Maggie McKay (Host): When most people get diagnosed with a brain tumor, your mind can easily go to the worst case scenario. But today, with new treatments and early detection, there are a lot of facts that can offer hope. Today I'm joined by Dr. Oluwaseun Omofoye. a neurosurgeon who leads the Brain Tumor program at Tidelands Health to tell us about the common symptoms of brain tumors, cutting edge treatment options, and more in this Better Health podcast.

Thank you so much for joining us today to talk about this very important topic. To start off with, can you tell us what a brain tumor is and how common it is? What the differences are between benign and malignant?

Dr Oluwaseun Omofoye: Yes, my pleasure to be here and thank you for having me. So a brain tumor is essentially an abnormal growth in the brain that has taken up space and it can cause pressure on the brain and it can be a growth from either from the brain tissue itself, meaning it's growing from the brain or sometimes even from the covering of the brain, putting pressure on the brain. And sometimes it can be a completely foreign growth, like a metastasis, which is a tumor that spreads from somewhere else and gets to the brain. For example, lung cancer can spread to the brain and cause a brain tumor. And in terms of the classification between benign and malignant really depends on how quickly it's growing. So if it's a tumor that's growing uncontrollably and growing very quickly, those are usually malignant. But if it's growing very slowly over time, that's considered the benign brain tumor. And most of the time, if it's a tumor that's spread from somewhere else, like a cancer already known in a different part of the body that spreads to the brain, those are typically considered malignant brain tumors.

Maggie McKay (Host): Is there a general age group that experience brain tumors or is it pretty much across the board?

Dr Oluwaseun Omofoye: There are different types of brain tumors. There are actually over 150 different types of brain tumors that have been identified. And the most common brain tumor that we see is metastasis. And these are tumors that spread from somewhere else in the body. And usually, lung cancer is the most common cause of this. And typically, patients who have cancer are usually older patients. So, overall brain tumor is common in older patients. And the first most common source of metastasis has been lung cancer. About almost a half of all patients who develop lung cancer end up developing a brain tumor. And that's followed by breast cancer as sort of the second most common cause of metastasis. And then, other kind of cancers, like skin cancers, like melanoma can spread to the brain and cancers of the blood like lymphoma, of the white blood cells, of the lymph nodes, those can spread to the brain. GI cancer, like colon cancer, kidney cancer as well. And so, we tend to see it more commonly elderly patients.

Maggie McKay (Host): So what are the symptoms? What are the first signs?

Dr Oluwaseun Omofoye: The symptoms, they can vary a lot. And sometimes they overlap with stroke-like symptoms because it's affecting the brain function and they can usually present depending on where the brain tumor is located in the brain. So for example, if it's a brain tumor that's located in the frontal lobe, for example, patients can have personality changes; for example, they can become confused, lethargic, really hard to wake up or having even personality changes, becoming more aggressive. If it's in the area of the brain that controls motor function, so the motor cortex, which controls their movement, a patient can present with weakness, either weakness in the hands or legs or even paralysis. If it's in the sensory area of the brain, which provides a sensation to be able to feel things, patient can present with numbness of the hands, the legs, or any other part of the body. If it's in the temporal lobe, which controls memory and speech, patients can have slurred speech, which also overlaps with signs of stroke or difficulty finding the right words, memory loss, hallucinations. And in other parts of the brain, they can cause like vision loss, if it's in occipital lobe, which provides vision, so patients may not be able to see a particular field of their vision into the left side or the right side.

And one of the most common symptoms is headaches, which tend to be multifactorial. People have headaches for different reasons. So not everyone who has a headache obviously has a brain tumor. But typically, when patients have headaches, that's associated with some kind of neurological deficit, like I mentioned before, that's concerning for a brain tumor. Another part of the brain that we sometimes see brain tumor is the cerebellum. That's the part of the brain that controls balance and coordination. So sometimes patients can have difficulty with coordination, reaching and grabbing things, it's difficult; dropping objects or falling, stumbling, not being able to walk in a straight line. If they do have headaches, usually the headaches is associated with nausea and vomiting as well.

And another common symptom is seizures. So a lot of patients who have brain tumor sometimes present with a seizure as their first presentation. And with a seizure, patients can have convulsions, basically shaking, which is associated with biting of the tongue, sometimes losing their urine, even sometimes just staring off into space. A patient may be talking with you and then suddenly they stare off and they lose their speech. That could be a sign of seizure. So those are the common symptoms that we.

