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First Treatment Approach is Critical

Program: Skull Base Surgery
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Andrew Schorr:

So one of the things with any cancer I believe but, I think where these cancers are located at the base of the skull especially true, isn't it critical that when somebody has a diagnosis of a cancer like that, and first of all you want to get the most accurate diagnosis, not just where there's a cancer but all its properties. As you said there can be many different types. Has it spread to the brain, or not? Where did it come from? What are the cells exactly? Really the first approach in treating this cancer is critical. And unfortunately I'm sure you see at M. D. Anderson people who had initial treatment somewhere else and it's maybe sometimes difficult to play catchup as a have a second line of treatment. Would you agree that that first approach is critical?

Dr. Hanna:

Absolutely. I couldn't agree more. The model for this is that your first shot is your best shot. And it couldn't be more true for these types of tumors. And you're absolutely right. The first, the very first thing we do is that if patients come in with a diagnosis before we go any further we want to revisit the diagnosis. We want to confirm that indeed this is the case, that this is the type of tumor we're dealing with. If they've had a biopsy elsewhere we bring that tissue here to be looked at by a special either head and neck pathologist or a neuropathologist that spend their career looking at these types of tumors as opposed to seeing one or two in their lifetime.

And I cannot stress to you how important this is. We have had examples where the diagnosis has changed, changed enough to affect the treatment recommendations. In fact we've had cancers that were diagnosed and we've found that they were not and tumors that were felt to be benign and we felt they were cancerous. And we've found cancers of one kind and we've changed them to a different kind based on our reading, moving their treatment from surgery to nonsurgery or vice versa. So I think you're absolutely right that you have to go and analyze specifically what you're dealing with.

And then the second phase is that once you've done that you have to come up with, of all the different options of treatment, surgery, radiation, chemotherapy and other treatments, since every tumor is different and every patient is different there is no sort of cookbook way of recommending the treatment. Like in Gerald’s case one of the key goals for us in addition obviously to curing his tumor was to preserve his vision because he's a pilot and he enjoys flying. And I remember when I met with him that obviously he wants to live, that was a given, but that his quality of life was very important to him, and flying was one of those things that he really enjoyed tremendously.

So one of the critical options for us that Dr. DeMonte and I had to grapple with, what is the best treatment recommendation for Mr. Ahrens that would preserve his eye. I believe he was told before he came here that he would lose his eye. And we explored whether starting with chemotherapy would be a good idea to shrink the tumor, but we felt that in the unlikely event that the tumor grows instead of shrinks on chemotherapy our window of opportunity to save the eye might be lost. And in his particular case we proceeded with surgery first. In other cases with similar tumor we may have chosen to start with chemotherapy. So this is just an example of how the multidisciplinary team works. Because when we see patients with skull base tumors we not only get the surgeons involved we get the medical oncologists and the radiation oncologists, the diagnostic radiologists and the pathologist s, and everybody else involved so that we come up with the best recommendation for each individual patient.

Andrew Schorr:

Well, thank you so much for taking us with that and relating it to Gerald's case.

We're going to take a brief break, and when we come back we're going to discuss some of the latest treatments that you have available, these tools you have with your expertise and the art of medicine of course that you can bring to bear today to people with skull base tumors at M. D. Anderson.

I'm Andrew Schorr. Stay tuned for more Patient Power brought to you by M. D. Anderson Cancer Center.

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