Melanie Cole, MS (Host): Welcome to Bryan Health Podcast. I'm Melanie Cole, and today we are talking about brain tumors. Something I know that everybody is afraid of all the time. You get a headache that's right where you go. Well, we're going to really learn about them today with Dr. Chris Hawkins. He's a Neurosurgeon at Neurological and Spinal Surgery LLC.

Dr. Hawkins, thank you so much for joining us today. As I said in the intro, you get a headache, you think to yourself, what is that? Right? Everybody kind of goes there because it's such a scary sounding thing. How really common are these and what are some of the conditions we're going to be discussing today?

Chris Hawkins, DO, FCNS: Well, thanks for having me, Melanie. So these are not overly common, you know, throughout the entire population, really less than 2% of the population is found to have a brain tumor. That being said, some of the things that we'll talk about today are the various types of brain tumors, you know, whether they arise from the brain itself or whether they arise from elsewhere in the body and spread to the brain.

Host: Well then tell us a little bit about that, because that's what some people don't understand between primary and secondary, if they originate somewhere else and metastasize to the brains. Just speak a little bit about what that means.

Chris Hawkins, DO, FCNS: There are some brain tumors that arise from the cells within the brain. These are called primary brain tumors. They're not typically, based on stages such as other cancers throughout the body, but rather on histological grade.

And we can go into more detail with that, later. But, there's also the possibility of tumors spreading from elsewhere in the body, and, they can spread to the brain that way.

Host: So are there risk factors that you can point to? Lifestyle, family history, anything we should know that would put us at a little bit of a higher risk?

Chris Hawkins, DO, FCNS: Yes. So there are some risk factors. One of them that's very well known is radiation, specifically, when you're exposed to radiation to the head as, a child, that is a known risk factor for developing brain tumors later on in life. There are also some other syndromes or conditions that can lead to brain tumors. This is less common, but some genetic syndromes such as Li-Fraumeni or neurofibromatosis either type one or type two, these are associated with increased likelihood of developing either benign or potentially, malignant brain tumors.

Host: Then speak a little bit about diagnoses and symptoms. What might somebody experience that would send them even to their primary care and then end up to see a neurologist?

Chris Hawkins, DO, FCNS: So symptoms with brain tumors, they can vary pretty significantly depending on the tumor size, the type, and really most importantly, the location within the brain. Common symptoms, they include persistent or worsening headaches that tend to be most severe in the morning or with straining such as coughing or exertion.

Seizures, especially if it's a new onset seizure in adults can also be a presenting symptom. Patients might also experience persistent nausea or vomiting, which are signs of increased intracranial pressure from the volume of the tumor. Depending on the affected area of the brain, symptoms also include confusion or disorientation, difficulty finding words or forming speech.

These can also be associated with changes in personality or behavior. There's also motor symptoms such as loss of balance or dizziness and weakness, or even sensory changes, such as changes with vision or hearing.

Host: Well, thank you for going over those so clearly. Now, are they always cancerous? If you determine that there is a brain tumor, are they always cancerous?

Chris Hawkins, DO, FCNS: So brain tumors, they aren't considered cancerous. They're not like other tumors throughout the body that tend to spread to other sites. So again, as I mentioned, the brain tumors are typically graded on, histologic and molecular features rather than on spread such as other cancers throughout the body.

So the World Health Organization, they classify brain tumors anywhere from grade I being the least aggressive, and oftentimes benign to grade IV, which is the most aggressive and typically what we call malignant. It doesn't necessarily spread throughout the body, but it is more invasive into local tissues.

So it's important to know that even benign tumors, they can be dangerous just because of the limited space within the skull. We also distinguish between primary brain tumors originating in the brain and metastatic brain tumors, again, which are cancers that spread to the brain from different parts of the body, lungs, breast, or even skin, such as in melanoma.

Host: Dr. Hawkins, you mentioned before, grading versus staging. Will you explain that to us now?

Chris Hawkins, DO, FCNS: So staging is essentially the spread of a tumor. So as it invades either adjacent or distant tissues throughout the body, it becomes a higher stage. So we don't typically use these for brain tumors. Rather we use grades, which is based on histologic and molecular features. And that essentially is a way to describe the aggressiveness of a tumor. The higher the grade, the more aggressive the tumor.

Host: Well, then what happens next Dr. Hawkins? Tell us about the brain tumor boards, your multidisciplinary team that meets to discuss treatments, the importance of that multidisciplinary approach for these patients. Tell us a little bit about how the process works.

Chris Hawkins, DO, FCNS: Sure. So typically brain tumors, you know, they're first diagnosed with imaging techniques, typically a CT as a screening tool in an emergency department and then with more detail with an MRI. So imaging alone can't always distinguish between, you know, benign, malignant tumors definitively. So tissue is, is oftentimes needed, either with a surgical resection or a biopsy.

And so treatment plans for brain tumors, they're very individualized. They depend on the factors such as tumor location, size, the histologic grade. In some cases, minimally invasive biopsies can be performed. In other cases, especially when the tumor is accessible or if it's causing symptoms, then surgical resection might be the first step.

So the goal of our surgery is to maximally remove the tumor, safely. So taking out as much of the tumor as possible while preserving neurologic function. Once that tissue is obtained, it's examined by a pathologist. Intraoperatively, we use a frozen section which can sometimes make a diagnosis, but oftentimes they'll need to send it out for molecular or genetic profiling. And this can take either several days or sometimes weeks.

