Cancer Dizziness and Fatigue: Potential Causes

Brain Cancer Treatment: 'Awake Surgery' And Other Innovations

New research on brain cancer treatment is providing hope for those with the disease.

Among the techniques is the evolving science of "awake brain surgery" as well as the emerging field of focused ultrasounds.

Experts say the White House's Cancer Moonshot program has helped spur some of the innovations.

Some say outer space is the final frontier. Others insist it is the sea.

But if you ask a cancer brain surgeon, he or she will likely tell you that the real final frontier is the human brain.

Brain cancer remains one of the most confounding cancers to understand and treat.

However, experts say that as researchers learn more about how the brain works, new modalities will follow and bring the brain cancer community new hope.

Dr. Shawn Hervey-Jumper is a neurosurgeon at the University of California San Francisco (UCSF). His subspecialty is neuro-oncology.

A kind, patient man with a deep but soft-spoken voice, Hervey-Jumper is revered by colleagues. But he remains humble.

Brain cancer will do that to just about anyone.

Hervey-Jumper's work is focused on the surgical management of people with brain tumors that are located in hard-to-reach areas of the brain that are responsible for language, motor, and cognition.

While it may sound frightening, the UCSF surgeon said that once he explains it, people with cancer actually embrace the idea.

"Doing the surgery while the patient is awake reduces the risk of damaging critical brain areas that control speech and other skills," Hervey-Jumper told Healthline.

"My priority is to provide the best possible surgical care for patients, while also considering rehabilitative therapies to maximize survival and improve their quality of life," he said.

Share on PinterestDr. Shawn Hervey-Jumper talks with a surgical team at the University of California San Francisco. Noah Berger for UCSF

Awake brain surgery allows the surgical team to map out important areas of the brain to avoid during the surgery to protect the patient's language, sensory, and motor abilities as well as communicate with the patient.

"If the tumor is near the parts of your brain that control vision, movement, or speech, I will sometimes ask the patient questions and monitor the activity in the brain. We have seen a resurgence in this technique as we learn more about how the brain is organized," Hervey-Jumper said.

"My patients are nervous when we tell them about this, but they are also enthusiastic. There are not a lot of cancer patients who get to participate in their own care. The patients do incredibly well. I do these operations 4 to 6 times a week."

Dr. James Snyder, a neuro-oncologist with Henry Ford Health in Detroit, told Healthline that brain cancer innovation is accelerating at a rapid rate now because of the dire need for success.

"We had to become more creative," said Snyder. "We are understanding brain cancer now from many new perspectives. The returns from genomic studies, computer science, machine learning, radiomics, and liquid biopsies, all of these and more are coming to a head and with all that data and insight we have seen a velocity of ingenuity."

He also believes a big part of this progress is the result of the White House's Cancer Moonshot program.

"I attribute many of these advances to the 2015 Cancer Moonshot for putting funding and energy into these new innovations to accelerate progress in cancer outcomes," Snyder said.

Historically, brain cancer treatments have been limited and difficult to navigate in part because of the blood-brain barrier.

That is the network of blood vessels and tissue made up of closely spaced cells that help keep harmful substances from reaching the brain, according to the National Cancer Institute.

The barrier lets some substances, including water, oxygen, carbon dioxide, and general anesthetics, pass into the brain. It also keeps out bacteria and other substances, including some cancer treatment drugs.

A variety of new techniques are being developed to improve current treatment for brain cancer and other brain diseases.

One of those new modalities being developed by researchers at Yale University in Connecticut deploys tiny bioadhesive nanoparticles to the brain.

The nanoparticles adhere to the site of the tumor and then slowly release the synthesized peptide nucleic acids that they're carrying, explained W. Mark Saltzman, PhD, a professor of biomedical and chemical engineering as well as cellular and molecular physiology at Yale.

Saltzman told Healthline that these nanoparticles can carry drug and gene delivery into tumors.

"On the good side, we're seeing lots of good work going on at reputable labs around the world and they are showing advances in treatment in animals. The challenge is moving it to the next stage," he said.

Another relatively new modality is focused ultrasound.

