Expert: Claes-Gustaf Nordquist, M.D. - 12/3/2010

Question
Hello Dr.

My best friends wife was diagnose with brain tumor the sized of an egg which was located at the front left lobe. The doctors (Oncologist-Neurosurgeons) performed a craniotomy and they successfully removed 100% of the tumor. Everything leading up until and after the surgery was positive. The family was happy and they though the nightmare was over and it was all about recovery now. Supposedly initially the tumor was benign and she was going to recover and go back to her normal life and go back to work within a month or two. However, a week after her surgery the pathology report came back and she was diagnosed with an Anaplastic Astrocytoma Stage 3. The Oncologist explained there was what they call “tentacles” or “fingers” growing within the brain. The family has been devastated ever since and trying to accept the diagnose one day at a time. It’s truly a nightmare. The Oncologist told them the estimated survival time is around 18 month or 24 months but longer than that might not be probable. They have an 8 year old son and they are currently going to go to family therapy to try to explain to their child what is going to happen in the near future with his mom and help them deal with the outcome as well. The Oncologist will be performing Radiation Therapy for six weeks and they will start one month after her surgery. The Oncologist said Chemotherapy is not necessary because it really won’t do anything at all. Radiation Therapy will prolong her survival time. They are going to go through the Radiation Therapy but they are also going to go to a second and third opinion. They are going to go to Sloan-Kettering Hospital in New York and Stanford, CT. They are hoping it was a misdiagnose and that it’s only a stage 1 or stage 2. It will be easier for her to live with knowing the probability of survival can be 10-20-30 years and not 2-3 years.

My questions are; what is the correct estimated survival time for an Anaplastic Astrocytoma Stage 3? Does it really come back after 18 months? She is feeling so healthy now and I’ve read that after the Radiation Therapy she will be feeling well again. Will that mean she will be fine and the tumor won’t come back? And after it comes back, what can be the possible options if any for her to survive/to try and fight this some more? The Oncologists told them when the tumor comes back they are not able to do anything further for her because the body can only take so much, so unfortunately the end will be near. If the diagnose is correct is it possible that there is a treatment out there than can help her prolong her life for years and years to come? It’s just so hard to believe this is truly happening to their family. Last question, do you really think there is a possibility of misdiagnose? Please let me know what your professional view of all of this is. I will appreciate any information no matter how bad/truthful it might be. We are really just looking for a little hope and not think of this as a “death sentence”. Also what can she expect at the end? Will she pass away in pain? How would my friend now the end is near?

Sorry for such a long post and so many questions, just looking for some hope….Thank you so much for taking the time to read my post.  

Answer
First of all. What she has is probably an anaplastic astrocytoma GRADE 3.
Brain tumors very rarely have stages since they in most cases normally do not spread outside the central nervous system (brain & spinal cord) but they all have grades (basically a measurement of malignancy). Usually brain tumors have grades from 1 to 4 where 4 is the most malignant (worst). As a rule of thumb you can say that grades 1 & 2 though also bad can allow a victim to live for years while grades 3 & 4 do have a worse prognosis with a quicker end. But in essence ALL malignant brain tumors have a bad prognosis. The only difference is the length of the survival time. The more malignant the tumor (= the higher the grade) is the shorter the survival time will be. Worst is grade 4 where survival time is usually around one year or so. ALL what treatment (surgery, radiation therapy and maybe chemotherapy) so far can do is to make the survival time longer and temporarily ease symptoms. No one anywhere can promise a cure when dealing with malignant brain tumors. Consequently no one should claim that 100% of a tumor has been removed or at least not until it is known with certainty - or as much of that that it is possible to have - what the diagnosis is. Now to diagnose brain tumors correctly is HARD and difficult! It is usually done on a concensus basis by a team of very gifted, talented and experienced neuro- & tumorpathologists. But there is still some uncertainty. So yes it may be a grade 2 perhaps, but about as likely maybe a grade 4 and that would not be welcome news. Even so, yes I think a second and even a third and a fourth opinion of the diagnosis is a path you should proceed along. The more people that agree on the diagnosis the more sure it will be - provided those people are among the real experts. On the other hand this should not be pushed into absurdity. Treatment however from now on is more or less the same everywhere and anywhere. I can not exclude new progress as a theoretical possibility when we consider her treatment. But revolutionary new treatments are not likely in the near future. No one is hiding any secret revolutionary new treatments either. It is correct that after her irradiation has been done not any more really effective treatment can be given. Do you really already now want to know how the end will be? There will anyway not be much pain - if any. I'm not planning to leave this site so we can discuss that matter later.


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