What is Tumor Fluorescence?

Each year, U.S. doctors diagnose 24,530 malignant brain and spinal cord tumors. One of the best tools that neurosurgeons have to manage these conditions is tumor fluorescence.

Ravi H. Gandhi, M.D., board-certified neurosurgeon says, “Here at Orlando Neurosurgery, we specialize in brain tumors. Tumor fluorescence is a very interesting technology that we use for taking out brain tumors.”

In this post, we’ll break down how making brain tumors glow can help doctors in their efforts to fight brain cancer.

What is Tumor Fluorescence?

Dr. Gandhi says, “Tumor fluorescence is basically using a fluorescent dye that’s given to a patient through their IV. During the surgery, we use a special microscope to fluoresce, or light up, the tumor. This enables us to differentiate tumor tissue from normal brain tissue.”

When a person is diagnosed with a malignant brain tumor, time is of the essence. Scientific research has yielded a technology to light up the tumor, so that doctors can see the minute details of life-threatening malignant gliomas.

Studies show tumor fluorescence makes it easier to remove malignant cells without harming healthy brain tissue. The benefit of tumor fluorescence is that it lights up microscopic cancer cells in the brain so your doctor has a better chance of removing them during surgery.

Why Are Brain Tumors So Hard to Treat?

Despite a number of advancements in the field, including tumor fluorescence, treating brain tumors is incredibly difficult. The brain has natural defenses, such as the blood-brain barrier that act as a kind of gatekeeper for this critical organ. The blood-brain barrier is a mesh of small blood vessels that work to block harmful substances from entering the brain. This includes cancer drugs aimed at shrinking a brain tumor. 

Surgical removal of a brain tumor is also incredibly difficult and risky. With other types of tumors, a surgeon can remove a little excess tissue around the malignancy to ensure that all of the cancerous cells are removed. However, there is no tissue to spare in the brain; every inch of this organ is tied to bodily functions, from breathing to speech, and much more. This means removing any excess tissue will have a negative effect on the person’s quality of life later on. That’s exactly why tumor fluorescence is so important. Your surgeon can see cancer cells light up under the microscope, which allows them more precision during the excision process.

With that said, the type of complex tumor that forms in brain tissue is also highly challenging. These cells can mutate and divide, making it hard for doctors to pinpoint what they’re dealing with from a treatment perspective.

What Are the Most Common Types of Malignant Brain Tumors?

Gliomas are the most common type of malignant adult brain tumor, occurring in 78% of cases. Within this category reside a number of subcategories of tumors named by the types of cells they’re formed from. 

In the glioma category, astrocytomas are very common, accounting for around one-half of all brain tumors. Typically, these tumors grow very slowly or not at all for long periods, so in some cases, they can be observed rather than treated. 

Glioblastoma, or a grade IV astrocytoma, is a type of fast-growing malignant tumor that resides primarily in the brain. A glioblastoma is the most common central nervous system tumor, accounting for nearly 50% of all brain tumor incidents, or about 3.21 cases per every 100,000 people in the U.S. The survival rate of these tumors is poor, with only 40% of people living through the first year of their diagnosis and just a 5% survival rate at the five-year mark.

Doctors are presented with a number of unique challenges related to these types of tumors, especially because of their localization in brain tissue, which is the central hub for all other bodily functions. Glioblastomas are uniquely resistant to other forms of conventional cancer therapy, in part, because the brain has a limited capacity to repair any collateral damage from radiation or other treatments. Surgery on these tumors can cause capillary leakage and the migration of malignant cells to other parts of the brain.

What Are the Techniques Neurosurgeons Use to Diagnose Brain Tumors?

Neurosurgeons today are armed with a number of critical tools in their fight against malignant brain tumors. Doctors use three primary technologies to confirm the brain cancer and determine the type:

• Conventional MRI, or magnetic resonance imaging can show the tumor and its effect on brain tissue
• MRI spectroscopy (MRS) is an imaging tool that leverages MRI technology to determine the chemical composition of the tumor
• Functional MRI (fMRI) can help highlight which parts of the brain are used when the brain tumor patient performs certain tasks 

Your neurosurgeon may also conduct a biopsy to remove a sample of the tumor and have it analyzed to determine its type and propensity for growth. Tumors are graded by stages and treatment plans depend on the prognosis.

What Are the Techniques Neurosurgeons Use to Treat Brain Tumors?

Typically, brain tumors are treated surgically, often followed by chemotherapy and radiation. The surgical goal is to remove as much of the tumor as possible without harming surrounding tissue. 

Tumor fluorescence is designed to give doctors a better picture at the cellular level of the tissue and improves their ability to reduce the volume of the mass in the most non-invasive way possible.

Neurosurgeons typically perform a craniotomy to open the skull during the surgical procedure. Technology to map the locations of key parts of the brain is used during this procedure. Sometimes the patient is even awake during the procedure, so that doctors can literally map their language functions as they perform the surgery. After the surgery, radiation therapy is usually begun to selectively kill any remaining tumor cells in the surrounding tissue. Chemotherapy is also selected as a treatment in some cases.

Brain surgery is one of the most complex and challenging of all the procedures doctors perform today. Dr. Gandhi says, “Using this and other types of brain technology enable us to treat patients best, whether it requires observation, non-invasive treatment such as radiation, or to make open neurosurgical techniques safer and more efficient.” 

At Orlando Neurosurgery, we understand how scary a diagnosis of cancer can be. Together, we help our patients and their families keep moving forward toward health. If you’d like to speak with our team, please contact us.