There are cancers ofthe brain. Understandably, because of fear of disease that affects our brain
and the fear about cancer, people don't like to hear the phrase "cancer of
the brain." So we speak in the medical profession of gliomas and
astrocytomas and the lay person talks about brain tumor. There are many types
of growths that affect the brain, everything from circumscribed, completely
benign tumors to the dreaded cancerous glioma.
Once a space-occupying lesion in
the brain is diagnosed, the doctor sees the out- look in terms of the
information pro- vided by special x-rays and radiation scan tests that
determine location and size of the tumor. A repeat of these observations
provides information about the rate of growth of the mass. A malignant growth
usually grows faster than a benign one. In most cases, there must be
operation-and there is that moment of prayer when the surgeon reaches the
growth and learns whether it is benign or cancerous.
If cancerous, the situation is more ominous than in other
organs where the surgeon usually can excise the cancer and surrounding
suspicious tissue. There are limitations in the brain because death or massive
paralysis might be the result of too extensive surgery. Striking advances have
been made in the treatment of some cancers for which there was once very little
hope. For choriocarcinoma of the uterus, for example, treatment with
methotrexate and actinomycin D now is producing long-term remission in nearly
75 percent of patients; and many children with tumor, a cancer of the kidney,
are responding to actinomycin D. These results provide hope that increasingly
effective chemical agents will be found for other cancers.
RADICAL SURGERY FOR SECONDARY PREVENTION
There is some
division of opinion among surgeons about how far to go in removing widespread
cancer. Most surgeons try to get the primary growth and adjacent lymph nodes. A
school of more radical surgeons believes that even important organs should be
sacrificed if permanent cure may be possible with extensive surgery. For
example, if cancer of the uterus has invaded the adjacent urinary bladder, more
conservative surgeons would feel that the spreading cancer has already
invaded other body areas and only palliation by radiation and chemical
treatment is feasible.
A radical surgeon, however, might hope that the cancer
had invaded only organs in the pelvic area and might remove the uterus and
bladder, and implant the urethras (which ordinarily connect bladder and kidney)
into the colon to permit urine to drain into the fecal stream. Or suppose a
cancer of the colon has been found to have spread to the liver. On the chance
that there has been no spread beyond this, a radical surgeon might remove thecancer in the colon and then operate on the liver to remove all cancerous
nodules there that he can see.
Obviously, the rate of cure of widespread
cancers by surgery is not high, but radical surgeons reason that even one life
in a dozen saved is worth the gamble and effort. When a patient has to decide
about radical surgery, he should discuss the problem openly with his family
doctor, who can be objective and weigh the pros and cons.
