Assessment of brain and spinal tumors

What the location means

A tumor may begin in the brain, in its coverings or in the spinal cord. Spinal tumors may also involve the vertebrae or the spaces around the cord and nerve roots. Some are metastases, that is, spread from a tumor in another organ.

These categories do not have the same investigation or treatment. A change in a vertebra is not necessarily a tumor of the spinal cord. The consultation clarifies what has been seen on imaging and what remains to be determined.

Symptoms and emergencies

Possible signs are new epileptic seizures, weakness, difficulty speaking, and changes in vision, balance or behavior. Headache has many other causes; a new or progressive pattern, or one accompanied by neurological signs, requires assessment.

In a person with known cancer, new or progressive back pain with leg weakness, a gait disturbance or a change in urination raises suspicion of spinal cord compression. Urgent hospital assessment is required; do not delay it for massage, physiotherapy or routine tests.

What the neurosurgeon considers

Symptoms, the neurological examination, previous illnesses and the original images are assessed. MRI, often with contrast as indicated, provides information on location and relation to nervous structures. CT and other tests are chosen according to the clinical question.

Bring the images in their original format, the radiology report, previous tests and oncology documents. Comparison over time may help distinguish a stable change from a growing process. The radiological appearance may suggest the diagnosis, but does not always fully determine the type of tumor.

The role of biopsy and tissue analysis

When necessary and safely possible, tissue is obtained by biopsy or during surgery. Histological examination and, for certain tumors, molecular tests help classify the tumor and choose treatment. A biopsy is planned taking into account the risk and the effect of the result on decision-making.

Some masses are followed without immediate biopsy when their features and circumstances justify it. For others, obtaining tissue is essential. A blood test or a tumor marker does not automatically replace this process.

How the plan is decided

Options include active surveillance, surgery, radiotherapy and systemic treatments depending on the diagnosis. The decision may require discussion among the neurosurgeon, oncologist, radiologist and pathologist. The aim may be removal of the mass, obtaining a diagnosis, relieving compression or controlling growth while preserving function.

Ask what is known, which results are missing and how urgent the next step is. Do not start or change corticosteroids or anti-seizure medicines yourself; their use is tied to specific indications and monitoring.

Frequently asked questions

Does a mass in the brain necessarily mean cancer? No. Some masses are benign, such as meningiomas or schwannomas, others are inflammatory or vascular in nature, and some are metastases. The appearance on imaging does not always determine the type; an accurate diagnosis may require a tissue sample and assessment by a multidisciplinary team.

Are all headaches dangerous? Most headaches are caused by other conditions, such as migraine or tension-type headache. Attention is needed for a new and progressive headache, one with a seizure, weakness, speech or visual disturbance, or one that wakes you from sleep and keeps worsening.

What should I bring to the consultation? The images in their original format, the radiology report, previous tests, oncology documents and the list of medicines. Comparison with older images helps assess whether the mass is stable or growing. It is good to come accompanied by a relative.

Is a biopsy performed at the clinic? No. Biopsy, surgery and oncological treatments are performed at the relevant specialized services. At the clinic we offer the consultation, explanation of findings, interpretation of external imaging and guidance toward the right team.

Active surveillance and preserving function

Active surveillance is a plan with defined check-ups and imaging, not simply waiting without supervision. A decision to change treatment may be linked to growth of the mass, the appearance of symptoms or a change in function. Intervals are not the same for all tumors and are set by the team that assessed the diagnosis.

When surgery is proposed, ask for an explanation of the balance between removing tumor tissue and preserving functions such as speech, movement or walking. Some masses cannot be removed completely without unacceptable risk. The need for additional treatment does not in itself imply that surgery has failed. Rehabilitation and symptom treatment may be part of care alongside tumor control, with goals tailored to the patient.

Care at Tirana Polyclinic: We offer neurosurgical consultation and specialist interpretation of imaging performed at other centers. We help explain the findings and guide you to the appropriate team. Biopsy, surgery and oncological treatments are performed at the relevant services.