What I Treat
Neuro-oncology
Cancer of the nervous system
Neuro-oncology is the branch of care for cancers of the brain, spinal cord, and the nerves that run through them, whether the cancer started there or spread from elsewhere in the body. No single specialist manages this alone: it is built around a team, and my role as the neurosurgeon is one part of a longer relationship that continues well beyond the operating theatre.
The scope
The field
Neuro-oncology encompasses primary tumours that arise within the brain and spine — gliomas, meningiomas, and medulloblastomas — as well as metastases from cancers elsewhere in the body, most commonly lung, breast, melanoma, kidney, and colon. The field is inherently multidisciplinary: no single clinician manages every aspect of care, and decision-making draws on the expertise of neurosurgery, medical oncology, radiation oncology, neuroradiology, and neuropathology together.
The team
The team
Neurosurgeon
Obtains tissue for diagnosis, removes tumour safely to the maximum extent possible, and manages raised intracranial pressure when it develops. The neurosurgeon is often the first specialist a patient meets after an abnormal scan.
Oncologist
Manages systemic therapy — chemotherapy, targeted agents, and immunotherapy — based on the molecular profile of the tumour. The oncologist oversees the treatment plan once the tissue diagnosis is established.
Radiation oncologist
Delivers radiotherapy — whether fractionated, stereotactic, or whole-brain — and determines the dose, target volume, and fractionation schedule based on tumour type and location.
Decisions are made together in tumour board meetings, with your case discussed by the full team — not any single clinician. Every patient discussed at the MDT (multidisciplinary team meeting) receives a consensus recommendation that draws on neurosurgical, oncological, radiological, and pathological expertise simultaneously.
Clinical picture
Symptoms
Symptoms depend on the location and rate of growth.
- Headaches that are worse in the morning
- Seizures
- Changes in vision or hearing
- Weakness on one side of the body
- Difficulty with balance or coordination
- Cognitive changes — memory, concentration, or personality
Work-up
How it is diagnosed
MRI with contrast
The primary imaging tool for brain tumours. Sometimes supplemented by MR spectroscopy or perfusion studies to characterise the tumour's metabolic activity and blood supply before surgery.
Tissue diagnosis
Biopsy or resection is essential in most cases. The tissue obtained at surgery is examined by a neuropathologist to determine the tumour type, grade, and molecular profile — information that directly shapes the treatment plan.
Molecular testing
Markers such as IDH mutation, MGMT promoter methylation, and 1p/19q co-deletion now guide treatment as much as the microscopic appearance. These tests are run on the tissue obtained at biopsy or resection.
Management
The three pillars
Surgery
Maximum safe resection — removing as much tumour as can be done without causing neurological injury. The extent of resection is one of the strongest predictors of outcome in both high-grade and low-grade gliomas.
Radiotherapy
Delivered concurrently with chemotherapy for glioblastoma, or as a standalone treatment for other tumour types. Fractionated schedules are the norm; stereotactic radiosurgery may be used for small, well-defined targets.
Chemotherapy
Temozolomide is the standard chemotherapy agent for glioblastoma. Other agents are used for different tumour types, guided by the molecular profile. The oncologist selects the regimen and manages toxicity.
For glioblastoma: maximum safe resection → concurrent radiotherapy + temozolomide → adjuvant temozolomide. For metastases: surgery, stereotactic radiosurgery, whole-brain radiotherapy, or systemic therapy — depending on the number, size, and location of the deposits and the status of the primary cancer.
Follow-up
A long-term relationship
Neuro-oncology care extends well beyond surgery — through surveillance scans at regular intervals and evolving treatment plans that adapt to the tumour's behaviour over time. This is not a single episode of care but an ongoing therapeutic relationship that may span years.
Medical disclaimer: The information on this page is for general educational purposes only. It is not a substitute for individual medical advice, diagnosis, or treatment. Always consult your own doctor or specialist with any questions you may have regarding a medical condition.