Diagnosis and treatments
How is a tumour diagnosed?
Before any treatment can begin, the doctors will need to perform a diagnosis to establish the position, and type of tumour you may have. There is a large variety of tumours, each with different symptoms and needing different treatments.
You may have several investigations or tests. These will give the doctors helpful information about your general health and the tumour, and how it is affecting you. Some of the tests are explained here.
X-rays of your chest and your skull or other bones may be taken. These will assess your general health and will help with your diagnosis and planning your treatment.
These will help to assess your general health and will also help the doctors to check on any changes which may occur with your treatment.
A CT scan or ‘Cat scan’ is a special x-ray. The machine produces images which correspond closely with cross section pictures of your head or body. It may be hard to understand what the pictures are like, but try to imagine a loaf of bread – the whole loaf represents the person being scanned and every slice of bread represents one cross section picture that is taken of your head or body. An injection of ‘contrast’ (dye) may be given into a vein in your arm or hand to help give clearer images on the scans. A CT scan lasts about 30 minutes and you will need to lie still. But none of it is painful or dangerous.
Magnetic Resonance Imaging (MRI)
An MRI scan is like a CT scan but it uses magnetic fields instead of x-rays to build up the series of pictures. Like with the CT scan an injection of dye may be necessary. The test may take up to an hour and it does not hurt. During the test you will have to lie very still inside a cylinder which is open at both ends. Some people might feel rather claustrophobic inside the cylinder but someone will sit close by you.
After your investigations and tests the doctors will carefully study all the results to decide what treatment would be best for you. There are several treatments for brain tumours. Much will depend on what type of tumour you have and which part of your brain it is in. The hospital staff will explain your treatment to you. Ask them about anything you do not understand or feel afraid about. Take someone with you, and take a notebook with you on treatment days to help you to remember what the staff said to you and what happened.
Remember that research into the treatment of cancer is always taking place and you will be given the most up-to-date care that is right for you.
You will probably chat to other patients at the hospital and get friendly. People usually find they get support from each other. But do not worry if you find out that you are not getting exactly the same treatment as another patient. Remember that every patient has individual treatment according to their particular needs.
You may need an operation, you may also have treatment with drugs, or possibly you may need to undergo radiotherapy or chemotherapy.
The operation may be a biopsy. This is a small operation in which a piece of tissue is removed and is sent to the laboratory to be examined under the microscope. This will identify the type of tumour you have. Its cells and tissue type may influence what sort of treatment you are given.
The operation may be a craniotomy. This operation opens the skull remove safely as much as the tumour from the brain as is possible.
There are several sorts of drugs which will help you.
Steroids are drugs which may reduce the swelling around the tumour and may improve some of the symptoms caused by the brain tumour. Dexamethasone is the name of the steroid drug which is usually used. Steroids can cause side effects such as an increase in appetite, weight gain, a puffy face, changes in mood and occasionally some weakness and indigestion. It is important to tell your doctor or nurse if any of these occur.
Anti-convulsant drugs are used to control seizures. A lot of progress has been made in these drugs and they can now greatly reduce the number of seizures you have or even completely control them. The particular drug you have will depend on the type of seizure and you as an individual. It may take a while to reach the correct dose that suits you. Occasional blood tests will be taken to check on this. It is very important to always take the exact dose you have been prescribed and always at the advised time. Your anti-convulsant drugs should never be stopped suddenly without medical advice.
Chemotherapy is a combination of medicines, which may take the form of tablets, or injections or both. They are given to destroy or control cancer cells. Chemotherapy can be used to treat brain tumours. If the doctor does recommend it for you, he will explain it to you and answer your questions.
Radiotherapy is a treatment which uses high energy x-ray beams to destroy or control cancer cells.
Planning your radiotherapy is always done very carefully in a planning department. You will need to visit a simulator, which is a machine used to take x-rays of the area to be treated in the treatment position. CT scans may also be used to plan your treatment. You might have to visit the simulator several times.
You may have an individual mask made for you, to help you to keep your head still while you have your treatment. This will make sure that the radiotherapy is given accurately. The mask is made from thermo plastic which when placed in warm water becomes pliable. It is placed over the patient’s face and moulded into shape. The mask is then attached to a frame where it cools and becomes rigid, You will only wear the mask for the short time that you are having your radiotherapy treatment.
Radiotherapy may be given once or twice a day, from Monday to Friday and it only takes 10-15 minutes. Some people stay in the hospital Monday to Friday, but others remain at home and go every day for their treatment. Everyone is encouraged to lead as normal life as possible during the treatment, but you may find you need to rest more often or cut down on some of your activities.