As for the multidisciplinary tumor board, we do have one here at Bryan Health. This team includes other fellow neurosurgeons, neuro oncologists, radiation oncologists, radiologists, and pathologists. All members of the team. And we collaborate to tailor this comprehensive treatment plan for each patient. So depending on the diagnosis, treatments that can include surgery, radiation therapy, chemotherapy, targeted therapies, or even a combination of all of these approaches.

Host: Dr. Hawkins, who helps them navigate all of that? Is there a nurse navigator? Is there a team that helps the patients make their appointments, get through all of this? Because what a confusing, scary world.

Chris Hawkins, DO, FCNS: It is really a team approach. I am fortunate to have a fantastic PA that works with me and she is crucial in helping navigate these things with the patients. So between, setting up our surgeries and our follow ups and then getting in touch with other members of the team in order to bring them in on the treatment, is all coordinated on a team approach.

Host: And what's exciting in your field? What are some of the advancements in brain surgery? Are there new treatments, robotic surgeries? Tell us what's exciting.

Chris Hawkins, DO, FCNS: So really, surgery for brain tumors, there have been several remarkable advancements in the recent years. These have improved both safety and outcomes. One major advancement is use of neuro navigation. This is a form of image guidance that functions much like a GPS for the brain. This allows us to plan and perform surgeries with a lot more precision.

At Bryan Health, my PA and I were actually the first team in the state of Nebraska to utilize Stryker's Q guidance platform, which enhances the intraoperative accuracy and, and minimizes risks. We also use fluorescein, which is a technique where a special dye is injected into the bloodstream prior to surgery.

This causes the tumors, or tumor cells to glow under a specific filter on the microscope. And this helps differentiate tumor tissue from healthy surrounding brain. There's Tractography, which is another image platform that uses MRI techniques to map out the brain's white matter tracks, which are critical nerve pathways and we can avoid these, especially the ones responsible for things like motor function and language. Also, I personally have brought preoperative tumor embolization, here to Lincoln, So this is a procedure that involves navigating a catheter into the blood vessels that feed the tumor and then blocking them off before surgery with a variety of techniques. But this reduces blood loss, makes the tumor resection safer, more efficient, and, these innovations all help us to offer a patient state-of-the-art care that wasn't available, at least in this area, even just a few years ago.

Host: Is there any exciting research you'd like to discuss or share with patients that can tell us about exciting work being done for the future? Things we can look forward to.

Chris Hawkins, DO, FCNS: So there have been several exciting advancements on treatments. One of them that has come out is, uh, a device called Optune, and this actually uses electric fields to disrupt tumor cell division and thereby slowing its growth. So it's shown promise, and I think that they'll continue to use it more widely and with more success.

There's also other treatments, such as a product called GammaTile, which is essentially a small tile that has radiation within it. And this is implanted at the time of surgery in the tumor bed, and it will destroy tumor cells over time. Some of the genetic analysis that's also revolutionized how we approach brain tumor treatments, with molecular profiling and identifying specific mutations or markers within a tumor.

These help us tailor treatments such as different chemotherapy regimens or different targeted therapies against particular tumor types. This has been a growing field within neurosurgery and brain tumor specifically. There's also actually ongoing research that include implanting viruses into tumors that selectively destroy cancer cells.

As well as immunotherapies that stimulate the body's own immune system to target and eliminate these cancer cells. So these novel approaches are still early in stages. But they're a new form of investigative treatments.

Host: Dr. Hawkins, you've given us so much great information today. What advice would you like to leave listeners with? What should someone do if they're concerned that they do have a brain tumor? If they've experienced some of the symptoms you've described here today. Just summarize this for us with the key takeaways.

Chris Hawkins, DO, FCNS: So for anyone concerned that they may have a brain tumor, I would say it's crucial to seek medical advice promptly. The first step to consult with is your doctor. They can perform an initial evaluation based on symptoms and history. If they're experiencing severe neurological deficits such as sudden weakness on one side of the body, or difficulty with speech or severe headaches, then I would advise going directly to the emergency department.

Rapid interventions, can be critical as some brain tumors require immediate care, but CTs and MRIs can help quickly identify any structural abnormalities in the brain. I would like to say that for brain tumors, they're relatively rare. Again, you know, less than 2% of the population, but it's very important just to stay vigilant about your health.

Leading a healthy lifestyle can have both direct and indirect benefits. Avoiding smoking, staying active, eating a balanced diet, managing stress; they also help maintain overall brain health as well. So while these behaviors might not directly prevent brain tumors, they can contribute to a healthier immune system, potentially lower risk for other health problems, and, potentially lower the risk of other health problems and might exacerbate other neurologic conditions. So lastly, I'd just say it's crucial to stay in just regular communication with your healthcare provider. If you have any kind of changes in your health or behavior, whether it be physical or cognitive, even emotional, then just inform your doctor, have a discussion.

Early detection and intervention are key in managing any medical condition, including brain tumors. So being proactive about your health, it just ensures that potential issues are addressed before they progress.

Host: Thank you so much Dr. Hawkins for joining us today and sharing your incredible expertise. And I'd also like to thank our Bryan Foundation partner Fiducient Advisors. To listen to more podcasts from our experts, please visit Bryanhealth.org/podcasts. And that concludes this episode of Bryan Health Podcast.

Please always remember to subscribe, rate and review Bryan Health podcast on Apple Podcast, Spotify, iHeart and Pandora. Until next time, I'm Melanie Cole.