Brain tumours

Emergency department referrals

Phone on call Oncology Registrar and send patient to the Department of Emergency Medicine at their nearest hospital.

Contact on call Oncology Registrar through:

Royal Brisbane & Women’s Hospital (07) 3646 8111
The Prince Charles Hospital (07) 3139 4000
Redcliffe Hospital (07) 3883 7777
Caboolture Hospital (07) 5433 8888

View the emergency contact details for referring General Practitioners.

If any of the following are present or suspected, refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.

Uncontrolled or disabling pain
New findings of symptomatic brain metastasis or leptomeningeal disease diagnosed in the community
Febrile neutropenia

Does your patient wish to be referred?

Minimum referral criteria

Does your patient meet the minimum referral criteria?

Category 1

Appointment within 30 days is desirable

Patients with new onset of symptoms and new findings on imaging of a suspected brain tumour should be referred to the local emergency department for urgent control of symptoms and evaluation.

Patients without symptoms and finding of suspected brain tumours should be referred to the Neurosurgical team for evaluation and further investigation. Patients are usually then presented in a multi-disciplinary meeting for treatment planning and further referral if required for Medical Oncology input. In some cases, new findings of brain tumours may represent metastatic disease from an alternative primary site and urgent evaluation with imaging of the chest, abdomen and pelvis may be also indicated.

Monitor neurological function; rapid progress or symptoms such as headache suspicious for raised intracranial pressure i.e. morning headache, vomiting and papilledema and/or associated neurological features i.e. new onset seizures, cognitive, behavioural or personality changes, neurological deficits warrant urgent referral to the Emergency Department

Pituitary tumours should be referred concurrently to the Neurosurgical and Endocrinology teams.

Acoustic neuroma/vestibular schwannoma should be referred concurrently to the Neurosurgical and Ear, Nose and Throat / Otology teams.

Adjuvant treatment after surgery for primary brain tumour diagnosis (either biopsy or debulking surgery). Note in this instance usually the patient is referred after MDT by the Neurosurgeon.
Patients with prior treatment for primary brain tumours under a Medical Oncologist with change in symptoms / progression of symptoms for evaluation of recurrence or progression.

Category 2

Appointment within 90 days is desirable

Transfer of care from another health service

Category 3

Appointment within 365 days is desirable

No category 3 criteria

If your patient does not meet the minimum referral criteria

Consider other treatment pathways or an alternative diagnosis.

If you still need to refer your patient:

Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
Please note that your referral may not be accepted or may be redirected to another service

Other important information for referring practitioners

Refer to local HealthPathways or local guidelines
Refer patients with suspected primary Brain tumours through local neurosurgical pathway for further investigation and management.
Often patients present acutely or sub-acutely with neurological symptoms and it may be more appropriate for these patients to be evaluated through the Emergency Department and then as an inpatient for urgent management of symptoms during the diagnostic process.
Many patients presenting with symptomatic brain lesions may have metastatic disease from an alternative primary site and evaluation for a primary site is necessary. In cases where the patient is significantly symptomatic of their brain disease it may be more appropriate for these patients to be evaluated through the Emergency Department and then as an inpatient for urgent management of symptoms during the diagnostic process.
Depending on the histological and molecular diagnosis, treatment options vary for different primary brain tumours, and patients’ cases are discussed through a multidisciplinary team meeting.
Histology (biopsy or surgical specimen) should include molecular testing for appropriate WHO classification of the patient’s tumour.
For women and men who have not completed their family, fertility preservation needs to be discussed
For patients with incurable (metastatic or recurrent) cancer consider the following:
- documentation of discussions with the patient (and their carers where appropriate) regarding the intent of treatment (anti-cancer therapy to improve quality of life and/or longevity without expectation of cure or symptom palliation), the Women’s and men’s prognosis and their understanding of their prognosis
- whether Advance Care Planning (ACP) conversations have been undertaken and their outcome
- specific patient goals and values that may impact on treatment choices
- whether the patient has been referred to a palliative or supportive care service

Referral requirements

A referral may be rejected without the following information.

Essential referral information

Detailed history of present signs and symptoms
Past medical history/pertinent social history
Current medications and allergies
Histology report
FBC, U&E, LFT, LDH results
CT and / or MR Brain.

Additional referral information (useful for processing the referral)

Other available imaging including CT CAP or PET report if available

Out of catchment

Metro North Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro North Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

Clinical Modifiers (where relevant)

Impact on employment
Impact on education
Impact on home
Impact on activities of daily living
Impact on ability to care for others
Impact on personal frailty or safety
Identifies as Aboriginal and/or Torres Strait Islander

Reason for Referral (essential)

To establish a diagnosis
For treatment or intervention
For advice and management
For specialist to take over management
Reassurance for GP/second opinion
For a specified test/investigation the GP can’t order, or the patient can’t afford or access
Reassurance for the patient/family
For other reason (e.g. rapidly accelerating disease progression)
Clinical judgement indicates a referral for specialist review is necessary

Clinical Information (essential)

Presenting symptoms (evolution and duration)
Physical findings
Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
Body mass index (BMI)
Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
Current medications and dosages
Drug allergies
Alcohol, tobacco and other drugs use