Q & A: Facts About Brain Tumors
When it comes to medical conditions, few diagnoses are more frightening than “cancer” and “brain tumor.” And whether you know someone who has developed a brain tumor or are learning about their impact through the news, like the recent diagnosis of Arizona senator John McCain, it can be difficult to understand just what a brain tumor is and how it can affect the body.
James Snyder, D.O., a neuro-oncologist at Henry Ford Health System, provides insight into what brain tumors are, what it means for a tumor to be cancerous or not (because not all brain tumors are cancerous), and who may be at risk.
Q: What is a brain tumor?
Dr. Snyder: In short, a brain tumor is a mass of abnormal cells that grow in the brain. Primary brain tumors start in the brain and do not typically spread to other parts of the body. Metastatic tumors are cancerous tumors that start in another part of the body and spread to the brain, most commonly from the lung, breast, colon, kidney or skin (melanoma).
The most common primary brain tumor is a meningioma. While typically non-cancerous, this tumor can cause serious issues depending on its location and behavior.
Primary brain tumors are classified in “grades” by the World Health Organization. Grade 1 tumors are the least aggressive and are sometimes referred to as benign, whereas grade 4 tumors are the most aggressive (malignant) and are life threatening, even with treatment.
Q: Does a brain tumor automatically indicate cancer?
Dr. Snyder: It truly depends. Primary brain tumors do not meet the classical definition of cancer because they don’t tend to spread to other parts of the body. That being said, if a patient has a grade 4 tumor, I often refer to it as cancer so that they understand that this is a malignant disease that behaves like advanced stage cancer.
Q: Speaking of treatment, what options are available for patients?
Dr. Snyder: Treatment depends on the type of tumor. Whether it’s an aggressive tumor or not, the first step is typically surgery to determine what type of brain tumor it is. Most often the goal is to remove as much of the tumor as possible without causing harm to the patient. Depending on what type of tumor it is, patients may be treated with chemotherapy, radiation, clinical trials or a combination of these to treat the tumor. At Henry Ford, this recommended treatment plan is reviewed and agreed upon by a group of brain tumor-specialized doctors and nurses at what is known as a tumor board. If the tumor is benign, we may elect to just monitor it with imaging.
When it comes to surgery, we have many advanced technologies to operate on even the most difficult of tumors. The most common limiting factor for surgery is the impact of the tumor or surgery on areas of the brain that control important functions. Some of the unique tools we have at Henry Ford help our surgeons to visualize critical brain connections so they can be protected. Brain tumors located on the brain stem, for example, are extremely dangerous. Think of your brain as a bundle of wires. The area where that bundle of wires comes together is the brain stem. There’s a lot of important information in that area, and if those pathways are disrupted severe damage could be the result.
Q: Can brain tumors be cured?
Dr. Snyder: Most of the malignant brain tumors do not currently have a cure, but we are working hard to change this. While this is a devastating disease, we do see some patients who have a brain tumor diagnosis with a two-year expected average survival rate and they’ve been living well for more than 10 years. There are several extremely promising new treatments for brain tumors that have researchers and doctors more excited and hopeful than ever before that we can find a cure.
Q: With other types of cancers, there are more definitive patterns as to who is at risk for developing them, while brain tumors seem to affect patients without much reasoning. Is there a pattern of diagnosis? Who is at risk of developing a brain tumor?
Dr. Snyder: We really cannot predict who is at risk of developing a brain tumor. While we know those who smoke are at greater risk of developing lung cancer, the same connections have not been identified for brain tumors. There are rare associations, such as patients who were treated with radiation therapy as children being at a greater risk. But association between something a patient does, an environmental factor or even a genetic predisposition (outside of a handful of rare syndromes) that would put someone at higher risk of a brain tumor has not yet been shown.
Q: If I have a brain tumor, should I be concerned about my personality changing?
Dr. Snyder: In most situations, we don’t recommend treatment options that would directly affect quality of life or cause changes in a patient’s personality. Our treatment solutions are meant to maximize quality of life so that patients can continue to live their best lives for as long as possible.
The symptoms of a tumor are very location-specific. Many of the problems patients encounter with a brain tumor diagnosis are directly related to where in the brain the tumor has developed.
Q: In light of Sen. John McCain’s glioblastoma diagnosis, can you provide some background on this condition?
Dr. Snyder: Glioblastoma is a grade 4 malignant brain tumor. It’s also the most aggressive and common primary brain tumor adults are diagnosed with. While the overall survival rate is less than two years, every case is different, and through treatment our goal is to give patients the longest, healthiest life possible.
Q: What advice do you give your brain tumor patients?
Dr. Snyder: Brain tumors are rare and complicated conditions. I recommend that those diagnosed with a brain tumor be treated — or at least meet with doctors — in a specialized multidisciplinary clinic dedicated to brain tumors. Beyond treatment, a specialized center may have resources and experience with caring for all the other concerns that come with a brain tumor, such as nutrition, counseling, family support and rehabilitation.
For any disease that does not have optimal treatment options or is incurable, I recommend participation in a clinical trial. This way, patients can contribute to finding new therapies for these devastating diseases and in the process possibly be treated with what may be the next breakthrough therapy.
Whether you are going through cancer treatment or serve a loved one as a caregiver, there are resources to help you. Visit henryford.com/cancer to learn more.
Dr. James Snyder is a neurologist specializing in neuro-oncology at the Hermelin Brain Tumor Center who sees patients at Henry Ford Hospital in Detroit and at Henry Ford West Bloomfield Hospital.