Expert: Claes-Gustaf Nordquist, M.D. - 5/29/2011

Question
QUESTION: My husband was dx with NPC in 1999 and treated with conventional radiotherapy. Recurrence in 2007 treated with radiotherapy and chemo. On May 3, 2011 he suffered a grande mal seizure and after a CT and MRI a lesion was discover in the left temporal lobe. Neurologist, oncologist,neurosurgeon and his ENT specialist initially said he needed immediate surgery to remove the tumor. The tumor is located in the language center. Some discussion over whether it could be temporal lobe necrosis. When I mentioned that the MRI taken in Dec 2010 indicated the lesion was probably  a necrotic mass the neurosurgeon decided to take a wait and see approach. It was also discovered that the lesion was first noted in a 2008 MRI, but we were not told of it because the radiologist just saw it as the beginning of temporal lobe necrosis.  The lesion has continued to grow and so has the mass effect. There is associated edema and he was started on steriod therapy.  While radiation induced brain malignancy is rare I have read of reported cases. The May MRI indicated blood product in the mass and that concerns me too. Should we press for surgery and finally find out if this is infact a malignant brain tumor?

ANSWER: There is another possibility too, probably much more probable, and that is that his original cancer - or another cancer - has spread to his brain. Yes it is a long time since it was treated originally but it did come back in 2007 and that makes that possibilty more probable - far more so than a radiation induced primary brain tumor (though a primary brain tumor, not associated with radiation, can appear at any time and anywhere in the brain it is like a radiation induced one FAR LESS likely than the possibility that his oricinal cancer has spread). Any cancer can include necrotic tissue since most cancers quickly outgrow their blood supply so such tumors are often necrotic in their centers and bleedings in such tumors are not uncommon. I think surgery is needed to quickly find out with certainty what it is he has. Unfortunately I think that it is likely that it is his original cancer that has spread.


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

QUESTION: It is my understanding that nasopharyngeal cancer is is unlikely to spread to the brain. Is this true? Do you know of cases where it has been reported? I haven't found any in my research. I need some compelling documentation to reason with my husband and his doctors to move on this surgery.

Thank you for your prompt response to my original question.

Answer
It may be less likely than some other cancers - lung cancers are especially prone to spread to the brain - but any cancer can spread to the brain. And since his cancer returned in 2007 it remains my first suspect. Check with the National Cancer Institute, Bethesta Maryland. I'm sure they can provide you with necessary statistics.




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