Notes from the 6th Annual Brain Tumor Conference
I stumbled across these notes of the 6th Annual Brain Tumor Conference at UCLA from another person’s individual meningioma journey: http://teamtumorerradication.blogspot.com.
This is fabulous, it looks like my theories are actually supported by people who treat meningiomas!! The fish oil and acai juice (MonaVie) that I take are supported in the nutrition section, as are my whey (not soy) protein shakes and vegetarianism, and exercise and yoga focus, and my sense to avoid SUGAR 
Holey Toledo, I’m so happy to see this, I can’t tell you how this makes me feel after I was beginning to get fearful and wonder if anything I was doing was any good.
I’ll only list the full notes for nutrition and natural healing topics and you can go to their blog if you’d like to see the full gamut. I’ll also BOLD the notes that are most interesting to what we’re discussing in this blog.
This was just the boost I needed today. Why don’t our doctors let us know of these options? (They don’t seek them out or know about them is my guess).
Note: The 8th Annual Brain Tumor Conference at UCLA will be held on April 18, 2008!
6th Annual Brain Tumor Conference: Nutrition and Brain Tumors
Nutrition and Brain Tumors
Carolyn Katzin, Certified Nutrition Specialist
www.cancernutrion.com
Cancer is a molecular diseases. Mistakes in the cells are not corrected. Cancer cell has lost its orientation.
What can I do to improve my outcome?
- Add the 3 P’s to enhance your health
- protein - whey, egg white, cottage cheese, etc.
o 15 grams of protein in about 4 ounces
o Eggs, fish, chicken, turkey, lean meat
o Tofu and beans
o Pre-digested or hydrolyzed protein (milk protein as whey)
o Almond or peanut butter, nuts, seeds
- phospholipids - lecithin, phosphatidyl choline, inositol and phosphatidyl serine
o active forms of fat
o key components of cell membranes
o essential for brain health
o oils and fats: recommended fatty acid balance (omega 6:3 of approx 4 to 1)
- phytonutrients - blueberries, spirulina, blue/green foods
o help to make sure cells are in good health
o ORAC scores in order of most to least: blueberry, blackberry, garlic, kale, strawberry, spinach, brussel sprouts, plum, broccoli, beet, red grape, kiwi, pink grapefruit
- work with the 3 Anti’s
- Anti-carcinogens: a chemical that reduces cancer processes
o Curry powder (combo of turmeric, cumin and other spices)
o Grapefruit and other citrus fruits (naringinin and limonene)
o Green tea (EGCG and other natural ingredients)
o Pomegranates (especially the oil from the seeds)
o Brazil nuts (excellent source of selenium)
o Tomatoes (source of lycopene)
o saffron
- Antioxidants: a chemical that reduces oxidation (eat them, not in supplements)
- anti-inflammatories: a chemical that reduces inflammation (redness, heat swelling)
o omega 3 fatty acids
o flaxseed, borage and blackcurrant seed oils
o natural salicylates: turmeric, rosemary, thyme, apricot, broccoli
o bioflavonoids: from citrus
o sugar and inflammation
* inflammation and sugar consumption may be linked
* Insulin-like Growth Factor is a genetic marker found to increase in high glucose diet; brain tumors are dependent on glucose
* Calorie restriction also lowers IGF-1
* Inflammatory reactions, wheat sensitivity - benefit from avoiding gluten
* Glucose uptake is measured by glycemic index and load
* Sucrose (one molecule each of glucose and fructose combined)
* Starch is composed of long chains of glucose
Fatigue - drink green tea, dark chocolate
Regular physical activity
Protein, iron, zinc, B vitamins and C
Avoid caffeine and stimulants
Drink green tea (not after 4pm)
Nausea - ginger, whole grain crackers, melba toast
Constipation - prune juice, dried prunes,figs,apricots,wheat bran, avoid apple sauce
Headache - avoid caffeine, chocolate, cheese and tyrmine foods (anchovies, gravies)
Weight loss - choose avocado, high calorie smoothies
Tendency to bleed easily - oranges, lemons, limes
Vision loss - dark green leafy veggies
Enhance your natural immunity
- mushroom extract or just plain white button mushrooms
The promise of nutigenomics
- individual genetic variations help tailor and personalize your recommendations
supplements
- alpha lipoic acid
- NAC
- Coenzyme Q10
- Green tea extract
Are some supplements harmful or of benefit?
