Scott Webb (Host): The diagnosis and treatment of a brain tumor can be very complex and many patients are overwhelmed when first diagnosed. Today we're going to learn from Neurosurgeon Dr. Kushal Shah about the different types of brain tumors, signs and symptoms to watch out for and treatment options available at Franciscan Health. This is the Franciscan Health Doc Pod. I'm Scott Webb.

Dr. Shah, thanks so much for your time today. We're going to talk about brain tumors, you know, maybe how folks get them, what you do to treat them, the latest treatment options and so on. But maybe just to have a little foundation here, what exactly is a brain tumor?

Kushal Shah, MD: So a brain tumor is an abnormal growth of cells that occurs in the brain or outside of the brain. Sometimes they're benign. Other times they are cancerous or malignant, and we don't always really know why they occur, but this growth of cells is ultimately what is the tumor.

Host: Yeah, so it's the growth of the cells. So let's then talk about the difference between benign and malignant and primary and secondary brain tumors.

Kushal Shah, MD: Yeah, I like to differentiate those because they make a big difference in our treatments, and ultimately making sure that we are treating them appropriately. A primary brain tumor is a brain tumor that starts in the brain, and a secondary brain tumor is one that has spread to the brain from elsewhere. So say for example, a patient with breast cancer, lung cancer, colon cancer that has spread to the brain, that's a secondary brain tumor. Benign and malignant is a very important delineation. Benign means non-cancerous. Malignant means cancerous. And so how we treat these tumors is also vastly different. Malignant or cancerous brain tumor many times needs surgery, chemotherapy and radiation treatments. Benign or non-cancerous brain tumor can sometimes be observed or may just need surgery for the treatment.

Host: Yeah, I see what you mean. So there's a range there, and I'm assuming then maybe there's a range when we think about the common signs and symptoms. So what would alert someone? How would they know? Not necessarily that they maybe have a brain tumor, but that there's something going on that isn't normal. So maybe you can talk about that. Just the common signs and symptoms.

Kushal Shah, MD: Yeah, so many times the symptoms can be vague and subtle. A lot of times patients will present with headaches, which is obviously a common symptom and definitely everyone who has a headache does not have a brain tumor. Most people who have a headache don't have a brain tumor, but when they also have some other signs or symptoms, specifically neurologic signs or symptoms, then we start to worry that there could be a brain tumor going on; that may mean weakness, speech difficulties, vision difficulties, some sort of stroke-like symptoms, a seizure or another type of neurologic symptoms. So if someone's got headaches, and one of those symptoms, or just one of those other symptoms, specifically something that has changed over time, then that's a reason to be suspicious that we could be dealing with a brain tumor.

And that's the time where they really need to visit with their primary care provider. And appropriate imaging, which usually entails an MRI is obtained and that's how we make the diagnosis.

Host: Yeah, that's good advice from an expert, right? We don't want everyone who has a headache, running to their doctors or running to the ED. Like, it doesn't necessarily mean you have a brain tumor, but you might, and that's why it's good to have conversations with our doctors, get the imaging and so on. So I want to have you tell us a little bit about the Brain Tumor Program at Franciscan Health.

Kushal Shah, MD: So the Brain Tumor Program at Franciscan Health, is truly top notch. We've got all the capabilities and skills to take care of patients with brain tumors. What we know is that brain tumors are not treated in silos. It really is a team approach, and that means you got to have neurosurgeons, oncologists, radiation oncologists, radiologists, and many other specialties. At Franciscan Health, we've got all of those capabilities and we know that working together, looking at this as a multidisciplinary problem for that individual patient, is the best way to treat them. Lot of times it starts with surgery and then they will get further treatments as is necessary by one of the other specialists at Franciscan Health.

Host: Yeah. And I have the pleasure, Doctor, of doing these sort of for a living. So I know what a nurse navigator is and I know what just huge roles they play in medicine. But want to have you talk specifically about the role of the Brain Tumor Nurse Navigators at Franciscan.

Kushal Shah, MD: So the Brain Tumor Nurse Navigator Program at Franciscan is very exciting and unique. It's one of the only brain tumor navigators in the area. And what this individual will do is really focus on the patient experience. We know that getting the diagnosis of a brain tumor is extremely frightening, anxiety provoking, not only for the patient, but also for their family.

So during the time that they're waiting to be seen by the specialists, which may just be one person or multiple physicians, that they have a lot of questions, and it's important that we have someone that can really help them during that time, as well as making sure that their care is coordinated and making sure that it's expedited.

No one wants to sit and wait after they've been given a diagnosis of a brain tumor or a cancerous brain tumor specifically, and so what our nurse navigators will do is they will reach out to the patient and the family, gather information, gather any prior information or imaging studies that might have been done, and really try to put everything into a nice package so that any of the physicians or providers that are seeing the patient are able to access all of that information. They will then work to get these patients into the appropriate specialists and many times coordinating. So when patients live far away, we know that it's challenging to transport.

And so if we can get them to see neurosurgery in the morning, radiation in the afternoon, or radiation oncology as well as oncology on the same day, it really makes a big difference. So this individual is going to guide the patient through the entire process and really be the point person until they've met with the right providers.

Host: Yeah. That's so awesome. And I love that sort of one stop shopping, right? If folks are making long trips to get there, you want them, you know, to be really productive and get the most done that they can while they're there. And you mentioned this earlier about observation, and I think I have a sense of what that means, but in practical terms for brain tumors, what does that mean? Observation.

