- MONDAY, June 2 (HealthDay News) — Sen. Edward M. Kennedy is
scheduled to undergo surgery Monday for the malignant brain tumor that was
diagnosed last month.

The 76-year-old senator will undergo the surgery for a malignant
glioma, an especially lethal type of brain tumor, at Duke University
Medical Center in Durham, N.C. A statement from the Massachusetts
Democrat's office said he would be operated on by one of the nation's top
neurosurgeons, Dr. Allan Friedman, followed by chemotherapy and radiation,
the Associated Press reported.

The American Cancer Society estimates that 21,810 malignant tumors of
the brain or spinal cord will be diagnosed this year in the United States.
Approximately 13,070 people — 7,420 men and 5,650 women — will die from
these malignant tumors. The cancers account for about 1.3 percent of all
cancers and 2.2 percent of all cancer-related deaths in the United
States.

A patient's prognosis depends on the “grade” of the tumor, said Dr.
Isabelle Germano, co-director of The Radiosurgery Program at Mount Sinai
Medical Center in New York City. Five-year survival rates for low-grade
(grade 1) tumors can be as high as 95 percent; for grade 4 tumors,
five-year survival plummets to about 5 percent, she said.

Dr. Deepa Subramaniam, director of the brain tumor center at Georgetown
University's Lombardi Cancer Center in Washington, D.C., said younger
people tend to be diagnosed with low-grade tumors while older individuals
tend to have more aggressive ones.

The first evidence that a person has a malignant tumor is often a
seizure like the one Kennedy suffered last month, or stroke-like
symptoms.

The parietal lobe, where Kennedy's tumor is located, governs strength
in one-half of the body. “It would leave him with weakness in one half of
his body, so they might not take it out,” Subramaniam said.

Without surgery, patients are left with chemotherapy (only one drug is
currently approved for malignant glioma) and radiation, often given
concurrently for the first six weeks. If that is well tolerated and if the
tumor hasn't grown, patients might receive additional chemotherapy for the
next five months or longer, Subramaniam said.

In the most aggressive form of the cancer — grade 4 — patients can
live for about a year with the full complement of therapies, Subramaniam
said. Without treatment, however, the prognosis is usually a few
months.

But the outlook isn't always that grim. Subramaniam said she has
examples of patients who have lived for two years, “so it's not clear why
some patients live so long while others die within a year.”

Dr. Jonathan Friedman, director of the Texas Brain and Spine Institute
in College Station, said that, given a “diagnosis of malignant glioma,
surgery is generally not curative. The primary role of surgery is to
biopsy and ascertain the diagnosis and, in some circumstances, there's a
role for debulking or removal of a significant volume of tumor. But in
some circumstances that's not possible or not desirable.

“But malignant glioma are infiltrative tumors,” added Friedman, who's
also an assistant professor of surgery and neuroscience and experimental
therapeutics at the Texas A&M Health Science Center College of
Medicine. “They don't have good margins. They grow into the brain, which
makes sense because they are made out of brain cells. Because of that,
they generally cannot be removed in their entirety.”

Added Dr. Keith L. Black, chairman of the department of neurosurgery at
Cedars-Sinai Medical Center in Los Angeles, “Age will be a very strong
predictor of how well the senator does, it's probably a stronger predictor
than the grade of the tumor. And the fact that the senator is 76 will be a
challenge to overcome in his overall prognosis. “

Kennedy, the second-longest serving Democratic senator currently in
Congress, suffered a seizure while at his family's Hyannisport compound
and was taken by helicopter to Boston last month.

In October 2007, a partially blocked carotid artery in Kennedy's neck
was discovered during a routine magnetic resonance imaging (MRI)
examination. Doctors cleared the blockage, and Kennedy was released to
convalesce in Hyannisport.

Dr. Otis W. Brawley, chief medical officer for the American Cancer
Society, last month called Kennedy an “unparalleled leader in the fight
against cancer and for access to quality health care for all Americans
throughout his distinguished career in the United States Senate. He yields
to no one in his accomplishments and in his efforts to bring all the
resources of the nation to bear in fighting cancer and other diseases, to
reigning in the tobacco industry, and to extending health insurance
coverage to all Americans, especially the most vulnerable among us.”

Kennedy is the youngest of nine children, and became a U.S. senator in
1962. His older brother, President John F. Kennedy, was assassinated in
1963. Another brother, Robert Kennedy, who was also a U.S. Senator, was
assassinated in 1968 during his presidential campaign.

More information

The National Library of Medicine has more on glioma.