It wasn't "just a headache."

March 22, 2007 11:13 AM

My husband's stepdad just got a tumor removed from his brain yesterday. It was malignant.

I have not spoken to my mother-in-law directly so I don't know exactly what kind of malignant tumor this is, but apparently it's a primary tumor and not something spread from somewhere else...my main question is this: Is a malignant brain tumor always a death sentence or can people recover from these things? I know there are a ton of variables, but I just want to know if it's okay to have some hope for him.

posted by konolia to health & fitness (17 comments total)

Oh gosh, in my limited experience with oncology, no a brain tumor isn't necessarily a death sentence. Of course, it depends on the area, what type of cell it was, how invasive etc etc. I was involved with a man who had a brain tumor removed back in the mid 70s and he had some lingering effects like loss of vision in one eye and needing to take medication to help regulate some body functions, but he survived and has led a normal life since then.

My thoughts are with you and your family.
posted by hollygoheavy at 11:32 AM on March 22, 2007

Very sorry to hear that, konolia.

First, it's always okay to have some hope for people.

The kind of tumor is important for prognosis, but unfortunately, the majority of malignant brain cancers in adults are GBMs (glioblastoma multiforme). Speaking in totally general terms, since all patients are different and unique, these tumors are highly aggressive and have a very poor prognosis. The median survival time without treatment is 3 months, and with oncology treatment (eg surgery, radiation, chemo) is unfortunately only 14 months. 5 year survival rates are around 3%.

There are other types of brain malignancies in adults, as well, so your husband's stepdad may have something else. I'm sure ikkyu2 can provide some more info if he stops by the thread.
posted by gramcracker at 11:34 AM on March 22, 2007

I'm not a doctor, I'm not an expert on these things. But in my experience, having known a few people with brain tumors (one of whom died just two days ago - one of the fittest, healthiest 57 year-olds you'd ever meet, another who died a few months ago, a healthy guy in his early 40s), and based on the experience of my parents, who've known several more with brain tumors, it's a death sentence. I'm sorry to say that. I know that there are miracle stories out there, but with a malignant tumor, I think your husband has to prepare himself that the cancer will come back. Even a few cells left alive can re-grow, unfortunately. Hope is always important, but I think he should try to spend time with him now. Best of luck to you and your husband. I sincerely hope I'm wrong.
posted by Dasein at 11:34 AM on March 22, 2007

IANAD, but AFAIK, a malignant tumor is just another word for "cancer." Benign tumors are not cancer. People can recover from cancer through radiotherapy and chemo, provided the tumor hasn't metastasized.

However, brain cancer is bad news, no matter what way you put it. I've heard that success of tumor removal from the brain is about 50%. It's okay to have some hope, but I wouldn't stop mentally preparing myself for bad news.

There's a ton of info at the Roswell Park Cancer Institute site.

Here's hoping for the best for your stepdad-in-law.
posted by Verdandi at 11:36 AM on March 22, 2007

On a more positive note, my friend's dad had a sizable tumor removed from his brain a few years ago. (Disclaimer: I don't remember if it was malignant or benign, and I know that's not an insignificant difference.) Apparently when they saw the size of it, they were shocked he was still standing (and walking and teaching classes), but his prognosis was excellent. Last I checked, he's still doing great.
posted by bassjump at 11:53 AM on March 22, 2007

On another positive note, my dad's buddy was diagnosed with a malignant tumour nearly ten years ago. He had surgery and has had treatment here and there since then. He and Mrs. Bickerton are still at it with no signs of it stopping. He is pushing 70.

Not a death sentence. There's some hope -- but, realistically, it's not one you can put money on.
posted by solid-one-love at 12:10 PM on March 22, 2007

gramcracker's mostly right. In these cases it's all about the tumor's grade, which is determined by the pathologist who looks at the removed tissue under a microscope.

Is it an aggressive GBM or anaplastic astrocytoma? In that case, the forecast is generally pretty poor. Is it a low-grade, slow-growing tumor? Some folks go for decades with these.

Primary brain tumors can almost never be removed completely, because the brain lacks a stroma; there are no barriers to growth throughout the whole brain, and there is no way for the surgeon to attempt to get a clean margin. So unlike other cancers, these pretty much always come back.

Probably the best thing to bear in mind is that docs don't own a crystal ball to foretell the future; every patient is different and the statistics don't always apply to a particular case. I have seen cases where glioblastomas regressed and disappeared for no reason we could identify. Where there is life, there is always hope.
posted by ikkyu2 at 12:10 PM on March 22, 2007

Malignant, when used in cancer terms, means "ability to metastasize" aka ability to spread to other parts of the body. Benign tumors by definition will not metastasize; unfortunately benign tumors are just as dangerous in the brain, since the skull creates an enclosed space, and a growing tumor compresses the brain.
posted by gramcracker at 12:16 PM on March 22, 2007

Well, unfortunately my husband says his mom told him it was stage 4. She told him the surgeon thinks he got it all but it sounds more like to us he was trying to soften the blow some.