- avoid mega-doses (more than twice RDI or acceptable intake) of any nutrient
- reduce supplemental antioxidants during treatment
Steroids and Weight
- reduce salt and sodium
- increase potassium eating more vegetables and fruits
- lower simple sugar; choose foods with a low glycemic index/load
- stay active
- drink lots of water
Nutrition and Inflammation
Beneficial foods
Specific issues related to treatment
Nutigenomics
- new field of nutrition and genetic expression
- The DNA Diet a new way of personalizing dietary recommendations
- Valuable tool for emphasizing which foods are most important for you
www.thednadiet.com
www.carolnkatzin.com
posted by andrea @ 8:58 AM 
6th Annual Brain Tumor Conference: Effects of Brain Tumors on Cognition, Mood and Behavior
The Effects of Brain Tumors on Cognition, Mood and Behavior
Dr. Thomas A. Kaleita, Neuropsychologist @ Dept. of Psychiatry UCLA
Symptoms
Fatigue and decreased stamina
Excessive sleepiness (often sleep 8+ hours)
Decreased alertness
Neurobehavioral dysfunction
- Attention
o Foundation for higher cortical functions
o Deficits appear as impaired ability regardless of intention
o Deficits can affect memory, language, executive functions, motor coordination and behavior
o Primary brain ability affected by malignant diseases and treatments
o Types of attention
* Focused
* Sustained (concentration over a period of time)
* Divided
* shifting
- memory
o differentiated theoretically from attention, but difficult at times to separate in observed behaviors
o capacity to retain info and utilize it for adaptive purposes
o verbal and nonverbal domains
o type and severity of deficits highly dependent on age
o memory abilities most often affect by tumor/treatment
* word finding/naming
* working memory (remembering phone numbers long enough to use it)
* retention of new info
* episodic memory (what happened earlier in the day, yesterday
)
- psychomotor speed (how fast brain processes information)
o often underlies attentional deficits
o may interact with physical impairments (i.e. visual perceptual difficulties)
o visual spatial and visual motor activities most commonly affected by deficits
o neurologic impairment differentiated from developmental or aging effects
o slowing a primary symptom of depression
* major depressive disorder
* 3% in US population
* 4-9% in studies of cancer patients
* 28% in brain tumor patients
* symptoms: major depression DSM IV
* sleep disorder
o difficulty falling asleep 52%
o continuity disturbance 41%
o early morning awakening 32%
o Modafinil (Provigil) - help alertness
* FDA-approved for narcolepsy, shift changes in employment and other sleep disorders
* Used to treat fatigue in multiple sclerosis
* Used to maintain performance by armed forces under sleep deprivation conditions
* Side effects: possible headache, nausea, dizziness, may have reaction with Dilantin
* concentration problem
* motor slowing
* weight change
* energy loss
* * sadness
* * diminished interest in activities
* guilt
* death ruminations
- other brain abilities - frontal, temporal, parietal, ,occipital, hypothalamic/pituitary regions
posted by andrea @ 8:56 AM
6th Annual Brain Tumor Conference: Alternative Medicine Approaches
Mary Hardy - trained as an intern
She found that what she was learning wasn’t sufficient to give patients all that they needed. Saw the power of traditional Chinese medicine
saw a man have a brain tumor operation under acupuncture only. Think about how you use your supplements. During radiation, you often lose muscle, lowering immune system and have difficulty exercising. Non restorative sleep increases your insulin resistance that can promote cancer.
