Ask the Expert: Why are brain tumours so difficult to cure?

Because there are so many different types of brain tumours, and their locations within the brain can vary, it is difficult to find an overall cure for the disease. Over the past several decades, however, control treatments like radiation and surgery have come a long way.

Cure = After treatment, the disease has been completely eliminated.

Control = Progression of the disease is minimized and symptoms are managed in an acceptable manner.

Why does the tumour type and location matter?

Perhaps the single most important characteristic of a brain tumour is its type. “Type” in the case of brain tumours is made up of several characteristics: primary vs. secondary, malignant vs. non-malignant and the grade of the tumour.

  • “Primary” means the tumour originates in the brain, while “secondary” means the brain tumour has metastasized from another origin point in the body.
     
  • Malignant tumours (also known as cancerous tumours) grow and divide rapidly, invading normal cells. Non-malignant tumours (sometimes referred to as benign) grow and divide slowly, tending to not attack normal tissue.
     
  • Grades for brain tumours can range from low to high, with low meaning the tumour cells are slow-growing and high meaning the tumour is aggressively infiltrating healthy tissue. High-grade malignant tumours can be difficult to remove surgically.

Location also plays an important role in the treatment of brain tumours. When a tumour is in or near an eloquent part of the brain (i.e. parts of the brain that control speech, motor functions and senses), treatment with either surgery, radiation, or both, is more of a challenge due to the risk of injuring normal brain tissue.

Also, in general, it is difficult to get chemotherapy drugs to brain tumours. This is because of the blood-brain barrier, which is a natural filter within the body and only allows some substances through from the blood to the brain. Because of this limitation, only a few chemotherapy drugs can cross the blood-brain barrier.

When might a brain tumour be inoperable?

Medical technology and surgical techniques have dramatically evolved over the past 50 years. From a purely technical viewpoint, any area of the brain is surgically accessible. However, that does not mean that surgery is the best treatment option for everyone.

For some, surgery may not be safe. Many areas of the brain are important because they involve a person’s ability to carry out everyday functions. Depending on the location of the tumour, a neurosurgeon may determine that surgery could cause irreparable damage and advise against operating.

Additionally, surgery is not the best treatment option for every type of brain tumour. There are types of brain tumour that may disappear with radiation therapy or chemotherapy and do not require surgical removal. Occasionally, it is possible to identify these types of tumours with an MRI, though often a surgical biopsy is required.

Lastly, surgery may not be appropriate. There are times when a brain tumour appears so extensive on an MRI scan that surgical removal is not only unsafe but also inappropriate. These types of tumour are usually malignant and so extensive that even a big operation will leave large amounts of tumour behind.

A neurosurgeon may advise against even a first operation. However, the neurosurgeon might recommend a smaller procedure, such as a biopsy. Also, there are cases where multiple brain surgeries have been done, as well as radiation therapy and chemotherapy, and the tumour still recurs, often quickly. This is an indication that the tumour is highly malignant and aggressive. In this circumstance, the neurosurgeon may counsel against further surgery.

It’s important to remember that while a cure is not available today, researchers and health care professionals across Canada and the world are working together to improve the quality of life for every patient and survivor as they strive towards the ultimate target – the end of brain tumours. 

Thank you Dr. Joseph Megyesi for taking the time to answer this important question. Dr. Megyesi is an accomplished neurosurgeon; his research work and published articles have won a number of prizes in both Canada and the United States. He is also a long-time supporter of Brain Tumour Foundation of Canada and was the chair of the organization’s board of directors for several years. In addition, Dr. Megyesi is an integral member of the Research Committee
and the Programs & Services Committee, helping guide decision-making around annual research granting and the
resources and services available for brain tumour patients and their families.

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