Expert: Claes-Gustaf Nordquist, M.D. - 3/2/2010

Question
My husbands Astrocytoma in the left temporal lobe is a WHO grade 2.  The addendum on his path report says "The homozygous loss of p16 in 35% of the tumor cells may indicate more aggressive behavior but is not a criterion for increasing the WHO grade.  What exactly does that mean?  Also isn't a grade 2, non-cancerous?  If so, why did they put him through radiation & chemo if it isn't cancer?  I would like to get you a copy of the path report but 9 pages long is a little to long to post on a web site.  He will start 2nd round of Temodar next wk at twice the strength.  Can he take herb supplements at the same time to boost his immune system?

Answer
No a grade 2 is also malignant - though less so (even a grade 1 is malignant, as long as grade is discussed it is malignant to some extent). Grades 1 & 2 are sometimes called the "good" or rather less bad grades compared to grades 3 & 4. 4 is worst. The paragraph you mention discusses that a genetic marker is absent in 35% of his tumor and that the loss of that marker may indicate a somewhat more aggressive behavior than is usual in a grade 2 tumor but is in itself not enough to "upgrade" it to a grade 3. I do not understand why radiation therapy is not given - unless it is saved for the (probable) eventuality of a return of his tumor. But you have to ask his doctor about that.


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