Cancerous Brain Tumors

frank hill was taken to the henry fordhospital emergency room for a head injuryand a cut above his eye. he and his family believedthis would be a short visit and a quick recovery. but after stitchesabove his eye and a precautionary scan, doctors found there wasmuch more to this story, a diagnosis thatno parent should ever hear.

all of the resultshad come back and the radiologist hadread it and they reported. when she came into tell us, oh my god, it was all over her facethat something else was wrong. she came in and saidthat they had found something elsein the cat scan. the lady saidthat it was massive. now a surgeryrisking his sight

and his life willneed to be performed, removing a brain tumorthe size of a tennis ball, and only after its removalwill doctors know if the tumorhe has is cancer. my first thought was thati'm going to lose my baby. but all cancersare not the same. they can appear at random or they can be sharedalong family lines. i had a bitof a weight loss

and i wanted toget that checked out. took a cat scan of me and they found an areathat concerned them, and john's four years,five years older than me, and he went intoford to get checked and they foundan area with him. after gettingthe ultrasound done, the doctor said they found somethingsuspicious on my kidney.

almost at the same time, we both came upwith the same problem. the traditional approach,which was an open... a big open incision and removal ofthe entire kidney, now we can do an approachthrough very small incisions, about the diameterof your pinky or a pen, and we can do thatwhole operation where the patient's out ofthe hospital within a few days,

avoiding the big scar, they're back to workmore quickly, and try to save the kidneyif it's technically feasible. i'm thinking the worstwhen i heard the word cancer, so he gave me great confidencethat this could be handled. i'm lucky, they caught it. years ago people diedfrom something like this. right now discover some of thegreatest surgical innovations transforming patient lives,

shared around the worldand developed right here. [music] these are the minds of medicine. this is their story. hello and welcometo minds of medicine! i'm paul w. smith. since the very beginningof modern medicine, surgery has beenused to treat cancer. for years it's beenused to remove tumors

in hopes of stopping cancer. today, thanks tosurgical innovations like some of the onesyou're about to see, cancerous tumors that formerlywere impossible to reach, now are being removed, preserving livesand improving outcomes. many of theseadvancements begin at the center for cancersurgery at henry ford hospital. this new collaboration focuseddozens of the very best surgeons

from virtuallyevery subspecialty on finding new innovativesurgical solutions for beating cancer. the center for cancersurgery team treats more adult cancer cases thananywhere else in the state. the center for cancer surgeryis an innovative collaboration really of all ofour cancer surgeons, as well as all of theinnovative technology research and clinical trial support

that goes into making a patient's prognosisthe best that it possibly can. we've endeavored to streamlinethis process for our patients and bring everyone togetherin one setting so thatmultidisciplinary tumor boards sharing the best practices and really promoting the bestpossible outcomes imaginable. with a history of surgery thatdates back nearly 100 years, henry ford hospitalhas always attracted

some of the country'smost talented physicians, and now with technologythat can only be found in a handful of locationsin the united states, they're breaking new ground against an illnessthat still strikes fear. anybody hears cancer, oh, you know,everybody flips out, you know, and fromtalking to various people, this is the way to goas far as i was concerned,

you know, just goand get it handled. you know, it's alittle thing right now. people used to diefrom it, you know, they didn't get it handled, and i want to get it handledand get it taken care of. -you ready?-oh yeah doc, i am. me too! so just to reviewthe plan for today. so the goal is to removethe tumor in the kidney,

save the rest of the kidney, and do it all throughthe small incisions. now, he arrivesfor a robotic surgery to remove a tumoron his kidney. his physician,dr. craig rogers, has performed more robotickidney cancer surgeries than anyoneelse in the world, and in bill's case, he will attemptto remove the tumor

and spare bill's kidney. it's a procedure he hasdone hundreds of times before and just months agofor bill's brother, john. i went in for my annualphysical in january and during routine examination one of the thingsi told my doctor about is, i felt a slightpain in my right side, towards the back. my doctor, dr. burch,called me the next morning,

and i said, oh, oh,what's wrong? he says, they have discoveredwhat they think is probably a malignanttumor on my kidney, and it scaredthe bejesus out of me. bill's brother john recentlyhad successful treatment for his kidney cancer,to remove his tumor. fortunately, becauseit was caught early enough, doctors wereable to remove it before the canceradvanced further.

