Brain tumours
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If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.
Emergency treatment required - needs discussion with on call specialist and/or emergency department.
- Uncontrolled or disabling pain
- New findings of symptomatic brain metastasis or leptomeningeal disease diagnosed in the community
- Febrile neutropenia
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- 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
| Category 1 (appointment within 30 calendar days) |
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.
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| Category 2 (appointment within 90 calendar days) |
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| Category 3 (appointment within 365 calendar days) |
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Please insert the below information and minimum referral criteria into referral
1. Reason for request Indicate on the referral
- 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
2. Essential referral information Referral will be returned without this
- 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
3. Additional referral information Useful for processing the referral
- Other available imaging including CT CAP or PET report if available
4. Request
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Patient's Demographic Details
- Full name (including aliases)
- Date of birth
- Residential and postal address
- Telephone contact number/s – home, mobile and alternative
- Medicare number (where eligible)
- Name of the parent or caregiver (if appropriate)
- Preferred language and interpreter requirements
- Identifies as Aboriginal and/or Torres Strait Islander
Referring Practitioner Details
- Full name
- Full address
- Contact details – telephone, fax, email
- Provider number
- Date of referral
- Signature
Relevant clinical information about the condition
- 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
Reason for request
- 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 modifiers
- 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
Other relevant information
- Willingness to have surgery (where surgery is a likely intervention)
- Choice to be treated as a public or private patient
- Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)
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If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.
- Please note that where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service. Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.
- A change in patient circumstance (such as condition deteriorating, or becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.
- Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.
Last updated: 28 January 2025
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