Recently, it has been all too frequent an occurrence to have to assess the survival chances of prominent individuals with cancer. Ted Kennedy’s recent diagnosis is the latest and his prognosis cannot be sugar coated. While the exact stage of his “malignant glioma” has not been revealed, a rough estimate on a credible website succinctly notes “of 10,000 Americans diagnosed each year with malignant gliomas, about half are alive 1 year after diagnosis, and 25% after two years.” Glioma has been classified into four grades, grade one being the most benign and grade four, also known as glioblastoma multiforme, the most malignant.
It is unwise for a physician to make specific comments on a patient without access to details of the case. There are, though, some signs and facts that can be commented upon in a generalized way. Senator Kennedy’s tumor is in the parietal lobe of his dominant hemisphere, the one controlling speech. The parietal lobe is concerned primarily with sensation, but some visual pathways course thorough it and some areas are adjacent to the speech area and control, among other functions, the ability to read and calculate. This would generally hamper the ability to provide a surgical palliation (safely removing as much tumor tissue as possible in order to delay the spread). Surgery to cure malignant glioma has not proven to be successful. Also, the fact that the senator had a normal brain MRI less than a year ago in conjunction with his carotid surgery suggests that the tumor is of an aggressive nature.
Malignant brain tumors when first diagnosed are often associated with swelling of surrounding tissue, known as edema, from breakdown of the blood-brain barrier. Edema usually responds quite well to corticosteroids and often there is a temporary but dramatic improvement in symptoms after initiation of treatment. Steroids have minimal, if any, effect on malignant gliomas themselves and the inexorable growth of residual tumor tissue, with steadily progressive decline, often rapidly supervenes. Seizures can usually be well-controlled with medications. The combination of chemotherapy, brain irradiation and medication often affects cognitive function in a mild way, though the major problem will be direct extension of the tumor throughout the brain. All in all, Senator Kennedy and his team of physicians are confronted by an extremely formidable opponent.
With respect to other recent cancer-related political news, a case summary with respect to his melanoma has just been released by Senator McCain’s doctors. The summary and the results of reviews of the extensive medical records examined on site by reporters, some of whom were doctors, fails to address the issue of testing the senator should have prior to his acceptance of the nomination. This is precisely the subject of my previous post.
To reiterate with added emphasis, Senator McCain has a small but significant chance of occult metastatic disease. A regimen of skin examination and bloodwork every three months described by his doctors is grossly insufficient to provide the best assurance of a disease free state. Even though the odds of finding metastatic disease are as small as they are, the gravity of the office and the devastating prognosis associated with widespread disease makes it, in the opinion of this neurologist, imperative to have these tests performed and their results publicly revealed prior to acceptance of the nomination. To be blunt, if he has metastatic melanoma, he should not run.