Joey Wahler (Host): They're two very scary words in the medical field, brain tumor. This is Jamaica Hospital Med Talk, brought to you by Jamaica Hospital. Thanks for listening. I'm Joey Wahler. Our guest is Dr. Benjamin Hartley. He's a neurosurgeon with Jamaica Hospital. Doctor, thanks for joining us.

Ben Hartley, MD: Thank you so much for having me, Joey.

Host: So, for those unfamiliar with the specifics, we hear the term brain tumor is mentioned. It can be a scary proposition indeed. What do we mean actually by brain tumor?

Ben Hartley, MD: Well, that's a great question, Joey. A brain tumor is a mass or a growth inside your brain. And in most cases, they'll grow over time. They can grow very quickly, very slowly or usually somewhere in between.

Host: Let me ask you first, before we get into any more details on the condition itself, when we talk about it being a scary proposition, what do you do as a physician, you and yours, to kind of quell nerves when somebody gets a brain tumor diagnosis? Because it's got to really throw people in a very difficult way, right?

Ben Hartley, MD: Yeah, being diagnosed with a brain tumor can be very scary. It might even be the worst day of your life. And it's very understandable that emotions will be running high and you often are going to assume the worst if this is the first time you're hearing about it. But one important thing to remember, and I've experienced this over many years of doing this, it's almost never going to be as bad as you think. There's many different treatment options and many types of brain tumors are even curable. And even the "bad ones" can be treated. And many of them just become sort of an annoyance or something you can't forget about rather than something that totally ruins your life.

Host: So, that being said, that's a perfect way to lead us into discussing some of those optimistic angles here. First, what are the symptoms that typically mean a brain tumor is, or at least, could be present?

Ben Hartley, MD: Well, it could be many things. But importantly, symptoms usually do not start suddenly with a couple exceptions that I'll mention. But usually, the symptoms grow over days, weeks, months or even years. Very important to note that if any of the symptoms we're going to discuss start suddenly, you need to call 911 immediately, because it could be a stroke or something otherwise that's an emergency. So, usually, the symptoms will start with a headache. Now if you get a headache, don't worry, 99% of people with headaches do not have a brain tumor, but that's often one of the first symptoms. You can also get nausea or vomiting; weakness or numbness on one side of the body; importantly, not sudden weakness or numbness, but it kind of grows slowly. You can have vision changes, trouble moving your eyes, seizures, trouble thinking, trouble speaking, personality changes, loss of balance or dizziness or unsteadiness. Usually, you'll have more than one of these symptoms at the same time, but not always.

Host: And again, you do say that these are things that typically would come on gradually, not suddenly. So, it should give the average person an opportunity to realize, "Hey, something's not right and get it checked out," right?

Ben Hartley, MD: Definitely.

Host: So, who's at risk for a brain tumor and why?

Ben Hartley, MD: That's a good question and something that is actually being investigated actively in the scientific community. So, one important detail is that in general there's two main types of brain tumors. There's what's called a primary brain tumor, and that's one that starts in your brain. It comes from the brain and it doesn't leave. The other kind is called a secondary brain tumor, and that's usually from cancer, somewhere else in your body that spreads into your brain later on.

So for the first type, for primary brain tumors, in general, we don't know what causes them in most cases. Very rarely, there's small populations that can get them from radiation exposure. But for the most part, we don't know what causes them. That can really happen to anybody.

Well, for the secondary type, we do know what causes those, and those are usually just the things that cause cancer. So, smoking, poor diet, obesity, sun exposure, things like that that cause cancer in general can also put you at risk for having a secondary brain tumor. So, regular exercise, a healthy diet, weight control, not smoking and only having limited alcohol intake, sunscreen, all these things can lower your risk for a secondary brain tumor

Host: It seems like those things you just listed there are the checklists for trying to reduce the risk of just about any really serious medical condition nowadays, right?

Ben Hartley, MD: Yeah, that's a very good point.

Host: So, how do you go about diagnosing a brain tumor if someone looks as though they may have one?

Ben Hartley, MD: Yeah. So, the first step and most important step, is a patient is to seek professional medical help. And if you can have any of those symptoms that I mentioned, and you're thinking it's time to see a doctor, better safe than sorry, you can just make an appointment with your regular primary medical doctor. And usually, the first step is they'll order a scan of your head. And that's either going to be a CT scan or an MRI scan. They're non-invasive. It's just a quick little picture of your head that shows us what's inside.

Host: And then, what specifically would you see that would tell you, let's say, beyond just it being a brain tumor, how serious, how far along it is?

Ben Hartley, MD: So, it's a little bit complicated, but some things look very characteristic on a brain scan, usually an MRI. And you'll get the MRI scan and your doctor may say, "We're pretty certain that this is what it is because it has the classic appearance of this tumor on an MRI scan." Some things you can't really tell very well what it is based on the imaging of your brain, and it just tells you that some thing is there and it needs further workup. So, it really depends on what type of thing that it is. And it doesn't always tell you whether it's malignant or benign in many cases, so you might need additional workup.

Host: So once that additional work is done, if someone does in fact have a brain tumor, let's talk about treatment options. Because, again, you mentioned when we started that there is reason for optimism nowadays, and I'm sure it's really treatment options that you're referring to.

