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Kennedy Diagnosed With Malignant Tumor

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Dr. Fabio Roberti
Neurosurgeon, Professor of Neurosurgery, The George Washington University Hospital
Tuesday, May 20, 2008; 3:30 PM

Sen. Edward M. Kennedy (D-Mass.), who was hospitalized in Boston Saturday after suffering a seizure, has a malignant brain tumor, according to a preliminary diagnosis released today by physicians at Massachusetts General Hospital.

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A biopsy of a portion of Kennedy's brain identified a malignant glioma as the cause of the seizure, Lee Schwamm, the hospital's vice chairman of neurology, and Larry Ronan, Kennedy's primary care physician, said in a statement.

Dr. Fabio Roberti, a neurosurgeon and professor of neurosurgery at The George Washington University Hospital in Washington, D.C., was online Tuesday, May 20, at 3:30 p.m. ET to answer questions about this particular type of cancer and its treatment.

A transcript follows.

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Fairfax, Va.: They said Kennedy had a seizure and that the tumor was diagnosed after that happened. Did the tumor cause the seizure? Was it a warning?

Dr. Fabio Roberti: Yes, the tumor did cause the seizure. The brain tissue reacts to the presence of the tumor with electrical activity

that leads to a clinical manifestation that we call a seizure. Such seizures can manifest itself in a different way according to the location of the tumor. Some seizure may lead the patient to lose consciousness while others can give a warning sign called an "aura" (such as visual disturbances and slurred speech).

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Washington, D.C.: How serious is a malignant gioma and do people recover with treatment or an operation?

Dr. Fabio Roberti: Malignant gliomas are serious conditions which require medical and surgical evaluation and treatment. Upon recovery from the surgery usually other treatments are required such as chemotherapy and radiotherapy. In a non- complicated case the recovery from the surgical procedure may be quick and allow the patient to leave the hospital in a few days after the surgery awaiting further treatment which is decided on a case by case basis according to the type of tumor.

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Milwaukee, Wisc.: Is removal of the tumor easily done via surgery and will Sen. Kennedy need a stent put in place?

Dr. Fabio Roberti: The difficulty of the surgery depends on the location of the tumor into the brain. Superficial lesions are usually easier to access and remove surgically. Nevertheless, today's technology may allow the surgeon to remove the tumor located in deeper parts of the brain. Stents are usually utilized for vascular pathology. Therefore, treatment of such disease does not require placement of a stent.

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Annapolis, Md.: The doctors said that nothing more would be known about Kennedy's condition until Monday. Why that long? Does it take that long to get results from the tests?

Dr. Fabio Roberti: After a biopsy of the tumor the pathologists will run the indicated tests on the sample that the surgeon obtained to determine the final diagnosis. That is why this "technical" time is required.

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D.C., formerly of Massachusetts: Genetics seems to play a role in longevity, and Sen. Kennedy has a lot of long-lived relatives on his mother's side. Could these longevity genes help him in his battle against cancer? (Obviously, I wish him all the best.)

Dr. Fabio Roberti: There is no data to support this statement. Nevertheless, genetics play a fundamental role in the genesis of this kind of tumor.

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Philadelphia, Pa.: Hi. I just read on a competing site that the prognosis on this type of tumor isn't good. On the other hand, Arlen Specter had a brain tumor (malignant, I believe) years ago. Is/was his a different type? Is he lucky? What can you tell us about the different situations? Thanks.

Dr. Fabio Roberti: I am unable to provide you with this information with the data that we have available at this time. Malignant gliomas are usually not cured with surgical intervention alone. Therefore, the long term prognosis depends on several factors such as age, location and type of the tumor as well as the treatment chosen after the tumor has been surgically removed and that can be different from patient to patient.

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Jacksonville Beach, Fla.: What is the prognosis for someone with this type of tumor?

Dr. Fabio Roberti: I think I just answered this in my previous question and with the data that we have I am unable to provide you with a comment.

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Washington, D.C.: Does Sen. Kennedy's age preclude him as a candidate for surgery?

