Oncologist on Kennedy

Neuro-oncologist Andrew Norden

Dr. Andrew Norden, a neuro-oncologist at the Dana-Farber Cancer Institute and neurologist at Brigham and Women's Hospital, answered questions from boston.com readers last week in the wake of the news that Senator Edward M. Kennedy has been diagnosed with a malignant brain tumor. Norden is not treating Kennedy. Here are excerpts from his online chat, available at boston.com/news/health:

Q: The news is viewed in the media as uniformly grim. Is a glioma by definition fatal?

A: Unfortunately, the majority of gliomas are ultimately fatal. A small number of patients have very long survival.

Q: Do you think at the time of Kennedy's surgery last fall for removal of plaque in the carotid artery that a brain MRI was conducted?

A: Probably yes. And in all likelihood, this tumor was not present at that time.

Q: I am wondering why there cannot be an agreed-upon screening test for brain tumors, much like a colonoscopy.

A: Unfortunately, malignant brain tumors like the senator's grow quickly, often in a period of a few months. Plus, if we did frequent scans as you suggest, we would detect a lot of abnormalities that might not be important. Patients might end up with unnecessary brain biopsies.

Q: Any idea why he would be released [from the hospital] so quickly? Why are they not attacking this ASAP?

A: Generally, we wait at least 10-14 days after surgery for adequate healing before starting radiation and chemotherapy. If you start too early there is a risk that the surgical wound will reopen.

Q: What is the next step in his diagnosis? Will they test to determine exactly what stage the tumor is in?

A: Yes, the pathologist is now working to determine the exact subtype. Some molecular studies may also be used to better predict prognosis.

Q: Could you discuss some of the cutting edge therapies for gliomas? And because this is such a deadly cancer, please include any alternative/complementary therapies that might help one's own body beat back the disease.

A: We are increasingly using "targeted molecular therapies" for gliomas. These are drugs that target specific molecular changes in the tumors. Also quite promising are treatments that target blood vessels, called anti-angiogenic therapies. At the moment, I am not aware of any alternative therapies that help to treat the tumors, but these treatments (e.g. acupuncture, massage, others) are very useful for management of symptoms such as nausea, fatigue, and headaches that some glioma patients experience.

Q: Is it reasonable to expect someone undergoing treatment for an advanced, aggressive glioma to continue a normal work schedule?

A: Some of my patients are able to maintain very busy schedules during treatment. Most of my patients, though, experience fatigue that prompts them to cut back. I advise my patients to plan for a significant reduction in work hours.

Q: What do you tell patients who are receiving a diagnosis as devastating as the senator's?

A: It's a difficult conversation, of course. I focus on the fact that treatments are constantly improving and that I will help the patient through the difficult road ahead.

Q: How do you give patients hope?

A: I focus on the emerging research and new drugs. And if all of our treatments fail, I focus on helpingP them to achieve a good death.