because of thisserious cancer risk, bill has electedto remove the tumor. a partial nephrectomy as opposed to a totalremoval of the kidney involves identifyingthe blood vessels and temporarily clampingthose blood vessels. now, that all has to bedone within a time window, because the kidneyonly tolerates about 30 minutesof no blood flow

without irreversible damage. we've done studiesthat have shown that the robotic approach lowersthe time that we're on clamp by about 25%. so i'm going to go on a... will go on inand get started here. using roboticsurgical technology, that is also usedat henry ford to treat prostate,gynecological,

bladder, throat, lung,and abdominal cancers, dr. rogers will travelvisually through tiny incisions usingthree-dimensional imagery and tools designedto cut, grab, and suture. with only a fractionof the blood loss of traditional surgery, he'll be able tospare bill's kidney and give hima recovery that last days, instead of months.

all right, let's lock theliver retractor one more time, we're going to goa little higher up. all right, so we've gotthe kidney in front of us, the bowels out ofthe way, perfect! okay, to findthe tumor now. all right, come inwith your sucker and just gently push the kidneytissue about 2 o'clock. we've gotthe kidney mobilized to the point where wecan get to the tumor.

we're closing in on it. we want to doeverything we can to keep this kidneyat full capacity, so we minimize the amount ofkidney that we're taking out by doing a kidneysparing surgery. we minimize the amount oftime that the kidney... the blood vesselsare clamped. now, the clamp timeis not going to start until i putthe second bulldog on,

because we're still going tohave inflow to this kidney, so we've got clampnumber one coming in, hold on, it's going to starthere in just a second. clamp number two, all right, we are on clamp. all right! so call out everyfive minutes please! with the bloodsupply cut off,

dr. rogers has lessthan a half hour before the kidney isirreversibly harmed. he must be sure toremove the entire tumor to ensure a surgical cure and be carefulnot to leave leaks that would keep the kidneyfrom retaining fluid. this is the bottomof the tumor, so we've got the... we got it.

and we're seeingjust the... beginning of the sinusfat collecting system, so we're definitelydeep enough. all right, we'll laythe tumor aside, needle driver. hardest suture first, which is going to be ourleft-sided suture. all right, now this mayhave to be an inner layer, so we're going tocome off clamp now.

hey, we're off clamp. nine minutes two seconds. okay. nine minutes. all right,let's bag the tumor. this is the tumor here. this is the normal surfaceof the kidney right there. tumor, and if we lookon the inside, this showsnormal kidney tissue,

sort of that tan color, so there's no kidney visiblethere or tumor visible, because there'sis a margin of normal tissueall the way around. so this looks good,looks like we got it all out and just a thin rimof normal tissue, but the majority, i'd say 95% of the kidney ispreserved and intact, and we've got agood specimen here.

all right, so wecan send this off. with the tumor removed, pathology will determinethe type of tumor bill has, and if further cancertreatment will be needed. dr. rogers goes totalk with the family. so everything wentlike clockwork. i was able to removethe tumor completely, save the rest of the kidney and do it all throughthe small incisions robotically.

clamp time on the kidneywas very short, -it was only nine minutes.-wow! the kidney looked veryhealthy when it was done. i'd say 95% of the kidneyor so is still intact and functioning well. oh, 45 minutes or so we'llprobably get him fully awake, moved to the recovery room, the nurses will gethim settled in there and then you cango back and see him.

-thank you!-thank you so much! -no problem!-thank you! good seeing you again! when we return, a family waitsas doctors use unique technology to remove an enormous tumorfrom a 22-year-old's brain. to learn more about thehenry ford hospital center for cancer surgery, go to henryford.com. we'll be right back!

these are theminds of medicine. hey mr. hill, good morning! hey!how are you doing? good! good!how are you doing? -i'm all right!-good! after coming into thehenry ford hospital er for stitches abovehis eye on a cat scan, doctors found a tumor the size of a tennis ballin frank hill's brain.

now, five days later, hewill have surgery to remove it. he has put hishealth into the hands of henry ford hospitalneurosurgeon, dr. ian lee. any diagnosis of a tumoris pretty shocking, but the diagnosisof a brain tumor, it can be devastating. a lot of thepatients that we see will eventually dieof their tumor. what we can do...what i can do is

not only provide themexcellent medical care, but also provide them hope. it's really actuallypretty amazing that he had nosymptoms at all. you know, normally you mightexpect to see a patient like that to have something, either some kind of weakness,perhaps vision trouble, or seizures,and he had none of those. it's probably almost aboutthe size of a tennis ball,

given a tumor that size,you have to know what it is. you know, your optionsat that point are either try to do asmall surgery, take a small piece of itand see what it is, or try to takethe whole thing out. and given thathe was so young and that the tumorwas so unusual appearing, we felt strongly thisis definitely a tumor that we should tryour best to try to take

