The month of May was first deemed Brain Tumor Awareness month by Congress in 2008 and has been passed with bipartisan support ever since. As stated by the National Brain Tumor Society, this month is “a time dedicated to supporting, empowering, and amplifying the voice of the brain tumor community.” During this month, it’s important for not just patients and their families to think about brain tumors, but for the scientists who perform the research, the physicians who treat the patients, the politicians who fund the grants, and the general public to think about brain tumors as well.
Brain Tumor Facts and Statistics
There are many types of brain tumors, and several have different grades which are used to indicate how benign (noncancerous) or malignant (cancerous) they are.
However, even the benign tumors can have adverse effects on the well-oiled machine that is the human brain. The malignant tumors can be primary, meaning the tumor first appeared in the brain, or metastatic, meaning cancerous cells from another part of the body have spread to the brain.
Brain and nervous system cancers are relatively rare, accounting for 1.3% of all new cancer cases in the United States and is only slightly more common amongst males. In adults, the 5-year survival rate has remained rather stagnant, but has improved in the pediatric population.
The First Innovators to Tackle Brain Tumors
The first surgeon who successfully removed a brain tumor described the brain as a “mysterious dome of thought.” Nonetheless, Scottish surgeon William Macewen was the first surgeon to document the successful resection of a brain tumor on July 27, 1897. To put that in perspective, that is the same year Edison invented the lightbulb. The patient was a 14-year-old girl who had been experiencing head pain, focal seizures, and slowed comprehension. Still 20 years away from the invention of the X-ray, Macewan deduced the location of the tumor from the girl’s presenting symptoms and medical history. The procedure itself was uncomplicated and she made a miraculous recovery. Though she died 8 years later from kidney disease, no evidence of a brain tumor (thought to have been a meningioma) was seen during her autopsy.
Thankfully, a more in depth understanding of the brain, brain tumors, and the advancement of medicine as a whole has led to safer and more successful brain tumor operations. A huge contributor to this is success is brain imaging, specifically magnetic resonance imaging (MRI), computed tomography (CT) scans, and position emission tomography (PET) scans. The first tool used when a brain tumor is suspected is often a CT, because it is quick to perform and analyze and shows a rather complete view of the brain. In some instances, an MRI may then be performed, as MRIs are particularly useful for brain tumor diagnosis and evaluation because they show the tumor location and its on the brain structure, ventricles, and blood supply. PET scans are often used in conjunction with the other two methods to determine whether a tumor is cancerous or not. PET scans show how the brain is functioning and detects cancerous cells by using a radioactive dye that metabolizes the substance differently than noncancerous cells. These three imaging mechanisms were all first utilized in the late 1900s and continue to improve even now.
Current Innovations to Treat Brain Tumors
Just as imaging has evolved as a diagnostic tool, surgery has evolved as the primary treatment for most brain tumors. Imaging is used as an important tool in guiding surgical decisions and can be used to judge how much of the tumor was able to removed during surgery. This is of critical importance, as surgery is the basic treatment for most brain tumors. Perhaps one of the most impressive advancements in neurosurgery is the use of imaging while performing surgery, also known as intraoperative imaging. Intraoperative MRIs (iMRI) allow for better precision and thus better outcomes since the tumor can be extracted while avoiding other critical brain structures. iMRI brain tumor resections have a greater rate of total removal and less progression of the tumor. However, iMRIs do present significant challenges for other surgical personnel (i.e anesthesiologist, nurses, other physicians) since MRIs are used creating a strong magnetic force.
Tumors in the motor cortex, sensory cortex, and language cortex are often deemed to risky to operate on since these are brain areas of vital importance to day to day functioning and quality of life. However, awake surgery for tumor removal has given these patients a new option. Awake brain surgeries had previously been used since the 1980s for deep brain stimulation (DBS) to evaluate motor improvement in patients with Parkinson’s disease, but the first awake brain tumor removal was not performed until 2011.
Awake brain surgeries involve different sedation than other surgeries which allows surgeons to wake the patient when needed to assess how removing a certain area may affect the patient. There are countless stories of patients being asked to sing, play guitar, or even talk to the surgery personnel so that the surgeon can decide where the tumor can be removed without affecting the patient’s functioning. This is perhaps one of the most miraculous and important developments in brain tumor treatment, since the tumor can be removed while greatly preserving quality of life. As this surgical practice has been used more frequently, analyses have shown that it is safer, allows for better resection, and improves survival in some patients with glioblastoma.
It is important to know though that not all incredible improvements in brain tumor treatments are quite as dramatic as awake brain surgery. For certain tumors, like low-grade gliomas which are slow growing and surgery is not typically indicated, radiation therapy and chemotherapy together resulted in an average 5.5 additional years to the survival time of the cohort of patients in a study who received both treatments versus those who just received radiation therapy.
The Future of Brain Tumor Treatment
The field of medicine and healthcare has recently been moving towards precision medical treatments (also referred to as personalized medicine), which are specifically tailored to each individual, recognizing their genetics, environment, socioeconomic status, and other factors that influence a person’s health overall. The National Brain Tumor Society (NBTS) has maintained that “gaining a deeper understanding of the specific biological, genetic, and/or molecular characteristics that are driving a patient’s tumor growth and finding or developing drugs to target those particular molecular abnormalities that are responsible for the disease” is very important to treatment of brain tumors, which can vary widely between individuals.
Immunotherapy, which utilizes the body’s immune response to target cancerous cells, has been studied rather extensively for cancers, including brain cancer. Specifically, this involves taking part of the brain tumor to make a vaccine for that specific patient which in theory will educate the immune response to target the tumor. However, it has shown to be less effective for brain tumors in general, specifically glioblastomas, which are a particularly aggressive form of brain cancer. That has not deterred researchers from exploring other treatments and adapting their protocols to what has been learned through the failures. The NBTS currently has over 2,000 clinical trials listed on their website for a variety of brain cancers and a variety of treatments.
Researchers, scientists, physicians, and patients and their families have all contributed immeasurably to the progress and success of brain tumor treatments thus far. We have made miraculous strides in understand and treating a cancer of the body’s most intricate organ and the continued dedication by those who treat these cancers as well as the participation by those with brain cancer, miraculous strides will continue to be made. Brain Tumor Awareness month serves as a reminder of this dedication of the past and gives us the perseverance and hope to continue searching for treatments.
Written by: Amanda Wilburn
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