What's a "mass" doing on my dad's brain?

February 23, 2008 4:22 PM

What's a "mass" doing on my dad's brain? Does anyone have any idea how I start researching this or what I can expect to see from all this?

My dad was just diagnosed with a "brain mass" that he says is cancer but my mom says is "just fine," but I'll find out what's going on tomorrow (when I fly down to make sense of all this). He's been in the hospital for two days and says he expects to be in there for at least two more. There is going to be a biopsy either tomorrow or the next day. The real facts are that he has a 2.5 cm by 2 centimeter mass growing on his left frontal lobe, and he can't walk. He's been smoking since he was 13 and his mom died at his age (58) from cancer also. I'm just trying to understand what's going on, and be as prepared as I can, but don't even know where to start. Wikipedia has too many latin medical words for me to understand.

posted by bash to health & fitness (12 comments total)

Even if you pounce on the attending physician, they will say that they're waiting for the biopsy to know for sure. Otherwise, they wouldn't do the biopsy. Talking with the family about the diagnosis is one of their jobs.

So sorry, but you'll have a much better chance of understanding what's going on when there's a definitive diagnosis and you can just learn the one thing instead of everything that could produce a brain mass.
posted by a robot made out of meat at 4:30 PM on February 23, 2008

Unfortunately, the right answer now is for you to be patient and to wait for the results of the biopsy. I know it's hard; I know you're scared. I know you feel out of control, and that doing something feels better than doing nothing.

But all you'll achieve if you try to research this without any real evidence is to tie yourself into knots.
posted by Class Goat at 4:45 PM on February 23, 2008

The term you're looking for is "differential diagnosis." A differential diagnosis is a list of diseases that can cause a particular problem, or a list of causes for a particular sign or symptom. For "brain mass," this would include things like primary brain cancer, brain tumor from a metastasis, infection, abscess, etc. The list is much longer, which is why they're likely doing a brain biopsy, to figure out what the mass is. Very sorry for your father.
posted by gramcracker at 4:46 PM on February 23, 2008

OK, for the differential, if you're wanting to know about cancer. (ps, 2nd year med student workin on nervous system right now). with his family history of cancer, that brings this high up on the list.
Astrocytoma--these are pretty common for this. In adults, they are automatically bad when it comes to staging them, which is how they help determine prognosis and treatment; but just this one can sit around for years to come and do nothing. The absolute worst, and what you do not want to hear the doctor say, is glioblastoma multiforme. The chances of metastases are good also. The most common organs from which mets occur are Lung, breast, skin, renal, gastrointestinal. This is unlikely being just one mass and it's not spread yet. Oligodendroglioma is another, which it is usually "managed" rather than cured. Lastly, a meningioma is a mass occurring off of the meninges. It's not part of the brain tissue itself, but can impinge on tissue and create symptoms. You should be able to use wiki to look a little more at these, but his is a starting point for you.

Symptoms will depend on where exactly the mass is, so lot of different things can come through that you may pick up on.

Hope this helps
posted by uncballzer at 5:12 PM on February 23, 2008

From a neuroscientist:

Is the mass IN or ON his left frontal lobe? Its a big place.

How long has he been noticing symptoms?

Besides trouble walking, what other symptoms?

Has it been growing?

Also...this is a 3-d mass...whats the other dimension?

Besides an MRI, what other diagnostic tests had he received?

And what was the intensity of the MRI...if he was in a hospital, it was 1.5-3 tesla...the more the tesla, the higher the resolution...get an MRI 5 or above.

If it is actually ON the left frontal lobe...no prob. A few friends and I got an MRI and a friend had one ON the frontal lobe. Scared half to death...but in the end...it was nothing.

Until you answer more of those questions, I can't tell (except if its ON the lobe...in which case, you have your answer).


Good luck, stay strong...
posted by hal_c_on at 5:25 PM on February 23, 2008

The other thing you may need to consider is that your mom is going to need support too. Perhaps even more than your dad; some people can be quite stoic about things that happen to themselves but fall apart when it comes to loved ones. If she's saying that a mass on your dad's brain is "just fine" before even a biopsy, she may be in denial.