as much of it out as possible; in fact, try to get thewhole thing out if we could. prior to surgery, frank underwent extensivetest to help map his brain and give doctors an exactlocation of the tumor. what they foundwas this large tumor pressing on an area of the braincontrolling frank's vision, making this surgeryeven more critical. to ensure the tumor'sprecise removal,

the team will usean intraoperative mri. this is the only high fieldadult imri in michigan, and one of only a handfulin the united states. in addition tobrain tumor surgeries, it's also used athenry ford hospital during deepbrain stimulation. with all of these tools, dr. lee will be ableto travel to the tumor, remove it, and sparefrank's normal brain tissue,

with precisionnever before available. the intraoperative mri allows usto know in a real-time way how much of the tumorwe've taken out and how much is left, if anything else has goneon during the operation; if there's a stroke, if there's bleedingthat we need to know about. and to determine, based onhow much tumor is left, whether or not we can takeanymore out safely.

the goal of anybrain tumor surgery is to take out as muchas possible safely. dr. lee was very confident and this tool would bringabout a greater success for frank and he wanted... he could have done thesurgery without the tool, however utilizing this toolwould give us the best results. he said the machinegives him a better chance of taking it all out.

getting all of it,instead of just parts of it, and he doesn't wantto leave any of it. that's what he was sayingwith being aggressive, so that made me feel evenbetter that the machine, along with his skills,would be able to remove it. you know, i'm a mom, he's my oldest son, and i wouldn't saythat i'm afraid, but i'm justvery hopeful, very hopeful.

once positioned, dr. leecan begin the delicate work of removing frank's tumor. be advised, what you are aboutto see is extremely graphic. look at this, feel it, feel the bone. even as he pulls away a smallpiece of frank's skull, dr. lee can see that this tumorhas been here for a while. what i wanted topoint out was on this side, the bone has beenremodeled by the tumor,

so it's been therefor a very long time, but you can feel that the bonehas been thinned out over here, compared to herewhere it's very thick, it's verythin over here. each step to remove thetumor must be done with care. because the tumor was pressedagainst an area of frank's brain that affects vision, the very removal of the tumor could mean frank's eyesightwill be affected;

remove too much tissueand frank could become blind. now with thetumor removed, frank will havean mri to determine how much, if any, of the tumoris left behind. while frank sleeps, using specializedstretchers and personnel, he is moved through steeldoors to the room next door. no metal can be leftinside frank or near the mri and every memberof the team

has beenspecially trained to make sure the scanis safe for him and for the othersurgical personnel. as frankundergoes his scan, dr. lee speaks with apathologist about what he found. i can tell you it's nota high grade glioma, it's not achoroid plexus tumor. it doesn't look like a pxa. we're doingintraoperative mri right now,

so this is definitely one where we're going to want totry to get the whole thing out, if possibly, if it'sone of these grade 1 tumors -and potentially-right, that's what thisthing looks like. it does look like it's probablywhat we call a glioma, so it's a tumorthat's come from the supportingcells of the brain called the glial cells.

there is a wide range of theseglial tumors from grade 1, which are potentially surgicallycurable, to the worst kind, which are the grade4s, the glioblastomas. this looks like it's probablyone of those grade 1 tumors, based on what they can seeso far on the frozen section. now with theintraoperative mri, if we can getthe whole thing out, potentially this issomething that can be cured. dr. lee returns to surgeryto review the scans

and to determine if moretumor must be removed. so that little tissueright there is enhancing. there might be alittle tissue there. it's inthe cavity itself, you know, surgical,the section side, more to the upper side. you know,that should be safe, we can cleanthat up a little bit, get that lastlittle bit out.

to ensure the best chanceof a surgical cure, dr. lee returns to surgery. because the scan showedpotential tumor tissue that is invisibleto the naked eye, he will remove a verysmall section of tissue based on thefindings of the imri. when we come back,dr. lee discusses what's next for frankand if his sight will be lost. we'll also visit withour kidney tumor patient

for his diagnosis. to learn more aboutthe henry ford hospital center for cancer surgery, we'll be right back. okay, next patientis frank hill. he's a22-year-old gentleman. intraoperatively is a very,very unusual looking tumor. it did look like it was in direct contactwith the ventricle,

we did get into the ventricle, but surprisinglyhe actually woke up with no visual deficits. so where we got in was actuallyin the occipital horn of the lateral ventricle, so that's why he was ableto avoid any visual deficits. so very unusual looking cystic,very tough on the outside and pathology is... so all three ofthe neuropathologists

examined the slides and came up with adiagnosis of consensus, and it's a low-grade glioma, with a gangling cell component, which would make ita ganglioglioma. probably the best outcomewe could think of and hope for, so i would recommendthat we just reimage him. and in three months to see that everything hassettled well, another mri,

and thenfollow him clinically. frank hill's braintumor was determined to be a grade 1 glioma, although dangerous, his tumor was determinedto be cured surgically and he will be watchedclosely by his team. no other immediate cancertreatment will be necessary, and frank can returnto a normal life. he returns to visit thesurgeon that saved his life.