Diet
Typical American diet is high in fat (wrong kind of fats derived from animals not plants/fish) which increases inflammation. Omega 3s (plant/fish) are what you want and limit omega 6s (animal). Many diseases are based on inflammation (i.e. cancer). Need to plan for a long future, decrease amount of animal protein in your diet. Fish in general tend to have more omega 3s but need to be careful about mercury contamination. Farm salmon is fatty, choose wild. Soy is a great protein substitute. Whey protein is a complete protein, amino acids and easy to digest, glutamine supportive for immune system. Omega 3 fatty acids are an important kind of supplement, it is a good fat that changes the ratio to help body decrease inflammation. Fish oil has EPA and DHA, you need a lot of unconcentrated amounts (~6g) to get enough omega 3. Vegetables have phytochemicals that help your liver process, regulate genetic function that can decrease rate of tumor growth/blood vessels, but they are tough to clean and cook. Juicing is an easy way to get your vegetables in as well as soups. The way you cook food can put carcinogens in your food (i.e. frying), grilling is good, but avoid the charred parts, be careful of smoked meats, steam/bake/broil best.
Meditation Therapies
Put your body into a physical state of restoration. Stress can break down the body. You want to be able to trigger the restorative part of the body that slows down breathing and relaxes you. Sitting meditation or moving meditation, tapes, etc. Basically, all of these techniques use your breath for relaxation. Regulate your breathing and your mind.
Supplements
Reduce side effects of therapy, reduce oxidative load on body, support immune system. Need support for energy and immune system. Traditional Chinese medicine has several parts: herbs, acupuncture.
posted by andrea @ 8:55 AM
6th Annual Brain Tumor Conference: Experimental Therapies
Experimental approaches in the Treatment of Malignant Gliomas
Best Available Care
Advantages: known benefit, well described side effects
Disadvantages: known benefit
Experimental
- novel mechanism of action, hope, expands knowledge
Disadvantages: phase 1 study not likely to provide a benefit, trying to find dose limit toxicity, unknown side effects
Goals of phase 1 studies: define dose (max tolerated dose vs. biologically effective dose); define toxicities; determine benefits; no controls (no placebo group)
Phase 2 (dosage set): define effect against tumor at set dose, define side effects, may use historical control vs. no control
Phase 3: define benefits against standard care (at least two arms -standard or experimental); benefits: shrinkage of tumor; survival; quality of life.
Informed Consent: defines the study in detail; defines the potential side effects; the cost to the patient; defines your rights; defines your physicians interests
When we enter experimental approaches, there a group of drugs called small molecular inhibitors. These drugs effected by liver metabolism. Anti seizure medicines that activate the liver often prevent you from participating in certain drug trials.
Try to define what is the biological active dose. Go through initial treatment at some point may have recurrence. Instead of going straight to surgery, we try an experimental drug then do surgery. When we get tumor sample, we can test how much of drug in tumor and if it blocked any pathways. This helps us to determine dosage for that patient in the future.
Cytostatic agents plus Temodar for recurrent or progressive GBM. Determine effectiveness by 6 month progression free survival.
Experimental approaches in neuro-oncology
- radiation
Sensitizers: GD TEX; ways to increase oxygen(RSR 13, Bovine hemoglobin); radio-labeled antibody (anti-tenasin, chlorotoxin, scorpion venom);Avastin to increase oxygen; AQ4N
Protection: stem cell research; growth factors
- Convection based delivery: conjugated proteins, chemotherapy Made proteins that match receptors on the tumor and not normal brain and gets pulled into the tumor to kill the cancer cell (put in with catheters) TP-38
- Gene/Viral Therapy: HSV tk (herpes - not so effective in humans, delivery impaired possibly by our own immune system); Oncolytic Virus - leads to activation of viruses to help kill the cancer cells (Onyx 15, Reovirus, NewCastle)
- Immune therapy (your own body helps fight tumor): Dendritic cell; antisense; TIL; LAK
- Focal Molecular Therapy: Receptor; cell cycle; signal transduction; angiogenesis
- combinational therapy: chemo/biologic, etc.
