Diagnostic Services and Treatment Options

The division of neuro-oncology treats patients with primary tumors of the brain and central nervous system or with tumors elsewhere in the body that affect the central nervous system, as well as neurological complications arising from cancer treatment. With our multidisciplinary approach, patients benefit from a broad range of clinical expertise and from recent advancements in surgery, radiation therapy, chemotherapy, and neuro-diagnostics.

The division's outpatient and inpatient services include:

  • Diagnostic evaluations with a full range of neuroimaging studies
  • Medical management, including medication trials with standard and investigational drugs (clinical research studies) including Immunotherapy trials
  • Surgical management
  • Chemotherapy, including chemotherapy delivered via an Ommaya reservoir. The Ommaya Reservoir is a device through which fluids can be added, or removed from, around the brain. It is used to administer chemotherapy directly into the fluid surrounding the brain and spinal cord. This method of chemotherapy is called intrathecal chemotherapy, which is beneficial because the drug(s) can get directly into the area where cancer cells may be. There is a network of blood vessels surrounding the brain that act as a screen (blood-brain barrier). This blood-brain barrier does not allow most chemotherapy to get from the bloodstream to the brain and spinal cord. Intrathecal chemotherapy is used to bypass this barrier, allowing chemotherapy to reach cancer cells.
  • Radiation therapy including GammaKnife, CyberKnife and BrainLab
  • Patient and family education
  • Psychosocial evaluation and management
  • Neuropsychiatric and behavioral consultation
  • Participation in clinical research studies
  • Continuing consultation with referring physicians

Advanced Diagnostics

Patients referred to the division of neuro-oncology are first seen by a neuro-oncologist, who performs a thorough medical and neurological evaluation to establish or confirm a diagnosis. The neuro-oncologist continues to see the patient on a regular basis and to coordinate the patient’s care throughout the treatment process.

Quick and highly accurate diagnoses result in timely and effective treatments. 

Equipped with the most current and precise imaging systems, the division of neuro-oncology may use any of the following methods to provide fast, precise diagnoses:

  • Magnetic resonance imaging (MRI) uses a strong magnetic field and radiowaves to image the body.
  • Perfusion MRI identifies brain tumors at an early stage by showing changes in blood volume and flow that result from angiogenesis. It can be used to evaluate blood flow in cerebral capillaries and venules and can identify areas of a tumor with highest malignancy potential, thereby helping to plan treatment.
  • Diffusion MRI is used to image the movement of water through the brain. Tumor cells reduce water movement. By tracking this movement, diffusion MRI provides images that show whether or not treatments are effective at killing cancer cells.
  • MRI spectroscopy uses the chemical signature generated by magnetic resonance imaging to monitor brain activity (that is, to see whether cells are actively multiplying from tumor growth or dying because of treatment) rather than just simply image the anatomical structure of the brain as traditional MRI does.
  • Computed tomography (CT) scans produce cross-section images of the body using x-rays and a computer.
  • Ultrasound creates images of the inside of the body by using high-frequency sound waves and a microphone.
  • Arteriography uses x-rays to image the blood vessels in the brain after injection of contrast material.
  • Neuropathology is the examination of biopsy tissue from the brain or spinal cord to diagnose disease. A biopsy may be done using a small needle or surgery.
  • Nuclear medicine uses small, safe amounts of radioactive material to aid in imaging body structures. Through the use of cameras, computer technology and medicine with radiopharmaceuticals, nuclear medicine provides information about the structure and function of organs that can be used to diagnose and treat disease.
  • NeuroRadiology is diagnostic radiology that focuses on the central nervous system, head, neck, and spine.
  • Functional magnetic resonance imaging (MRI) is used to determine the specific location of the brain where a certain function, such as speech or memory, occurs. The general areas of the brain in which such functions occur are known, but the exact location may vary from person to person. During functional resonance imaging of the brain, the patient will be asked to perform a specific task, such as recite the U.S. Pledge of Allegiance, while the scan is being done. By pinpointing the exact location of the functional center in the brain, doctors can plan surgery or other treatments for a particular disorder of the brain.

In addition to these diagnostic tools, Rhode Island Hospital is the first facility to offer:

  • Positron emission tomography (PET), which allows physicians to identify illnesses much earlier than ever before.
  • Stereotactic biopsy, which is a precise, computer-assisted method of obtaining the tissue sample required for diagnosis.

Treating Neurological Complications of Cancer

Neurological complications involving both the central and peripheral nervous system -- such as stroke, seizure, headache, confusion, myelopathy, myopathy, neuropathy, and others -- may result from surgical, chemotherapy, or radiation therapy treatment of systemic cancer. Neurologic problems are relatively common in patients with systemic cancers, and the frequency of these complications can increase due to aggressive therapies and prolonged treatment. These complications can be debilitating and their diagnoses can be difficult. Prompt recognition and treatment of these problems can significantly improve patient outcomes. The neuro-oncology team helps determine the cause of neurologic problems and assists in their treatment.

The division of neuro-oncology works closely with a number of other areas related to the care of patients with neurological conditions:

  • The Neurocritical Care Unit provides comprehensive multidisciplinary care for patients with life-threatening neurological illnesses and injuries. Rhode Island Hospital is the only hospital in the state to have a critical care service dedicated to the care of neurological patients. The neurointensivist works closely with neurosurgeons, neuro-oncologists, neurologists, neuroradiologists, emergency medicine physicians, and other specialists in an environment that fosters collaboration.
  • The Neuropsychology Program offers neuropsychological evaluation of memory and other cognitive functions on both an inpatient and outpatient basis. Services include comprehensive memory and cognitive assessment and treatment recommendations for known or suspected neurologic or neuropsychiatric disorders, such as memory disorders, dementia, traumatic brain injury, stroke, brain tumors, and neurocognitive and behavioral impairments resulting from physical illness.
  • Under the department of neurology, the Clinical Neurophysiology Program provides inpatient and outpatient physiologic evaluation of central and peripheral nervous system function by a variety of diagnostic tests, including nerve conduction studies, electromyography, evoked potentials, electroencephalogpraphy, long-term epilepsy monitoring, and intraoperative monitoring. The clinical anesthesiology elaborates are used to assess patients with epilepsy, tumors, neuropathy, myopathy, motor neuron disease, root compression, encephalopathy, and multiple sclerosis.
  • The Alzheimer's Disease and Memory Disorders Center is a comprehensive diagnostic and treatment center for patients with memory disorders and is the largest memory assessment program in Rhode Island. The center's neurologists are memory disorder specialists who thoroughly evaluate each patient, including a careful review of the patient’s medical history, a physical examination, and neuropsychological evaluation of mental functions that may include neuroimaging and other laboratory tests.
  • The division of neuropsychiatry and behavioral neurology evaluates and treats individuals with brain-behavior disorders. Services include comprehensive memory and cognitive assessment and treatment for known or suspected neurologic or neuropsychiatric disorders, including neurocognitive and behavioral impairments secondary to medical illness. Services also include cognitive rehabilitation and counseling/education for patients and their families.
  • To recover from or manage the effects of brain or central nervous system disease, the patient will often need ongoing rehabilitative therapy that may include physical therapy, occupational therapy, and speech therapy.