How it is Performed
Many factors are considered when doctors arrive at a brain cancer diagnosis including: age of the patient, location, size, and shape of the tumor, and how the cancer appears on MRI’s or CT’s. But, the gold standard is the pathology diagnosis where a pathologist microscopically examines a small sample of the tumor taken during a biopsy or surgery. During this analysis, the pathologist may use certain stains, perform special studies, and closely examine both the type of cells and their morphology (form and structure).
From their analysis, the pathologist renders a pathology diagnosis. Based on this diagnosis, a prognosis is determined and oncologists create an appropriate treatment plan.
Why it is Challenging
There are two major reasons why arriving at the correct pathology diagnosis can be Challenging in brain tumors:
1) Subtle Differences – First, the differences between high grade and low grade brain tumor cells can be subtle and difficult to distinguish. Sometimes there can be a great overlap of features and it requires a very experienced eye to make the correct identification.
2) Infrequent – Brain tumors, although they are steadily increasing in incidence, are still relatively rare compared to lung, breast and prostate cancers. This means that a general anatomic pathologist may not see brain tumors more than several times a year.
The difficulty in distinguishing one brain tumor from another combined with the infrequency of their occurrence can result in a misdiagnosis.
What you Should Do
Given the importance of having the correct brain tumor diagnosis, it may be prudent to have a second opinion provided by another pathologist, preferable a neuro-pathologist (someone who specializes in diagnosing brain tumors). Very often the most experienced neuro-pathologists are those who practice at leading medical schools because they see the most brain tumors.
To get a second opinion, you should request that the original microscopic slides from your tumor be forwarded to an outside pathologist, laboratory or hospital. (The more preeminent, the better.) Your tumor tissue from the surgery or biopsy will be archived in the pathology department and your doctor or surgeon should be able to facilitate your request for a second opinion. Sometimes there is a cost for this. Be sure to inquire as to whether your insurance will pay.
If you are curious as to whether your “aggressive” brain cancer or your child’s “high grade” brain cancer was improperly diagnosed take the quiz.