Combination Therapy from NABTC
Tarceva CCI-779
Sorafinib and R115777
Sorafinib and Tarceva
Sorafinib and CCI-779
ABC2 Clinical Trials
Avastin vs. Avastin CPT-11
Rad001
A lot of trials don’t make it to phase 3 because the can’t show that they are better than standard treatment (20% progression free for 6 months).
–
UCLA Database project
Approach
- consented patient
- tissue samples
- clinical data
- imaging
- genomic
- gene expression
- protein
- cell lines
Created a computer environment where clinical & research needs are equally served. Software to help: mobile hand helds, PC, research edition to take data out of lab info. Real-time data screening to apply filters to data center to customize which data sets to return. Once results are returned, users are able to customize what visualization options to view the data set in. The data being gathered will help to determine similarities among patients and their treatments to help get data that may increase individualized therapies.
posted by andrea @ 8:55 AM
6th Annual Brain Tumor Conference: Pathology
Paul Mishel - pathologist
Neuropathology of brain tumors.
We help establish the diagnosis on biopsies done at UCLA and other institutions.
We work with our colleagues in the tumor board. He examines the tumors under the microscope and comes up with a diagnosis and is also involved in research. We try to figure out how to get the right drug to the right patient. Provide preliminary diagnosis at time of surgery - intraoperative frozen section. They identify the type and grade of tumor. We provide molecular information that may help better target patients for treatments. Surgeon removes the tumor, neuropathologist makes intraoperative diagnoses at time of surgery then final diagnosis made later (type & grade), team decides best theraputic approach. What to we look for. Is it a tumor? Does it arise from the brain or a metastasis. Tumor type tells us about the probable cell origin (how it looks and proteins it expresses). Conveys prognostic information and general therapeutic information. The grade tells us how biologically aggressive the tumor is likely to be, grade is based on the presence of certain characteristic microscopic features. Is it a tumor? Come from brain or elsewhere? Cells in primary tumor kind of cannonball shape, primaries have similar cells to the brain itself. Gliomas: pilocytic astrocytomas grade 1 less common, most are astrocytomas 1-4 and oligodendrogliomas, ependymomas, rarely are neuronal tumors, lymphomas, hemangioblastoma (unknown origin). Skull based: meningiomas, pituitary tumors, rare. Gliomas tumors arising from the supporting cells of the brain. Astrocytes - astrocytomas, oligodendrocoytes (cells that sheath nerves of brain - oligodendrogliomas, ependyma- ependymomas. Astrocytomas : indolent (not invasive) but most of them are infiltrating. These are graded on their biological aggressiveness. Most frequent types of glioma, infiltrative nature, spectrum from low grade to high. Grade determined by examining features: high cellularity and cellular atypia, mitotic activity (proliferation rate ) , vascular proliferation, necrosis. Different grades have different age distributions: grade 2 30-40, Oligodendroglioma - another common glioma: rounded cells fried egg appearance, patternless sheets, they are graded by features as well similar to gliomas. Meningiomas: usually press on but do not invade brain. Arise from covering of brain (durra), they can be scooped out for the most part. Small subset have a more aggressive appearance. Current grading systems: useful for diagnosis and prognosis but there are shortcomings: morphologically identical tumors may behave very differently, does not yet let us individualize therapy. The Tolstoy metaphor: All happy families are alike: each unhappy family is unhappy in its own way. The highly regulated molecular events that are crucial for normal development and function are very similar between individuals. In cancer, genetic and epigenetic alterations lead to highly complex individual tumors. The challenge: find consistencies that can be therapeutically regulated
Traditional approach to cancer diagnosis:
The genomic revolution is transforming clinical medicine. Instead of the current model of population -based risk assessment and empirical treatment. We will move to predictive individualized care based on molecular classification and targeted therapy. Targeted molecular therapy trying to find Achilles heal of cancer. Exploits gene defects and signaling abnormalities specific to cancer cells. Holds the promise of non-toxic treatments. Already being for other types of cancer. The success of this approach will depend on targeting it to the right subset of GBM patients.
