An accurate diagnosis helps ensure the best treatment approach and outcome for brain tumors and brain cancer. Your diagnosis starts with a full physical exam followed by a neurological evaluation and additional tests.

Your doctor will first review your symptoms, family history, overall health, and any other relevant factors to identify any signs of brain tumor and see what further testing is needed. During your neurological exam, your doctor may perform exercises to check your hearing, balance, cognition, speech, and other functions that may be impacted by your tumor.

After these exams are complete, your care team will recommend imaging tests and other diagnostic approaches to see if a tumor is present and what type of tumor it is, along with its size, its location, and how far it’s progressed. Penn Medicine offers the latest and most advanced diagnostic techniques to give you the clearest and most accurate answers for your brain tumor care.

A biopsy involves your doctor removing a sample of your tumor for further testing. It usually follows whatever imaging tests your doctor performs either to confirm a diagnosis or because the results of the imaging tests were unclear. Sometimes, a full surgical removal of the tumor is recommended as the initial step rather than only obtaining a biopsy.

A biopsy is often done through surgery but can also be done less invasively by a process called stereotactic biopsy. During this procedure, your doctor uses a device that reads your MRI or CT results to precisely guide a needle to the tumor through a small incision in the scalp.

Biopsy samples can also be used for genetic testing of the tumor. Genetic testing helps to determine what type of tumor you have, whether it’s malignant or benign, and what treatment is best.

How are brain tumors graded?

There are four grades of brain tumors. Grading helps your treatment team determine if your brain tumor is malignant or benign.

• Grade I: These tumors are considered benign and indolent (slow growing). They may be treated with surgery and there is a high probability of long-term survival, although a subset of these tumors can transform into higher grades over time  
• Grade II: These tumors are considered malignant but grow slowly. They are less likely to spread, but they may recur after surgery or treatment.
• Grade III: These tumors are malignant, often recur after treatment, and tend to spread to other parts of the brain.
• Grade IV: These tumors are the most malignant tumors. They grow and spread most rapidly and require the most aggressive treatment.

Your care team will help you fully understand what grade of tumor you’re facing and provide expert, compassionate treatment.

Our approach to brain tumor diagnosis

The Penn Brain Tumor Center offers the latest and most advanced diagnostic capabilities to give you an accurate and reliable path to care. In addition to the most sophisticated and effective imaging techniques, we also offer neuromonitoring during surgery to preserve cranial nerves that affect vision, hearing, balance, facial expressions, speech, and swallowing. Neuromonitoring also provides motor mapping (to preserve strength) and language mapping (to preserve speech) and avoid damage to healthy areas of the brain.

Our expert Brain Tumor Board meets weekly to consider new brain tumor cases and current cases—especially those that present challenges. This multidisciplinary board, made up of radiologists, pathologists, clinical trial investigators, neurosurgeons, and neuro-oncologists, discusses your individual diagnosis to provide the most wide-ranging look at your specific case to pinpoint your diagnosis and inform your care plan.

Many individuals seek a second opinion from Penn Medicine to help decide what the best treatment option might be. When you get a second opinion, a Penn doctor will review your medical history, current diagnosis, and any existing images to give you the most accurate diagnosis and discuss the best path toward treatment and management of your brain tumor.