What are the key clinical features that should raise suspicion for a brain or spinal cord tumour in a primary care setting?

Key clinical features raising suspicion for a brain tumour in primary care include:

• New onset or worsening neurological symptoms such as seizures, persistent headaches, cognitive or personality changes, focal neurological deficits (e.g., weakness, sensory loss), and gait disturbances.
• Symptoms of raised intracranial pressure such as persistent vomiting, visual disturbances, or papilloedema.
• Any new neurological symptoms or signs that are progressive or unexplained should prompt consideration of brain tumour referral.

Key clinical features raising suspicion for a spinal cord tumour or spinal metastases in primary care include:

• Severe, unremitting, or progressive back pain, especially if mechanical in nature (aggravated by standing, sitting, or movement) or worsened by straining (coughing, sneezing, or bowel movements).
• Night-time back pain disturbing sleep or localised spinal tenderness.
• Neurological signs suggestive of spinal cord or cauda equina compression such as limb weakness, numbness, paraesthesia, radicular pain, gait disturbance, bladder or bowel dysfunction, and claudication (muscle pain or cramping in legs on walking).
• A past or current diagnosis of cancer or suspected cancer increases suspicion for spinal metastases or metastatic spinal cord compression and warrants urgent assessment.

In any patient presenting with these features, especially with a history of cancer, urgent referral and investigation are indicated to exclude brain or spinal cord tumours ¹,².