Kushal Shah, MD: So when we're talking about a benign brain tumor, such as a meningioma, which is a very common brain tumor that we see; sometimes the treatment is observation, which means we're getting repeat MRIs to see if this thing is changing or growing in a negative way. Many times, especially today, as we are getting more and more MRIs, we find these benign brain tumors incidentally, meaning they don't actually cause any symptoms, and they were discovered because they were looking for something else.

So I see many patients every single day in the office that have a benign tumor that have no symptoms that is being caused by it. And many times I'll recommend we just observe this with MRIs, whether it be annually or more frequently, to see if there's been a change.

Host: Yeah. And that's why we need experts like yourself cause I'm thinking, well I don't want brain tumors, right? I don't want them in there. They shouldn't be there. Just, you know, take them out. But as you're saying here, especially with benign tumors, surveillance or observation might be the best course of action.

But I did want to ask you about malignant brain tumors and, you know, is surgery almost always indicated and how do you decide if a tumor can be removed safely or not?

Kushal Shah, MD: That's a great question, and certainly it's a complex question that has to be looked at case by case for every patient. For me, the type of brain tumor it is, the type of cancerous brain tumor it is, whether it is primary starting in the brain or secondary spread from elsewhere, the symptoms that the patient has, the size that they have of their tumor, and also if they have some other type of cancer. How is that? Is it something that is very well treated and controlled, or is it something that appears to be growing despite the treatments? So I take a lot of factors as well as what is the patient's ability to have surgery and what is the risk of surgery? So all of those factors are taken into consideration when determining the best treatment course for that individual.

If it is a patient that's doing very well and has a tumor that can be resected safely with a low risk profile, then a lot of times surgery's undertaken and then they will get adjuvant or postoperative treatments after that. In someone that has very extensive disease or the tumor is in a critical location where it's likely to cause neurologic problems, we may elect to only do a biopsy or maybe just treat it with other chemotherapy and or radiation treatments.

Host: Yeah. And it's always good as patients, certainly doctors and nurses are patients too, but it's always good from my perspective as a patient and a host to know that there's lots of options for folks. And it sounds like there are, especially at Franciscan and wondering, you know, at Franciscan Health, is there anything special, like the latest, greatest, newest technology?

I know it seems like, especially when it comes to cancer, things are changing practically by the minute, but any things you want to mention, technology, recovery times, anything that you know, on top of everything else that makes Franciscan Health unique.

Kushal Shah, MD: We're always looking to make our treatments better. We know that today the treatments we have are good, but we are hopeful that our treatments are only going to get better as technology and treatments improve. And what we know at Franciscan is we're always trying to push the envelope to make things better. We have invested in state-of-the-art technology. We've invested in our staff and the importance of the post-operative care. So patients will go to the ICU routinely after brain surgery, and we also know that clinical trials for oncologic treatments and radiation treatments are important. So all of those, as well as the fact that we have providers who specialize in this, make a big impact on trying to make the care better for each and every individual patient.

Host: For sure. And you mentioned that, you know, all the patients go to the ICU. This struck me, I should ask you about that. Let's talk about recovery a little bit. So, whatever treatment someone has gone through besides observation of course, what's that like? Can you maybe just take patients briefly through that? Either, you know, if they've had surgery or it's been treated otherwise. What's the, you know, the recovery process like for a brain tumor?

Kushal Shah, MD: So most patients with a brain tumor who need surgery will undergo what's called a craniotomy. And those patients will have their surgery and after their surgery go to the recovery room after surgery, which is pretty routine. They will then go to the ICU where they're monitored very closely by specialized trained nurses and staff members.

Typically, they're there overnight for the first 24 hours, and assuming they're doing well, they'll then go to our neuro floor, which is our specialized floor for neurologic diseases. And as long as they're doing well with therapies, which would be physical therapy, occupational therapy, and or speech therapy; then most of them are able to go home two, maybe three days after surgery. Some folks will need rehab to work on their skills to get them better so they can be home safely, and those patients will go directly to rehab before getting home.

Host: Yeah. It's all really encouraging. Of course, none of us want brain tumors, benign or otherwise, but good to know that there's lots of options, surgical, non-surgical, and all the work, that great team that you have there at Franciscan Health, and just wanted to give you an opportunity here at the end to just, not necessarily brag, but you know, encourage folks especially in the area, if it's convenient for them, if they've been diagnosed or they have concerns, why would you like them to choose Franciscan Health?

Kushal Shah, MD: You know, I'm very proud to work with Franciscan Health, and I know that we offer the best treatments and one that's individualized to the patients. Obviously getting a diagnosis of a brain tumor can be very scary and anxiety provoking. I would certainly encourage patients to seek out the best care that they can and that absolutely can be offered at Franciscan Health. A lot of times people are scared and therefore don't seek out attention to this problem, which sometimes is worse because it, getting an earlier diagnosis allows that patient to get all the best treatments as quickly and expedited as possible. So if you're listening and you've been diagnosed with a brain tumor, we encourage you to reach out to us and our Nurse Navigator program and we will be more than happy to meet with you and come up with the best treatment plan that suits your needs.

Host: That's perfect, Doctor. Well, I get to do these and I love these cause I get to learn from experts and I get to speak with compassionate, knowledgeable experts like yourself. And you are a great guest today. So thanks so much. You stay well.

Kushal Shah, MD: Thank you very much. Appreciate your time.

Host: And to learn more about brain tumors and the Brain Tumor Program at Franciscan Health, please visit franciscanhealth.org and search brain tumor. And if you found this podcast helpful, please share it on your social channels. And be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.