STEP 3: Diagnosis, staging and treatment planning

Diagnosis and grading

All patients should undergo:

  • T1- and T2-weighted fluid-attenuated inversion recovery (FLAIR), T2-weighted and post-contrast T1-weighted MRI, and diffusion-weighted imaging (DWI)
  • tissue biopsy to reliably diagnose brain cancer:
    • The histological diagnosis of brain tumours should be undertaken by a neuropathologist or by an appropriately trained anatomical pathologist with experience in tumour neuropathology.
    • Tumours should be classified according to the latest World Health Organization classification of tumours of the central nervous system.

Molecular markers must be identified for an accurate diagnosis.

Grading for high-grade gliomas involves both:

  • neuroimaging with MRI +/– CT
  • histological testing.

Genetic testing

The features that suggest a genetic predisposition may include:

  • early age at onset
  • multiple primary cancers
  • a family history of similar or related cancers, neurofibromatosis type 1 or tuberous sclerosis.

If present, these features may indicate that familial genetic testing is appropriate.

Treatment planning

All newly diagnosed patients should be discussed in a multidisciplinary meeting (MDM) within 2 weeks of diagnosis.

However, immediate treatment is often required before a full MDM ratifies details of the management plan (which should include full details of the response assessment).

Research and clinical trials

Consider enrolment where available and appropriate. Search for a trial.


The lead clinician’s (1) responsibilities include:

  • discussing a timeframe for diagnosis and treatment options with the patient and/or carer
  • explaining the role of the multidisciplinary team in treatment planning and ongoing care
  • providing contact details of a key contact for the patient
  • encouraging discussion about the diagnosis, prognosis, advance care planning and palliative care while clarifying the patient’s wishes, needs, beliefs and expectations, and their ability to comprehend the communication
  • providing appropriate information and referral to support services as required
  • communicating with the patient’s GP about the diagnosis, treatment plan and recommendations from MDMs.

1: Lead clinician – the clinician who is responsible for managing patient care.

The lead clinician may change over time depending on the stage of the care pathway and where care is being provided.



Complete diagnostic investigations within 1 week of referral to specialist. Note that molecular testing may take 1–2 weeks.