The doctor should tell you what is going on with your dad and you can go from there, but keep an eye on your mom too.
posted by Justinian at 5:26 PM on February 23, 2008

My neuropath professor used to do an illustrative little vignette for his residents.

He would take the slides of the last month's brain mass biopsies - there were usually about 20 - and hand them to his residents. The residents were to examine the slides under a microscope and render a pathologic diagnosis for each. These diagnoses would be written down on a piece of paper, in order.

While the residents were looking at the slides, my professor would then take a piece of paper and number it 1 through 20 (or however many cases there were that month). After every number he would write, "metastasis from primary lung cancer.")

Then they would score the residents - and the professor - according to percent of correct diagnoses. The professor nearly always won.

I'm very sorry to learn about your father. Since individual patients are never statistics, the advice to keep a calm head and wait for the results of the biopsy is well taken.
posted by ikkyu2 at 5:37 PM on February 23, 2008 [3 favorites has favorites]

i have a brain tumor (it's now in remission) in my hypothalamus & on my pituitary stalk.

first: it's often impossible to diagnose what sort of mass it is without a biopsy. i chose to go for the biopsy, since it's relatively low risk compared with just choosing a treatment without knowing how the tumor will respond. after that, we were able to determine exactly which treatment would be best - chemo, radiation, or surgery - based on the tumor (mine was a pilocytic astrocytoma). i went for radiation, since the type of tumor i had responded well to it historically. it's been great since then.

from what my docs told me, just about any mass will be labelled "cancer," since it's mutated cells. the benign/malignant distinction is a little more interesting, however. evidently, a mass can be considered malignant either due to its growth rate or its location. mine was not matastisizing, but was still considered malignant because it was in my brain.

with all that said, definitely keep a clear head about the situation. it may not be that bad (like mine). many of these masses are VERY treatable, and he needs loved-ones to help him make some heavy decisions during this time.
posted by ncc1701d at 6:25 PM on February 23, 2008

As both a neuroscience student and someone whose father has had a brain tumor, let me give you a few words of advice.

My father had an astrocytoma in the same location and is also a smoker. It was removed, he had chemo, he had radiation, and he's fine now.

Astrocytomata (the proper Greek-based plural) are not the worst kind of tumor, and are not difficult to deal about. The left frontal lobe is the ideal (if you have to have a tumor) place to have a brain tumor. Talk to your father's neurosurgeon about this. (I hope you have a neurosurgeon, not just a neurologist. You do not want someone who hasn't taken the seven year residency poking around in your dad's brain!) Astrocytes are glial cells, which are support cells for your neurons.

Trouble walking is not surprising. Does he have bladder control problems, fuzzy vision, frequent falls? The frontal lobe controls executive functions, so he may have some impulse control problems as well.

Hopefully, it's not a glioblastoma multiforme, and there is little that I know about oligodendrogliomata.

If your father has an astrocytoma, the treatment will be hard; there may be some mild personality change, lots of chemo (my father did well on Temodar, which is expensive but it works), and lots of radiation .

MAKE SURE YOU HAVE A GOOD NEUROSURGEON. My father, luckily enough, has the same neurosurgeon as the First Lady.

AND MAKE SURE YOUR FATHER QUITS SMOKING .
posted by kldickson at 10:53 PM on February 23, 2008

My grandfather *just* had this happen to him, and yes, it was/is lung cancer.
posted by jopreacher at 11:59 PM on February 23, 2008

Thanks everyone. I don't know too much about what's going on. It's hard to get information from my father (because he's a little bit incoherent right now), or my mother (who is in straight-up denial). What I do know is that he has been falling, can't hold things in his right hand, has had pneumonia for about 5 weeks, is dizzy, and his brain is swollen so they have him on some IV steroids to lessen the swell. I will post more when I know more. They are checking the rest of his body for things that shouldn't be there today. They were going to do it yesterday, but for some reason they couldn't.

I truly appreciate all the helpful advice here. I feel less crazy about it now, and a bit more informed too.
posted by bash at 7:36 AM on February 24, 2008

Good luck, bash. Keep us updated. If you need any help, I have a neuroscientist who can answer any questions about the treatment/brain you may have.
posted by hal_c_on at 10:22 PM on February 25, 2008