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In the United States this diversity has increased significantly over the past decade. It is essential that healthcare professionals provide genomic-focused care in a culturally sensitive manner, recognizing and respecting the cultural values and beliefs of each and every patient.

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Brain Tumour 11 The World Health Organization Classification of Tumors of the Central Nervous System Introduction In the summer ofthe World Health Organization WHO published an updated classification of central nervous system tumors, setting a new standard for brain tumor research and communication between different centers around the world.

The revised fourth edition is a major update to the existing WHO classification and brings the naming and grouping of brain tumors into line with current scientific understanding and technology.

For the first time, the new WHO classification combines genetic information about brain tumors with their histology, thereby formulating a more accurate concept for how brain tumor diagnoses should be described and structured.

This new classification is the culmination of work by experts from 20 countries and will allow for more accurate diagnosis, treatment planning and prognosis.

With the new classification, brain tumor patients in clinical trials may be stratified into groups that reflect the particular molecular profile of their tumor, allowing suitable targeted treatments to be used in a hopefully effective way.

The new classification will also aid researchers by helping them to make more precise analyses of data in the lab, and to accurately compare their results with other institutions.

The IBTA is excited by the publication of the new classification and recognises that it represents a significant step forward in the ongoing challenge to improve outcomes for brain tumor patients.

Professor David N Louis, lead editor for the WHO classification of central nervous system tumors 12 Brain Tumour international experts whose hard work has brought about the updated classification, which will serve to benefit brain tumor patients around the world.

Additional thanks to Steven LaFond at NBTS for interviewing Dr Louis and for his help with creating the transcripts of these videos which form the basis of this article. Why do we do brain tumor classifications in the first place? Tumor classifications are done for many reasons.

They range from helping individual patients manage their diseases, to helping studies get done for example clinical trials or experimental studies involving cells or animals. They help epidemiologists and governments to figure out what causes disease. By classifying the disease you can study it and then find out what causes it and then devote resources by governments or by insurance companies to addressing the health care needs of patients with those diseases.

For about a hundred years, tumors were classified by pathologists looking under the microscope at small pieces of tumor given to them by the surgeons. Why did the World Health Organization decide to revisit the classification?

The whole field of pathology and cancer medicine in general has undergone a revolution over the last two decades since we now know a lot of the genetic underpinnings of tumors. And those genetic underpinnings are changing the way we think about classifying them, but also the way we think about treating the patients who have the different types of tumors.

So, it was clear to the field at large that we needed to think about this beyond simply the microscope. In in Haarlem in The Netherlands we put together a group of leading people in the field of CNS tumor classification and the meeting published its guidelines.

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The good news is that patients are getting a more precise diagnosis, but the bad news is that the precise diagnosis - at least because of the technical challenges of the present time with doing these tests - may require a couple more weeks.

How will the new WHO classification impact brain tumor patients diagnosed before the updated tumor types? The types of tests that we do can be done on existing materials.

So, if a patient discusses that exact question with his or her physician, and they together decide it would be important to go back and do the analysis, then we can go ahead and do that if sufficient tissue remains in their specimens.

There are certain times where the importance of it may be more related to what happens on individual treatment, and others where that may not be true. For this reason, it is up to individual patients and their oncologists to decide.

What are the major changes to the brain tumor classification? The major takeaway is that the diagnosis of many CNS tumors, but not all CNS tumors, will not only be based on the microscope but on the microscope plus genetic analysis. How will the new WHO classification impact brain tumor patients?

Patients will be getting more specific diagnoses on their tumors if they are the kinds of tumors for which we have incorporated molecular parameters into classification. But there are many, many tumors that will be classified the same in as they were in Will be there any changes to the way a brain tumor is diagnosed?

The difference is that the diagnostic reports will come out in layers, but also in stages. So, one thing that patients are going to have to be aware of is that if they have one of the tumors for which we do genetic analysis, the full diagnosis may be delayed for a few weeks.

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