Before diagnosis of a suspected brain tumour you may have attended your GP or your local Emergency Department with worrying symptoms. After initial assessment, you may have further investigations including a brain scan and then referred to a specialist brain tumour team for further advice.
After referral to the Brain Tumour Service at UCLH your case will be discussed at one of our brain tumour specialist multidisciplinary team (MDT) meetings. This is attended by all key members of the MDT who will discuss a management plan for you.
You may be booked in to an outpatient clinic to see a member of the Brain Tumour Service MDT for further review and investigations if required. This will take place at either the National Hospital for Neurology and Neurosurgery (NHNN) or University College Hospital Macmillan Cancer Centre.
Some people are transferred directly to the NHNN for assessment. The next step is often to confirm the type of brain tumour by having an operation. This may be a biopsy to help guide further treatment for you, or a bigger operation to remove as much of the tumour that is safely possible. You can find out further information about how we diagnose and treat brain tumours using the tabs below.
You can find out further information about how we diagnose and treat brain tumours using the tabs below.
Diagnosing brain and spinal tumours
A number of tests may have to help diagnose whether you have a brain or spinal tumour.
This scan uses powerful magnets to build up a detailed three-dimensional picture of areas of the body. Before this scan you will be asked to remove any metal objects such as jewellery and will be asked about any metal implants you may have such as a pacemaker or surgical clips. You may be given an injection of a dye into a vein in the arm which allows particular areas to be seen more clearly.
The scan is painless and you will be required to lie still on a couch inside a tube. Some people find this a bit claustrophobic and it can be noisy. The scan lasts for about 30 to 45 minutes.
A biopsy is a diagnostic procedure. It is not a treatment in itself but is done to guide other treatments. It is usually done under general anaesthetic. A small hole is made in the skull and a computer guidance system is used to place a needle in the suspected tumour. A few pieces of the tumour are removed, each about the size of a grain of rice.
Most people are unaffected by their biopsy and remain as well afterwards as they were before the procedure. Often this means that you can go home within 24-48 hours of the procedure. When the results are ready you will be called back for a discussion.
A resection is a treatment as well as diagnostic procedure. It is usually done under general anaesthetic. A large hole is made in the skull (craniotomy) by the neurosurgeon and a computer guidance system is used to ensure accuracy. This approach is used if the surgeon deems it safe to remove a large proportion of the tumour without causing harm.
Treating brain and spinal tumours
Surgery will be recommended for most people with a brain tumour. If the size or position of the tumour mean surgery is not possible, one or more of the treatments described below may be recommended instead.
The main operation used to treat people with brain tumours is called a craniotomy. You will be given a general anaesthetic so you are asleep while the procedure is carried out. At surgery a section of the skull is cut out as a flap to reveal the brain and tumour underneath.
The neurosurgeon can then remove as much of the tumour as is safely possible and secure the flap of skull back in place.
After surgery, treatment with radiotherapy and/or chemotherapy may be recommended to treat any cells left behind and reduce the risk of the tumour coming back. This can be sometimes be delivered at a centre nearer to your home if you wish, rather than at UCLH.
The National Hospital for Neurology and Neurosurgery (NHNN) offers state of the art operative facilities. There are five fully equipped neurosurgical theatres including the largest specialised neurosurgical Intensive Care Unit (ITU) in the country ensuring neurosurgical oncology procedures are as safe as possible.
We can also provide ‘awake surgeries’. This is surgery which takes place whilst the patient is awake, allowing the patient to talk to the team during the procedure. The purpose is to avoid the complications of the highly specialist surgery.
The National Hospital for Neurology and Neurosurgery (NHNN) is home to the UK’s first interventional MRI scanner. This is the use of magnetic resonance imaging (MRI) to help guide the surgeon during a surgical procedure and enable them to take a scan immediately after the surgery.
Radiotherapy may be used to treat tumours instead of surgery, or as a treatment for any remaining tumour cells after surgery. Radiotherapy involves controlled doses of high-energy radiation, usually X-rays.
The world class Radiotherapy department at UCLH is equipped with the latest radiation technology to facilitate delivery of a wide range of specialist and state of the art treatments, including Rapidarc Intensity Modulated Radiotherapy (IMRT) and fractionated radiosurgery
The UK’s first Varian Truebeam Linear Accelerator was installed at UCLH and the first patients (all patients with brain tumours) were treated in September 2011. The Truebeam is the world’s fastest and most accurate linear accelerator.
Chemotherapy uses medication to treat tumour cells and is given as either a tablet or an injection.
The University College Hospital Macmillan Cancer Centre hosts the chemotherapy day unit where the majority of brain chemotherapy treatments are delivered.
Chemotherapy is usually delivered on an outpatient basis at the Cancer Centre, but can be administered on the oncology wards if you need to be admitted.
Chemotherapy is provided by a team of oncologists.
Some tumours are situated deep inside the brain and are difficult to remove without damaging surrounding tissue. In such cases, a special type of radiotherapy called stereotactic radiosurgery (SRS) may be used.
During radiosurgery, several beams of high-energy radiation are focused on the tumour to treat the abnormal cells. The treatment is usually completed in one session, recovery is quick and an overnight stay in hospital is not usually required. The accuracy of SRS results in minimal damage to healthy tissues.
UCLH delivers radiosurgery using both the gamma knife based at NHNN, and also the Trubeam Linear Accelerator in the UCLH radiotherapy department.
A specialist MDT will decide if your brain tumour is suitable for radiosurgery.
Find out more about The Gamma Knife Centre at Queen Square
One of only two NHS proton beam therapy (PBT) centres in the UK is based at the University College Hospital Grafton Way Building. PBT is a form of radiotherapy used to treat certain cancers. It uses high-energy beams of protons, rather than X-rays, to deliver a dose of radiotherapy. It is highly targeted and so reduces the risk of radiation damage to healthy tissues surrounding the tumour.
