Care pathway for brain cancer

Brain tumor symptoms depend on the size, location and growth rate of the tumor. A benign brain tumor may remain asymptomatic for a long time.

An epileptic seizure is the most typical initial symptom of a brain tumor: it is the symptom leading to examinations in one out of three patients. Such a seizure may present as arm or leg cramps or a brief blank or absence episode. Whenever a patient experiences their first ever epileptic seizure, we always look at whether it was caused by a brain tumor. Seizures may be the only symptom of a slowly progressing tumor.

A brain tumor can cause headaches. There are also other symptoms in almost all cases. Patients may experience nausea in the early hours of the morning. Persistent or repeated headaches as a new symptom in an adult patient are reason to suspect a brain tumor, although there are several other possible causes.

A brain tumor may also impair mental performance in terms of attentiveness, concentration, regulation of actions, speech, memory, observations or reasoning.

The imaging examinations required for brain tumor diagnostics are generally not available in primary healthcare.

If a brain tumor is suspected, the primary healthcare physician will write you a referral based on your symptoms to a neurologist at HUS or to an emergency department where head imaging examinations are planned.

Based on your symptoms, your referral will in many cases first be directed to a HUS neurology outpatient clinic, and you will be invited to further examinations. Additional primary examinations include head imaging examinations. If your referral was to a hospital emergency department, we begin examinations there.

If an actual or suspected tumor is found in imaging examinations, you will be referred to a neurosurgeon for evaluation of surgery or for a biopsy. After the surgery or biopsy, once a pathologist has examined the tissue removed, we make decisions on further treatment at a neuro-oncological meeting. This meeting is attended by a neurosurgeon, a neuropathologist, a neuroradiologist, a neurologist, and radiation therapy and pharmacotherapy physicians.

After the surgery or biopsy, you will be discharged from the neurosurgery unit and invited to the Comprehensive Cancer Center for planning further treatment.

The brain tumor is detected in an MRI or CT scan. Scans are usually made with a contrast agent. MRI is more accurate and versatile than a CT scan. CT scans are mainly used at emergency departments.

The examinations performed will help us determine the location and size of the tumor. A tissue sample from the tumor itself is needed for determining its type. A neurosurgeon removes a sample by cutting into the tumor or by performing a biopsy.

A neuropathologist examines the sample and identifies the progenitor cells and malignancy of the tumor. These will lead us to a final diagnosis and treatment planning.

A diagnosis will not be based only on imaging examinations unless surgery or biopsy is not possible.

Your first appointment will be with a neurosurgeon. After the surgery or biopsy, the neurosurgeon will refer you to the Comprehensive Cancer Center for further treatment.

You will be booked for an initial visit to a radiation therapy unit or to the pharmacotherapy outpatient clinic, depending on the treatment required. At the appointment, we will discuss your treatment plan and give you instructions.

Brain tumor treatment is always planned on an individual basis. The treatment will depend on the type of tumor, its malignancy, its location and in what way and how fast it is growing. With brain tumors, we always consider the possibility of removing the tumor in full or in part. 

After the treatments, the frequency and number of your follow-up appointments will be determined according to the type of your tumor. For patients with glioma, follow-ups generally last for the rest of their lives.

After the original brain tumor treatment, we monitor your wellbeing closely with repeated imaging examinations so that any recurrences can be detected early and the necessary treatments begun. 

We always aim to treat the symptoms of cancer in the best possible way at all stages of the disease. Support from the Palliative Care Center can be used as early as at the diagnostic stage, and this may continue during growth-decelerating treatments.

Palliative care means shifting the focus of care from stopping the progress of the cancer to managing its symptoms. Typically, at this stage, your care responsibility is transferred to the Palliative Care Center or the hospital-at-home unit in your area.

For patients with glioma, follow-ups generally last for the rest of their lives.