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So once that diagnosis has been made or
someone's told from their MRI scan that there's
something on the MRI scan, you need to be evaluated.
Oftentimes they'll say you need to be evaluated by
a neurosurgeon.
The doctor might say you need to go to the emergency room.
And so the patient or
the patient's family needs to decide, of course,
where to go, who to see.
They use their family doctor,
their primary care doctor to help guide them.
But with the Internet, with the access to information,
of course, it's easy to sort of search out, well,
where should I go?
The important thing is to be seen timely, and the timeliness
of that, again is dependent on those two categories.
So the person that's having symptoms, has an MRI scan
that shows a mass, they should really be seen within a week.
If they're having severe symptoms,
then they should just go to the emergency room.
It's not necessarily that they need an emergent operation in
the next 24 hours.
That's very unusual for this kind of a problem.
But if they're having symptoms, then there are situations that
are threatening and need some kind of medication or treatment
to temporize while a treatment plan is being put in place.
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Of course, it's fine to say you need to be seen within a week,
it's not so easy always to find access to be seen quickly.
And a lot of that has to do with who the primary care
doctor may know, if they say call this person.
A lot of times the instruction to go to the emergency room is
because the primary care doctor says you need urgent evaluation.
It's gonna be hard for me to get you in to see somebody.
Here, we'll see somebody with a brain tumor within 48 hours.
So if someone has even an asymptomatic problem, so
it's picked up by accident,
if they call the access line, they'll be seen within 48 hours.
Lot of times the images can be uploaded to a website.
So if somebody doesn't live within an hour, and
they want an evaluation or they're from out of state,
they can contact the department.
They can upload their images to a website.
And we're able to look at those images and
give them some guidance about well you should come right now,
or you should go to your local.
Or here's a center nearby you that would be excellent for
you to get care at.
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So brain tumors sort of fall into two categories.
One is those that are within the substance of the brain and
those that are outside the brain pushing on the brain.
And the most common ones are glioma,
which are tumors that form inside brain.
Metastatic tumors are tumors that come from somewhere else in
the body and land in the brain.
And then the tumors that are outside the brain pushing on
the brain are called meningiomas.
They all fall under the general classification of a brain tumor.
So a department or here at Johns Hopkins, the brain tumor
division would take care of all of those kinds of problems.
The symptoms that are generated from those are different.
The treatments are different, and that depends on location as
well as which type of tumor appears on the MRI scan.
The imaging studies that people have to evaluate these kind of
problems generally do differentiate those two groups.
And so one can right away have an idea that,
I have this kind of a problem or I have that kind of a problem.
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The most common one, say the glioma,
that can be either observation for a low grade tumor.
It could be radiation and chemotherapy for
a high grade tumor.
So even within that sort of subcategory of glioma, there
are different grades of tumor, which really just describe what
the growth potential, what the sort of biology of the tumor is.
And that grade then dictates what the treatment would be for
that person.
And again it could be just observation and
nothing more after surgery and nothing more.
For the metastatic tumors, that's a person of course that
has a known cancer somewhere else, and
the tumor travels to the brain.
So that treatment involves surgery
followed by focused radiation.
Sometimes there are more than one metastatic tumor to
the brain, and it might involve radiation only for that problem.
They might not need a biopsy or even a resection based on
the location and, of course, how they're doing.
For meningioma,
the treatment after surgery involves observation, usually.
There are certain meningiomas that need more treatment
than just surgery.
They may regrow, or they may have biological potential that's
a little more aggressive.
And they might need some radiation therapy.
There are many meningiomas that don't need any treatment.
So they're small, they're not really causing a problem, and
observation is appropriate.
And I think that that's one of the real key aspects
of if you have this kind of a problem of being evaluated
at a center that has a lot of experience with these things.
And the reason for that is that many of these problems don't
need aggressive management.
They can be managed conservatively.
The key thing of course is you wanna intervene in that person's
life at a time when it can make the most difference for them,
when it can impact their quality of life and
impact their length of life.
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Well the goal of treatment,
certainly in terms of the surgery, but
in all treatment is to get them back to their normal life.
Now a lot of whether that can be accomplished depends on
location of the tumor and the diagnosis.
Again, diagnosis is so important in terms of understanding what
we call the natural history of how that will affect somebody.
But the goal would be to get them back to independent living,
[COUGH] to get them back to work if they wanna go back to work.
Certainly for a very low-grade tumor like a meningioma or
a low grade astrocytoma, full expectation would be to get
back to your normal activity level, your normal life.
For surgery itself,
there is nothing about surgery, the majority of the time,
that would affect what somebody can do after surgery.
So all the things that they could do before surgery,
they should be able to do again after surgery.
If the problem, the tumor in this case,
has impacted some of their neurological function,
sometimes that's not reversible with surgery.
And therefore they may be limited in some of the things
that they can do.
So that's where the diagnosis and
the location impacts kinda what people can expect.
But the goal of the treatment,
even with radiation and chemotherapy,
is to get people back to having happy, normal lives.
Diagnosis will certainly have prognostic implications.
And so for more aggressive tumors there are more issues
associated with with what's going to happen.
And so sometimes the chemotherapy and
the radiation can impact energy levels.
There can be fatigue and difficulty in getting back to
normal exercise, normal driving, even getting back to work.
But the goal for everybody, regardless of location,
is to intervene and get them to be the best that they can be.
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Here at Johns Hopkins we have an amazing brain tumor program.
I mean, it involves so many different kinds of doctors,
nurses, therapists, the surgeons, the neuro oncologist,
the radiation oncologist, the pathologist,
a large group of people whose primary focus is to take care of
this one kinda problem.
And the benefit to a patient is that the attention to detail,
the attention to what their issues are is spectacular, and
that leads to better outcomes.
We have multi-disciplinary conferences that
look at different treatment options.
We participate in all the different consortiums for
new clinical trials.
We're close to the NIH, so we have a close link with the NIH.
We have experience in terms of managing these problems that's
unmatched.
We probably operate on 1,000 to 1,200 patients a year with
brain tumors.
We're taking care of even more in terms of medical oncology and
radiation oncology.
The experience that then is given to the patient in terms
of, this is sorta the decisions that you should make.
This is how you might wanna make your decision.
These are the choices, only benefits them in terms of
doing the best that they can do with their problem.
In addition, even outside of just the surgery alone,
which is oftentimes sort of the initial starting point, and may
be the biggest hurdle initially for people to have to climb and
get over, is that all the other resources that support that
person to get through that experience are phenomenal.
It's never sort of a new walk for people here.
So all the little bumps that can happen with people who have
surgery, or even chemotherapy or radiation for
these kind of problems, have been seen many times.
And so that's only beneficial to
people in terms of getting through the experience.
Because we're so interested in this problem,
we're very prompt at seeing people and taking care of them.
If someone calls again with either a new diagnosis or
they have a diagnosis and
they want another opinion, we'll see them immediately.
We'll get them to upload their pictures and look at them.
So they don't even have to be local.
They can be from out of state.
They can be from out of the country, and we can instantly
evaluate their problem and help them with their problem.
Even if they didn't come here, to offer that service and
be able to help somebody is worth whatever time one gives.
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