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NCCN Guidelines for Patients



Brain Cancer – Gliomas, Version 1.2016


Test and treatment overview


CT scan

Not everyone can have an MRI. The magnetic fields

can be an issue. You cannot get an MRI if you have

a pacemaker, some types of cardiac monitors, or

certain types of surgical clips.

Instead of MRI, you may get a CT (




omography). CT takes many pictures of a body

part from different angles using x-rays. A computer

combines the x-ray images to make a detailed

picture. Images will be made with and without

contrast. Getting a CT scan is like getting a MRI scan.

Brain PET







omography) scan is not

typically used for diagnosis. It is sometimes used

in addition to MRI or CT scans if the cancer returns

after treatment. For PET, a sugar radiotracer will first

be injected into your body. After a few hours, the

radiotracer is detected with a special camera during

the scan. Cancer cells appear brighter than normal

cells because they use sugar more quickly.


You will likely undergo surgery if there may be a

primary tumor in your brain or spine. One goal of

surgery is to confirm the diagnosis. Tissue from

the tumor must be removed and tested to know for

certain if there’s cancer. Another goal of surgery is to

remove as much of the tumor as possible. For brain

tumors, surgery may be used to relieve pressure

inside the skull or to treat seizures that are hard to


The types of surgery used for gliomas are briefly

described next. Your treatment team can provide

more information. A neurosurgeon—an expert in

surgery of the nervous system—will perform your



Resection is a major surgery that removes a large

piece of tissue. A gross total resection removes all

of the cancer that your surgeon can see. A subtotal

resection removes part of the tumor. Carmustine

wafers may be inserted into your brain after surgery.

This treatment is described more in the section,



Brain resection

You will be given medicine to help you relax or sleep

during the surgery. Your scalp will also be numbed.

The brain does not feel pain, which is why you can

be awake.

Imaging and sometimes other tests are used to get

the best results. Your surgeon needs to know where

in your brain is the tumor and the key brain areas

(eg, speech, movement). Tests will be received

before and sometimes during the operation. You may

need to be awake during the operation so that the

key brain areas can be found.

Your surgeon will first cut your scalp and fold back

your skin. Next, he or she will use a small drill to

Helpful Tips


Once home from surgery, use a

recliner that lays back but is inclined.


Get a shower chair. You should

not stand until you're stable on your



Get help with washing your hair

to keep clear of the incision. Have

someone in the bathroom to make

sure nothing happens.