According to UVA Health in Virginia, one ultrasound technique hits cancer cells with a drug that sensitizes them to sound waves, then blasts them with a focused ultrasound.

The technology may treat many cancers through non-invasively destroying malignant tissue or enhancing adjuvant therapies, such as chemotherapy, radiation, or immunotherapies. There's also research around the globe assessing the potential of the technology to enhance the delivery and effectiveness of cancer drugs.

Clinical trials are showing positive results with this technology in temporarily and reversibly opening the blood-brain barrier.

This technology has not yet been approved to treat brain tumors.

John Grisham, the bestselling author who has sold more than 300 million books worldwide, published a book in 2016 called "The Tumor" about focused ultrasound.

The book has two endings. In the first, the lead character is treated with radiation and lives less than a year.

In an alternative ending, the lead character lives between 5 to 10 years because he chooses to be treated with focused ultrasound.

Grisham, who's on the board of the global Focused Ultrasound Foundation, told Healthline that "I have often said that 'The Tumor' is the most important book I've ever written because it has the potential to impact so many."

"When I wrote the fictional story about a young father with a deadly brain tumor, I described his current treatment options and then fast-forwarded 10 years into the future, when noninvasive focused ultrasound could potentially rewrite his story with a better outcome," he said.

Since the book was released, focused ultrasound for brain tumors has become more common in clinical trials.

"It has been incredibly exciting to see the technology evolve to where we are today. There are ongoing clinical trials around the world using focused ultrasound to temporarily and reversibly open the blood-brain barrier in brain tumor patients," Grisham said.

In December, Insightec, a global healthcare company focused on deploying acoustic energy to transform patient care, announced the LIBERATE clinical trial of liquid biopsy with low-intensity ultrasound in brain tumors.

The trial kicked off an international effort to assess the safety and efficacy of the company's focused ultrasound platform to temporarily disrupt the blood-brain barrier and enable liquid biopsies in patients with glioblastoma.

The first participants were enrolled in the United States and Canada at the Mayo Clinic in Rochester, Minnesota, and at Sunnybrook Health Sciences Centre in Toronto.

"Our team at Mayo Clinic is excited to have enrolled the first patient in this pivotal trial," Dr. Terry Burns, a neurosurgeon at the Mayo Clinic, said in a press statement.

"If successful, this work has the potential to substantially decrease the risk of obtaining the initial diagnosis. Importantly, FUS can be repeated non-invasively, allowing a rare molecular window into individual patient's brain tumors as they evolve during treatment," Burns said.

Promising Brain Tumor Treatment Hijacks "monorail" That Lets Cancer Spread

Tough-to-treat glioblastoma brain tumors may have met their match in a promising new treatment that "hijacks" what makes the deadly cancers spread so easily, turning that mechanism against the cancer itself.

The new treatment approach keeps cancer drugs out of the brain by directing tumor cells along an artificial track that leads them to tumor drugs, sparing healthy brain tissue that's often damaged by treatment. 

"One attraction about the approach is that it is purely a device," lead research investigator Ravi Bellamkonda, chair of the Wallace H. Coulter Department of Biomedical Engineering at Georgia Tech and Emory University, said in a statement. "Treating these cancers with minimally-invasive films could be a lot less dangerous than deploying pharmaceutical chemicals."

Glioblastoma is one of the most common forms of brain cancer, affecting about 10,000 patients each year -- about half of whom will die within 15 months of diagnosis.

Tumors that arise in the brain without a known origin are called gliomas, and the most malignant forms are glioblastomas. They are aggressive, infiltrative and cannot be cured by surgery, according to the University of Texas MD Anderson Cancer Center.

The researchers pointed out that more tumor that can be removed, the better the prognosis. But, the tumor spreads throughout the brain on nerve fibers and blood vessels, allowing it to invade new areas that surgeons are typically reluctant to operate on. Even if the main tumor can be removed, it's often spread throughout the brain by the time a person is diagnosed.

That's where the new technique -- developed by scientists at the Georgia Institute of Technology in Atlanta -- comes in. The team designed an alternative fiber out of a polymer called polycaprolactone (PCL) surrounded by flexible polyurethane that mimics the surfaces of nerves and blood vessels that glioblastoma cells would typically follow.