Ben Hartley, MD: Yeah. So, there's a variety of treatment options for brain tumors. It really depends on the type of tumor you have, where it is in your brain, how old you are, and other medications you take or medical problems that you might have. In general, the options for treatment are in three types, one being surgery. And that can be anything from a minimally invasive biopsy, where a small needle is placed into the brain to get a small piece of the tumor, or it can be what's called a craniotomy, where you do a more involved surgery and a small window is made in your skull to access the tumor. And importantly with the craniotomy, the bone is put back in place after surgery, so you don't have a hole in your head or anything like that. And when you do have surgery, you're completely asleep and under anesthesia in almost all cases, so you won't experience or remember anything.

In addition, one of the other treatment options is radiation therapy, of which there's a few types. Radiosurgery is the name for when a small beam is focused on just the tumor itself, or you can have radiation therapy where a large area of the brain is treated with radiation. And again, that type you get depends on what tumor you might have. And the third type of treatment is medical treatment, which is either chemotherapy or some other of medications that can treat tumors. And importantly in many cases, your tumor will be treated with some combination of the above three approaches. Some need one, some need two, and occasionally you might need all three of those treatments to control the tumor.

Host: And you mentioned biopsy at the beginning there. So when you biopsy a piece of a tumor, what are you looking for there?

Ben Hartley, MD: So, you do a variety of tests on the tissue, because in general, the only way to tell 100% what a tumor is, is to have a piece of it outside the body. So, to do that requires some type of surgery, at least a biopsy. And we look at it under the microscope to look what it actually looks like to your eye. There's also a variety of tests we do on the tissue to see what molecules are in it, and what the DNA of the tumor is. And all these things can tell us exactly what type of tumor it is, and then we can devise a treatment plan based on the results.

Host: Gotcha. Couple of other things. How about in the area of newer treatments, the latest research, anything that you're most excited about that's just arrived or is coming down the pike, so to speak?

Ben Hartley, MD: the latest research you're most excited about that's There's a lot of very exciting things in brain tumor research. There's a lot of clinical trials that are available for patients with brain tumors. And surgery for the most part hasn't really changed much appreciably in the last 50 years, let's say. There's new techniques we have. However, in the medical therapy arm, so different medications that can treat tumors, we're discovering new ones of those all the time. And that's kind of the most exciting advancements, are in the medical arm. And that includes things like vaccines, so they can devise vaccines that are specific to your personal tumor and help your immune system actually fight the tumor off with your own body. And there's also new other types of specially targeted drugs that affect just one single cell type that can destroy the tumor, but then not have as many side effects on your body. So, those are really some exciting advancements we're having right now.

Host: And so in summary here, a very general question to close on, and I know it might be a little bit difficult to answer just because of all the different scenarios you mentioned that someone could be in when they have a brain tumor. But generally speaking, if possible, what's the kind of timetable and work involved in someone getting through the treatment they need typically? And what's generally the prognosis? And when I talk about, or when I have you talk about prognosis, perhaps you can kind of break down a little bit what a couple of variables might be that would determine that.

Ben Hartley, MD: Of course. Once you first have the diagnosis, that's when most of the work happens. Because while it's not always an emergency, time is of the essence when you're first diagnosed with a brain tumor. So for the most part, we should be dealing with it sooner than later. So usually, if it is something that needs surgery, you'll have the surgery pretty quickly after the diagnosis. You'll be in the hospital for a few days, because after surgery you need to be monitored. But in most cases, after you have surgery for a brain tumor, you can go home within three days. So, it's a flurry of activity in those first few days. And then for about a month after surgery, you're going to be relaxing, recovering. And then at about a one-month mark after surgery, we start talking about the other treatments. And this is where it really depends on what the results of the surgery show. And some people need radiation treatment for a couple months, starting a month after surgery. Some people just need it for one day after surgery. And then for the medications, in many cases, it's not traditional chemotherapy. It's just a pill you take at home. So, some of the good news is that the treatment isn't particularly challenging compared to other types of cancers and tumors. And you can, for the most part, go about your normal life relatively quickly.

As far as prognosis, many types of tumors are completely curable with surgery or a combination of the treatments I mentioned. And so, really the prognosis is very good in those types. On the other end, there's some types of tumors that the prognosis is not as good. And really, that depends on the very specific type of tumor that it is, and you'll likely need more intensive treatment. So radiation, again, in more of a month's time course, and then medical therapies going forward. But importantly, some of the worst tumors in the brain that we know of have the most aggressive research behind them. And every year. We're increasing the survival on these types of tumors.

So really, it's a big question mark with the prognosis and some of the more deadly tumors. So, that's some of the good news is that we're always making strides in treating these patients.

Host: Yes, and that's what you mentioned at the top and it certainly sounds like that is indeed the case. Folks, we trust you're now more familiar with brain tumors, the different types, and the treatment options for them. Dr. Benjamin Hartley, thanks so much again.

Ben Hartley, MD: Thank you for having me.

Host: Thanks for being with us. And for more information, anyone diagnosed with a brain tumor can call the Jamaica Hospital Neurosurgery Appointment Line at 718-206-6713 or you can visit jamaicahospital.org. Now, if you found this podcast helpful, please do share it on your social media. I'm Joey Wahler. And thanks again for listening to Jamaica Hospital Med Talk, brought to you by Jamaica Hospital.