When Warren had a brain tumor in the early 1970s, there was only one neurologist and one neurosurgeon in his city. With trained neuro nurses unavailable, the neurosurgeon sat at Warren’s bedside overnight following surgery so that he could observe signs of hemorrhage or other danger signs.
That was before MRI, before sophisticated surgical techniques to locate and shrink tumors, before new radiation and chemotherapy treatments had emerged. Yet Warren, like a minority of patients today, survived.
Even with the major advances that have taken place over those four decades, a brain tumor today is no less of a personal tragedy. And the death rate for patients has remained about the same.
A brain tumor is not necessarily cancer. By definition, a tumor is an accumulation of abnormal cells. Some tumors are cancerous, meaning they grow faster than other tissues, aggressively invade nearby cells and spread to other parts of the body.
Even a malignant brain tumor, however, rarely spreads outside the brain.
And a benign brain tumor may be at least equally threatening. Inside the boney confines of the skull, any abnormal growth can cause inflammation and put increased pressure on tissue under and around it.
Symptoms depend largely on where the tumor is located and what areas of the brain receive the pressure. Warren suddenly developed double vision (diplopia) and initially thought he needed new glasses. A more common symptom is a severe headache, unlike any you have ever had and one that does not respond to usual headache remedies.
Other symptoms include:
• seizures or convulsions;
• balance problems;
• changes in speech, vision or hearing;
• difficulty walking;
• memory glitches;
• changes in mood, personality or ability to concentrate;
• weakness in one part of the body; and
• numbness or tingling in the arms or legs.
All of these symptoms are also common with other disorders.
Who Is at Risk?
Why one person gets a brain tumor and another does not is always a puzzle. There are, however, two main risk factors: 1) having received ionizing radiation to the head through high-dose x-ray, perhaps for another cancer, many years earlier, and 2) family history. It’s important to note that only a very few families have such a history.
Cell phones, head injuries and exposure to magnetic fields or workplace chemicals have been proposed as possible risk factors, but studies have not found consistent associations.
When symptoms and a physical examination suggest a brain tumor, a doctor can confirm the diagnosis with an MRI or CT scan, angiogram, spinal tap and/or biopsy. The biopsy may be taken at the same time that part or all of the tumor is removed.
Initial treatment, as it was in Warren’s time, is usually surgery. An incision is made in the scalp and a specialized saw is used to remove a piece of bone from the skull through which instruments can be placed.
Although general anesthesia can be used, the surgeon may want the patient to be awake while the tumor is being removed. To determine effects on crucial parts of the brain, the doctor may ask the patient to move a hand or leg, count, repeat the alphabet or tell a story.
When the procedure is complete, the surgeon covers the opening in the skull and closes the incision in the scalp.
In some cases, the tumor cannot be removed safely through surgery without harming normal brain tissue and crucial functions.
Specialized neurosurgical nurses are trained so they can monitor the patient and look for signs of swelling or accumulation of fluid, which can cause severe problems. In some cases, a second surgery is necessary to drain fluid. Another possible complication after surgery is infection.
Some changes in personality, thinking, seeing or speaking can occur following surgery, but these often disappear with time and with physical or occupational therapy. Sometimes, though, damage is permanent.
In cases where surgical removal threatens normal functions, radiation can be used instead. Radiation therapy can also be used after surgery to kill tumor cells that may remain.
Research in the 1970s and 1980s concluded that radiation following surgery improved survival significantly in patients with glioma, the most common kind of brain tumor.
In some cases, fractionated external beam radiation targets not only the tumor but nearby tissue or even the entire brain. Each treatment lasts only a few minutes but is repeated five days a week for several weeks.
The radiation may also be delivered in ways that more closely target the tumor and lessen the damage to healthy tissue.
A newer method involves internal radiation–implanting radioactive material in seeds that give off radiation inside the brain for months.
Chemotherapy was not a standard treatment for brain tumors in Warren’s day because most chemotherapy drugs at that time could not cross the blood brain barrier.
Today, chemotherapy may be delivered effectively by mouth, intravenously or in wafers that are placed in the brain. As the wafers dissolve, the drug is released into the brain, killing cancer cells and helping to prevent return of the tumor.
When used for some types of childhood brain cancer, high-dose chemotherapy has been found effective in delaying the need for radiation therapy, reducing potential harm to the developing brain.
Gliomas, which account for about 70 percent of brain tumors, are highly vascularized; in other words, they require a large number of blood vessels to grow. The most recent treatment focuses on antiangiogenesis agents–drugs that block the growth of these new blood vessels.
Bevacizumab (Avastin), an antiangiogenesis drug approved for treatment of colorectal and other cancers, is now being studied for possible treatment of gliomas. However, a large multicenter study [American Society of Clinical Oncology, June, 2013] found that glioblastoma patients given Avastin did not live any longer than those given chemoradiation alone. And Avastin added to the toxicity of the treatment regimen.
Even though brain tumor patients continue to face long odds, some hopeful signs have begun to appear over the last five years. More patients are surviving for at least two years after the diagnosis, and those who survive that long are even more likely to be long-term survivors.
REFERENCES:
Charles Bankhead, “ASCO: no benefit from Avastin in glioblastoma,” MedPageToday, June 3, 2013.
“Brain tumors in adults,” WebMD Brain Cancer Health Center, reviewed September 25, 2012.
“Brain tumor–primary–adults,” MedlinePlus updated November 2, 2012.
Zosia Chustecka, “Improved survival in certain patients with primary brain tumors,” Medscape Medical News, June 13, 2012 (2012 Annual Meeting of the American Society of Clinical Oncology, June 3, 2012).l
Victoria Colliver, “Survival odds increase for brain tumor,” San Francisco Chronicle, December 25, 2012.
J. Stephen Huff, M.D., “Brain neoplasms, Medscape Medical Reference 2011.
Daniel M. Keller, Ph.D., “Children’s solid tumors rarely metastasize to the brain,” Medscape Medical News, July 24, 2013.
National Cancer Institute, “Cancer advances in focus,” reviewed December 13, 20120.
National Cancer Institute, “What you need to know about brain tumors,” April 29, 2009.
Roxanne Nelson, “Cell phones and brain tumors: no link, but is study flawed?”Medscape Medical News, October 21, 2011 (British Medical Journal, October 20, 2011).
Roxanne Nelson, “Curcumin holds promise as treatment for brain tumors,” Medscape Medical News, March 29, 2012 (BMC Cancer 2012;12-44.
“Neurologic manifestations of glioblastoma multiforme,” Medscape Medical Reference, updated October 8, 2012.
Rosalind Segal, M.D., Ph.D., “Two-drug combination slows malignant brain tumors in mice,” Health News.
12/13/2013
For more information, sample newsletters or to get on our mailing list contact:
Community Relations
West River Regional Medical Center
1000 Highway 12
Hettinger, ND 58639-753