The fibers are about half the diameter of human hair. Instead of guiding the cancers to different areas of the brain, the track takes the cells to a "tumor collector" gel located outside of the brain containing a drug called cyclopamine, which is toxic to cancer.

The scientists tested this novel approach in rats, comparing the effects with implanted fibers made of a different polymer, or a PCL fiber without the contours mimicking nerves and blood vessels.

After 18 days, they found rats treated with the new technique had tumor sizes reduced by up to 90 percent compared to the other rats, with cancer cells seen moving the entire length of the fibers into the tumor collector gel.

"Cancer cells normally latch onto these natural structures and ride them like a monorail to other parts of the brain," said Bellamkonda. "By providing an attractive alternative fiber, we can efficiently move the tumors along a different path to a destination that we choose."

The treatment is far from ready for human use. The Food and Drug Administration requires extensive testing that can take up to a decade, with rat research among the earliest steps. The scientists are hopeful that if successful, the approach may one day be used to treat other diseases as well.

"If we can provide cancer an escape valve of these fibers, that may provide a way of maintaining slow-growing tumors such that, while they may be inoperable, people could live with the cancers because they are not growing," he said. "Perhaps with ideas like this, we may be able to live with cancer just as we live with diabetes or high blood pressure."

The new research was published Feb. 16 in Nature Materials, with research supported by the National Cancer Institute.

Ryan Jaslow

Ryan Jaslow is CBSNews.Com's health editor.

What Patients Need To Know About Brain Cancer Treatments

Brain cancer remains one of medicine's most formidable challenges, requiring sophisticated treatment approaches tailored to each patient's specific situation. With advances in surgical techniques, radiation delivery, drug development and immunology, treatment options continue to evolve, offering improved outcomes and quality of life for many facing this diagnosis.

Customized treatment planning

When confronted with a brain cancer diagnosis, patients face numerous decisions about their care path. Treatment plans vary significantly based on several critical factors including the tumor's precise location, size, specific type, and growth rate. A patient's age, overall health status and medical history also influence which approaches offer the best balance of effectiveness and tolerability.

Most patients work with a multidisciplinary team including neurosurgeons, oncologists, radiation specialists and support staff who collaborate to design comprehensive treatment strategies. This coordinated approach ensures all aspects of care work together toward the best possible outcome.

Surgery: Removing the tumor

For many brain cancer patients, surgery represents the first treatment step. The primary goal involves removing as much tumor tissue as possible while preserving surrounding healthy brain function. Complete removal sometimes proves impossible due to tumors growing in critical brain regions where surgery would cause unacceptable functional damage.

Modern surgical approaches include standard craniotomy procedures where surgeons temporarily remove a portion of the skull to access and extract the tumor. Laser surgery offers another option, using heat to destroy cancer cells while minimizing damage to nearby tissues. Some patients undergo awake brain surgery, remaining conscious during portions of the procedure so surgeons can monitor critical functions through patient responses.

While surgery often proves effective at reducing tumor burden, it rarely serves as a standalone cure. Most patients require additional treatments to eliminate remaining cancer cells not visible or accessible during the operation. The extent of surgical success significantly influences subsequent treatment planning.

Radiation therapy: Targeted destruction

Radiation therapy plays a central role in brain cancer treatment, using high-energy rays to destroy cancer cells and prevent their multiplication. This approach proves particularly valuable for tumors that cannot be completely removed surgically due to location or other factors.

Several radiation approaches exist. External beam radiation therapy directs radiation at the tumor from outside the body over multiple treatment sessions. Stereotactic radiosurgery delivers highly precise radiation doses to tumors in fewer treatments, minimizing damage to surrounding healthy tissue. Proton therapy represents a newer technology using proton beams to attack cancer cells with exceptional accuracy.

Treatment effects including fatigue, headaches or cognitive difficulties may develop during or after radiation therapy. The severity of these effects typically depends on the radiation dose and brain regions treated. Most side effects improve gradually after treatment completion, though some may persist.

