One of the biggest changes we’ve experienced in neurological surgery — and in medicine overall — in the past few decades is the use of high-tech imaging to see inside the body with great clarity and detail. MRIs, CT scans, ultrasounds, and PET scans allow us to detect and diagnose a wide range of brain and spine problems, greatly reducing the need for “exploratory surgery” to make a diagnosis. Imaging tests are now routinely used for those who sustain a head injury, who have learning or attention issues, or whose headaches don’t respond to medication.
One consequence of increased imaging has been the number of “incidental” findings of brain tumors. An athlete may be scanned to rule out a hemorrhage after a collision on the playing field, or a driver or passenger after a car accident, only to reveal a tumor. This often creates a conundrum for a patient — do you treat a small, benign tumor that may never grow, or risk brain surgery now to prevent a catastrophic diagnosis later?
A patient with an incidental finding of a brain tumor is usually completely overwhelmed by the news. It can be difficult to believe that you even have a brain tumor when you have no symptoms. We doctors must make difficult decisions about the course of action to recommend — we try to recommend surgery only when absolutely necessary, but if that small, benign tumor does progress into a malignancy, then a decision to forgo early treatment could prove fatal. That’s one of the reasons major medical centers convene multidisciplinary tumor boards to review findings and study the research, so we can determine the best treatment recommendation to make for each patient.
For a neurosurgeon, the ability to treat a tumor before it progresses is a powerful way to save lives. I know that one of the most painful things I ever have to say to a patient is “you have a glioblastoma (GBM),” so I see early detection as a great opportunity. Glioblastoma multiforme is a deadly disease, and in the 40 years I’ve spent in neuroscience we’ve only managed to extend its average survival time from 12 months to 15 months. The ability to detect and treat a low-grade glioma today, before it progresses to GBM, can be the difference between life and death.
In the United States, about 350,000 people a year are diagnosed with a brain tumor — that’s more new diagnoses than there are for breast or prostate cancer or Alzheimer’s disease. The most common of these new diagnoses are metastatic tumors, secondary to another cancer elsewhere in the body. But around 75,000 of the diagnoses will be of primary brain tumors, and that number is growing. (Whether the incidence is actually increasing, or more tumors are diagnosed simply because of the increase in imaging, is unknown.) The New York City Police Department, where I am proud to serve as a police surgeon, recently released statistics that show malignant brain tumors tripling among police officers in the years after 9/11/2001. And although I don’t believe there is any evidence to support cell phone use as creating an increased risk of brain tumors, conflicting studies continue to create concern among our patients. We physicians and educators certainly have our work cut out for us.
There are multiple research studies going on right now investigating the progression of low-grade gliomas into malignant GBM, several of them right here at the Weill Cornell Brain and Spine Center. (Find out more about our brain tumor and other neurosurgical research.) As we learn to understand how these tumors progress, we will find ways to disrupt that progression. We would love to be able to cure each and every case, but stopping progression and turning low-grade glioma into a chronic condition rather than an ultimately fatal one would be a worthy goal, especially in children and adolescents, where brain tumors are the #1 cancer killer. (Find out more about the Weill Cornell Children’s Brain Tumor Project.)
I currently serve as the president of the Brain Tumor Foundation, which makes early detection of brain tumors a priority. Please visit the foundation’s site for more information about their efforts to bring diagnostic capability to multiple cities around the country.