Glivec for leukemia, doesn’t make you sick but suppresses cancer.
Cancers are a very mixed group, some are susceptible to certain drugs and other not. Targeted inhibitors work in some GBM patients - who are they? Some patients show a clear response. A clinical trial will likely fail to show efficacy if the drug is not targeted to the right patients Tumor should be targeted not on the basis of morphology, but on pathway deregulation. Need to develop ways to identify which patients are likely to benefit. How do go from a patient’s biopsy to right drug? Pathway signatures are beginning to be used to identify which individual patient may benefit most from a particular drug. In vivo analysis of signaling pathways may tell us how to individualize therapy for patients. We found a way to examine proteins that are turned on when they should be turned off in GBM patients. We can identify if they are activated in certain patients. EGFR is an attractive target in GBM: frequently amplified, over expressed or mutated. Response limited to a subset: only 10-20% respond to EGFR inhibitors. Molecular determinants of response in GBM unknown. 11/10/05 article in NE Journal of Medicine: Molecular Determinants of the Response of Glioblastoms to EGFR Kinase Inhibitors Asked if more of the gene target made person more sensitive to drug, answer was no. There are some proteins that we thought might interact with each other and we found that when both proteins present in tumor cells, patient 50% more likely to respond to Tarceva. (Mark’s tumor did not express these two proteins, so Tarceva not a good choice.) In the process of doing clinical testing for these proteins. Understanding why some one doesn’t respond is almost as important as trying to figure out why some one does. Malignant glioma patients can benefit from EGFT kinase inhibitor therapy Summary:
- we work as part of the team
- we diagnosis the tumor
- info about the presumed cell of origin its likely life of biological aggressiveness provides a diagnosis and provides basic info about the prognosis and treatment
- we work closely with the neuro-oncologists, surgeons and radiation oncologists to help optimize a treatment plan
- we are at a new and hopeful phase in which we may help to individualize therapy and help determine which therapy is likely to benefit each patient
- our group at UCLA is moving forward with the developing such targeted molecular approaches
Will the pathway signature work in low grade settings? Probably yes, but what we know comes from high grade tumors.
Diagnosis of cancer is based on what it looks like under the microscope. There are some cases where the pathologist can’t make a definitive diagnosis because there are not enough cells and trouble getting them without harming the patient.
Cells go about their business through a series of signals. One protein enzymatically interacts with another protein and so on to activate a certain function in a cell. These are called pathways. In cancer, these pathways get distorted so cell can’t do what it is intended to do.
Blood brain barrier when normally functioning prevents things from getting into the brain. In brain cancer, the barrier becomes leaky so things can get in. Sometimes can exclude some cancer therapies. Most inhibitors appear to be getting in, in sufficient doses.
posted by andrea @ 8:54 AM
Dr. Cloughsey
Primary Brain Tumors: Incidence
Close to 40,000 new cases in 2002
60% are high grade = poor prognosis
50% increase in incidence since 1984
Gliomas can have devastating function
People over 65 had highest increase in brain tumors
Molecular and genetic considerations
Causes -
Unknown
(small percentage) Increased incidence in farmers, ham radio operators, nuclear industry worker, petroleum field workers and those exposed to radiation to central nervous system
Hot issues: aspartame and cellular phones (unknown risk - no supportive data exist - we think the answer is no)
5% related to inherited genetic condition
19% report family incidence of cancer
Molecular Biology -
DNA stored in every cell and gets replicated when cells are made (kind of like blueprint)
RNA only made if cells wants to make something for that cell. Small percentage of DNA used to make RNA. Acts as an assembly line, adds amino acid into complex string that turns into a protein that goes in cell and interacts with other cells (this is where you get the cells that are made for specific functions, heart cell, brain cell, etc.)
