Expert: Claes-Gustaf Nordquist, M.D. - 5/14/2008

Question
QUESTION: Dear Doctor,

I am 29 yr old, MRI suggested a low grade glioma (appox 20mm in all dimensions) in dec 07; The location was in right frontal lobe (on the upper part of the brain; i.e. towards skull). I underwent a surgery & as per doctor they have removed 100% of it. A biopsy was done, which suggested Grade 2 Astrocytoma (but with some mitosis); the sample block was then sent to a different lab for a second opinion, which reconfirmed Grade 2 Astrocytoma (but "DID NOT" mention anything about mitosis). To be on a safer side docto suggested Radiation therapy of 5600 units (28 days; completed on 10th March08)). Since then I have not observed any physical problem / symptoms of post surgery / radiation. But sometimes I do observe some shivering on my left hand & wobling in the speech (probably because I am always looking for any abnormal function). Is it a symptom...? I have not undergone any post surgery MRI (doctor suggested to wait for 6 months after radiation); Do you suggest me to undertake MRI earlier...? What is in future for me; What all can I expect in future...? & when...?please be specific, I have a lot to plan for my family. THANKS A TON FOR YOUR UNBIASED OPINION.

Regards,
Sunil

ANSWER: Well with such a low grade tumour you will probably be able to live for many years after this treatment. Unfortunately it is not possible for me to be more specific than that - too many individual variations - nor for anybody else really! the slight symptoms you have noticed MAY be due to your surgery too. Good luck!


---------- FOLLOW-UP ----------

QUESTION: Thanks for your reply... but few more question -
1. What does Mitosis suggest in above the mentioned biopsy report...? Does it mean that it is moving towards grade 3...?
2. Since the surgery, my facial features (looks) have changed (few people do not recognize me in first look). Is it due to the surgery or radiation...?
3. After radiation, I have lost hairs in some parts of my head & in some parts the growth is very poor (thin). Will it be normal after sometime...?
4. I am taking enchorate chrono 500. Will I have to take it lige long...?
5. In 2002, I had undertaken a MRI (because of vertigo experienced by me since 1999; I was experiencing vertogo till my 1 month before my surgery (at a frequency of once in a quarter existing for 4~5days); but after surgery (3rd Jan 2008) I have not observed any); The MRI suugested a "small infarct" in the right frontal lobe. Is it possible that this was the tumour at the begining stage...?
6. What medication / procedure will I need if the tumour again comes up...?
7. Do you suggest to join any clinical trial...?

Thanks again for your patience & reply.

Regards,
Sunil

Answer
1. That means that they see some dividing cells (cells multiplying) there. However, even in the specimen where that was seen it was regarded as a grade 2! I can not speculate further than that.
2. More probably due to surgery, but since I have not seen you (before AND after) I can not be sure.
3. That is normal. Hopefully it will grow back eventually. But I can not be certain nor how long it will take. Too much individual variations.
4. I have never used that. So my experience is very limited. You will have to ask your dr.
5. Yes it is possible. But to be sure you will have to ask your dr. to reexamine and compare the old pictures with the newer ones.
6. Well, that will be - if it happens - at some time in the future. We will then use what is available then, which probably is not available now. So no use to speculate in that.
7. Probably not at the moment.