On the first day after the cold season, the snow in Beijing has not completely melted, but the weather is very “powerful”, even in the late afternoon, giving people a feeling of spring flowers.
Zhang Zhiwen, who had just returned from the ward, was in a slightly relaxed mood because the condition of a critically ill patient admitted a few days ago had greatly improved after careful treatment. The neurosurgeon, who has been dancing on the tip of the knife for nearly 30 years, still feels that his daily work is “like walking on thin ice, like facing the abyss”.
”Even if the location of the tumor is the same, each patient’s treatment plan is different, especially in the post-surgical intensive care stage, we need to patiently and meticulously observe the small changes of the patient.” Professor Zhang Zhiwen, director of the Department of Neurosurgery of the First Affiliated Hospital of PLA General Hospital and the National Center for Treatment of Malignant Neurological Tumors, told China Science News that compared with other tumors, brain tumors may sound more frightening, but in fact, most brain tumors can be effectively treated, especially some benign brain tumors are completely curable. In fact, most brain tumors can be treated effectively, especially some benign brain tumors can be cured.
Early symptoms are not obvious
”If intracranial tumors grow to a certain size, whether benign or malignant, there will be an increase in intracranial pressure, which will lead to central nervous system dysfunction and may even endanger life.”
Zhang Zhiwen said brain tumors are common in neurosurgery and can occur at any age, mostly in middle-aged people, with an incidence rate of one in 10,000. In adults, brain tumors account for 2 percent of the total number of tumors in the whole body, and brain tumors in childhood account for 7 percent of the total number of tumors in all parts of the body.
Benign brain tumors mainly include meningioma, pituitary tumor and auditory neuroma, while malignant brain tumors include glioma and metastases.
”Benign brain tumors grow slowly and most of them can be cured, while malignant tumors grow faster and are more troublesome to treat.” Zhang Zhiwen said that brain tumor symptoms mainly depend on the location and nature of tumor growth as well as the speed of growth.
Usually the early symptoms of brain tumor are not obvious. Only when the tumor grows to a certain degree and the occupancy is more obvious, will the intracranial pressure increase, which leads to dizziness and headache, nausea and vomiting, vision loss, tinnitus and deafness, elevated blood pressure, slower heart rate, insomnia, and even symptoms such as numbness and paralysis, dementia and coma, and convulsions and epilepsy.
”Most patients are often in the middle to late stages when they come to the hospital.” Zhang Zhiwen said that in the process of receiving medical treatment, he often encountered some patients who “took the wrong path” and delayed the best time for treatment.
He once saw a middle-aged female patient who went to the ophthalmology department of a local hospital for vision loss and narrowing of the visual field, and underwent two glaucoma surgeries, but her vision did not improve and she was nearly blind. “Finally, after going to us for examination, it was diagnosed as intracranial saddle area meningioma, but unfortunately, due to the prolonged tumor compression, the optic nerve was severely damaged, and the patient’s vision did not improve much after surgery.”
”The nerve distribution in the brain is extremely rich, once it is compressed by the tumor, it will affect the nerve transmission function of its functional area. If we compare the nerve conduction pathway to a bundle of cables, any one of the wires out of order will affect its transmission function.” Zhang Zhiwen said frankly.
Pathology is still the “gold standard” for diagnosis
Since brain tumors can cause so much damage to the body, how can they be diagnosed in time without delay? Zhang Zhiwen especially reminds that, like other tumors, the earlier the brain tumor is detected, the better the treatment effect.
At present, CT brain scan and magnetic resonance imaging (MRI) are the most valuable examination methods for brain tumor diagnosis clinically, and can be the first choice for those suspected of having intracranial tumor. Through the scan, the growth site, size and scope of the tumor can be clarified, and the nature of the tumor can be initially judged.
”If conditions are available, it is better to do magnetic resonance imaging, which has less radiation to the human body and clearer images, especially children should try to avoid CT scans with radiation.” Zhang Zhiwen said that cranial X-ray plain examination, cerebral angiography, brain ultrasonography and lumbar puncture with cerebrospinal fluid examination may also be used clinically when necessary, with the ultimate goal of accurately locating the brain tumor lesion and seeking to make a preliminary qualitative diagnosis.
In Zhang Zhiwen’s opinion, before conducting any examination, clinicians need to combine the patient’s complaints, understand the time of onset and symptoms in detail, and choose the appropriate examination method.
Even with the most advanced medical technology, there are times when the diagnosis is inaccurate. “For example, some gliomas are difficult to distinguish from benign tumors on imaging, which requires postoperative histopathological analysis for final characterization.” Zhang Zhiwen said that pathological diagnosis is the “gold standard” for determining the benign and malignant nature of tumors in the medical field.
Surgery is the preferred treatment
Once the diagnosis of brain tumor is confirmed, patients are most concerned about the treatment method. “The first treatment option is to try to remove the tumor completely as long as it meets the three conditions of cranial anatomy, physiological condition and doctor’s skill. ” Zhang Zhiwen said.
For smaller tumors, slow growth rate, surgery risk of the elderly and frail patients, Zhang Zhiwen recommended that dynamic observation can be used, if necessary, can choose stereotactic radiation (Gamma knife) treatment.
”In addition to surgical treatment, radiotherapy and chemotherapy are also more effective means of treating brain tumors. For some patients with intracranial tumors that cannot be completely removed through surgery, postoperative supplementation with radiotherapy and chemotherapy can improve the efficacy and delay recurrence or extend life.” With the development of biomedical technology, some new means of biological therapy such as tumor bioimmunotherapy have also been applied in brain tumor treatment, said Zhang Zhiwen.
For patients with malignant brain tumors, especially those who have recurred after surgery or are in special areas that cannot be operated, Zhang Zhiwen suggested the use of anti-angiogenic targeted therapy, which is one of the proven methods. It is reported that this treatment method has been approved by the U.S. Food and Drug Administration (FDA) as early as 2009 and applied to the treatment of malignant brain tumors with good results. In China, only a few hospitals have mastered and carried out this technology.
”Simply put, anti-angiogenesis targeted therapy is to use angiogenesis inhibitors to specifically inhibit the proliferation and activity of tumor vascular endothelial cells, so as to stop tumor angiogenesis, cut off the nutrient supply to the tumor, so that cancer cells do not get enough nutrients and starve the tumor.”
At the end of the interview, night had fallen and Zhang Zhiwen could not go home because he was still thinking about the patients in the ward. He said that doctor is a sacred profession, as a neurosurgeon, although often have to deal with “death”, but still feel the pain and happiness. “It can be said that we treat patients like artists creating works of art as meticulously crafted, see the patient through our efforts to successfully recover, I feel that life is worthwhile.”
After shaking hands with the reporter to say goodbye, Zhang Zhiwen began to shuttle in different wards again, guarding the life of each patient in the ward ……