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Learn About Brain Tumors from the Neurosurgeons Who Study Them

“This is an exciting time to be in the brain tumor field,” says neurosurgeon Dr. Jeffrey Bruce, Co-Director of the Brain Tumor Center and Director of the Bartoli Brain Tumor Research Laboratory at Columbia University Irving Medical Center/NewYork-Presbyterian Hospital. “In fact, there are more scientists working on brain tumors now than at any other time in our history.”

This research is essential if we are going to one day find a cure for brain tumors. The month of May has been designated National Brain Tumor Awareness Month and groups like the National Brain Tumor Society are encouraging people to raise awareness about brain tumors and the importance of research.

An estimated 80,000 patients in the United States are expected to be diagnosed with a primary brain tumor this year. Brain tumors are grouped as either primary or secondary brain tumors, depending on where they originate. Primary brain tumors, the less common of the two, originate in the brain, and secondary brain tumors, also called metastatic brain tumors, start elsewhere in the body and then spread to the brain.

An estimated 200,000 to 300,000 patients develop a secondary brain tumor each year. A person who develops a secondary brain tumor usually has a diagnosis of breast, lung, skin or kidney cancer. Although brain tumors can arise at any age, they tend to occur in the very young or the very old.

The cause of any brain tumor depends on the type of tumor, and the exact cause is often unclear. Tumors form when a cell acquires a genetic change that triggers the cell to grow and multiply uncontrollably, eventually forming a mass. Although researchers have identified genetic changes that lead to brain tumors, it’s often unclear how these genetic changes happen in the first place.

Most often the genetic changes arise at random, but for a minority of patients (about one in 20), brain tumors may be the result of an inherited condition that increases the risk of tumors in the body, such as neurofibromatosis. The genetic changes can also be the result of radiation therapy for a previous brain tumor.

Symptoms of a brain tumor depend on location, growth rate and size of the tumor. When a tumor forms, it can interfere with the function of that particular area of the brain. For example, a tumor on the left side of the brain can cause difficulty with speech. Tumors can also interfere with nearby adjoining structures, such as nerves. For example, a tumor that presses on the optic nerve, which transmits visual information from the eye to the brain, can lead to vision problems.

Rate of growth can affect how quickly symptoms become noticeable. Fast-growing tumors tend to produce symptoms that can worsen in a matter of weeks, whereas slow-growing tumors can produce symptoms that take months or years to worsen. As for size, smaller tumors tend to produce milder symptoms, or no symptoms at all, whereas larger tumors can have more severe symptoms. This also all depends on their location.

Dr. Bruce and his colleagues in the Bartoli Brain Tumor Lab are working on several research projects. In particular, they are looking at ways to cross the blood brain barrier and deliver cancer drugs directly into brain tumors. Also, they are studying how brain tumor cells behave in order to develop more effective therapies.

Brain tumors can be difficult to treat with medication because the brain is protected like a fortress. The brain resides in a thick skull and is enveloped in a membrane called the blood brain barrier. The blood brain barrier is highly selective, allowing only certain substances through. Although the blood brain barrier protects the brain from harmful substances in the body, it can also block helpful medications from entering the brain.

To overcome this challenge, Dr. Bruce’s research team developed a medication delivery system that bypasses the blood brain barrier. “We just launched the first clinical trial ever where the drug is given directly into the tumor through an implantable pump in the patient’s abdomen,” Dr. Bruce says. “Instead of having the drug taken by pill or given intravenously, it’s pumped directly into the tumor itself.”

In a separate effort to better understand how brain tumor cells behave, Dr. Bruce and other Columbia neurosurgeons are looking at tumor cells from the edge of the tumor, known as the tumor margin. When brain tumors are removed, the tumor cells in the margin may be left behind because they can’t be seen by the naked eye and are difficult to extract from healthy tissue. They may give rise to a tumor months or even years after surgery.

Columbia scientists have already discovered that these cells in the tumor margin can wriggle through tight spaces between brain cells, allowing them to weave into healthy brain tissue. The researchers are now looking for substances (from which they might develop helpful drugs) that hinder this function and prevent another tumor from developing.

The aim of the work done by Dr. Bruce in the Bartoli Lab is ultimately to develop new therapies that can help patients like Maria Bonyhay. She and her husband were raising two sons in Boston when she was diagnosed with a glioblastoma. Glioblastoma is a highly aggressive and deadly tumor, and Maria was given less than two years to live.

Maria’s tumor was located in the pineal region, which is deep within the brain and controls important functions, such as the sleep/wake cycle. Tumors in this area are often designated inoperable because of their location. Their removal can only be done by neurosurgeons with a high level of skill. Dr. Bruce has pioneered a new technique to remove tumors in the pineal region, and he successfully removed Maria’s entire tumor.

Stories like Maria’s remind us that brain tumor research is about people’s lives. So this May, raise awareness about brain tumors and the important role research plays in bringing better therapies to patients.

You can learn more about brain tumors and treatments available here.

Learn more about Dr. Bruce on his bio page here.

patient journey

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