Head, Division of Neurosurgery, UBC/VGH; Assistant Professor, UBC, Department Surgery; Director, BrainCare BC, BC Cancer Agency

Now I’d like to focus on brain surgery. You’ve likely heard the phrase “it ain’t brain surgery” used in a casual conversation, but it’s not to me—it IS brain surgery.

Every once in a while there is a situation where surgical removal of a tumour isn’t safe. In truth, I can operate on any tumour in any part of the brain—it is never a technical limitation—but in some situations, I would do more harm than good.

Surgery is never curative of a primary cancerous brain tumour—never. These nasty tumours penetrate the brain with microscopic invasion. These rogue cells are always well beyond the visibility or safe reach of surgery. The best that surgery can do is gather enough tissue to make a clear diagnosis and remove enough central mass to take pressure off the brain—to preserve function. Even after the best surgery, there are going to be malignant cells left behind.

For the occasional patient who hears that his or her tumour is, effectively, “inoperable,” it is understandably disheartening. But it shouldn’t be. Despite the romantic notion of undergoing brain surgery (well okay, maybe romantic is my idea), there are fortunately two other extremely powerful means of attacking these tumour cells, both of which are much more comprehensive than mechanical surgical removal.

Radiation and chemotherapy (or drug therapy) have the ability to penetrate throughout the brain and track down those nebulous invading cells in ways surgery never could.

If surgery isn’t the first option, it only means that we have come up with better and less invasive ways of attacking the tumour. That has not always been the case though; we now live in a time where having an inoperable tumour can actually be a good thing. In fact, my longest survivor had a biopsy followed by radiation and chemotherapy, and not a surgical removal. Go figure.

Brian