We're here in NC and they are in Colorado-good thing we went out there for Thanksgiving.

OTOH, ikkyu2's last paragraph is one I agree with. God holds the keys to life and death, after all. My step-father-in-law is one tough old coot. If anyone was gonna look at death in the face and spit in his eye, it'd be him.
posted by konolia at 12:21 PM on March 22, 2007

Sorry to hear about your husband's stepfather and I too would like to add that both concern and hope are appropriate I have another bit of anectdotal evidence that may help put things in perspective. I recently helped care for a young girl who beat the odds and is doing well several years out from a resection of a glioblastoma multiforme. But getting there was not easy; she had aggressive chemotherapy and the original surgery left her with seizures and some significant motor deficits. So don't give up hope, but be realistic. The waiting period you are going through right now must be hard because there are far more questions than answers. Once you get some more information it will be easier for you to know how optimistic or pessimistic to be.
posted by TedW at 12:23 PM on March 22, 2007

Anecdotes: I've known several people with brain tumors. One who was diagnosed, had surgery, they told him he had about a year, but he lived ten years beyond that. One was diagnosed, had surgery, and lived for an up-and-down couple of years; fought it hard for a while and then had about 3 months where she accepted she wasn't going to win the fight, and concentrated on doing things she had always wanted to do and seeing people she cared about. One was diagnosed and had surgery to remove almost half her brain last summer, and is back to normal functioning now, though they have told her it will almost surely come back. One was diagnosed, had surgery, was okay for a few months after and then went downhill very suddenly before he had a chance to resolve some of the things he had been saying "well, I'll get around to that soon".

It's impossible to know; hopefully his doctors will have a bit more concrete prediction. One thing I hate to say, but which is worth saying in cases of aggressive cancers: if there are critical legal things that need working out (eg if he doesn't have a will), it's best to do them ASAP since things can get worse fast. Once those critical things are taken care of, then hope and fight, and he may have a bunch of years in front of him.
posted by LobsterMitten at 1:15 PM on March 22, 2007

Praying for you, konolia.
posted by orangemiles at 1:52 PM on March 22, 2007 [2 favorites]

It's my understanding that he does have a will.


Thanks, everybody. I'm hoping to have more info later this evening.

(Thank you so much, orangemiles.)
posted by konolia at 3:09 PM on March 22, 2007

I'm so sorry to hear about this diagnosis.

When they said stage IV, they most likely were talking about the grading of the tumor (which is how it appeared under the microscope to the neuropathologist, specifically for GBM they needed to see either tumor necrosis or endovascular proliferation to give it that grading). Most astrocytomas that occur in people over the age of 50 are glioblastoma multiforme, which is a WHO Grade IV tumor. Unfortunately, compared to lower grade tumors (II-III) the survival time is generally very short.

Diffuse Astrocytomas (of which GBM is the most aggressive) are not well-circumscribed lesions. That is, while they might look like a discrete mass that could be removed entirely, they are infiltrating (diffusely infiltrating). The tumor cells infiltrate throughout the structure of the brain, weaving their way around neurons. Initially, they can infiltrate without causing much functional damage, but over time they start to interfere with the function of the areas they are infiltrating.

So basically, these diffuse astrocytomas are not surgically resectable, because they diffusely infiltrate. (Sharp contrast between that and the type of astrocytomas that children get called Pilocytic astrocytomas, WHO grade I, which can be cured surgically because they're not infiltrating).

But of course, hope is never lost and never let anyone tell that there is nothing else they can do for him. There's always something else that can be done, if not to cure, then to make him comfortable.
posted by i_am_a_Jedi at 3:36 PM on March 22, 2007

I'm sorry to hear that, konolia.

The American Brain Tumor Association site might be of use to you.

Sorry mefietes if I'm repeating, but I can't bear to read this thread.
posted by yohko at 3:57 PM on March 22, 2007

So basically, these diffuse astrocytomas are not surgically resectable

Assuming this is what he had, I wonder why they said they got it all?

BTW he went into surgery before they determined WHAT it was so I guess they were gonna go ahead and take whatever they could out...this is so confusing.
posted by konolia at 4:15 PM on March 22, 2007

Not always a death sentence, at least not any more than life itself is. My father-in-law has a malignant but non-aggressive brain tumour. The doctors reckon he's had it for years (it came to light after a couple of major seizures last year - it was starting to cause pressure on his brain) and that it's so slow-growing that it's not likely to kill him unless it suddenly starts getting aggressive. He's not undergoing chemo, he's just on anti-fitting meds.
posted by corvine at 6:34 AM on March 23, 2007