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Dr. Joseffer explains recent brain tumor diagnosis of Sen. John McCain
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The recent diagnosis of Senator John McCain’s brain tumor has given rise to speculation and in some cases ill-informed opinions in news media. Since the news broke, I’ve found myself answering questions from friends, patients, and even some of the administrative staff in our practice.
I haven’t treated Senator McCain nor have I seen his medical records so I’ll try to explain what a glioblastoma is, and what is the most likely scenario facing Senator McCain.
According to news stories, Senator McCain underwent a routine CT scan of the brain last week to assess the symptoms of fatigue and double vision that he was experiencing. He attributed the symptoms to the stress of travel, but wisely consulted his doctors.
A review of the scans revealed a 2 inch blood clot that appeared to be about a week old. Given Senator McCain’s history of malignant skin cancer (including a major surgical procedure in August 2000) his doctors were suspicious of tumor and recommended an urgent MRI. This is exactly what should have happened and suggests that he’s receiving excellent care.
Senator McCain then underwent a minimally invasive surgery where an incision was made along the left eyebrow to gain access to the clot in the left frontal lobe of his brain. This procedure is called a craniotomy. The clot was removed and tissue samples were sent for further examination. After the procedure, pathologists discovered abnormal cells that are consistent with a condition known as Glioblastoma Multiforme (GBM). This is the same type of tumor that lead to the death of Senator Ted Kennedy in August 2009 and Beau Biden in 2015.
According to the treating physicians, post-operative imaging indicates that the tumor was completely removed along with the clot during the surgery.
GBM is an extremely aggressive type of cancer that arises from the cells called glia which support and nourish the nerve cells that are responsible for thought, movement and sensation. Although GBM represents only 2% of all adult tumors, it is responsible for almost half of all brain tumors and has an average survival of 15 months. Only around 10% of patients with a glioblastoma survive for 5 years or more. This is a tough diagnosis.
The main reason is that a GBM is a “diffuse” tumor; it has no defined borders so it is very difficult to remove by surgery without injuring important nearby brain structures. Treatment typically consists of surgery to debulk the tumor followed by radiation treatment and chemotherapy. This tumor is not typically considered an inherited family condition but risk factors include Caucasian ethnicity and older age. Men are slightly more likely to be affected. 64 is the mean age of occurrence and the highest numbers of people are diagnosed between ages 75 – 84.
Survival rates are affected by the location of the tumor and by how early it is detected. Symptoms most commonly experienced are headaches, changes in vision, strength and sensation as well as seizures. It seems that this was a relatively early detection.
Realistically, a glioblastoma is a diagnosis that no neurosurgeon wants to deliver to a patient. The Senator has a very tough fight ahead of him…, perhaps the toughest of his life, and everyone here at PBS is rooting for him.
If you have further questions about glioblastomas, I’ve added a few links of interest. If you’re experiencing the symptoms, I urge you to be examined by your doctor. Early detection can make a difference.
LastUpdate: 2017-07-24 22:40:33