Low-grade Glioma and Brain Surgery: Considerations

Low Grade Glioma-- shall I have surgery? Some thoughts and ideas I encountered along the way:

• Are you sure it is a tumor? Doctors can differ. MR Spectroscopy is not real reliable yet at distinguishing between non-tumors and tumors.
• Is it possible to remove 100 percent of the tumor? (Not 100 percent of tumor cells -- they're always some cells that leave the tumor and travel to other parts of the brain)
• If so, is the surgeon you are considering capable of doing this? Find out exactly how they ensure that 100 percent of the tumor has been removed prior to completing surgery. Do they check it with MRI during surgery? What is their track record in 100 percent removal when looking at MRI scans after surgery? (What can look like complete removal during surgery can turn out not to be.)
• Removing less than 100 percent of the tumor does not appear to improve either long-term survival or years until the tumor progresses to a grade III (or IV I suppose). It is possible, I never explored this myself, that if it is pressing on something (or very near to something) such as motor skills, language skills, etc. that there is a benefit to surgery. This would be something to discuss with doctors.
• Radiation is full of side effects. This is because they apply it to an area much larger than the original brain tumor to try to kill the small tumor cells that leave the tumor itself. Normal brain cells can be damaged by radiation therapy resulting in permanent loss of functionality. I have noted problems that can happen in the frontal lobe. A different set of problems can happen elsewhere.
• Younger people are starting to have chemotherapy before radiation. Chemotherapy works better for some types of low-grade tumors than others. Frankly, if younger people are doing this it seems to me older people my want to try this well...
• A perfectly reasonable treatment for low-grade glioma is to wait and watch. As one doctor said, the first tenet of medicine is "First, Do No Harm."