Maggie McKay (Host): So let's say you're having symptoms. You go to the doctor, you get a diagnosis of having a brain tumor. Then what? What are the cutting edge treatment options at Tidelands?

Dr Oluwaseun Omofoye: So at Tidelands, we focus on the multidisciplinary approach to treating brain tumors. So the options range from a combination of surgery, radiation and chemotherapy. Depending on the type of brain tumor kind of determines what the treatment modality would be. And usually, we will walk with a patient to try to figure out what type of brain tumor we think it is.

So first step is a patient will get some kind of imaging, and it will most of the time start with a CAT scan, then followed by an MRI. Based on the MRI, we can make some educated guess to what we think it is. If it's a malignant tumor, if it looks like a malignant tumor, for example, then typically, it's a combination of surgery, chemotherapy and radiation as the common treatments.

The most aggressive brain cancer we know of, it's called glioblastoma. And this is a rapidly-growing tumor that US senators like Ted Kennedy and President Biden's son was diagnosed with as well. And unfortunately, this is a diagnosis with poor prognosis. But the patients that do the best with this diagnosis typically would start with surgery. And usually, if you can get most of the tumor out safely, that puts the patient on a path to prolonging their life and increasing their outcomes. So what I focus is in surgery. And with surgical management of brain tumors, it's important to use the right equipment. And there's a lot of technology involved nowadays that helps to be able to take out a brain tumor safely by minimizing the side effects.

So here are at Tidelands, we have advanced robotics that we used with brain surgery. So if a patient needs a biopsy, for example, historically, the way it's done is you'll drill a hole about the size of a dime into a patient's skull, and then go in and try to get a Small sample of a tumor. there's a newer technology and, at Tidelands, we're actually the first hospital in South Carolina to be able to use this advanced cranial robotics to be able to do a brain biopsy. And this involves drilling a small hole about the tip of a pen, for example, into the skull. And then, we insert a needle into the brain. We use the patient's MRI, which we use a GPS system. It's kind of like a navigation system that we use to merge the patient's MRI with their skull. And then, we can track as we are doing the biopsy exactly where we are in the patient's brain, look on the MRI to get a good sample of the tumor to biopsy.

The other newer areas of technology are using things like minimally invasive approaches. So, we can do brain surgery through a small tube, for example. We have tubes with a diameter or width of about 13 millimeters, and we can dock that into the brain, and get to the tumor, if it's a tumor that's deep within the brain, and take out the tumor through that tube. And the reason why we do this is to basically minimize any damage to the normal brain structures and just focus on taking the tumor out safely.

We also use an advanced microscope, which has what we call virtual reality capabilities. So, while we use that navigation system to merge the patient's skull to their MRI and their brain tumor image on the MRI, we can use the microscope. Basically, once we take part of the skull off to get to the brain and we look through a microscope, we can see an outlay of the patient's MRI through the view on the microscope and that helps localize exactly where the tumor is. And this is important for some brain tumors that are not distinct from the normal brain. And so we can basically take out just the tumor itself while preserving normal brain tissue.

The other things we use are things like ultrasound, for example. We use that during the surgery before and after taking out the tumor to make sure we got all of the tumor out. So those are some of the technologies we use in the operating room.

Maggie McKay (Host): Sounds like you have a lot of options, which is a good thing. Compared to, say, even a decade ago, does somebody with a brain tumor have a better chance now of survival than 10 years ago?

Dr Oluwaseun Omofoye: Yes, I would say so, depending on what type of tumor it is. So, obviously, with the benign tumors, tumors like meningiomas, for example, these are tumors that grow from the covering of the brain, most of those types of tumors are benign and in terms of the chances of the tumor coming back. So typically, patients who have surgery for meningiomas do really well.

Now, the other end of the spectrum is glioblastoma, which I had mentioned is the worst prognosis, patients are living longer, but it's still a poor prognosis. But compared to 10, 20 years ago, we've been able to increase survival by a number of months. Obviously, there are a lot more medical therapy that's available. So things like immunotherapy, for example, using the patient's immune system to tackle the tumor is new. There's also newer technologies such as there's something called tumor-treating fields, which is basically using an electrical field to prevent the tumor from growing. We use this for patients with glioblastoma, and this is a technology that we can prescribe patients after surgery as well.

Patients are living longer overall in terms of cancer in general. So, even though patients with lung cancer and breast cancer are living longer, we are now seeing those tumors spread into the brain. So even though we've been able to prolong survival in patients with cancer, because those patients are living longer, we are now seeing more brain tumors as well. But there's active ongoing research in brain tumors.

