Friday, March 11, 2011
Grading brain tumours
It is always encouraging when people come up with the growing number of instances where people with brain tumours have extended life with recent treatments. As someone whose life has extended well beyond expectations for a person with a Grade 4 tumour, I am very happy for others with reports of success, whether spectacular or limited.
It’s a year ago, almost to the day, when we arrived back in Armidale, my having spent months in Melbourne being blasted by radiotherapy, experiencing the discomfort of oral chemotherapy, injections, blood tests and the stress of travel, appointments with doctors, specialists, etc.
The time since then has been a rollercoaster, no doubt about it. The slow steady deterioration that led mid year to the use of steroids and the beginning of the soul-sapping intravenous chemotherapy made it seem almost inevitable that the battle was being lost and would be before 2010 was out.
But the use of Avastin changed things for the better, and in a strange way, I found it hard to adjust to an extension of reasonable quality of life when little hope of that remained. The thought that it could all come undone in an instant makes one wary of hoping, and almost afraid to do something positive only to find crushing disappointment just over the hill.
But it is possible to get past that as the time lengthens.
I really started out to write this posting with one important thing to get across. Frequently people report success stories with little or no knowledge of the condition. A happy report that someone had a brain tumour removed decades ago and is fine now is wonderful, but when I dig around, I often find that the tumour was benign, as in the case of Sylvia.
Long periods of extended life with malignant tumours usually reveal that the grade of tumour that the person has is, or was, low – not so aggressive a type as mine is. Not too impossible to remove by surgical or chemical means known at present, at least.
A GBM (i.e., Grade 4) is the most difficult to inhibit. The brain is intimately interconnected – that’s why it functions so well in all its tasks – and a GBM hijacks these pathways and sends its cloned cells along the myriads of connections, nerve cells and synapses in a way that other brain tumours don’t. If not with radiotherapy and chemotherapy, it can only be treated with inhibitors, such as Avastin, or perhaps unconventional methods that may or may not be useful. To be truthful, I have not heard of any success with these on a highly aggressive GBM, but will be delighted if someone can prove me wrong.
I guess what I’m saying is that success stories, cures, extended reprieves etc. have to take such things into account, together with age and medical record prior to detection of the cancer, tumour location as well as psychological outlook. Nothing is off the books completely, but the spectrum is very broad.
This of course is true of other cancers as well, in different parts of the body, some of which can be even more aggressive by the time they’re discovered than a GBM.
The main thing is to be as realistic, positive, and active as possible, and to deal with things as they arise while looking as far into the future as we can. But let's not treat them as if they are all the same.