U.S Senator Edward Kennedy leaves Massachusetts General Hospital in Boston on May 21, 2008.
Somewhere deep inside the brain of Senator Edward Kennedy, the neurons in his left parietal lobe were becoming angry. Something had invaded their territory in this part of the brain — located at about eye level, just behind the ear — and they were about to react in a way that would frighten the Senator and those around him. The neurons sparked a burst of electrical activity, causing a seizure that made parts of his body become rigid and start to shake.
As with most patients, there was really no way for the Senator to pick up on any warning signs prior to that first seizure. A vague headache at some point in the past, possibly some numbness in his right arm, maybe even the inability to think of a certain word when speaking. Any of these things may have easily been forgotten or dismissed. A seizure, on the other hand, is the medical equivalent of a flashing neon sign. For doctors, it is a call to action, spurring those in my field of neurosurgery into medical mystery-solving mode. What exactly caused the seizure? In Kennedy's case, an MRI scan revealed the source of the neural storm: a big clump of cells that probably looked like an octopus with tentacles reaching into other areas of the brain. It was a tumor, and doctors had to figure out just how bad it was.
The only way to know for sure would be to drill a hole in the skull — using something akin to your basic Black & Decker — and insert a probe to remove small pieces from the middle of the tough, fibrous mass. Under a microscope, a pathologist would see the telltale cells that are consistent with a malignant glioma, a brain tumor of the very worst kind. Each year in the U.S., some 40,000 people receive a diagnosis of this fast-growing cancer — which in its most malicious form, known as a glioblastoma, often forces the neurosurgeon to tell the patient that chances are they won't live longer than a year, even with the most aggressive therapies. In the past 20 years, the grim survival statistics have barely budged.
Recent years have brought new treatment options. Doctors can now perform what is known as a functional MRI scan. If the Senator hasn't had one already, he will likely be asked during such a scan to speak or raise his right arm — or to simply think about doing either of these things — and the resulting images will show if the tumor is located in the parts of the brain responsible for speech or movement. Depending on how close the malignancy is to these critical areas, doctors may decide against surgery, or they may forge ahead, making Kennedy stay awake during the operation and asking him throughout the procedure to talk and move his arm. Any abnormalities with these activities, and the surgeon stops cutting.
Unfortunately, more times than not, surgery simply isn't that effective in treating gliomas. Cut out this type of tumor, and it will just keep growing back. Chemo and radiation generally aren't much help either. Patients and their doctors may have the option of turning to some promising new therapies like the so-called brain-tumor vaccine that combines a patient's tumor cells with his own white blood cells. According to Dr. Michael Gruber, Medical Director of the Brain Tumor Center of New Jersey, this concoction triggers the immune system to attack the tumor; in a small study, it raised the two-year survival rate to 50%, nearly double that of non-vaccine recipients. There is also a type of gene therapy that injects custom-made viruses into tumor cells, causing them to die or at least become more susceptible to radiation. These aren't great choices, which means the Senator may have to rely as much on his own strength and optimism as on modern medicine.