In any tumor, there are abnormalities that occur in the DNA, mutation or loss in gene which can work on the protein and when activated to create new cells, it gets knocked out and then you have reproducing cells with abnormality. This can happen in any kind if cell brain, breast, etc.
Brain cancer is molecularly heterogeneous (they might look the same under the microscope, but they are different in behavior)
Primary brain tumors are classified according to the cells of origin
Malignancy determined by cellular characteristics
Primary gliomas do not spread outside of the central nervous system (except in rare cases)
- astrocytoma (Grade 2)
- anaplastic astrocytoma (grade 3)
- glioblastoma multiforme (grade 4)
features to determine grading:
pleomorphism
mitosis - cells actively dividing
endothelial proliferation (new blood cells forming)
necrosis (cell death)
astrocytoma can accumulate abnormalities and increase in grades
some tumors right out of the gate are grade 4
features on imaging give insight as well, Mark’s tumor looks like it was the type that has been around for a long time and eventually changed grade over time vs. one that was GBM right out of the gate, because it was well defined instead of diffused. Typically, Mark’s kind has better survival rate.
tumors look the same but have very different expression of genes and different survival
we can select antibodies that will look for specific protein and see if exists or not in tumor cells (PTEN and other types of proteins), we can see if metabolics pathway has been activated or not and we can characterize which pathways have been activated that can help us choose therapy. There are agents that can block certain pathways if activated or driving tumor.
Proneural, proliferation, met
How do we individualize therapy? This is what we’re actively working on at UCLA.
Signs and symptoms
Headaches most common initial system
Seizures about ½ of patients have some type of seizure
Mental changes - memory, speech and communication
Nausea and vomiting; drowsiness, vision problems, blurred or double vision (usually cause by increased intracranial pressure that can be due to tumor’s growth within skull, blockage of cerebral spinal fluid that flows through ventricular system or edema of the brain around the tumor (fluid leaking outside of contrast enhancing area)
Brain stem tumor - clumsiness, swallowing, double vision, hearing loss, anything effecting cranial nerves, headache on awakening
Cerebral hemisphere tumor
- frontal lobe tumor (unilateral paralysis, memory, impaired judgment, personality, mental changes)
- occipital lobe tumor - blindness in one visual field
schwannoma -
meningioma - growing off base of skull, don’t change that rapidly, 20% of all primary brain tumors, slow growing, arachnoidal cells,
medulloblastoma - typically in children, in 4th ventricle, in cerebellum, doesn’t spread outside of CNS, needs spine radiation as well as brain
astrocytoma/glioma - can grow rapidly,
MRIs can detect better than CT scans
New PET imaging - typically use glucose as a tracer, now trying thymidine or dopa(goes past blood brain barrier and goes into any area that is tumor, can show low grade tumors too, good for after surgery because you can identify tumor activity vs. scarring) as tracers now that reflect cell proliferation (rapidly dividing) Usually only available for patients on clinical trials.
What are you learning from GBM survivors? We’re big progression if seeing if molecular makeup helps determine survival.
MRSpec - can get lots of false reads because of volume averaging
Radiation therapy
Conformal
Focused: seeds, sterotactic, proton
Sensitizers - not a confirmed effective sensitizer for brain radiation
30% progression
27% stable disease
43% shrinkage of tumor
Chemotherapies effective for malignant gliomas?
Try to cause abnormality in DNA so it can’t replicate
In the past, chemo didn’t seem to have much effect in GBM; however, Temodar seemed to have some radiation sensitizer effect and studies now show the Temodar/radiation combo has a noticeable improvement over radiation alone. (26% increase in 2year survival)
Different tumors respond differently to different agents. The most effective approved chemotherapies are CARBO(alkylating/cross linking), BCNU(alkylating agent), CPT-11(topoisomerase I inhibitor), TEMODAR(alkylating/methylating), PCV combination chemotherapy, VP-16(topo
Unfortunately, we don’t yet have good ways of knowing which ones will work for the different tumors and have to do trial/error most of the times.