If you are having a course of radiotherapy as treatment for a brain tumour, you may experience some side effects:
Tiredness - Feelings of tiredness usually start towards the end of the second week. If you are receiving radiotherapy twice a day, you may experience tiredness earlier. Allow yourself plenty of time to rest. You may find yourself going to bed earlier or sleeping in later than usual. travelling to and from the hospital can be tiring. Don’t worry if you fall asleep – your driver won’t mind.
Somnolence - This is a term for extreme lethargy and fatigue, can be experienced approximately two weeks after radiotherapy is completed. For some people, this reoccurs at about eight weeks.
Hair loss - Your hair is likely to start to fall out in the area being treated after two to three weeks. For some people, a specific area will not grow back, but the surrounding area will slowly grow back usually in three to four months.
Skin irritation - The skin, on the area being treated, will become sensitive, sometimes red and sore similar to sunburn. Do not put anything on your skin, but tell the radiographer, doctor or nurse, who will prescribe cream specifically for this type of reaction.
Nausea or headaches - If you experience nausea or headaches, again tell the staff who are treating you, who will be able to prescribe medication to relieve this.
Hair care during radiotherapy
Skin becomes very sensitive to the area of the brain being treated with radiotherapy. Due to this skin sensitivity, there are some restrictions on washing your hair. The following hair care is advised -
Wash your hair once a week with a mild baby shampoo. You should use warm water only.
After washing, pat your hair dry with a towel. Do not rub the head dry. If using a hair dryer, use the warm or cool settings.
Never use anti-dandruff shampoos, hair mousse, gels, lotions or lacquers.
The hair must not be permed or coloured during your course of radiotherapy or for four to six weeks after.
Due to sensitivity of your skin and scalp, as a result of radiotherapy, your head should be protected from the rays of the sun and the wind chill factor. This applies to the period of time you are having radiotherapy and for two years afterwards. Various forms of head coverings can be used.
The team who are caring for your will arrange an appointment for you at the follow-up clinic. At the clinic they will be able to help and advise you about any problems which may arise, and they will explain your drugs to you. It is important for you to know what your drugs are for, and when you should take them and any likely side-effects. The doctor will also be able to advise you about returning to work.
A further CT scan or MRI scan of the brain will be taken about a month after the end of your treatment. This is so that there is a record of how your treatment area looks. It can then be compared with any future scans which may be necessary. But regular scanning is not usually required.
The medical team
This will be led by a consultant who specialises in the treatment of tumours of the central nervous system. The other doctors who work with him or her are called senior registrars, registrars, or house officers.
There may be a nurse specialist (CNS) who can explain about your treatment and any possible side effects, and help you whenever you need it in the ward or in the outpatient clinic.
You may meet a community liaison nurse who is qualified in hospital and community nursing. This nurse will give you advice and support and arrange any practical help or nursing care which you need at home after your discharge from hospital or if you are having your treatment as an outpatient.
An occupational therapist (OT) is a person who helps anyone who has a temporary or permanent disability or who is recovering from illness. Their work is to help you get back to ordinary life again. The therapist can assess what help you need, such as practice in preparing a meal. Their help can be given either on the ward or in the Occupational Therapy Department. The therapist may also visit your home or workplace, to help and advise on practical problems in your familiar surroundings.
A physiotherapist will help you with specially designed exercises for your arms and legs to improve your movements and balance and help you to relax. Physiotherapists may also give you exercises to help with any breathing problems. Your physical recovery may need help at another hospital which specialises in rehabilitation. Your physiotherapist will arrange this for you.
A speech therapist can help you if the tumour causes any speech problems or swallowing difficulties or any problems with reading and writing.
Doctors, psychologists and nurses who specialise in psychological care may be available. You and your family will be able to talk to them about any worries or fears you have and they will provide you with extra emotional support.
A social worker is also available to help patients, relatives and friends who may have emotional problems. Social workers can also advise on employment, benefits, personal finances, or changes in home responsibilities.
A dietician can advise you how to maintain or improve your diet. Anyone with a problem, such as weight loss or weight gain, taste changes or loss of appetite, nausea or abnormal blood sugar level, may be referred to the dietician for advice.
Domiciliary physiotherapists and occupational therapists are professionals who work for the local Health Authorities and local authority social services department and visit people at home. They can give advice on such things as coping with household chores, managing stairs, bathing, cooking. The hospital or your GP may put you in touch with a domiciliary professional if they think you need this sort of help and it cannot be given from the hospital.