The world recently lost NBA legend Dikembe Mutombo to brain cancer, while former President Jimmy Carter continues to defy expectations. Despite being diagnosed with metastatic melanoma, including brain and liver metastasis he has just celebrated his 100th birthday. These two public figures have brought significant attention to CNS (Central Nervous System) malignancies, sparking curiosity about the different types of brain tumors, how they are treated, and the progress being made in managing these challenging diagnoses.
In this article, we will explore the difference between primary and secondary brain cancers, common types of each, and the multidisciplinary treatment approaches that are helping to extend survival and improve quality of life for patients like President Carter.
Primary vs. Secondary Brain Tumors
When we talk about brain cancer, it’s important to understand the distinction between primary and secondary (metastatic) tumors.
- Primary brain tumors are those that originate in the brain or spinal cord. They include tumors like glioblastomas, meningiomas, and astrocytomas. These tumors may stay confined to the CNS or spread within it but do not spread outside the brain and spinal cord.
- Secondary brain tumors, also known as brain metastases, occur when cancer from another part of the body—like the lungs, breasts, or skin—spreads to the brain. In the case of Jimmy Carter, his melanoma, a type of skin cancer, metastasized to his brain and liver, but he survived thanks to innovative treatments.
The prognosis and treatment plans differ significantly between primary and secondary brain cancers, as does the underlying biology of the disease.
Primary Brain Tumors: A Devastating Diagnosis
Primary brain tumors like glioblastoma multiforme (GBM) are among the most aggressive and challenging cancers to treat. Unfortunately, they are also the most common malignant brain tumor in adults. GBM grows rapidly, often infiltrating healthy brain tissue, making surgical removal difficult and recurrence likely.
Though we do not have specific details about Dikembe Mutombo’s type of brain cancer, it’s possible or my own speculation he faced a form of primary brain tumor such as glioblastoma. GBM has a notoriously poor prognosis, with a median survival of only 12-18 months despite aggressive treatment. For primary brain tumors like this, treatment often involves:
- Neurosurgery: The goal is to remove as much of the tumor as possible while preserving neurological function.
- Radiation therapy: Typically used after surgery to target any remaining cancer cells.
- Chemotherapy: Drugs like temozolomide are commonly used to slow tumor growth.
- Emerging therapies: Newer approaches like tumor-treating fields (TTF) and clinical trials for targeted therapies are being explored to improve outcomes.
Secondary Brain Tumors: The Battle Against Metastasis
Secondary brain tumors, or brain metastases, are far more common than primary brain cancers. Up to 40% of cancer patients will develop brain metastases, with lung, breast, and melanoma being the most common sources. When cancer spreads to the brain, it presents unique challenges, but recent advances in treatment are offering more hope.
President Jimmy Carter’s case is a remarkable story of survival. Diagnosed with metastatic melanoma in 2015, his cancer had spread to his brain and liver, yet he defied the odds thanks to multidisciplinary care and evolving systemic therapies. One of the most notable treatments in his case was immunotherapy, which helped his immune system target and destroy cancer cells not just in his body, but in his brain as well.
Treatment Approaches: A Multidisciplinary Effort
Both primary and secondary brain cancers are typically managed with a multidisciplinary approach, involving neurosurgeons, radiation oncologists, and medical oncologists to deliver the most effective care. The goal is to optimize local control of the tumor while addressing any systemic disease.
1. Neurosurgery and Radiosurgery:
- For primary brain tumors and larger metastases, surgery plays a key role in removing as much of the tumor as possible.
- When surgery is not feasible or tumors are in hard-to-reach areas, stereotactic radiosurgery (SRS) can deliver high doses of radiation with pinpoint precision, helping control the tumor without invasive surgery. This is especially valuable for patients with small, asymptomatic metastases or for those whose tumors are in delicate areas of the brain.
2. Radiation Therapy:
- Whole-brain radiation therapy (WBRT) has historically been used for patients with multiple brain metastases. However, because of potential cognitive side effects, it’s now used more sparingly, often in combination with newer systemic therapies.
- Stereotactic radiosurgery (SRS) is a preferred option for smaller, limited metastases, and can be repeated if needed.
3. Systemic Therapy: A Growing Role in Brain Metastasis:
- Recent advancements have shown that systemic therapies, such as targeted therapies and immunotherapies, can be highly effective at controlling both systemic disease (below the neck) and brain metastasis. These therapies are becoming an increasingly important part of the treatment plan, especially for cancers like melanoma, lung cancer, and breast cancer.
- In the case of President Carter, immunotherapy played a crucial role. Drugs like pembrolizumab or more recently and preferred dual checkpoint with ipilimumab/nivolumab, checkpoint inhibitors, have shown the ability to cross the blood-brain barrier and shrink tumors in the brain, offering a less invasive alternative for patients with small, asymptomatic metastases.
Looking Ahead: The Future of CNS Malignancy Treatment
The field of brain cancer treatment is rapidly evolving. As systemic therapies become more effective at targeting both brain and body, we are moving towards more personalized, less invasive treatments for patients with brain metastases.
For patients like Jimmy Carter, who once faced grim odds with metastatic melanoma, innovations in immunotherapy have changed the game. The same could be said for countless other cancer patients who develop secondary brain tumors, as systemic therapies continue to show promising results.
Optimism Through Multidisciplinary Care
While Dikembe Mutombo’s loss to brain cancer reminds us of the challenges we still face, Jimmy Carter’s extraordinary journey through metastatic cancer demonstrates that progress is being made. Whether it’s through neurosurgery, radiosurgery, or systemic treatments, the fight against CNS malignancies is a multidisciplinary effort, with new therapies giving hope to patients and families facing these difficult diagnoses. Clinical trial enrollment if available is always encouraged in trying newer or more novel therapies.
If you or someone you know is diagnosed with a brain tumor, whether primary or secondary, it’s important to explore all treatment options and consult a multidisciplinary neurological team of specialists. With ongoing advancements in therapy, there is hope for extending survival and improving quality of life for patients with CNS tumors.
About the Author
Dr. Thomas is a distinguished medical professional and a compassionate guide in the field of oncology. With over a decade of dedicated experience as a board-certified medical oncologist/internal medicine specialist, Dr. Thomas has become a trusted expert in the treatment of melanoma, sarcoma, and gastrointestinal conditions. With his many years of experience, he brings a wealth of expertise to the complex and challenging world of oncology. About Dr Thomas – MedOncMD