Brain tumors, though relatively rare, can strike anyone, as saddened Americans learned during the recent diagnosis of Senator Edward Kennedy. They have few known causes and risk factors, but when they do occur, they can profoundly affect not only physical function, but thought, feeling and perception.
Neurosurgeon Behnam Badie, M.D., director of City of Hope’s Brain Tumor Program, faces head-on both the physical and emotional implications of the disease. An expert on the various forms of brain cancer, as well as those of the spinal cord and spinal column, Badie spoke with eHope to provide facts about the disease.
EHope: What are the warning signs of a brain tumor?
Behnam Badie, M.D.: Common symptoms include seizure, neurological deficit such as weakness or paralysis, vision problems, changes to personality and difficulty walking. Also, severe and persistent headaches, usually accompanied by nausea and vomiting, can be a sign. For headaches and such, I’m referring to the sudden onset of these signs. For example, if you have a history of migraine headaches, you shouldn’t suddenly be afraid you have a brain tumor. If you are really concerned or if you notice other signs, of course, check with your doctor.
EH: What causes brain tumors?
BB: There are two categories: primary and metastatic. Metastatic are more common. These result from cancer spreading from other sites, such as the lungs or colon.
Primary brain tumors are those that originate in the brain, and for most the causes are not clearly understood. They seem to be spontaneous for the most part. One exception is meningiomas. These have a definite link to previous exposure to radiation therapy, though that’s not the only cause.
Links to some genetic disorders, such as neurofibromatosis, exist, but these are rare.
EH: Do cell phones cause brain tumors?
BB: There is no known connection. In fact, a large study done in Sweden seems to rule out any correlation. Also, now that cell phones are so prevalent, we should be seeing a clear increase in brain tumors if there is a connection. We see no such increase.
EH: What are the different types of brain tumors?
BB: Meningiomas and schwannomas are usually benign. Meningiomas arise in the meninges — the membranes that surround the brain. Schwannomas develop in the sheath that surrounds nerves. We also include pituitary tumors, though technically they are not brain tumors; they are endocrine tumors. But since the pituitary sits under the brain, we also treat those.
Gliomas arise in the brain itself.
EH: How common is each type?
BB: Gliomas are the most common, followed by meningiomas and schwannomas. Overall, though, brain tumors are relatively rare. They make up only about 1 percent of all cancers.
EH: Which type of brain tumor is most difficult to treat?
BB: High-grade gliomas. They are aggressive, and the prognosis generally isn’t good. But we’re working to change that.
EH: What are the different available treatments?
BB: Aggressive surgery is the most effective treatment, whenever possible. This usually cures benign tumors. We do minimally invasive, endoscopic surgeries when we can to minimize the amount of tissue trauma and, therefore, the recovery time. If a tumor comes back, we sometimes use radiosurgery. We’re fortunate to have TomoTherapy for this, so we can pinpoint the radiation. We definitely want to minimize exposure to healthy parts of the brain.
For gliomas, we follow surgery with chemotherapy and radiation therapy. We’re also looking at next-generation therapies, such as anti-angiogenic drugs, which cut off the blood supply to tumors, immunotherapies that use engineered T-cells to target tumor cells, and stem cell therapies. And, we just began a clinical trial using gene therapy to make brain tumor cells more sensitive to radiation therapy. These new therapies hold a great deal of promise, and we’re really hoping they’ll improve survival rates.