Clinical Subspecialties

Neuro-Oncology

A Neuro-Oncologist is a doctor with special training for the diagnosis and medical treatment of tumors of the nervous system. Neuro-Oncologists are either neurologists with subspecialty training in oncology or, vice versa, oncologists with subspecialty training in brain tumors.

The neuro-oncologist will coordinate the diagnostic work-up. Many non-cancerous conditions such as multiple sclerosis or an infection can mimick a brain tumor. A large number of these conditions can be diagnosed without surgery

Brain MRI of a patient with a condition similar to multiple sclerosis, a benign 'inflammatory' process of the brain that can look like a brain tumor.

After the diagnosis of a brain tumor is established, chemotherapy may be needed which will be given by the medical neuro-oncologist.

MRI of a patient with lymphoma of the brain before (left) and after (right) chemotherapy.

Cancer of breast, skin (melanoma), blood cells (lymphoma) and other organ systems can seed to the brain. Whereas metastases to the substance of the brain and spinal cord are usually treated by radiation, spread of cancer cells to the spinal fluid - a clear liquid that surrounds the nervous system - frequently requires additional chemotherapy. This is given into a vein or directly into the spinal fluid.

Spinal fluid specimen examined under microscopic magnification of a patient with lymphoma that spread to the spinal fluid. A lumbar puncture was performed by the patient’s neuro-oncologist. After the diagnosis was made, chemotherapy was given through injection into the spinal fluid.

Seizures are the most common complication of brain cancer. Seizures can be 'focal' (such as twitching of an arm or a leg) or generalized ('Grand mal' seizure) which renders the patient unconscious. Even after successful treatment of the brain tumor many patients remain at risk of having more seizures. In the majority of cases seizures can be controlled with medication. Diagnosis and treatment is provided by your neuro-oncologist.

EEG – a recording of the electrical activity of the brain – of a patient with a brain tumor on the right side of the brain. In the middle of the page the onset of a ‘focal’ seizure is recorded that can be recognized as rhythmic spikes occurring at a high frequency.

Cancer not primarily located within the nervous system can affect the nervous system in an indirect way. Neuro-oncologists have a special expertise in diagnosing and treating these neurological complications. Cancer patients may be at a higher risk of having a stroke. Nerve damage is frequent, either as a consequence of therapy, the cancer itself or an immune reaction. Patients with cancer of the mouth, larynx or esophagus may suffer from neurological complications of vitamin deficiencies due to malnutrition. In other patients, the immune system attacks the tumor but at the same time causes 'collateral damage' to parts of the nervous system ('paraneoplastic syndrome').

EMG – a diagnostic procedure testing nerve and muscle function – of a cancer patient. This patient complained of weakness which was caused by a reaction of his immune system to his cancer (a ‘paraneoplastic syndrome’) that disturbed the transmission of nerve signals to his muscles.

Brain MRI scan of a patient with colon cancer who suddenly lost the ability to talk. Work-up by her neuro-oncologist revealed an acute stroke involving the left side of the brain (bright spot on the right side of the picture).

Pain is another frequent complication of cancer of the nervous system. If surgery, radiation or chemotherapy don't abolish the pain, medication may be the only feasible treatment.

This patient complained about shooting pain on the left side of her face (‘trigeminal neuralgia’). A brain MRI showed an abnormality within the trigeminal nerve (the nerve that transmits sensation from the face to the brain; white arrowhead). She was diagnosed with lymphoma – a blood cell tumor – and treated with chemotherapy and radiation. The pain persisted but was relieved with pain medication.