By Steve Blanchard - June 27, 2022
The field of neuro-oncology is ever evolving and treating cancers in the brain require experience and ongoing research to understand how the disease develops.
Dr. Michael Vogelbaum, program leader of the Department of Neuro-Oncology and chief of Neurosurgery, and Department of Neuro-Oncology Chair Dr. Peter Forsyth recently discussed some of the more common questions surrounding brain cancer.
Check out the video below to watch the entire Facebook Live event.
What are some of the symptoms that people should know about before they seek medical help?
Vogelbaum: A major new neurologic event, a seizure, particularly in an adult who’s never had seizures before is a very, very common presenting symptom for a brain tumor. So are strokelike symptoms, such as a loss of function on one side of the body or in the face. Again, it might be a stroke, but it could also be a tumor. These are the kinds of major neurologic events that really need immediate attention. Sometimes they’re more subtle developing over time. So gradual weakness on one side or the other is another one that can be associated with a tumor.
If you are caring for someone who may be elderly or you’re a caretaker of someone, what type of things should you look for?
Forsyth: I think headaches and a change in headaches or maybe a seizure or sudden strokelike episode or even a change in behavior are not uncommon things that as people get older they experience. So, it’s pretty difficult to sort out what should alert you to the problem of a brain tumor. I think if you know that your family member or loved one already has a diagnosis of cancer and you see one of these things … say a woman has breast cancer and they have these symptoms, you should really look into that and take it seriously and get imaging done right away. It’s more of a problem with the primary gliomas, for example, when you don’t have a previous history.
Vogelbaum: A key point here, though, is that a vast majority of headaches have nothing to do with a brain tumor. Context matters. If someone with a known history of cancer has new headaches that come up or a personality change, there should be some type of imaging done.
In so many cancers we hear that early detection is key. But there really isn’t a screening process in place for brain cancers, is there?
Forsyth: For primary glioma patients it’s true that they’re pretty rare or pretty uncommon, so there really isn’t a way to predict who is going to get one and you can’t screen the entire population. So, there isn’t a way to predict it as far as we know. If you want to see if someone is going to have a brain metastasis or not, though, there is some indication that it’s more common in certain kinds of cancer. I think you have a higher index of suspicion with cancers like lung cancer, some breast cancers or melanomas.
Do genetics play a role in brain cancers?
Vogelbaum: For gliomas, that question comes up all the time. But it’s a different thing because some may be lifestyle related or environmental related. Some of them are like certain forms of breast cancer that are familial. The answer is that for the vast majority of gliomas, there is no inheritable factor that can say someone has an increased risk.
Forsyth: We are working to try to develop easier tools that can help us to identify these tumors earlier, and that will make it much easier for people to undergo screening. But it’s going to involve identifying at-risk populations as best as possible and that’s another area of research. There is a large epidemiology program here and that’s the kind of work they do.
In layman’s terms, what is a glioma?
Vogelbaum: Gliomas are a type of tumor that arises from the brain tumor itself as opposed to cancers that spread to the brain. So, gliomas arise from the brain tissue. Their biology is what drives them as different from other cancers. Gliomas tend to spread within the brain and they don’t spread to other organs like other cancers. The reality is they are all malignant but there are lower and higher grades of malignancy.
How is someone who receives this diagnosis typically treated?
Vogelbaum: For gliomas it always starts with the imaging. That’s where the preliminary diagnosis is made and then there is going to be a surgical procedure depending on a number of factors. Factors range from if it is a low grade or if it is in a very deep location that would be hard to get to without creating a neurologic disability.
Forsyth: For most gliomas it’s complicated. Low grade tumors with a great resection and a suitable molecular profile can be observed and followed up with surgery. Then there’s treatment with some combination of radiation and chemotherapy. One of the most important points is really understanding the molecular markers that are present in the glioma because it helps with making a prognosis or prediction of what the future may bring.
When someone seeks treatment, we often hear the treatment versus quality-of-life conversation. As medical professionals, what do you tell patients? Is there survivability here?
Vogelbaum: It’s hard to really lump them all into one group and one set of expectations. But generally, I will set the expectation in terms of talking about what we know works and the fact that we don’t have a cure. But we absolutely have tools that help like surgery and removing a tumor. Sometimes the best option is a clinical trial.
One term we often hear when discussing neuro-oncology is leptomeningeal disease. Can you explain what that is and how it fits into the neuro-oncology world?
Forsyth: This is a problem where tumor cells go into the spinal fluid that circulates around your brain and spinal cord. For reasons that aren’t entirely understood, these cells enter the spinal fluid and then grow into the brain and around the spine. It’s a thing that is difficult to diagnose and the prognosis and outlook for most patients is pretty unsatisfactory. People, on average, live just a few months since it can advance pretty rapidly.
What is ahead of us in this field? Are you optimistic about treatment options moving forward?
Forsyth: I’m quite optimistic, actually. There are new technologies that understand both the tumor micro-environment, as well as the tumor itself and how the two interact. It’s also through research that we’re going to be able to understand all this and I’m confident that we can. The patients and families have been fantastic. They are hopeful, supportive, loving and appreciative. It’s really humbling to be involved in that enterprise and I’m sure we are going to cure them.
Vogelbaum: When I started in my training, melanoma was one of the scariest cancers. The treatments were not great and had a lot of side effects. But things have changed. In the last five to 10 years the word “cure” started coming up in conversation. No one could have predicted that. That’s where we are with gliomas and glioblastomas. We are in that period of frustration but there is a lot of work that is being done to get past that. So yes, I am confident we’re going to get past that just like we did with melanoma.