Dr. Fabio Roberti: No, surgery can be performed at any age unless there are other serious medical conditions that warrant more conservative treatments.

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Dallas, Tex.: Is the Gamma knife an option for those with Sen. Kennedy's diagnosis?

Dr. Fabio Roberti: Gamma knife (radiosurgery) is considered an optional treatment in patients with a recurrence of the tumor or patients where the tumor is not controlled with the therapies we have already discussed (such as surgery, conventional radiotherapy and chemotherapy).

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Washington, D.C.: So how serious is serious? What's the chance of death during a surgical procedure? How long do most people live after removing these tumors?

Dr. Fabio Roberti: Any surgery has the risk of intraoperative complications. The average median survival of patients with a malignant gliomas after conventional therapy varies depending on the type of tumor, location, size and condition of the patient. Every patient is different and so is the response to the treatment

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I thought he was being monitored.: How big must a tumor be before detected? What are some of the tell-tale signs that would harbinger its existence? What is required to detect this condition in the very early stages? The fact that it was not detected: what does this hypothetically say about whether the right/enough monitoring was being done and about our medical system in general?

What percentage of the 50 million who do not have access to health care can be expected to experience this tumor?

Dr. Fabio Roberti: Even a small tumor can produce "warning" signs (such as seizure) but usually common symptoms such as headache, nausea or vomiting occur when the tumor is compressing the surrounding brain. Unfortunately, the first diagnosis may not be made until the tumor is fairly large in size.

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Washington, D.C.: The statement from the doctors did not discuss surgery as a potential treatment. Is it safe to assume that means surgery isn't possible here? And if that is the case, is the prognosis usually pretty grim?

Dr. Fabio Roberti: As I previously mentioned, not all the patients are surgical candidates. Therefore, it is possible that in some cases surgery is not the best treatment.

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Minneapolis, Minn.: Sen. Kennedy's glioma is located in the parietal lobe of the brain. What can you tell me about this area and its function.

Dr. Fabio Roberti: A tumor located in this area may manifest itself with sensory deficits (such as numbness and tingling), seizures, visual disturbances and sometimes, when the tumor is large, even with weakness or speech difficulties.

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Washington, D.C.: Is it possible that the seizure was the first indication of this problem? How long does it take for a tumor to develop? Would MRIs of the brain been taken when he had the clot in his neck?

Dr. Fabio Roberti: Yes, a seizure may be the first symptom of a growing brain tumor. Time of the progression of the tumor depends on the type of the tumor and its grade of malignancy.

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Brookline, Mass.: Are seizures similar to the ones that Kennedy suffered any indication of the stage of development or type of the malignant glioma?

Dr. Fabio Roberti: No, even a very small tumor if located in particular areas of the brain such as the temporal lobe may lead to a seizure disorder.

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Muskegon, Mich.: AT UCLA, I believe that post surgery for gliomas, a "shell" (for lack of better nomenclature) is placed at the post surgical area to further treat cancer cells in that area of the brain. Is this type of chemotherapy applied at Boston?

Dr. Fabio Roberti: I believe you are referring to a form of intraoperative chemotherapy that has been shown to be useful in the treatment of some malignant gliomas. This treatment may be performed at the time of the surgery once most of the tumor has been removed. This treatment is available nationally.

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Fairfax County, Va.: I know prostate cancer goes slower in older men. Is that true of this type of cancer? Is it helpful the senator is older in terms of its rate of spread, or is that irrelevant?

Dr. Fabio Roberti: No, from what is known, this appears to be a primary brain tumor. You were referring to what is called a metastic tumor to the brain (tumors that start somewhere else in the body and spread to the brain).

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Trenton, Mich.: What percentage of malignant gliomas end up being a glioblastoma mutliform, a very serious glioma?

Dr. Fabio Roberti: A glioblastoma is the most frequent brain tumor. It accounts for about 15% of all intracranial neoplasms.

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Dr. Fabio Roberti: Goodbye. Thank you for this opportunity to discuss such an important topic

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