How Did Doctors Diagnose Katy Tur Brain Tumor Initially?

I read through several clinical descriptions as well as interviews, and the initial diagnostic approach seemed to follow a similar pattern. Urgent assessment was initiated by symptoms, followed by imaging studies, often starting with a CT scan in an emergency situation, but typically followed by an MRI with contrast. The Mystery Mass was found to be a growth in the brain that needed to be removed or at least a sample of tissue to be studied by the pathologists. They would identify the type of tumor and often look for specific molecular markers. The results from the pathology would determine if the patient would require surgery, radiation, chemotherapy, or even targeted therapy for their specific cancer. In the mean time, other symptoms such as increased intracranial pressure with resulting swelling of the brain would be treated with steroids. Seizures would be prevented if that was a concern for the patient. Looking through all of this makes me realize how important timely and quality imaging as well as good cooperation between several different specialists is for a good outcome. It’s a very intense and detailed process but there is always hope for the best possible outcome based on the results of the pathology.

Reading through these reports has been kind of a wake up call to me. This is how someone like Katy Tur would have gone through an evaluation at first. She would have started with a primary evaluation. Someone would have described her symptoms to her. She would have gone through a quick neurology screen. And then she would have had some imaging. Most people with a brain tumor will have their tumor identified on their first MRI with contrast. This type of imaging gives the best pictures of soft tissue structures and helps to differentiate between a few possible causes of symptoms such as a tumor, an abscess or even a stroke.

Typically within hours of the diagnosis, neurosurgery or neuro-oncology evaluates the MRI images. Additional testing such as functional MRI, MR spectroscopy or CT perfusion studies may be ordered to plan the best treatment. If the lesion is felt to be resectable and the patient is symptomatic, surgical removal of the lesion can be diagnostic and therapeutic. If immediate surgical intervention is not possible or recommended, a stereotactic needle biopsy can be performed to obtain tissue for pathology to make a definitive diagnosis and perform molecular testing to guide treatment. The patient’s medical team focuses on the patient’s baseline supportive care measures such as use of steroids to decrease swelling, seizure prophylaxis as indicated, and an early introduction to physical medicine and rehabilitation and/or palliative care as appropriate. Throughout all of this, it is essential for the team to communicate clearly and in a timely manner to ensure the best possible outcomes for the patient in those first critical hours.

A diagnosis like Katy Tur’s (new persistent headaches, occasional tingling sensation down her arm, losing her vision temporarily) follows a pretty standard route, and many of these steps are publicly revealed. The initial red flags of new persistent symptoms of headaches, progressive visual disturbances, imbalance and even acute neurological episodes typically prompt a visit to a primary care doctor or emergency room where she would undergo a neurologic exam that attempts to localize her symptoms. If a doctor has reason to believe that her symptoms are caused by a structural problem in her brain then she would order an imaging study.

For a suspected brain tumor, the search begins with imaging studies. A non-contrast head CT is usually the first study to determine if there is bleeding. But if there is no bleeding, a MRI with and without contrast is the best study to identify and characterize a brain lesion. The location, size and enhancement of a brain lesion along with any surrounding mass effect or edema can often lead to a suspected diagnosis. If high suspicion of a tumor exists, the neurosurgeon or neuro-oncologist is usually called in to assist in the diagnosis. A definitive diagnosis of a brain tumor is usually achieved by obtaining tissue from the tumor either by an open brain surgery or a stereotactic brain biopsy. The pathology then can determine the type of brain tumor and often obtain important molecular markers to help treat and predict patient’s outcome. Additional studies such as blood work, preoperative neurocognitive testing, lumbar puncture and even a PET scan can also be very useful in the diagnosis and treatment of brain tumors.

I was surprised to see how many specialists were involved in diagnosing and treating her condition. ER docs, radiologists, neurosurgeons, pathologists, medical and radiation oncologists and many others in support of patients with cancer all play critical roles. Knowing how each test was used to arrive at a diagnosis made me less anxious when friends were recently diagnosed with serious illnesses.