Facing a brain tumor diagnosis can be an overwhelming experience, filled with uncertainty and fear.
While the initial shock may seem terrifying, it’s essential to carefully gather information that will help guide the next steps in your care.
Michigan Medicine neurosurgeon Wajd Al-Holou, M.D., weighs in on the importance of understanding the diagnosis, exploring various treatment options and seeking the best medical care — all crucial aspects of navigating this journey.
As a surgeon, how do you determine the best course of action for patients diagnosed with a brain tumor?
Al-Holou: When a patient is diagnosed with a brain tumor, as providers and surgeons we consider many things.
What type of tumor is this? Is it something that’s resectable (can it be removed by surgery)? How much of the tumor can be removed? What are the critical areas of the brain near the tumor that could be affected by surgery? What are the patient’s goals
When we’re reviewing brain scans and making these types of decisions, we have a multidisciplinary team that includes neurosurgeons, neuro-oncologists and radiation-oncologists.
The team has extensive experience treating both malignant and benign tumors.
Our team is available to patients seeking comprehensive recommendations for a recent brain tumor diagnosis or those seeking second opinion consultations.
What should a patient look for when deciding where to have surgery?
Al-Holou: When a patient first learns they have a brain tumor diagnosis, there are many things to think about.
One is timing.
In general, rushing into surgery within a few days often isn’t the right thing to do.
The most important determinant of how well a patient does is the quality of the first surgery.
Although surgery needs to happen within a reasonable amount of time, depending on the tumor type, this can sometimes range from one to two weeks or longer.
Patients with brain tumors are seen in our Multidisciplinary Brain Tumor Clinic, where expert physicians in neurosurgery, neuro-oncology and radiation-oncology help care for all types of tumors, including gliomas, metastases and pituitary tumors.”
— Wajd Al-Holou, M.D.
Treatment for a brain tumor requires specialized training and expertise.
The patient should ask the surgeon how many brain tumor surgeries they’ve performed, and how many of these surgeries reflect the type of tumor the patient has been diagnosed with.
What percent of their practice focuses on brain tumors, as opposed to other types of neurosurgeries?
There are other important questions, as well: Can the tumor be removed? Can it be removed entirely? What are the risks of surgery? What are the important brain functions near the tumor that could be affected and how will the surgeon work to protect those important brain functions?
It’s also important to know how invested the surgeon and brain tumor team are in treating brain tumors. Do they offer the most advanced treatment options, both surgical and non-surgical? Can they offer participation in clinical trials?
What are the latest innovations in brain tumor treatment?
Al-Holou: Because University of Michigan Health is such an amazing research institution, we’ve developed many treatment and technique options that might not be available elsewhere.
We have one of the few programs in the nation that offers a comprehensive awake brain surgery program.
Tumors that grow in the brain can sometimes invade critical areas that control, for example, speech or movement.
Awake surgery allows us to remove the maximum amount of tumor while protecting the surrounding brain.
We also have techniques that allow us to visualize a tumor during surgery.
FastGlioma, for example, was developed here and uses artificial intelligence to help us quickly identify at microscopic resolution where a tumor ends and where the brain begins, greatly reducing the risk of missing residual tumor.
Another technique is laser ablation, a minimally invasive approach that allows us to treat all types of tumors, including those that are deep within the brain and not easily removed.
Beyond surgical resection, we’re working to find better treatment options.
For many tumors, surgery is often followed by chemotherapy and radiation. Despite these treatments, tumors often relapse.
At U-M Health we have a comprehensive program to study these tumors at the genetic level to identify what causes them to relapse.
Based on our studies, we’ve developed multiple clinical trials focused on attacking these tumors.
Another aspect of these tumors is that they’re heterogeneous, meaning one patient’s tumor is different from another patient’s tumor.
To address this, we have a program to develop treatment options that are personalized for each patient’s individual tumor.
We’ve also developed a system in which we take a tumor directly from surgery to the lab to test different treatment drugs to determine how patients respond.
We’re able to develop a list of potential drugs that could be used in a personalized treatment plan.
What more can you tell us about treatment for brain tumors?
Al-Holou: Patients with brain tumors are seen in our Multidisciplinary Brain Tumor Clinic, where expert physicians in neurosurgery, neuro-oncology and radiation-oncology — three specialties most crucial for successful treatment — help care for all types of tumors, including gliomas, metastases and pituitary tumors.
This clinic gives patients a full team approach and unparalleled expertise all at once.
A patient is able to see all the experts who will provide a comprehensive recommendation for their treatment, which could include surgery, chemotherapy, radiation or clinical trials, many of which are developed from our own research and scientific findings in University of Michigan Health labs.
Our Metastatic Brain Tumor Clinic is for patients with metastatic disease.
These patients are seen by surgeons and radiation oncologists as well as other oncologists to develop a comprehensive plan for treatment of their tumors.
Our Pituitary and Neuroendocrine Clinic provides evaluation and treatment of patients with disorders of the pituitary gland and surrounding area of the brain. The multidisciplinary clinic involves neurosurgeons and endocrinologists.
We also offer a number of clinical trials focused on treating brain tumors.
Through one recent trial, we established the first in-human brain cancer isotope tracing program that allows us to identify the metabolites (energy sources in the diet) that fuel cancers.
We’re working on a second clinical trial to determine how to attack these energy sources.
What research and advancements are on the horizon for treating brain tumors?
Al-Holou: At University of Michigan Health, we’re involved in developing the next generation of brain tumor therapies, including new medications that could improve survival in those with brain tumors.
Diagnosing tumors without the need for a brain biopsy is something we’re actively working on by studying the cerebral spinal fluid surrounding the tumors.
These tumors will often shed parts of their cells into the fluid around the body. And if we take a small quantity of that fluid, we can study it and identify the genetics of the tumor.
That’s something we call liquid biomarkers.
Ultrasound therapy is another advanced tool that will allow us to treat some deep tumors that are hard to resect without surgery.
Known as histotripsy, this will allow us to treat brain tumors without having to make an incision.
As a surgeon, what developments are you most excited about?
Al-Holou: This is a very exciting time in the treatment of brain tumors.
We finally understand that each patient’s tumor is different, and so we need to change our plan of attack for each tumor.
We need to consider what type of surgery is necessary, what type of treatment is necessary, what other options exist other than standard treatment.
Our ultimate goal to do less invasive surgeries for patients, and to provide more effective long term treatments.
Recent studies, including some from University of Michigan Heath, have given us a lot more hope in the treatment of some tumors, including glioblastomas.
We have an amazing collaborative team that is working to make surgery less necessary.
To do that, we need to find better treatment options for patients through clinical trials that will result in a significant impact on patient outcomes, survival and quality of life.
If you care about cancer, please read studies about how to fight cancer with these anti-cancer superfoods, and a berry that can prevent cancer, diabetes and obesity.
For more health information, please see recent studies about how to harness the power of anti-cancer foods and supplements, and cancer-fighting foods and recipes.
Written by Jane Racey Gleeson, Michigan Medicine.