Chemotherapy: Systemic treatment

Chemotherapy involves powerful medications that attack cancer cells throughout the body. Unlike surgery and radiation, which focus on specific areas, chemotherapy works systemically to prevent cancer spread and target cells that may have migrated from the original tumor.

Several chemotherapy medications show effectiveness against brain cancers. Temozolomide represents a widely used option that crosses the blood-brain barrier to reach tumor cells. Bevacizumab helps slow the growth of new blood vessels that tumors need for continued growth and spread.

These medications may be administered orally, through intravenous infusion, or in some cases, directly into the cerebrospinal fluid to more effectively reach the brain. Side effects range from nausea and fatigue to increased infection risk due to lowered white blood cell counts. Doctors carefully monitor patients during treatment, adjusting dosages when necessary to manage these effects.

Targeted therapy: Precision approaches

Targeted therapy represents a more modern treatment approach focused on specific genes or proteins that contribute to cancer growth. These treatments interfere with cancer cell pathways while generally sparing healthy cells, often resulting in fewer side effects than traditional chemotherapy.

Recent advances include EGFR inhibitors that target mutations in the epidermal growth factor receptor found in some brain tumors. Checkpoint inhibitors boost the immune system's ability to recognize and attack cancer cells. While targeted therapy development continues for brain cancer, clinical trials show encouraging results in improving survival rates for certain tumor types.

Treatment selection depends on molecular testing of tumor tissue to identify specific targets. This personalized approach allows doctors to match patients with treatments most likely to be effective against their particular cancer.

Immunotherapy: Activating natural defenses

Immunotherapy harnesses the body's own immune system to fight cancer cells. While not yet as widely used for brain cancer as other treatment forms, research continues to explore its potential against these challenging tumors.

CAR T-cell therapy genetically modifies a patient's immune cells to recognize and attack cancer. Cancer vaccines train the immune system to identify cancer cells as threats requiring elimination. These treatments remain in experimental phases for many brain cancers but offer new hope for patients with aggressive tumors.

The blood-brain barrier, which protects the brain from harmful substances but also blocks many medications, presents a particular challenge for immunotherapy. Researchers continue developing methods to overcome this barrier and deliver immune treatments effectively to brain tumors.

Clinical trials: Access to emerging treatments

Patients who have exhausted traditional treatment options may benefit from clinical trials testing new approaches. These research studies evaluate new drugs, procedures and combination treatments to determine their effectiveness and safety before broader approval.

Clinical trials offer access to cutting-edge therapies not yet widely available. While participation involves certain risks since treatments remain under investigation, these studies provide hope for patients with limited options. The careful monitoring that accompanies trial participation represents an additional benefit.

Patients considering clinical trials should discuss potential risks and benefits thoroughly with their medical team. Not all experimental treatments prove successful, but participation contributes to scientific knowledge that may help future patients.

Managing side effects and recovery

Brain cancer treatments significantly impact physical and cognitive function. Side effects may include fatigue, memory problems, speech difficulties or motor function impairment. Many patients work with rehabilitation specialists including physical, occupational and speech therapists to regain strength and skills.

Support networks including family, friends and formal support groups play crucial roles in recovery. Mental health care helps patients cope with the emotional challenges accompanying diagnosis and treatment. Complementary approaches like meditation, nutrition counseling and exercise may help manage symptoms and improve quality of life during and after treatment.

Advancing treatment frontiers

Brain cancer treatment continues evolving rapidly as researchers develop innovative approaches. Personalized medicine, which tailors treatments to a patient's specific tumor characteristics, increasingly guides treatment decisions.

Emerging research areas include nanotechnology using microscopic particles to deliver drugs directly to tumors, gene therapy modifying genetic material to fight cancer at the molecular level, and artificial intelligence applications that improve tumor detection and treatment planning.

These innovations offer hope for improved survival rates and enhanced quality of life for brain cancer patients. While complete cures remain elusive for many brain cancers, treatment advances continue extending survival and improving function for those facing this diagnosis.

Early detection, comprehensive care from specialized medical teams, and personalized treatment approaches significantly influence outcomes. For patients navigating this difficult journey, staying informed about treatment options while seeking appropriate support provides essential tools for facing brain cancer's challenges.

This story was created using AI technology.

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