August - December 2007 Issue
Brain Tumor Specialist Talks Symptoms, Treatment
Mark G. Malkin, MD, FRCPC, FAANMedical College of Wisconsin Neuro-Oncologist
Named one of the “Best Doctors in America®” 2006 by Best Doctors, Inc.
Compared to other kinds of cancer, brain tumors are rare. Unfortunately, they remain among the most difficult to cure. Mark Malkin, MD, is one of only three physicians in Wisconsin with special training in cancers of the brain and nervous system. He sat down recently to talk about these challenging diseases.
Q. What are the most common kinds of brain cancer?
The two most common diagnoses are primary malignant brain tumors and secondary, or metastatic, malignant brain tumors. Primary malignant brain tumors are those tumors that start within the brain. About 18,000 cases are newly diagnosed in this country each year.
Metastatic brain tumors are cancers that start in another part of the body and get to the brain through the bloodstream. They are actually much more common — maybe 180,000 new cases per year. Certain cancers like lung cancer and melanoma are more likely to spread to the brain than others.
Q. What is the survival outlook for malignant brain tumors?
Unfortunately, the most common primary malignant tumor, known as glioblastoma multiforme, is still in the vast majority of cases an incurable tumor. The median survival of patients with this disease is only about 18 months.
For metastatic tumors, the prognosis varies according to the underlying malignancy. For melanoma with brain metastases, the median survival is 3 months; for lung cancer with brain metastases, 4 months; for breast cancer with brain metastases, 6 months. However, these survival curves have a long tail on the upper end, so you will see long-term survivors.
Q. What are the symptoms of brain cancer?
The common symptoms of brain cancer are headache, seizure and change in mental state — those are the big three. Change in mental state can include a difference in one’s ability to remember, one’s ability to use language, or one’s ability to concentrate or multitask.
Obviously, the most common reason for any of these symptoms is something other than a brain tumor. But when a patient shows an alteration in the way they think, or notes a persistent headache, or experiences a seizure that does not conform to the usual profile of a benign condition, the primary care physician needs to recognize that and refer the patient to a neurologist or a neuro-oncologist so that the appropriate work-up can be done.
Q. What is the appropriate work-up for these individuals?
The most appropriate test today is an MRI scan with contrast. This helps you be sure that you’re not dealing with a brain tumor. Usually you won’t be, but you need to make sure, because early diagnosis makes for a better treatment outcome.
Q. How do you treat patients who do have brain cancer?
For primary brain tumors, our therapy typically consists of a combination of surgical resection (removal of tumor tissue) followed by radiation therapy and chemotherapy.
Treatment of metastatic brain tumor involves surgical resection and radiation therapy. Chemotherapy doesn’t play as prominent a role in metastatic brain tumors, partly because there are a limited number of drugs that can cross the barrier between the bloodstream and the brain, and partly because the brain metastasis represents a clone of tumor cells that may already be resistant to the chemotherapy initially used to treat the underlying cancer.
Q. How does radiation affect the brain itself?
There’s a feeling out there that radiation can be bad for the brain, and I think in a minority of patients there can be long-term effects on memory and attention span. But data that’s now coming out shows that if you are able to shrink a patient’s brain tumor, you will actually improve their mental state. That more than offsets the short- and long-term side effects of the radiation.
Q. Why is interdisciplinary care important for patients with brain cancer?
The proper treatment of these patients cannot be done by one person, and it cannot even be best done by multiple people from multiple disciplines who pass the patient from one caregiver to the other relay-race fashion. One of the special features of Froedtert & the Medical College of Wisconsin is that we have all of the disciplines here to properly care for these patients, and we all practice in the same place and increasingly at the same time – more like a basketball team where everybody is on the court simultaneously, and for one purpose.
The wonderful thing about working here is that we have a tremendous number of well-trained, highly motivated, modest expert team players who can see outside the box of their particular discipline. I see really good things happening on this campus, and with some additional philanthropic support, we can really make this place rock. There’s no reason why we can’t have a profile here as high as any of the more established brain tumor centers in the country. No reason at all. The talent is here.
Source: Every Day
Date: Aug - Dec 2007 Issue