Brain tumours are uncommon, so it is unlikely that you have one – even if you have all of the symptoms. There are many other things that could be causing your symptoms, most of which are harmless. However, if you are worried it is important to go and see your GP as soon as possible. Your may refer you to a specialist doctor who will explore your symptoms in detail.

An introduction to diagnosis

How is a brain tumour diagnosed?

Usually, if you have a tumour which has developed over a long time, you will see your GP, who will examine you.

If your GP suspects you may have a brain tumour, they will refer you to a specialist doctor – a neurologist (a specialist in brain and nerve problems) or an oncologist (a specialist in cancer treatment).

Sometimes, a brain tumour may cause a sudden epileptic seizure or other sudden problem because of where the tumour is in your brain. In this case, you may be taken straight to hospital where tests will be carried out to find out whether you have a tumour or what else has caused the problem.

The doctors or specialists can do a series of tests to find out whether you have a brain tumour. They will choose the best tests for your set of symptoms. The tests may include:

• checks to see if your brain and nerves are working normally - a neurological examination;
• blood tests;
• scans and X-rays;
• tests with special monitors;
• an operation to take a sample of cells - a surgical biopsy.

Answering questions about your health

The first thing the doctor at the hospital or your GP will do is ask you detailed questions about your symptoms, your general health, your past health, and your family’s health.

A general physical check-up

You may also have a general physical check-up at this point. The doctor may listen to your chest, and examine your breasts, tummy (abdomen) or back passage (rectum) to make sure there are no obvious signs of cancer somewhere else in your body.

Neurological examination

This is a series of tests to see if your brain, nerves and other things controlled by the brain are working normally.

This will include:

• Mental exercises, such as simple arithmetic and testing your memory;
• Looking into your eyes, shining a light at your eyes to see if your pupils react and testing your eye sight;
• Hearing tests;
• Face muscle tests such as smiling and grimacing;
• Tongue and swallowing - checking tongue movement and your swallow (gag) reflex;
• Strength and movement, including checking the strength of your arms and legs, your knee jerks and other reflexes;
• A test of your ability to feel pinpricks on areas of skin, to tell the difference between hot and cold, and possibly to recognise the feeling and shape of familiar objects like coins;
• Checking your balance and coordination, for example by asking you to walk a few steps or perform repeated movements.

A blood test

The nurse at your GP surgery may do this or you may be asked to go to your local hospital. They will take a small sample of blood using a syringe from a vein in your arm. This is a very quick and harmless test that can pick up many common problems in the brain or elsewhere in the body.

In the same way as a detective puts together all the clues, each of these steps will help to build a better picture of what is happening inside your brain.

At the hospital

If they think that you may have a tumour or even if they find nothing wrong but your symptoms suggest you may have a tumour, your GP may refer you to a specialist.

This means that you will get an appointment to see a specialist in an outpatient clinic at a hospital. This is where hospital doctors see patients who are not staying at the hospital.

You should see someone within two weeks.

It will usually be a neurologist, who is someone that specialises in brain and nerve problems.

However, your GP might also ask you to see a specialist if they think that you have a different problem. In this case, it may take longer than two weeks.

If your GP does not send you off to have further investigations, it is because they do not think that something is wrong, based on what they have seen.

When should my GP refer me to a specialist?

It is not always easy for a GP to decide who may have a brain tumour. Less than one in every 100 people suffering from headaches has a brain tumour.

The National Institute for Health and Clinical Excellence (NICE) has drawn up guidelines to help doctors decide who to refer to a specialist.

NICE says you need urgent referral within two weeks if you have these symptoms:

• If you have headaches (especially in the morning) while also feeling drowsy or being sick, having blackouts or changes in personality and memory;
• New symptoms linked to your brain and nerves that are getting worse, such as fits, mental changes, deafness on one side, double vision, weakness of an arm or leg, or loss of feeling in part of the body;
• Unexplained sudden seizures either affecting the whole body or just one part, such as jerking or twitching in a hand, arm or leg;
• Changes in behaviour, mental abilities or personality that are getting worse quite quickly.

The guidelines say that your doctor should consider referring you to a specialist urgently if you have started having recent headaches (but for at least a month) which are not migraines.

But this is only if you have other symptoms that suggest you may have increased pressure in your head.

This raised intercranial pressure may include being sick, being woken by a headache or a headache that gets worse or better depending on your position. If you have persistent headaches that do not come on with other symptoms, your GP may think about discussing your case with a specialist or making a non-urgent referral for you.

If you are drowsy, your GP should refer you to a specialist immediately.

Headaches can often be part of a chronic condition such as depression, or caused by stress. NICE advises the GP to use their judgement. If you have been having the same symptoms on and off for years, have had them investigated and have been found not to have cancer or a brain tumour, your GP should not be expected to refer you as an urgent case each time your symptoms come back.

According to Department of Health guidelines, you should ideally get an appointment within two weeks for an urgent referral.