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 see a neurologist at HUS or to an emergency department where head imaging examinations will be 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 the referral was to a hospital emergency department, we will 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.

Once the nature of the tumor tissue has been determined following surgery or a biopsy through a pathologist’s examination, a decision regarding further treatment is made at a meeting of neuro-oncologists. 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. We usually perform these scans using contrast agents. 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.

At the Comprehensive Cancer Center, you will have an initial visit to the Radiation Therapy Unit or to the Medical Treatment Unit, 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. Treatment depends on the tumor’s

• type
• degree of malignancy
• location
• growth pattern and rate.

With brain tumors, we always consider the possibility of removing the tumor in full or in part. 

A multidisciplinary care team is in charge of the treatment of brain cancer. You can reach your treatment team on the Maisa portal and by phone. You will find the contact information for the unit treating you on the invitation letter.

• The Comprehensive Cancer Center helpline at 09 471 74900 is open Monday through Friday from 7:30 a.m. to 4:00 p.m.
• If your condition deteriorates suddenly or your fever rises above 38 degrees Celsius, contact the 24-hour emergency Medical Helpline at 116 117 (toll-free) or the nearest hospital with on-call services.
• In an emergency, always call 112.

After the treatments, the frequency and number of your follow-up appointments at HUS will be determined according to the type of your tumor. For patients with glioma, follow-ups will generally continue 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 initiated. 

Physical therapists, occupational therapists, speech therapists, and neuropsychologists examine and treat patients at the neurology outpatient clinic. In our outpatient clinic, we also conduct work capacity assessments and monitor epilepsy.

If your mobility has declined, a physical therapist can also assess your condition at the Comprehensive Cancer Center.

If you need physical therapy services at home, your physician will refer you to your local health center if necessary.