Tuesday, May 20, 2008
Ted Kennedy Brain Tumor Coverage
A friend asked me what I thought of the New York Times coverage of Ted Kennedy's brain tumor. I wrote a long, fast email, which I'm also posting here:
They gave the general tumor type (glioma) but not the specifics. There are several types of gliomas, including astrocytomas, glioblastomas, and oligodendrogliomas. Also four grades, from I to IV (the higher the number, the more aggressive). Malignant gliomas are grades III or IV, though so-called "benign" ones still cause lots of trouble because the cranium is an enclosed space and anything that squeezes the brain in that space can cause trouble. Jane's tumor was a mixed astrocytoma-oligodendroglioma, grade III.
They gave the location of Kennedy's tumor as left parietal, and said that area of the brain was involved in sensation, motor control and language. Would have been more accurate to say USUALLY involved in language. Not always. Whether or not often depends on handedness. Jane was left handed, and had her initial tumor in the left occipital and parietal lobes. (Toward the end it spread to the frontal lobes and into the right hemisphere.) Frequently, left-handed people have their language more distributed between the hemispheres than right-handers, but still centered largely in the left hemisphere. Jane had a Wada test that determined that her language was almost entirely in the right hemisphere. (She never did play by the book!) This allowed for a much more aggressive left-hemisphere surgery back in 1998 and 2000.
I have the videotape of Jane's Wada test, by the way -- I remember it as strange and fascinating to watch, but I haven't viewed it in years. I also have a photograph of her open cranium.
One article quoted Keith Black, a neurosurgeon at Cedars-Sinai in LA. He's a rock star among brain surgeons, more famous but NOT more sought after than Jane's surgeon (Mitchel Berger). Keith Black was written up in TIME magazine a decade or so ago, I think.
One article rightly says that age has a lot to do with prognosis. Getting a malignant glioma at age 76 is not a good thing. Another article rightly says that the disease is "treatable but not curable."
The articles refer to the disease as brain tumor and not brain cancer. The distinction is subtle; generally, cancers can metastasize to other tissues, but brain tumors cannot. (You can't get a brain tumor in your lungs, but you can get lung cancer in your brain.) Doctors will very rarely say "brain cancer" in my experience, probably because to do so is imprecise, but a lot of brain tumor patients and advocates (I'm not among them) prefer to use the term "cancer" because, I think, it sounds more urgent. A tumor sounds like something that can be sliced off, like a wart. Brain tumors, especially gliomas, tend to have lots of tendrils and stray cells throughout the brain; it's rare that they're encapsulated. (One NYT article said this, in a roundabout way.)
They gave the general tumor type (glioma) but not the specifics. There are several types of gliomas, including astrocytomas, glioblastomas, and oligodendrogliomas. Also four grades, from I to IV (the higher the number, the more aggressive). Malignant gliomas are grades III or IV, though so-called "benign" ones still cause lots of trouble because the cranium is an enclosed space and anything that squeezes the brain in that space can cause trouble. Jane's tumor was a mixed astrocytoma-oligodendroglioma, grade III.
They gave the location of Kennedy's tumor as left parietal, and said that area of the brain was involved in sensation, motor control and language. Would have been more accurate to say USUALLY involved in language. Not always. Whether or not often depends on handedness. Jane was left handed, and had her initial tumor in the left occipital and parietal lobes. (Toward the end it spread to the frontal lobes and into the right hemisphere.) Frequently, left-handed people have their language more distributed between the hemispheres than right-handers, but still centered largely in the left hemisphere. Jane had a Wada test that determined that her language was almost entirely in the right hemisphere. (She never did play by the book!) This allowed for a much more aggressive left-hemisphere surgery back in 1998 and 2000.
I have the videotape of Jane's Wada test, by the way -- I remember it as strange and fascinating to watch, but I haven't viewed it in years. I also have a photograph of her open cranium.
One article quoted Keith Black, a neurosurgeon at Cedars-Sinai in LA. He's a rock star among brain surgeons, more famous but NOT more sought after than Jane's surgeon (Mitchel Berger). Keith Black was written up in TIME magazine a decade or so ago, I think.
One article rightly says that age has a lot to do with prognosis. Getting a malignant glioma at age 76 is not a good thing. Another article rightly says that the disease is "treatable but not curable."
The articles refer to the disease as brain tumor and not brain cancer. The distinction is subtle; generally, cancers can metastasize to other tissues, but brain tumors cannot. (You can't get a brain tumor in your lungs, but you can get lung cancer in your brain.) Doctors will very rarely say "brain cancer" in my experience, probably because to do so is imprecise, but a lot of brain tumor patients and advocates (I'm not among them) prefer to use the term "cancer" because, I think, it sounds more urgent. A tumor sounds like something that can be sliced off, like a wart. Brain tumors, especially gliomas, tend to have lots of tendrils and stray cells throughout the brain; it's rare that they're encapsulated. (One NYT article said this, in a roundabout way.)
Labels: brain tumor, health, Jane, language, medicine, people, politics
# posted by F.S. @ 11:20 PM 
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I wonder if Ted Kennedy is right or left-handed. His tumor is on the left side just above his ear. Perhaps he used his cell phone excessively. Who knows if there is a connection. Since it takes 10 years to develop from cell phone use we will have an epidemic if there is a relationship between the two.
# posted by 
: 8:31 AM
: 8:31 AM
My opinion -- and it's just that, an opinion -- is that there's no connection between cell phones and brain tumors. I'm curious, anonymous commenter: can you please clarify your comment that "it takes 10 years to develop from cell phone use"? Develop what? And where do you get that statistic?
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