WebMD Medical News
Michael W. Smith, MD
May 20, 2008 -- Sen. Edward M.
Kennedy, 76, has been diagnosed with a malignant glioma, a type of brain
A glioma is a brain
tumor that begins in glial cells, which are cells that surround and support
Kennedy remains at Massachusetts
General Hospital, where he has been since he suffered a seizure on
His doctors -- who include Lee
Schwamm, MD, vice chairman of the neurology department at Massachusetts General
Hospital, and Larry Ronan, MD, a primary care physician at Massachusetts
General Hospital -- today released the following statement about Kennedy's
"Over the course of the last
several days, we've done a series of tests on Senator Kennedy to determine the
cause of his seizure. He has had no further seizures, remains in good overall
condition, and is up and walking around the hospital. Some of the tests we had
performed were inconclusive, particularly in light of the fact that the senator
had severe narrowing of the left carotid artery [which supplies blood from the
heart to the brain] and underwent surgery just 6 months ago. However,
preliminary results from a biopsy of the brain identified the cause of the
seizure as a malignant glioma in the left parietal lobe. The usual course of
treatment includes combinations of various forms of radiation and chemotherapy.
Decisions regarding the best course of treatment for Senator Kennedy will be
determined after further testing and analysis. Senator Kennedy will remain at
Massachusetts General Hospital for the next couple of days, according to
routine protocol. He remains in good spirits and full of energy."
WebMD spoke about Kennedy's
diagnosis with Deborah Heros, MD, associate professor of clinical neurology and
neuro-oncology at the University of Miami Leonard M. Miller School of Medicine.
Heros is not involved in Kennedy's treatment or diagnosis.
What do you make of the
I think that he had a biopsy and
it showed that he had what's called a malignant glioma, and seizures can be a
presenting symptom for a brain tumor. As they had mentioned, usually we use
radiation therapy and chemotherapy for treatment of this tumor after surgery.
It appears as though Massachusetts General Hospital will be discussing that
further and that we would expect him to begin treatment.
The newer treatments available
include oral chemotherapy. Oftentimes, the oral chemotherapy is combined with
the radiation treatments over six weeks and people tolerate it well. Hopefully,
he'll be released from the hospital soon and be able to begin his treatment as
You mentioned surgery. What
kind of surgery would that be?
Typically surgery can be a biopsy
alone to identify and document the specific type of tumor and prove that it is
a tumor. A biopsy alone is done if the tumor is located either deep in the
brain or in an area where removing tissue could cause neurological impairment
[brain damage]. Apparently, this may have been on the left side of his brain,
where speech function is located. So that may have been the reason why they
chose to do a biopsy rather than what we call a craniotomy, with tumor removal.
If the tumor is in an area that can be operated on, sometimes a larger surgical
procedure is done to remove as much tumor as possible. The limiting factor is
the location in the brain.
What is the left parietal lobe
The left parietal lobe does
control speech and various parts of language so that the decision needs to be
made by the neurosurgeon of what type of surgical procedure is the
Are radiation and chemotherapy
Very standard. Even if it is
located in an area that can be operated on more extensively, we know we
cannot remove all of the tumor because it is what we call an infiltrating
tumor. We talk about rootlets or tentacles of tumor that grow into the brain,
almost like fingers. ... We don't [expect] to be able to remove all of it
surgically, so we really rely on ... radiation and
What is the prognosis for this
sort of condition?
Well, it is a serious tumor.
Patients tolerate the radiation and chemotherapy well, and we have many
patients that have responded well to this combination of treatment. I think
that's how we usually describe the prognosis -- it's a wait-and-see type of
tumor where we have to see how well he responds to additional
How rare is this type of
Every year in the United States,
there are about 18,000 new primary brain tumors, and over half of those tumors
are some type of malignant glioma.
Do you think he may have had
this for a while? How quickly do these develop?
That's a question that most people
usually ask and we don't know. I think for some patients, it's very active or
aggressive from the very beginning, and so they can grow very quickly, probably
over weeks to months, and that's probably his type. Others start as a less
active tumor and then over time become more active, and those can be present
for a longer period of time. It sounds like his symptoms developed rather
recently, and that suggests to us that it probably has not been there very
The doctors mentioned other
tests and analyses. What types of additional tests would the doctors be
I suspect they may be doing some
more specialized pathologic studies on the [biopsy].
Is that a tumor grade or
They may try to set tumor grade.
This is not a tumor that tends to metastasize [spread] outside of the
nervous system, so we don't typically stage it like we do other tumors that can
spread to lymph nodes or to other organs in the body. But we do oftentimes a
grading of the tumor cells to see how active or aggressive the tumors would be.
That may be what they're working on with special staining and special tests
from the neuropathologists. There are also some newer, what I would say
investigational, studies looking at the pathology to try to determine what
types of treatment might be appropriate for him, more specific types of
After the treatment, what sort
of recovery is likely or possible? Would he be able to step back into his
That would depend totally on his
energy, how he's feeling overall from the treatment, and if he has any
neurologic deficits from the tumor itself; how intact his speech is and his
Anything else you would want to
The hope that he'll be out of the
hospital soon and be able to feel well during the treatment and remain
active and have good time with his family and continue to be active in his
SOURCES:Statement from Lee Schwamm, MD, vice chairman, department of neurology,
Massachusetts General Hospital, and Larry Ronan, MD, primary care physician,
Massachusetts General Hospital.National Cancer Institute:
"Glioma."Deborah Heros, MD, associate
professor of clinical neurology and neuro-oncology, University of Miami Leonard
M. Miller School of Medicine.
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