Understanding brain cancer

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Seton brain, cancer experts discuss glioblastoma

Sen. John McCain’s brain cancer diagnosis announcement on Wednesday brings one of the most aggressive tumors of all human cancers to the forefront of the public eye. Neurosurgeons from Seton Brain and Spine Institute — the largest, most comprehensive neuroscience program in Central Texas  — explain more about this type of tumor.

According to a statement from the senator’s office, McCain, age 80, had an operation to remove a blood clot last Friday, which doctors discovered was related to a primary brain tumor known as a glioblastoma. Doctors did a craniotomy to take out the tumor with a minimally invasive eyebrow incision. Scans done afterward show that the tissue of concern was completed removed.

“While brain tumors are relatively rare, they are devastating because they hit the brain with many unpleasant symptoms including cognitive decline,” said Mateo Ziu, MD, Austin’s only neurosurgeon with advanced training in surgical treatment of brain tumors. Seton’s brain tumor treatment program is the only comprehensive neuro-oncology program in Austin, serving all of Central Texas. Seton is part of Ascension, the largest nonprofit health system in the U.S. and the world’s largest Catholic health system.

“Patients can have seizures, paralysis or headache,” Ziu says. “But worse, they may have problems like memory loss, changes in behavior, early dementia, inability to concentrate, confusion, and loss of ability to speak, count or read.”

What role does age play in glioblastoma?

“For many, getting diagnosed with glioblastoma is the beginning of a fight – a battle against the odds, a battle for survival, and a call to ‘get one’s affairs in order,’” said Ramsey Ashour, MD, chief of cerebrovascular neurosurgery at Seton Brain and Spine Institute.

Survival for the average person with a glioblastoma is 14 months, and less than 13 percent of patients live up to two years after diagnosis, said Ziu,

However, most studies done are in people under age 65 and little is known for people in McCain’s age group, for whom the survival is seven to 12 months, said Ziu.

But keep in mind that the statistics apply to populations rather than individual people. Even though people over 65 tend to tolerate chemotherapy and radiation less than their younger counterparts, people such as McCain who have a good starting baseline health and whose tumors can be entirely removed may have a better outcome than those with a less favorable start, Ziu said.

“Research is ongoing and very much needed, because we have no cure for this ominous and humbling disease,” Ashour said.

Difficult to recognize symptoms in older patients

“Since brain tumors are rare, when an older person has memory problems, personality changes, fatigue, or even confusion, most people think of dementia, depression, or something else – not a brain tumor,” said Ashour.

“Once the brain tumor is identified, earlier symptoms that were subtle and unexplained become obvious in retrospect,” he said.

The type of symptoms depend on the tumor’s location. If it’s in the language areas of the brain, the person may have speech problems. But because of swelling and irritation, “even if the tumor doesn’t strictly reside in the language area, it can cause speech difficulties from a distance,” said Ashour.

Treatments for glioblastoma

Generally, glioblastoma is treated with surgery, followed by chemotherapy and radiation. If a tumor is not detected early enough, it may grow in size and thus become more difficult to remove with surgery, thus worsening a person’s prognosis, said Ziu. “That’s why it’s important for family members and primary care providers to be alert so they can recognize symptoms early,” he said.