When the Mighty are Stricken

Americans were shocked yesterday to hear of John McCain’s recent challenge – a malignant brain tumor known as a glioblastoma. When I heard that McCain had a brain tumor I suspected that he had a spread of the malignant melanoma that has plagued him for the last decade, requiring multiple surgeries and removal of his parotid gland and some of the lymph nodes in his neck. (President Carter has brain metastasis from his malignant melanoma and has had successful treatment). But this tumor is new, different, and totally unrelated to his skin cancer. This is is a rare but very aggressive malignant brain tumor that responds to surgery, radiation, and chemotherapy but is rarely cured. In fact most patients can expect to survive only 12-15 months. This is the same tumor that took the life of Senator Edward Kennedy.

What makes this tumor so deadly? Glioblastoma sends out microscopic finger-like projections of tumor that during surgery may not be visible to the naked eye. So even if a surgeon believes that she is able to resect it all, the reality is that some tumor is left behind. This tumor also spurs the formation of new blood vessels which feed the tumor and lead to rapid growth. It remains the deadliest of all brain tumors.

I lost one of my best friends to this tumor and the family conversation always starts with the treatment/benefit ratio of what makes sense. Do you throw everything but the kitchen sink at the tumor hoping to beat that fifteen month projection?    Or do you look at your life, your bucket list, and decide to pack the next year with catching up with friends and family and defer treatment completely? So many of my friends facing such a dilemma over the years have believed that they would opt for the latter but when staring death in the face say to their doctor, “Bring it on.  I want to fight.”

I suspect that is what Senator McCain will do. It is possible that McCain can have his chemotherapy and radiotherapy in the Washington, DC area and participate in the workings of the Senate until the day that he can’t.

There hasn’t been much optimism with the treatment options for this tumor in the past. But in increasingly, by harnessing the human immune system, doctors are able to take a person’s tumor cells and create a specific vaccine that could target the tumor and attack it as a foreign entity. Some of the most exciting work is being done at the Duke Cancer Institute. So for as sad as this news is today, there is real science behind the optimism for future treatments and I hope that ten years from now we will be able to put the treatment of glioblastoma in the success category with other tumors like lymphoma or HPV cancers.

But for today we root for an American hero, a former POW, a cancer survivor, a Senator, husband, father and grandfather and patriot. We root for John McCain as we do for all of our patients.

Posted in Senior Care, Uncategorized.