Expert: Claes-Gustaf Nordquist, M.D. - 1/12/2008

Question
My sister, age 57, was diagnosed with a brain tumor less than 4 weeks ago, on 12/18. It is near the 3rd ventricle/thalamus, was 3.5 cm at that time. An attempted laparoscopic biopsy did not go well - the tumor bled a lot, they could not retrieve any tissue, and her recovery was difficult. Just yesterday, 01/10, they performed a needle biopsy with MRI assist. All the information we have from that so far is, they got a good sample, but the tumor has grown "significantly" in this short period. Even without biopsy results the neurosurgeon is already suggesting that the tumor is not treatable - definitely not operable, he says. I'm beginning to wonder if he is not being as aggressive as other surgeons would be. Is it possible to involve another hospital while she is recovering from these two procedures, even before her release from the first hospital?

Even though I'm trying to be realistic and accept the recommendations of the best doctors we have access to, it seems like, from internet research, that some forms of treatment are still worth pursuing within the balance of quality vs. quantity of life. All the feedback we have gotten from this surgeon (and after 3+ weeks we still don't know what kind of tumor it *is*!!) is to give up.
She's in the University of Mississippi Medical Center. Her daughter who now has custody lives in Cincinnati, Ohio and fortunately has good access to any of the hospitals in that area. Assuming insurance is no problem, should we be trying to get a second opinion ASAP?

Answer
I do not know enough of this case to be very specific. All I can go on is general knowledge of brain tumors. We still do not have the pathology result from the biopsy of her tumor. It was done on January 10, where I am (Stockholm, Sweden) it is right now VERY early morning - 1.34. AM - January 12. I'm 6 or 7 hours ahead of you. So from your perspective the biopsy was done yesterday. To expect a pathology report on a probably malignant brain tumor within one day is extremely optimistic. Normally a malignant brain tumor needs to be examined by several very skilled and experienced neuropathologists before an agreement is reached on the diagnosis and grade! Grade defines the behaviour of the tumor. The higher the grade (from one to four) is the worse the tumor is! Brain tumors are often tricky to evaluate and diagnose. A second opinion if done correctly would not be faster! In fact you would lose time since everything would need to start from the beginning again. I do understand your concern but you have asked me a straight question and such a question deserves a straight, truthful and honest answer, that is why I give you this plain and frank reply even though you may consider it blunt. Anyway her neurosurgeon has expressed doubts with regards to the possibility of surgery in this case. I'm not a neurosurgeon but a medical oncologist and radiation therapist with experience in treating brain tumors. So I have in my reply here to rely on his expertise since he is the expert! Many brain tumors ARE hard to operate! It is also by your description very deep inside the brain and therefore hard to reach. And it is not small. If it also has grown considerably in a short time it is probably very malignant/of a high grade! Though of course we can not be sure of that until we have the pathology report hopefully some time next week - tomorrow/today here  being Saturday. Anyway it is therefore, all known things considered, that it is very probable that this  tumor is malignant and very malignant and therefore of a high grade (three or four). From that position I CAN give you a probable evaluation (her surgeon has probably reached the same conclusions, though under the circumstances he could hardly descibe it in detail to you as I can here). ALL high grade malignant brain tumors have a very bad prognoses REGARDLESS of what therapy (surgery, radiation therapy and chemo therapy or combinations thereof)they receive! So unfortunately in the case of your sister her surgery most probably does not really matter regardless of if it is possible or not. The only thing therapy of any kind can do is to somewhat prolong survival time and to some extent at best relieve symptoms - for a time. The difference between grade three and four is mainly that grade four patients pass away somewhat sooner. A grade four case rarely survives much more than a year. This is the same all over the world regardless of who is doing the treatment unfortunately! I AM sorry I have nothing better to tell you!