case the open MRI can be an alternative option

Lack of widespread availability

The relatively high cost of such an investigation

Another widely use diagnostic tool is computerised tomography.  Advantages here are excellent imaging of bony structures, short duration of the procedure, greater availability and it is cheaper.

In specific cases a lumbar puncture can be useful to measure the cerebral spinal fluid (CSF) that bathes the brain and spinal cord, and is possible to analyse a small amount allowing a differential diagnosis between infections and tumours.

Surgical removal of the tissue sample through a biopsy or in the contest of a surgical resection, whenever it is possible: the pathological diagnosis is the important final step allowing a differential diagnosis between eventually benign/malign tumours. The neurophatologist will see the type of cells present, their abnormalities and speed of growth, plus other biological features that will allow tumours to be rated and graded from the least malignant to the most aggressive ones.

Whenever the surgical approach is not possible, the radiological diagnosis can be a satisfactory criterion for the diagnosis itself, based on the features of the lesions that can be highly indicative of their nature.

Should the tumour turn out to be a benign one, late diagnosis does not always imply a negative prognosis.  Should the tumour, however, turn out to be a malignant one, a possible consequence of late diagnosis is that at times, even at the point of first presentation of symptoms, the tumour is already either much too large with massive infiltration, or spread over many locations in the brain, thereby precluding effective neurosurgical intervention of any kind right from the start.

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