Brain Tumors Are Not Political

Understanding the cancer that took the life of the Vice President’s young son

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Whether or not you like the Vice President’s politics, we can all sympathize with Joe Biden at the loss of his son, Beau, to brain cancer last week.  Beau was only 46 years old, and the tumor that killed him was described as “small” when surgically removed in 2013 (after which he reportedly received both radiation and chemotherapy).

Sadly, neither Beau Biden’s youth nor the small size of the tumor that ultimately killed him are unusual for brain cancer.

Even tiny growths in the brain are dangerous. Even tiny benign (non-cancerous growths).  This is because among your three body cavities, your skull is unique.

Your abdomen (what people commonly refer to as the “the stomach” or “belly”) is a body cavity, a contained space filled with plenty of soft, mobile intestines sliding around between your hard, immobile liver and spleen on the sides and your rigid backbone (spine) and surrounding back muscles.  Everyone knows from seeing others (or themselves in the mirror) how easily the abdomen stretches with the accumulation of fat, or even after a big meal.  There’s plenty of “give” in your belly, both because of the flexible, soft muscles and skin in the front and sides, and also because those intestines inside can get shoved and crushed quite a bit before you really notice it.  Thus, abdominal tumors can grow to impressive size before you develop pain or problems eating, urinating, or moving your bowels.

  (Every surgeon, myself included, has removed softball-size tumors from abdomen.)  And while counter-intuitive, most very large abdominal tumors are benign (non-cancerous), because most abdominal cancers spread to other parts of the body (leading to symptoms and diagnosis) long before the primary (original) abdominal tumor gets very large.

Your chest cavity (“thorax”), while limited in flexibility by your ribs, has plenty of room inside for tumors to grow.  Areas of your lungs can be pressed down by a tumor, often only eventually causing symptoms only after they’ve grown a bit.  (That said, individual tumors which develop or spread to the lung rarely achieve the large size more frequently found within the abdomen.)

Your skull is different in both ways.  The adult human skull is a solid vault, the only break being the small hole at the base through which your spinal cord exits down your back.  Thus unlike your abdomen, your skull has absolutely no “give.”  And unlike both your abdomen and chest, there no real space between your brain and the inside of your skull (just room enough for a thin layer of cerebrospinal fluid).  Nor is your brain soft.  Your brain is firm, so virtually any pressure on it or from within causes problems (symptoms).  And here’s the kicker:  even small benign (non-cancerous) growths cause symptoms because of the firmness of the skull and brain and the absence of any space for growth in between.

  So unlike your abdomen or chest, brain tumors cannot grow to even a moderate size before you know that something is wrong.  There’s simply no room, and the brain tells you early on when it’s getting pushed out of shape.  And unlike benign tumors, brain cancers don’t simply push on surrounding brain tissue.  They invade and destroy it, a process that also produces symptoms when the tumors are small.

There are many types of brain cancer, and there are many areas within your brain in which a cancer can develop (each with a different function).  As a result, there are a wide variety of symptoms that can be caused by brain cancers, including:  changes in vision, hearing, balance, or speech; vomiting; confusion; seizures; personality changes; headaches; loss of feeling or muscle control; and others.

As to Beau Biden’s young age, while it is true that primary brain cancers (malignancies that originate within, rather than spread to, the brain) are not common (just under 23,000 diagnoses and a just over 15,000 deaths in the U.S. this year), malignancies of the central nervous system (the brain and the spinal cord) are among the most common cancers in young adolescents and adults (ages 15 to 39).  So while a healthy 46 year old getting cancer of any kind is unusual, that Beau Biden’s malignancy was a brain tumor is not as surprising.  Nor was his death.  Even with aggressive treatment (as Beau Biden received), depending on the type of brain cancer, fewer than one in three, and as few as one in ten, brain cancer patients are alive five years after diagnosis.

So regardless of how your brain views Democrats and Republicans, we can all view the loss of a young man to brain cancer as tragic.

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