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Overview: brain tumour diagnosis and management/Royal College of Physicians guidelines
  1. R Grant
  1. Correspondence to:
 Dr Robert Grant
 Department of Clinical Neurosciences, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, UK; rgrantskull.dcn.ed.ac.uk

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This article is intended to reflect the current level of services for patients with brain tumours in the UK, “warts and all”. I have taken the evidence from first hand experiences auditing practice and implementation of the Royal College of Physicians guidelines for good practice in three of the four neuroscience centres in Scotland. I anticipate the findings are no better or no worse than what you will find in your local neuroscience centre. I hope it encourages you to work closely with neuropathology, neuro-radiology, neurosurgical and clinical oncological colleagues to improve the standard of care for patients with brain tumours. Hopefully this review will provide some evidence and support for submissions to improve the service in your local centre.

PRIMARY AND SECONDARY BRAIN TUMOURS

Primary brain tumours, although numerically fairly uncommon (incidence 8/100 000 per year), have a major impact on family and working life as they are the most common solid tumour in children and the eighth most common cancer in people of working age.1 Cerebral gliomas account for > 90% of primary brain tumours and are the fifth most common cause of death from cancer under the age of 65 years. They have a five year survival of only 18%. Patients with brain tumours are rare in general practice (four or five new cases in one general practitioner’s (GP’s) working lifetime), yet they remain a common concern of patients and GPs. Primary and secondary brain tumours present with similar symptoms and can be difficult to distinguish either clinically or by imaging. Usually, patients are referred to a physician or neurologist at their local major hospital. Brain imaging demonstrates an abnormality that could be a tumour. The patient may then be referred to a neurosurgeon.

Care pathways can be depicted as a “timeline” (fig 1). At each decision time point patients are …

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