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Doctors Diagnose Kennedy With Malignant Brain Tumor
By Miranda Hitti
WebMD Health News
Reviewed By Louise Chang, MD
May 20, 2008 — Sen. Edward M. Kennedy, 76, has been diagnosed with a malignant glioma, a type of brain cancer.
A glioma is a brain tumor that begins in glial cells, which are cells that surround and support nerve cells.
Kennedy remains at Massachusetts General Hospital, where he has been since he suffered a seizure on Saturday.
His doctors — who include Lee Schwamm, MD, vice chairman of the neurology department at Massachusetts General Hospital, and Larry Ronan, MD, a primary care physician at Massachusetts General Hospital — today released the following statement about Kennedy's condition:
"Over the course of the last several days, we've done a series of tests on Senator Kennedy to determine the cause of his seizure. He has had no further seizures, remains in good overall condition, and is up and walking around the hospital. Some of the tests we had performed were inconclusive, particularly in light of the fact that the senator had severe narrowing of the left carotid artery [which supplies blood from the heart to the brain] and underwent surgery just 6 months ago. However, preliminary results from a biopsy of the brain identified the cause of the seizure as a malignant glioma in the left parietal lobe. The usual course of treatment includes combinations of various forms of radiation and chemotherapy. Decisions regarding the best course of treatment for Senator Kennedy will be determined after further testing and analysis. Senator Kennedy will remain at Massachusetts General Hospital for the next couple of days, according to routine protocol. He remains in good spirits and full of energy."
WebMD spoke about Kennedy's diagnosis with Deborah Heros, MD, associate professor of clinical neurology and neuro-oncology at the University of Miami Leonard M. Miller School of Medicine. Heros is not involved in Kennedy's treatment or diagnosis.
What do you make of the doctors' statement?
I think that he had a biopsy and it showed that he had what's called a malignant glioma, and seizures can be a presenting symptom for a brain tumor. As they had mentioned, usually we use radiation therapy and chemotherapy for treatment of this tumor after surgery. It appears as though Massachusetts General Hospital will be discussing that further and that we would expect him to begin treatment.
The newer treatments available include oral chemotherapy. Oftentimes, the oral chemotherapy is combined with the radiation treatments over six weeks and people tolerate it well. Hopefully, he'll be released from the hospital soon and be able to begin his treatment as an outpatient.
You mentioned surgery. What kind of surgery would that be?
Typically surgery can be a biopsy alone to identify and document the specific type of tumor and prove that it is a tumor. A biopsy alone is done if the tumor is located either deep in the brain or in an area where removing tissue could cause neurological impairment [brain damage]. Apparently, this may have been on the left side of his brain, where speech function is located. So that may have been the reason why they chose to do a biopsy rather than what we call a craniotomy, with tumor removal. If the tumor is in an area that can be operated on, sometimes a larger surgical procedure is done to remove as much tumor as possible. The limiting factor is the location in the brain.
What is the left parietal lobe involved in?
The left parietal lobe does control speech and various parts of language so that the decision needs to be made by the neurosurgeon of what type of surgical procedure is the safest.
Are radiation and chemotherapy standard?
Very standard. Even if it is located in an area that can be operated on more extensively, we know we cannot remove all of the tumor because it is what we call an infiltrating tumor. We talk about rootlets or tentacles of tumor that grow into the brain, almost like fingers ... We don't [expect] to be able to remove all of it surgically, so we really rely on ... radiation and chemotherapy.
What is the prognosis for this sort of condition?
Well, it is a serious tumor. Patients tolerate the radiation and chemotherapy well, and we have many patients that have responded well to this combination of treatment. I think that's how we usually describe the prognosis — it's a wait-and-see type of tumor where we have to see how well he responds to additional treatment.
How rare is this type of tumor?
Every year in the United States, there are about 18,000 new primary brain tumors, and over half of those tumors are some type of malignant glioma.
Do you think he may have had this for a while? How quickly do these develop?
That's a question that most people usually ask and we don't know. I think for some patients, it's very active or aggressive from the very beginning, and so they can grow very quickly, probably over weeks to months, and that's probably his type. Others start as a less active tumor and then over time become more active, and those can be present for a longer period of time. It sounds like his symptoms developed rather recently, and that suggests to us that it probably has not been there very long.
The doctors mentioned other tests and analyses. What types of additional tests would the doctors be doing?
I suspect they may be doing some more specialized pathologic studies on the [biopsy].
Is that a tumor grade or staging?
They may try to set tumor grade. This is not a tumor that tends to metastasize [spread] outside of the nervous system, so we don't typically stage it like we do other tumors that can spread to lymph nodes or to other organs in the body. But we do oftentimes a grading of the tumor cells to see how active or aggressive the tumors would be. That may be what they're working on with special staining and special tests from the neuropathologists. There are also some newer, what I would say investigational, studies looking at the pathology to try to determine what types of treatment might be appropriate for him, more specific types of treatment.
After the treatment, what sort of recovery is likely or possible? Would he be able to step back into his job?
That would depend totally on his energy, how he's feeling overall from the treatment, and if he has any neurologic deficits from the tumor itself; how intact his speech is and his language function.
Anything else you would want to add?
The hope that he'll be out of the hospital soon and be able to feel well during the treatment and remain active and have good time with his family and continue to be active in his political career.
SOURCES: Statement from Lee Schwamm, MD, vice chairman, department of neurology, Massachusetts General Hospital, and Larry Ronan, MD, primary care physician, Massachusetts General Hospital. National Cancer Institute: "Glioma." Deborah Heros, MD, associate professor of clinical neurology and neuro-oncology, University of Miami Leonard M. Miller School of Medicine.
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