hi!how are you doing? hello. -how you been?-i'm doing good. good to see you! it's good to see you! generally speaking, most gangliogliomasare benign tumors, okay, meaning thatif it's completely resected, potentially you can becured of this tumor.

okay, there are gangliogliomasthat are more aggressive, all right, they'recalled anaplastic, but this is not one of those. -okay.-okay? now, this doesn'tmean that you're... doesn't absolutelymean that you're cured, but at least right now, you know, thingsare looking good. -got you!-okay? so you know...

they say i'm cured, but just in case anythingstarts to go back or anything, they keep track of it, and they gotme under their radar. i've got set goals. i want to go onthe same track pursuing, trying to get downwith school as fast as i can, but i'm verygrateful for dr. lee and everybodyat henry ford.

all right, do you haveany questions, ma'am? you have been amazing. we have told this story somany times to so many people that if it hadnot been for dr. lee and the intraoperativemri and the surgery, we wouldn't know basically where we would be today. so frank is very gratefuland i'm very grateful. like frank, bill returnsto meet with dr. rogers

hoping to hearsimilar good news. -good to see you!-good morning! welcome! well, how are things going,it's been a couple of weeks? -good!-yeah? you feel like yourrecovery is coming okay? no pain wherethe incisions are? any dizziness, lightheadedness,anything like that? -no.-okay.

well, i have somegood news for you. i've got yourpathology report. so i think you'llbe happy with this. so you were in oneof the lucky ten percentile in which your tumorended up not being cancerous. that's great! and now you won't evenneed to follow this. so there won't be...unlike your brother, who still gets tosee me a few more times,

where we'll get cat scans, in your case you don't evenneed follow-up with the imaging. well, mr. maclnnis,i want to thank you for putting yourcare in our hands and your confidenceyou put in us. thank you very much! it's been a pleasureworking with you! -thanks doc!-thank you! -best of luck to you!-thank you!

you know, in my case,i don't know why, but i always knewi wanted to be a surgeon. i didn't know exactly whatkind of surgeon i wanted to be. and then there weresome events in my family that really hit home to me, or that became very personalinto doing what i do now. my mother was diagnosed with a very aggressiveform of kidney cancer and i had bothof my grandparents

diagnosed withprostate cancer. as i look back on just howeverything happens in life, i didn't go into this planningto end up where i am today, but it really is satisfyingto go to work everyday and to usecutting-edge technologies to treat thosevery cancers that, you know, affectedpeople in my family. i had all kinds of confidence inrogers and i still do, you know. he's a great... he's a real,real good man and good doctor.

all my activities,i am back at now. it's been three, fourmonths, i feel great. i've resumed everything. in fact, almost two weeks after i was operatedi resumed everything. you get alot of chance to think and, you know,about changing habits; my diet's changed alot and i feel a lot better. there used to besteak and potatoes,

you know, and it's not anymore, you know, it's very seldomin fact to have a steak now; a lot more fish,a lot more vegetables. you know, we're gettingreal big on salads. we're living longer. i think we're living better. i think we all got toprobably adjust our ways of going at things. i notice myself,

i couldn't do the same thingsnow i could do ten years ago, but that doesn't meani can't be smarter about it. where i go from here, there's nothing tostop me that's for sure. what's gratifying for me,there are a lot of things that we can do nowto help prolong survival and prolongmeaningful survival, and what'sgratifying for me is to be able to help them liveas long a life as possible,

in a way theywant to live it. cancer surgeons are in thefront lines of cancer therapy and we often findourselves in a position where we're the oneswho are telling the patient and their familythat in fact, yes, cancer is there. because of everythingthat we have to offer, we are going at thisdisease full throttle. not only is there a hope,but there is a plan,

there's an action plan to actually makethe path easier, and to take the steps that are necessaryto combat the cancer and to improvequality of life. unlike any other illness, beating cancertakes a team effort, and with the centerfor cancer surgery, henry ford hospital

has assembled a group ofspecialists like nowhere else. if you've recentlybeen diagnosed with cancer and want to see one ofthe country's best cancer teams, if you'd like to watchepisodes of minds of medicine at any time, go to henryford.com/mindsofmedicine.