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Spine-Directed Oncology Program Archive Questions

Below are Dr. Kwok’s answers to Spine-Directed Oncology Program questions
received through the Ask the Expert feature.

This content is provided for informational purposes only, and is not intended
to be a substitute for individual medical advice in diagnosing or treating a
health problem. Please consult with your physician about your specific health
care concerns.

Now displaying records 1 to 15 of 29.

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Q : 1

Can tumors from neurofibromatosis be removed with the Cyber Knife procedure?

It cannot be "removed." The Cyber Knife, and other forms of radiation delivery, kills the tumor but it doesn't necessarily get smaller. I would only give radiation to a patient with neurofibromatosis as a last resort.

Q : 2

My 22-year-old brother was diagnosed with having an inoperable glioblastoma multiforme tumor located at t12 in his spinal cord. He had six weeks of radiation therapy. If his tumor is still present after his next MRI scan, would it be possible for him to receive trilogy therapy?

Spinal cord glioblastoma multiforme (GBM) are very complex. Given the rarity, no firm recommendations exist. The real challenge to giving more radiation via trilogy or other methods is that it will certainly cause paraplegia if not already. Given the potential GBM patterns of failure throughout the cranial-spinal axis, more radiation may not be the answer and perhaps experimental chemotherapy or Avastin should be strongly considered.

Q : 3

Can a PET scan be used on a patient with a pacemaker to determine if the patient has cancer of the spine?

Yes, it is safe to perform a PET scan with a pacemaker.

Q : 4

I was diagnosed with spinal hemangiomas. I am experiencing pain and restricted movement. What can I do to improve this? The doctor I saw said that nothing can be done due to the location of the tumors.

There is data to suggest radiation therapy can work in spinal hemangiomas. However, we always try to avoid radiation for benign conditions if we can given its theoretical risk of a radiation-induced cancers. I would maximize physical therapy or exercise/stretching regimens before considering radiation therapy. You would be surprised how effective these can be.

Q : 5

My brother has been diagnosed with cancer of the spine stage 4, grade 3? This is the first time I have heard of a grade being ascribed to a cancer diagnosis. What does it mean?

Stage 4 typically refers to the cancer spreading throughout the body and grade 3 typically refers to how the tumor looks under the microscope. In stage 4 cancers, chemotherapy is very important and radiation is typically reserved for pain relief.

Q : 6

Is there a study for rising PSA after radical prostatectomy? It's been about 5 years since the operation and I have had hormone treatment, but my PSA is rising slowly and my oncologist says I may have to have hormone treatment again. I am 67.

Yes, you can receive radiation therapy for it for curative intent. In fact, you may be eligible for RTOG 0534 which is a protocol available at UMMC.

Q : 7

I'm told that I have severe arthritis of the spine along with degenerative disks. Would a spinal tap be sufficient to check for cancer?

No. We typically don't check for cancer. Clinical symptoms and x-ray appearance are generally enough to diagnosis someone with arthritis/disc problems.

Q : 8

My mom has advanced endometrial cancer that has spread to her L5 and sacrum. Currently she is not going under any treatment. Can you help her?

For recurrent cancer, the standard is chemotherapy. Radiation is typically reserved for when the cancer causes symptoms such as pain or bleeding, which can be performed at many medical centers.

Q : 9

I had breast cancer 15 years ago that has returned with metastasis to the bones. Currently, I am taking chemotherapy pills and Zometa through an IV every month. Are there any other treatment options?

The standard of care for breast cancer that has spread to the bones is Zometa and chemotherapy. It sounds like you are getting the correct therapy. Radiation only attacks one area at a time while chemotherapy attacks all of the cancer. Zometa is a medication designed to strengthen the bones.

Q : 10

My mom is 72 and is suffering greatly from bone cancer. I was told the tumors were small and and there were many approaches that could be tried last year. No one ever said anything about removing them. Her doctors kept trying chemo but she got too sick. Now they have her on medication for pain. Is there really nothing else that can be done?

If the bone lesions are small but numerous, then the best action is to try to treat all of them at once, which is best done with chemotherapy.

Q : 11

Is cancer in the spine from metastatic breast cancer treated the same way as other cancers in the spine? I am looking for treatment for my mother who has it from breast cancer all through her spine and in the disk areas. Your site indicates that cancer of the spine originates somewhere else in the body, but doesn't make clear the differences between treatment options.

If the breast cancer spreads to only one area in the spine, there are several options including surgery and stereotactic body radiation therapy. Unfortunately, your mother has breast cancer that has spread throughout the spine, so in cases like this, typically only the symptomatic (e.g., pain) areas are treated with fractionated radiation over two to three weeks. This kind of radiation can be safely delivered at many radiation oncology centers.

Q : 12

My father was recently diagnosed with a leiomiosarcoma in the mouth. According to the surgeon who operated on him, the surgery was successful and no evidence of residual disease was found on further CT scan and MRI studies. I would like to know your opinion regarding the necessity for additional chemo and/or radiotherapy.

This is difficult to assess at this point since I don't know the anatomy of the tumor. Microscopic residual disease by definition cannot be seen on CT/MRI scans. The fact that these scans did not show a large tumor that is detectable by the eyes of a radiologist is great sign. This is a relatively rare tumor that can definitely behave aggressively. Chemotherapy has not been shown to be beneficial after surgical resection of sarcomas. The value of radiation therapy is a different matter. Because of the rarity, there is a controversy regarding the role of radiation therapy. Therefore, we have to extrapolate from much more common location of sarcomas, which classically occurs in soft tissues of the extremities, such as the arms or legs. Adjuvant radiation therapy after surgery in soft tissue sarcomas of the extremity is the standard of care. Thus, if it were my "mouth" (ie., oral cavity), I would want adjuvant radiation. This could come in the form of external radiation or brachytherapy in the form of catheters. A significant factor in determining whether radiation is necessary is the pathology, whether there was a big margin or how big the tumor was. Your father must be evaluated by an experienced radiation oncologist. He should ideally be evaluated by a radiation oncologist who treats head and neck cancers.

Q : 13

I was wondering if there were any treatment options for someone with a very symptomatic pineal cyst?

On rare occasions, pineal cyst has to be drained either stereotactically or via a craniotomy. There are cystic tumors that can occur in this location. Thus, you have to be evaluated thoroughly by an experienced neurosurgeon.

Q : 14

After several months of what I though was pain in my abdomen, I had an MRI the showed I have a bone lesion on T7and T8 of my spine and some area of the rib. I had an open biopsy on the lesion that showed normal tissue. My internist wants me to go to an Orthopedic Oncology surgeon because of the ongoing pain and the fact I have had swollen lymph nodes and weight loss of 30 lbs. Given that the biopsy was normal, is bone cancer still a possibility here and what else could cause all this?

This is a difficult question to answer without examining the images and pathology. Clearly, there are sampling errors to biopsies and not infrequently, multiple biopsies may be performed. The differential diagnosis is very broad here, ranging from benign to malignant causes. Given that you have swollen lymph nodes, weight loss and bony abnormalities, it is crucial that you see an experienced oncologist to rule out a malignancy. Good luck.

Q : 15

Is it possible for a glioma to spread to other parts of the body?

A high-grade glioma such as glioblastoma multiforme can spread to other parts of the body, but this is very rare. If an undiagnosed metastatic cancer, such as lung or breast cancer, is involving the brain, then this is very serious and needs to be evaluated by an experienced physician as soon as possible.

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