Biologic Agents
Tamoxifen, Accutane, b-interferon,
Cytostatic agents plus Temozolomide
Saw some significance with marinated, but couldn’t be repeated in successive studies, many times there hasn’t been a significant benefit overall
Vascular endothelial growth factor
Avastin/cpt11 (approved for colon cancer, breast) Avastin side effects could be local hemorrhage (1 in 30) which is why they are concerned about using it in the brain; high blood pressure, proteinuria; cost - many health plans don’t pay because it isn’t approved for GBM (could be $5-10 thousand dollars every 2 weeks), Duke is doing a trial for this and UCLA is managing about 65 patients on this trial (our friend Tom is trying out this new chemo combo), given every 2 weeks. Preliminary data shows 51% have shrinkage of recurrent GBM
Molecular evaluations on tumors
Not always that reliable, so it makes it difficult to provide guidance. This is the type of information that will be coming soon to help guide therapy. Molecular biology has helped in oligodendroglioma tumors because they could see if there were big chunks of genes missing in 1st chromosome that patients did better when this chunk was gone, and those with it present didn’t do as well. Helps with prognostic information, but not treatment. We know that genes are missing, but we don’t know which ones - but some how important that it is missing? Not useful enough in clinic to determine treatment. We’re trying to find similar data in GBM patients to find out what chemotherapies will work better than others for specific patients. Findings that ones with methylated MGMT did better than patients whose gene is not methylated, but this hasn’t been validated.
How do you decide which inhibitor to give to a GBM patient? There isn’t just one thing to target. There could be several pathways that are driving the tumor to grow. We try EGFR, mTor or others as prohibitors, but not sure if we’re going to get an effect. Studies show that some patients do have positive results in a minority of patients. Tested EGFR/PTEN molecular features of tumors and found that when both expressed, it identifies the responders and could help identify if you should be using growth factor receptor or not. (Mark’s tumor didn’t show these, so that we know Tarceva probably wouldn’t be a good prohibitor for him).
We are getting closer to individualized therapies. We are beginning to identify subgroups.
posted by andrea @ 8:50 AM
6th Annual Brain Tumor Conference: Neurosurgery
Dr. Donald P. Becker - former chief of neurosurgery and has battled brain cancer himself, he’s 70 years old (looks like 55!)
Elementary talk on what a neurosurgeon does. A neurosurgeon’s role in treating benign or low grade gliomas, they remove it. In higher grade tumors, they are to reduce as much pressure as possible by removing as much of mass as possible and getting tissue for other research and trials. He would often take x-rays home night before surgery to really prepare himself and know as much possible, so that he assured him self he was doing the best that he could. You want your surgeon to be careful, attentive, have patience and not overloaded. Technology has really advanced the field. Back in the day, they didn’t have magnification and the lighting was terrible. Now the magnification is incredible and we have headlights over our head, sometimes use operating microscope with light coming right through the lens. Usually have an MR scan done in advance to all you to have computer with images in the operating room. We register the computer pictures to the patient’s head that is fixed and can use the screen during surgery to verify tumor location. Showed us pictures of a metastatic tumor removal. Patient’s head fixed and shave area around where incision to be made and mark area. They make a hole in the skull to identify the durra mater underneath, place a small saw underneath and cut out the marked area of the skull with an angle (like when you cut a pumpkin lid) then wrap in gauge and place in sterile solution. They then open the durra mater to expose the brain (gyrus - hills and valleys of the brain). Tumor different color than brain tissue. Metastatic tumors can often come out completely, like Lance Armstrong. Try to take at tumor as a whole, so cells don’t spread, then we put the skull back with titanium plates and screws using 3 point fixation, durra mater held up with a suture. A