No matter where your political party loyalties lie, the recent news of Arizona Senator McCain’s grave brain cancer diagnosis has surely left many of you in disbelief. As a past prisoner of Vietnam war, two presidential runs, and one of the most outspoken Republicans, Senator McCain has gained the political attention of everyone. So his recent diagnosis of Glioblastoma Multiforme (GBM), the most common type of brain cancer, hasn’t been an easy one to digest.
Of note, Ted Kennedy and Beau Biden also suffered from brain cancer. So what is “glioblastoma multiforme?’ And what does this mean for Senator McCain and his prognosis?
This one hits home for me as well, as one of my very close family member suffered through this diagnosis near end-of-life.
What is Glioblastoma Multiforme?
When we talk about “brain cancer,” what we are really referring to is a cancer that begins in the brain itself. It’s the brain cells themselves that go out of whack and turn cancerous. It’s different than other cancers that can “metastasize” (meaning spread) after originating from a different location in the body (such as breast, lung, or melanoma).
Glioblastoma Multiforme (GBM) is the most common type of brain cancer in adults. Yet, it is still a rare type of cancer. It specifically originates from the “glial cells” of the brain (hence, the term “glio-“), which comprise the greatest amount of our brain matter. These glial cells help “neurons” (the nerve cells that transmit information) do their job. Without them, our brains truly are unable to function.
No one knows what causes GBM. Unlike some other cancers, we do not really know of any risk factors that can contribute to it. For instance, we know some breast cancers are hormonally driven. And Most lung cancer is secondary to cigarette smoking. Sun exposure can cause some skin cancers. But we don’t really know what causes GBM.Contrary to popular belief, there is no good evidence that cell phones and electromagnetic field lines are contributing factors.
Symptoms of Brain Tumors
This one may create some anxiety in some of you, because headaches are quite common; almost all of us have experienced at least one. Some of us with migraines or tension headaches tend to experience them more frequently. So before you dart to your doctor’s office in fear of a brain tumor, it’s important to note that brain tumors are a very rare cause of headaches.
Also, headaches caused by brain tumors are also often accompanied by specific “red flags”:
- A new headache in an adult without a history of similar headaches: For example, if you’ve suffered from migraines since your 20’s intermittently, then that is not typically a cause for alarm when you experience another similar headache. It would be more concerning if let’s say a 50 year old adult with no prior migraines all of a sudden starts experience migraine-type headaches without ever having experienced one prior.
- Headaches that progressively worsen through time: For instance, if your headache becomes more severe with each episode.
- Headaches that worsen with position changes, such as bending over or coughing/sneezing
- Headaches that awaken you from sleep: Note that there’s a distinction between waking up and realizing you have a headache and a headache that is so severe that it awakens. The latter is much less common.
- Neurologic: Symptoms such as problems with motor skills, sensation, speech, vision, etc.
- Vomiting upon waking up, most especially when invoked by a change in position. Although it’s important to not get carried away by this one, because nausea and vomiting is a common feature in those with migraines.
- Memory loss
- Vision loss
- Double vision (Reportedly Senator McCain experienced this)
- A significant personality change
Diagnosis of Brain Cancer
If a brain tumor is suspected, the best initial study is typically an MRI with contrast. Although CT of the brains can often reveal a blatant abnormality, it may not be able to pick up smaller tumors.
Treatment of Glioblastoma Multiforme
Sadly, there is no cure for GBM. It’s one of those less tangible cancers, hence difficult to eradicate. Surgical resection is an option, but because it is almost impossible to resect the tumor in its entirety, it’s reserved to improve quality of life, and less frequently to prolong survival rates. The challenge is to remove as much of the cancer as possible without having to damage the rest of the healthy brain.
Radiation and chemotherapy are also options to help keep the glial cells from going out of control too quickly. But the quality of life due to the side effects of these treatments is also a consideration.
Therefore, treatment really depends on the age of the patient and how healthy they are to withstand surgery, radiation, and/or chemotherapy.
Prognosis of Glioblastoma Multiforme
With treatment, survival is increased on average by months, sadly, not years.
Studies show that the older the patient, the worse the prognosis is. And about half of those diagnosed with GBM are over the age of 65. But this may be because older patients tend to fight the disease less aggressively due to their already fragile health.
However, despite therapeutic advances, all measures are typically temporary, relieving discomfort and distressing symptoms for a short time period. The tumor progressively enlarges, impinging on other brain structures, causing further damage to the brain until it eventually cannot be sustainable.
Median survival after diagnosis for Glioblastoma Multiforme is one year
Before making any further advances on the treatment of GBM, we really need more studies.
Before making any further advances on the treatment of GBM, we really need more studies. For more information on how to enroll in clinical trials for GBM, please check out the following links:
Please note that all content here is strictly for informational purposes only. This content does not substitute any medical advice, and does not replace any medical judgment or reasoning by your own personal health provider. Please always seek a licensed physician in your area regarding all health related questions and issues.