Follow up to Rule out Brain Tumor

[mar2124]

A small focus of increased signal in the right frontoparietal region is detected on FLAIR. Patient has a history of Renal Carcinoma. The MRI was ordered as a result of patient complaining of facial paralysis, Headache, and some visual problems. Would follow up MRIs at a later time, be adequate to Rule out metastasis to the brain from the Renal Carcinoma, What would be the most prudent approach to this patient?

[mar2124]

Negative, as she was never informed, and no referrals were done, she never knew anything was out of the ordinary. Continued to have follow ups on her Nephrectomy and other medical issues. But that particular ER and physician never let her know of the results, so NO follow up was ever done, and she remained symptom free until May of 2013. with some headaches but not until a thunder clap headache in May did they find the 2.5cm Glioma.
These tumors tend to progress from lesser grade tumors, had she been informed a resection could have been the difference of a few months to a better prognosis in general And forget Malpractice and negligence, the statute of limitations are up. complete shame

[rumpled]

I am so sorry to hear about your sister.  

I always advocate getting copies of reports and MRIs for this reason - doctors tend (sadly) to overlook some things and yes, most times routine blood tests  won't pick up the changes.

Even with the progression of her symptoms - they did not follow up!?

[mar2124]

No it's not me unfortunately, it's my sister. Who through neglect and lack of proper referrals at the time they spotted the increased signal on an MRI on Sept. 2007 with history of Renal Carcinoma (Nephrectomy) should have been monitored routinely for metastasis to the brain. On May of this year she was diagnosed with an inoperable Glioma multiforme and has just finished RT+TMZ tx. It's sad that if she had been told about that FLAIR finding, she would have informed her other doctors that see her on a regular basis. Though Gliomas grow rapidly, I'm sure that with a heads up on that one MRI she would have had a chance to have detected any other lesion. I understand the different markers P53, MGMT, etc, but chances are that very few patients get these tests on routine blood.  

[rumpled]

Some tumors, not all, have markers that they can test for - and then there can be some general tests like white blood cells and general health tests that can give the doctor a clue. Again, I am not a doctor so my information is general and not specific.

I would think that you are correct that they would continue to do imaging to follow up - but the frequency may be increased depending on history. As well, a normal MRI has 3mm slices, so an enhanced MRI (1mm slices) may be ordered or even a PET scan could be ordered if there is a lot of clinical suspicion.

With the visual issues, is the person (is it you?) seeing a neuro- opthomalogist?

[mar2124]

What blood test can determine if there is a brain tumor? I thought the medical approach knowing the history regardless of age and the other factors you mention would be to at least continue to do radiologic studies to rule out a tumor with T1 or T2 enhancement.

[rumpled]

This is a patient forum - so any response I give you is from patient to patient.

I would, if I were the patient, get some blood testing done to see if the lesion can be determined to be benign or malignant. From the little that I know, a focus may not be enough to *see* well enough the edges and usually smooth is good, not smooth is not so good.

Not knowing the timing of the cancer, the aggressiveness of the cancer, the timing of the follow up MRIs, anything about the person (young person was in great health! old person in frail condition!) it is not easy to really comment on a guess for a prudent approach? You really have to work with your doctor on an approach you feel happy and *safe* with.