little talk about anatomy: have to be cognizant of where arteries are that feed the brain, cranial nerves responsible for swallowing and sensation of the throat (if you injure those patients have 6month recovery and can’t swallow), optic nerves (nerves cross and operate opposite sides of body), olfactory nerves (smell, taste), vessels come off artery and can’t be damaged during surgery and could cause stroke of contra lateral weakness, brain divided into frontal, parietal, temporal and occipital Lobes. Central sulcus controls motion, frontal lobes relatively silent. Cerebellum controls coordination. Frontal lobe controls personality. In the center of the brain you have lateral ventricles that hold cerebral spinal fluid, you generate 2 cups a day that helps clean the brain. With and MR scan, you can see all of the anatomy and we can tell where lesion is and if it is near risky areas. All blood vessels are critical and we try to avoid damage, but the brain is covered with veins. Every cardiac pulse, 20% of the blood goes to the brain, so we need to know where all the veins are and where they go to. Thalamus cannot be damaged or patient has weakness or contra lateral paralysis. Showed us pictures of lesions
glioblastoma is the worst kind, grows rapidly and strips its own blood supply and can end up with a hemorrhagic tumor. GBMs can have cysts in them too. As they grow they destroy brain tissue and can distort it and cause problems for the patient and their family. If it grows in the pons (near spinal cord) have trouble with sensation and eye control, but can have success with medical therapy. Metastatic are usually well circumscribed and easy to totally remove. Cranial nerve controls facial movement. Hypothalamus keeps person awake and keeps metabolism in order. When tumor is near eloquent areas, we’ll do a functional MRI to test hand movement, speech and tongue movement. Questions: Are brains different from person to person? Each brain is a little different in position of central sulcus, some have larger frontal lobes (usually smart folks), some functional differences as well. If a person learns two languages, the zones for primary language is in a different area than their secondary language (functional MRIs can detect this). Being in an academic research center, we’re learning fascinating new things all of the time. Have you ever used gliadel wafers? He has used gliadel wafers, but only in consult with neuro-oncologist. What about low grade astrocytomas? Low grade astrocytomas can be cured if removed properly; however, we can’t always remove the whole thing if it might damage the patient’s functions.
posted by andrea @ 8:49 AM
6th Annual Brain Tumor Conference:
We spent all day Friday and Saturday (3/31,4/1) at the 6th Annual Brain Tumor Conference at UCLA. It was a great event that filled us with knowledge and solidified our choice to work with the program at UCLA. We also got to meet several other survivors, families and medical professionals. What will come next is A LOT of information. I took notes on everything in case anyone wanted to know what we heard.
Here’s just some of the intro information we learned:
In the end, we don’t have the answer. We try to educate the best we can and you will help us to make right decisions.
Here’s the outline of what was covered:
UCLA’s Approach to Brain Tumor Care: Multidisciplinary
Surgery (maximal surgical resection , functional mapping, operative mapping, navigational surgery, operative MRI, utilize tissue)
Pathology (determination of grade, determination of molecular pathway activation)
Radiation therapy (Novalis shaped beam therapy, conformal therapy, experimental), chemo/biologic (individualized care, experimental-NABTC,ABC2,Investigator initiated)
Immunotherapy(dendritic cell therapy, Poly ICLC, IL13)
Radiology (tumor vs. necrosis , MRI, diffusion, MRS, pet ,fdg, flt, dopa), Fatigue (provigil)
Comprehensive care (principal care, psychosocial, education/updates, caregiver support, social work)
www.neurooncology.com
Interesting facts learned:
Turtles are the only creature that is known to not get cancer. Some cultures use ground up turtle in their treatments.
6th Annual Brain Tumor Conference: GBM Tumors
6th Annual Brain Tumor Conference: Support for the Caregiver
6th Annual Brain Tumor Conference: Radio Surgery
Filed under: Medical News | Tagged: brain tumor, meningioma, natural healing
