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May/Jun 2009 | www.MyFamilyDoctorMag.com | 25 housecalls the brain Q What do you know about treatment for malignant brain tumors? —cRistina, noRth caRolina AnSWER With all seriousness, not nearly enough. Malignant brain tumors have defied successful treatment since their initial description a century ago. But in the last four years this situation has begun to change rapidly. The most common malignant brain tumor is glioblastoma, the type Sen. Ted Kennedy has. It's also unfortunately a fatal type. Finding a cure is the goal for the future. The goal for today is to transform it into a chronic disease. MySTERIOuS ORIGInS Brain tumors are full of nasty tricks. They evade the immune system; their cells multiply without listening to normal biological controls, and they induce the brain to form new blood vessels to maintain their nutrient sup- ply. Each of these tricks results from gene alterations within the tumor cells. We've learned a lot about these alterations. What we still don't know is why the genes transform from nor- mal to abnormal in the first place. COMMOn SyMPTOMS Common brain-tumor symptoms include seizures, changes in mental function such as memory and lan- guage, weakness on one side of the body and problems with walking. An MRI or CT scan helps identify these symptoms' cause. (They can also indi- cate stroke.) Once your doctor sees a tumor on a scan, he or she recommends a biopsy—getting a sample—to prove the diagnosis. Often, this coincides with the first step in treatment. What to Do for a Brain Tumor By John hEnSon, M.D., F.a.a.n. THE THREE PILLARS OF TREATMEnT The three major components of brain-tumor treatment are surgery, radiation and chemotherapy. During the surgery, we remove as much of the tumor as we can without risking new problems, such as paraly- sis. Oddly enough, researchers have been unable to prove that this helps people live longer, in part because we can never completely remove the tumor and in part because it's impos- sible to do a study in which some people don't get surgery. But we think it helps prolong survival and we do know people have better neurologi- cal function if we can remove large amounts of the tumor. Then, we recommend a six-week course of radiation, together with some chemotherapy pills, to start about two to three weeks after sur- gery. These treatments have minimal side effects. One of the big advances in brain-tumor treatment has been to give radiation and chemotherapy together. This combination has more than doubled the number of people alive after two years with glioblas- toma—26 percent, compared to 10 percent. (Other types of brain tumors often have different types of treat- ment and better survival rates.) We have some exciting new drugs, such as antibodies against proteins that stimulate blood-vessel formation, that are rapidly changing the way we treat our patients. Despite these successes, most brain tumors are still very resistant to treatment, and we're looking hard for a better way. An ORPHAn DISEASE Uncommon conditions like brain tumors are sometimes called orphan diseases because there's less motiva- tion to fund research or develop spe- cific treatments for them. But we're making steady progress and the fu- ture is finally beginning to brighten. Board-certified neurologist John henson, M.d., F.a.a.n., specializes in neuro-oncol- ogy—nervous-system tumors—and is medical director of Swedish Neuroscience Institute's Center for Advanced Brain Tumor Treatment in Seattle, Wash. Why do brain tumors kill? Glioblastomas grow roots that spread and are impossible to eradicate through surgery. these roots then send cancerous cells into different parts of the brain and spinal cord.