Maggie McKay (Host): And do genetics play a part at all? Like, let's say one of your parents had a brain tumor. Is it passed on or how does that work?

Dr Oluwaseun Omofoye: There are some brain tumors that have genetic syndromes that's associated with them. But that's a small percentage of patients with brain tumors. Most patients who develop brain tumors has a random mutation that causes the brain tumor to happen. But there are a few genetic syndromes that can cause familial brain tumors to happen. But those are not as common, that's just the random mutation.

Maggie McKay (Host): Once in the clear, how often does a patient who has had a brain tumor have to come back for followup appointments?

Dr Oluwaseun Omofoye: Usually, when I do surgery to take out a brain tumor on a patient, we typically see them back in about two weeks after surgery. And that's just to make sure the incision is healing okay, the wound is healing well, and the patients are doing well. And typically, after that, I like to see them back about three months after that, just to check in to make sure they're doing well.

If they have a benign tumor, like a meningioma, for example, typically based on the results or about the two-week mark, we get the results of the diagnosis back because we send that to pathology. They do a bunch of genetic and molecular studies on it to identify the specific type of brain tumor they have. And if it turns out to be a slow-growing tumor, usually after the three-month mark, the patient can come back in about a year and oftentimes we'll follow patients to get an MRI every year to make sure the tumor's not coming back.

If it's a very aggressive brain tumor, like, you know, glioblastoma, for example, those patients are followed very closely because that type of tumor has a high chance of recurrence. So, oftentimes, the tumor can come back, you know, months after surgery is done. And that's why it's critical that patients get chemotherapy and radiation, you know, after surgery to reduce the chances of the tumor coming back. But those patients will typically get MRIs about every two to three months, just to follow them closely to make sure they're doing well.

Maggie McKay (Host): Is there any research going on right now that might offer some new therapies in the future?

Dr Oluwaseun Omofoye: Yes. There's a lot of research going on specifically in the area of glioblastoma and other types of gliomas. President Biden just announced relaunching of the Cancer Moonshot, which is a US government initiative that was launched in 2016 to tackle brain cancer and also to reduce the death rate from cancer in general, to cut it to about half within the next 25 years. So the NIH, the National Institute of Health and other private, governmental groups interested in reducing impact of brain tumor in the society and the families and caretakers and increasing the long-time survival.

So there's a lot of tumor in immunotherapy, using the immune system. There are lots of research in terms of using a combination of different chemotherapy agents. So there are clinical trials that are going on that are testing different agents to look at specific brain tumors and other areas of research, like I talked about and in terms of using electrical fields, for example, to stop brain tumors from growing quickly.

And one of the things that we are looking at here currently is there's a research group in South Carolina that they can take a sample of the tumor. So when we take a patient to surgery, either doing a biopsy or doing a resection of the brain tumor, we can send a sample of the tumor to this research lab and what they do is they basically grow the tumor cells in the lab and create sort of what's called an organoid of the tumor. And then, they can test that against 12 different chemotherapy agents. And within one week of doing the surgery, we can get that results back and we can tell the patient that, "Hey, your tumor is going to be more responsive to this specific type of chemotherapy," so that patient can get that specific treatment as opposed to waiting months after starting the chemotherapy and then finding out the patient is not responding to it. So that's one of the areas that we will be launching in the next few months here at Tidelands as well, to be able to provide patients that opportunity, so basically creating personalized care and personalized medicine.

Maggie McKay (Host): In closing doctor, is there anything else you'd like to add?

Dr Oluwaseun Omofoye: Yeah, I'd just like to say, you know, here at Tidelands, we have a multidisciplinary brain tumor program. Our mission is to be able to provide patients with brain tumors in our region the best possible care they can receive anywhere else in the country. And our team here includes fellowship-trained physicians and fellowship- trained in neurosurgical oncology, meaning, you know, I've spent additional year of training after my neurosurgery residency exclusively dealing with brain tumors. And we have experienced medical oncologists, neuroradiologists, pathologists, and radiation-oncologists here who treat patients with a multidisciplinary approach and provide individually tailored care with compassion and hope for patients, their caretakers and their family.

Maggie McKay (Host): Well, that sounds like a lot of hopeful information, which is good to hear. Thank you so much, Dr. Omofoye, for your expertise and sharing your knowledge with us. We appreciate your time today.

Dr Oluwaseun Omofoye: Thank you. It's a pleasure.

Maggie McKay (Host): To learn more, please visit tidelandshealth.org. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is the Better Health Podcast. I'm Maggie McKay. Thank you for listening.