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A life in pictures

Kacey Hobson

As a part-time nurse, Kacey Hobson knew something was wrong when her stamina and balance began to falter. Scans revealed a meningioma – a slow growing, benign tumor – in the membrane covering her brain. The placement of her tumor made its removal precarious, so she turned to the neurosurgeons at The University of Kansas Health System for help. Read her story.

Symptoms and Diagnosis

Experienced specialists provide proper diagnosis

Although it is possible to be diagnosed with a brain or spinal tumor when the patient has no symptoms, it is rare. In such cases, an unrelated medical study – such as an X-ray after a car accident – may reveal the unexpected mass. More often, patients seek medical attention for symptoms that can include:

  • Progressive headaches
  • New seizures
  • Weakness
  • Personality changes

There is no single symptom that definitely indicates a brain or spinal tumor.

Some tumors grow quickly, causing symptoms that worsen rapidly over several days or weeks. Other tumors result in symptoms that slowly worsen over months or even years. And sometimes patients with a bleeding tumor or bad seizure can experience a seemingly sudden event that leads to diagnosis. Often patients feel normal a week or two before diagnosis.

To ensure proper diagnosis of a brain or spinal tumor, your care team may include specialists in:

Neuroradiology

Most patients will receive diagnostic brain or spine imaging after they have visited their primary doctor or the emergency room with symptoms. Results of these imaging tests, along with a physical exam and review of the patient's history and risk factors, will help with the diagnosis.

A CT scan (computed tomography) is often the first imaging test you will receive. It is fairly quick and can show many abnormalities of the brain, yet some tumors are hard to see with a CT scan. Depending on your condition, you may also receive an MRI (magnetic resonance imaging) of the brain or spine.

Interpreting a CT or MRI scan can be challenging because disease processes can look similar. For example, an aggressive primary brain tumor like glioblastoma can resemble a metastatic tumor that originated somewhere else in the body. These lesions can also look like a brain abscess (infection) or even multiple sclerosis.

It is important to quickly and correctly diagnose these conditions because each one requires a different evaluation and treatment. Effective treatment should begin promptly.

Our radiologists are trained in reading and interpreting many different kinds of imaging studies, including X-rays, CT scans, MRIs and other imaging tests, from all parts of the body. The neuroradiologists on your care team have completed additional specialized training specifically focused on interpreting imaging studies of the brain and spinal cord.

Board-certified neuroradiologists at The University of Kansas Health System are available around the clock to review CT and MRI scans and discuss results with your care team.

Additional tests a neuroradiologist may recommend include:

  • Magnetic resonance perfusion
    This procedure captures images of blood flow and volume, which is often elevated in aggressive tumors.
  • Magnetic resonance spectroscopy
    This imaging procedure reveals the chemical composition of the brain. The region of the brain that is of interest often appears to be abnormal in both aggressive and nonaggressive tumors.
  • Positron emission tomography, or PET imaging
    PET scans detect metabolic activity in the body, such as aggressive tumors that typically grow quickly and consume a lot of nutrients.
  • CT scan of the chest, abdomen and pelvis
    We may perform a CT scan if you have risk factors for metastatic cancer or if your physician suspects it. This test gives specialists the opportunity to look at the lungs, adrenal glands, bone and other sites in the body that are often affected by metastatic cancers.

If your care team suspects an infection or autoimmune issue, they may conduct blood or spinal fluid tests. If a tumor is still possible based on test and evaluation results, additional specialists will join your care team to help guide further testing. These specialists may include neurosurgeons, neuro-oncologists and/or neurologists.

Neurosurgery

If CT or MRI scans indicate concern for a tumor, a neurosurgeon who is experienced in brain tumor surgery will join your care team. This is important for the accurate diagnosis and removal of as much underlying tumor as possible while leaving healthy tissue intact.

Although there are no definitive studies, available evidence and general consensus among neurosurgeons and neuro-oncologists indicate that the more completely a tumor is removed, the better the outcome and symptom control for the patient. This is true for both malignant and nonmalignant tumors.

Neuropathology

A pathologist is a physician who is trained in analyzing tissue samples from all parts of the body, often using a microscope to identify fine details. Becoming board-certified in neuropathology requires focused training in studying diseases and conditions found in the brain and spine and interpreting tissue samples from these locations.

Because many different brain and spine conditions can appear to be quite similar under the microscope, a neuropathologist plays an important role in helping the care team arrive at the correct diagnosis. These specialists understand the complicated interpretation of studies such as:

  • Flow cytometry, which looks for important surface markers on hundreds of tumor cells.
  • Florescence in-situ hybridization (FISH) testing for chromosome abnormalities in the tumor cells.
  • Polymerase chain reaction testing (PCR), which can amplify portions of the tumor cells' DNA.
  • Cytology, which looks at cells in fluid collections, usually spinal fluid.

The University of Kansas Cancer Center has one of the only neuropathologists in the Kansas City region.

Frozen section biopsy

Biopsy is the surgical removal of a small tissue sample from the tumor, which is examined under a microscope to help make a diagnosis.

As an additional safety check before surgery begins, the surgeon will remove a small tissue sample that the neuropathologist will quickly freeze, slice and examine. This frozen section procedure is performed minutes before the neurosurgeon begins to remove the suspected tumor.

When the pathologist indicates that the mass indeed looks like a tumor and removal is appropriate, the neurosurgery team can proceed with confidence.

Final diagnosis

Once surgery is complete, the suspected tumor tissue is placed in special preservative for fixation overnight. This will cause the tissue to become firm, allowing it to be thinly sliced.

If the patient has given consent to donate tumor tissue for use in clinical trials, a portion of the tissue is fixed for diagnosis while the rest is preserved and sent to the tissue bank. Slices of the fixed tumor tissue are placed onto glass slides and stained with different markers that aid the final diagnosis.

Additional studies are often necessary for the full description of these tumors. These include FISH testing for chormosomes, PCR testing for MGMT, IDH mutation status and EGFR.

Biospecimen Bank

The University of Kansas Cancer Center maintains a biospecimen repository allowing banking of tumor tissue from many different types of tumors for support of ongoing research efforts. Any extra tissue not needed for diagnosis or clinical trial purposes can be preserved for use in future studies. Your name and other identifying information would not be included with this banked tissue.