When it comes to cancer, patient care is a team effort and not the work of a single doctor. Life Healthcare doctors take a multidisciplinary approach and utilise good teamwork between the various specialists, which is crucial to the successful care of cancer patients from detection to treatment and follow-up.
Discovering the brain tumour
People with brain tumours present first to many different doctors due to the varied symptoms caused by brain tumours. These symptoms are mainly due either to raised pressure in the head or neurological symptoms that are caused by compression or invasion of brain tissue. “Headaches, seizures or stroke-like symptoms often cause patients to see a neurologist first, whilst blurred or double vision might prompt a visit to an ophthalmologist. For patients who are known to have other tumours that later spread to the brain the first contact is often the oncologist seeing them already. Some patients have the tumour picked up incidentally when having a scan for another reason, so see the radiologist first,” explains Dr Grant White, neurosurgeon at Life Vincent Pallotti Hospital. “Many patients will have been referred after starting with their General Practitioner for these and other symptoms.” Dr CF Kieck, neurosurgeon at Life Vincent Pallotti Hospital adds that not every headache is an indication of a brain tumour. “See your GP first if you are experiencing any problems or symptoms which are worrying and they will refer you on to the specialists.”
Referral to a neurologist
“Very often the neurologist is the first port of call after the patient has consulted a GP. Patients might present with complaints of blurred vision, headaches, weakness, slurred speech, etc. The location and size of the tumour plays an important role in how the patient might present. For instance, if the tumour is located in the left side of the brain, the patient might experience difficulty expressing themselves or might complain of right-sided weakness. If the tumour is located in the right side of the brain, their visuospatial ability might be affected and they might experience left-sided weakness. Should the tumour be located in the front part of the brain, the patient might present with behavioural disturbances or personality changes,” explains Dr A Rawoot, neurologist at Life Vincent Pallotti. Neurologists are clinical specialists who diagnose and manage neurological disorders. If a neurologist suspects a brain tumour based on the patient’s symptoms and examination, a scan of the brain would be requested to confirm the diagnosis. The patient will then be referred to a neurosurgeon for further management.”
Meeting the radiologist
When a tumour or an abnormality is detected, the first task of the radiologist is to identify the exact location of the tumour and the extent of the disease, says Dr Christian Stoyanov of Life Empangeni Private Hospital, “C Stoyanov Radiological Services Inc.” “After the detection of cancer, the radiologist interprets the cross-sectional images of the patient, makes the diagnosis and determines the stage and extent of the disease based on their findings,” he says. “Image interpretation is the most visible contribution of radiologists. Diagnosis by expert radiologists is based on the extensive knowledge of anatomy, normal variants, pathology and technical principles of the imaging modality.” In some cases, the radiologist may intervene and provide treatment using small catheters and needles under the guidance of the imaging equipment. These techniques can assist in the treatment of many conditions, including cancer, with minimally invasive interventions, thus avoiding open surgery. “With the technological advances in the field of medical imaging, brain tumour imaging has become an essential component in diagnosis, treatment planning, and monitoring treatment response as well as patient prognosis,” adds Dr Stoyanov.
Consulting the neurosurgeon
Once the tumour has been confirmed via high-tech imaging, the neurosurgeon would take on the role of decision-making regarding further treatment of the patient and this is where the collaboration with the radiologist and oncologist is essential. “Often, the specific diagnosis of the tumour may be made only after surgery when part of the tumour has been provided to the pathologist for microscopic and laboratory analysis.” says Dr White. “Distinguishing between benign and malignant tumours and between different types of tumours allows for the best treatment to be selected for a patient. The neurosurgeon’s most specific expertise is in the planning and performance of surgery for the brain tumour. This involves balancing the risks of various surgical approaches against their benefits, choosing the right tool for the job and deciding on the specific aim of the surgery and then doing the procedure as safely and effectively as possible.” Guiding and educating the patient and family is an essential preparation before any operation; brain tumour surgery is particularly challenging and everyone needs to understand the risks and limitations of surgery, adds Dr CF Kieck; “After surgery, the neurosurgeon will continue to look after the patient through their hospitalisation and will refer them for any rehabilitation needed and involve the oncologist where chemotherapy or radiotherapy is appropriate. The neurosurgeon will usually continue to check up on a patient who has had a brain tumour at intervals for the rest of their lives.” he says.
Seeing the oncologist
Once the diagnosis has been established, patients are then referred to an oncologist for treatment. “Secondary brain tumours are often diagnosed by oncologists, as we are following up patients with previously diagnosed cancers and when they present with brain associated symptoms we would proceed with a scan. We would then sometimes refer them to a neurosurgeon if we felt surgery was possible or necessary,” says Dr Jacqueline May Hall, clinical oncologist, Life Vincent Pallotti Hospital. “We also sometimes enlist a neurologist to help us with the management of associated seizures. An oncologist’s role is to perform treatment (obviously other than surgery) and would oversee, monitor and prescribe any radiotherapy or chemotherapy required. We would also support the patient holistically with for example – symptom control that includes steroids, analgesia, anti-seizure medication; referral for physiotherapy, occupational therapy, rehabilitation and we would also counsel and refer for counselling as needed. We also refer to Hospice as appropriate.”