If patients attending A&E as an emergency have a CT scan which shows a tumour, the treating team will usually telephone the neurosurgical team on-call at Salford Royal Foundation Trust (SRFT).
The neurosurgical team on-call will assess whether emergency transfer and surgery is required. For most patients, this is not the case. They generally recommend that the patient is started on steroids (dexamethasone, as tablets or injections) to reduce the swelling within the brain and arrange for the case to be discussed at the specialist neuro-oncology multi-disciplinary team meeting. Some patients are very well, and may not need to be admitted, or may be referred as an outpatient. All new tumour diagnoses are treated with the utmost urgency.
The MDT meets every week on a Tuesday morning; every case will be discussed within one week of referral. Although this may seem like a long time to wait, or that this risks introducing delays, this period of a few days allows the response to steroids to be assessed. Unless emergency surgery is needed, it is generally preferable to get the opinion of the whole MDT and see one of the sub-specialist brain tumour team.
At the Neuro-oncology MDT, the case and all of the scans are reviewed and a treatment plan is recommended. The plan may include any one, or a combination of, active surveillance (watchful waiting), surgery, radiotherapy, chemotherapy and symptomatic and supportive care.