Finding out that you have a brain tumor can turn your world upside-down. It’s perfectly normal to feel scared, overwhelmed, and confused — not just about the tumor itself, but also about the diagnosis process.
Learning what to expect can help ease these feelings, and allow you to dive into the testing and diagnosis stage with confidence.
Steven Brem, MD, Co-Director of the Brain Tumor Center and Director of Neurosurgical Oncology at Penn Medicine, explains how a diagnosis is made, what information might be coming your way, and what makes Penn Medicine’s approach to brain tumor diagnosis unique.
Q: What Happens Leading up to a Brain Tumor Diagnosis?
Dr. Brem: The process usually begins with an imaging test called magnetic resonance imaging (MRI). The MRI shows the tumor but doesn't give us specifics about the makeup of the tumor.
The next step is a surgical procedure where we remove a sample of the tumor. This allows us to look at the tumor in more detail and confirm whether or not it's cancerous. It also gives us an idea if the cancer has spread from somewhere else in the body (glioma metastasis), as well as the likelihood that the cancer could grow or spread. We put all of this information together to determine the exact diagnosis and how we will treat the tumor.
Q: What’s the Process of Diagnosing a Brain Tumor and Explaining It to a Patient?
Dr. Brem: Diagnosis is a team process. I’m like the coach in the owner’s box — I share my perspective with a team of experts, such as radiation and medical oncologists, but we all work together. We huddle and come up with the best game plan for you.
Q: What Will a Patient Find out During the Diagnosis?
Dr. Brem: You will find out the type of tumor. We use a classification system from the World Health Organization (WHO), which recognizes 120 different types. However, we keep it simple by using three main categories:
- Tumors on the surface or under the surface of the brain: These are generally benign (non-cancerous) tumors, including meningiomas, pituitary tumors, and acoustic neuromas. They can usually be cured with surgery.
- Tumors inside the brain (intra-axial): These tumors, called gliomas, can either start in the brain or have spread from somewhere else in the body. The most common brain tumor we see is actually lung cancer that has spread to the brain.
Large tumors require surgery, but smaller ones can usually be treated with the Gamma Knife — a precise radiation therapy that uses computer software. Because we’re able to detect tumors earlier and the tumors are smaller, we’re able to treat more and more of these tumors with Gamma Knife therapy rather than whole brain radiation therapy, and patients have more success with targeted therapy.
- Gliomas: These are tough tumors because we can remove them with surgery, but they usually come back 100% of the time and spread throughout the brain.
Of the gliomas, there are four types. The first is a pediatric tumor, which is curable. The second is a low-grade tumor, which almost certainly leads to malignant (cancerous) tumors and requires aggressive surgery. The third and the fourth are very aggressive tumors and can be fatal, which we treat with surgery because that leads to better outcomes for the patient.
Q: What Makes Penn’s Approach to Explaining a Brain Tumor Diagnosis Unique?
Dr. Brem: It’s not just that we’re warm and compassionate. It’s also what we have available for our patients — cutting-edge technologies and surgeries, opportunities to participate in clinical trials, and the breadth and depth of our providers’ expertise.
A specialized center like Penn Medicine is especially valuable for aggressive tumors because of the expertise and treatment options we have available.
We don’t just tell you what to do. We provide many different options — and that’s what makes Penn unique.