Tuesday, May 27, 2008
Magnectic Resonance Spectroscopy
What is magnetic resonance imaging (MRI) and MRS?
MRI, or magnetic resonance imaging, is a means of “seeing” inside of the body in order for doctors to find certain diseases or abnormal conditions. MRI does not rely on the type of radiation (i.e., ionizing radiation) used for an x-ray or computed tomography (CT) scan. The MRI examination requires specialized equipment that uses a powerful, constant magnetic field, rapidly changing local magnetic fields, radiofrequency energy, and dedicated equipment including a powerful computer to create very clear pictures of internal body structures.
During the MRI examination, Norman is placed within the MR system or “scanner”. The powerful, constant magnetic field aligns a tiny fraction of subatomic particles called protons that are present in most of the body's tissues. Radiofrequency energy is applied to cause these protons to produce signals that are picked up by a receiver within the scanner. The signals are specially characterized using the rapidly changing, local magnetic field and computer-processed to produce images of the body part of interest.
MR spectroscopy is used to characterize biochemical components of normal and abnormal brain tissue. MRS complements MRI as a non-invasive means for the characterization of tissue. The most widely used clinical application of MRS has been in the evaluation of central nervous system disorders. MRS has its limitations and is not always specific but, with good technique and in combination with clinical information and conventional MRI, can be very helpful in diagnosing certain entities. MRS may also be helpful in the differentiation of high grade from low grade brain tumors, and perhaps in separating recurrent brain neoplasm from radiation injury.
On the 3rd May 2008, Norman had his 2nd MRI and MRS done at Wijaya Medical center in PJ. The result shows necrotic brain tissues. It was indeed good news for us. There are 2 rounded heterogeneously enhancing lesions in the left frontal lobe measuring about 1.0x1.5cm and 0.6x0.5cm. There was still some edema seen.
Norman finished his 4th cycle of Temodar chemotherapy on the 22nd May. He experience the usual side effects of gastric bloatedness, loss of appetite and lethargy. However he still manage a full round of 18 hole at the golf course!! 3 cheers! Golf power wins!! Another 2 more cycles of temodar in June and July and that’s the end of chemotherapy(I pray he doesn’t need any more of this toxic poison anymore).
MRI, or magnetic resonance imaging, is a means of “seeing” inside of the body in order for doctors to find certain diseases or abnormal conditions. MRI does not rely on the type of radiation (i.e., ionizing radiation) used for an x-ray or computed tomography (CT) scan. The MRI examination requires specialized equipment that uses a powerful, constant magnetic field, rapidly changing local magnetic fields, radiofrequency energy, and dedicated equipment including a powerful computer to create very clear pictures of internal body structures.
During the MRI examination, Norman is placed within the MR system or “scanner”. The powerful, constant magnetic field aligns a tiny fraction of subatomic particles called protons that are present in most of the body's tissues. Radiofrequency energy is applied to cause these protons to produce signals that are picked up by a receiver within the scanner. The signals are specially characterized using the rapidly changing, local magnetic field and computer-processed to produce images of the body part of interest.
MR spectroscopy is used to characterize biochemical components of normal and abnormal brain tissue. MRS complements MRI as a non-invasive means for the characterization of tissue. The most widely used clinical application of MRS has been in the evaluation of central nervous system disorders. MRS has its limitations and is not always specific but, with good technique and in combination with clinical information and conventional MRI, can be very helpful in diagnosing certain entities. MRS may also be helpful in the differentiation of high grade from low grade brain tumors, and perhaps in separating recurrent brain neoplasm from radiation injury.
On the 3rd May 2008, Norman had his 2nd MRI and MRS done at Wijaya Medical center in PJ. The result shows necrotic brain tissues. It was indeed good news for us. There are 2 rounded heterogeneously enhancing lesions in the left frontal lobe measuring about 1.0x1.5cm and 0.6x0.5cm. There was still some edema seen.
Norman finished his 4th cycle of Temodar chemotherapy on the 22nd May. He experience the usual side effects of gastric bloatedness, loss of appetite and lethargy. However he still manage a full round of 18 hole at the golf course!! 3 cheers! Golf power wins!! Another 2 more cycles of temodar in June and July and that’s the end of chemotherapy(I pray he doesn’t need any more of this toxic poison anymore).
Saturday, March 29, 2008
Baptism Day
Easter is the festival commemorating the resurrection of christ. Christian celebrate this day in observance of their believe that Jesus rose from the dead on the third day after his crucifixion. This year easter falls on the 23rd of march. It is a very special day for the whole family as Norman was baptized on this meaningful day. Praise the Lord!
Quote:Revelation3:20 Look! I stand at the door and knock. If you hear my voice and open the door, I will come in and we will share a meal together as friends.
Saturday, March 8, 2008
Brain Necrosis
Brain Necrosis
Radiation is a powerful weapon against cancer cells, but sometimes it kills healthy brain tissue as well, resulting in a severe side effect called radiation necrosis. Necrosis can cause headaches, seizures, or even death.
Radiation necrosis is a focal structural lesion that usually occurs at the original tumor site. It is a potential long-term central nervous system complication of radiotherapy.
Regular follow-up treatment is extremely important after treatment for a brain tumor. Besides regular physical and neurological exams, Norman need periodic magnetic resonance (MRI)or computed tomography (CT)and regular blood test.
On March 1st, Norman had his 1st MRI check up. There was a lesion measuring 1.9cm by 1.2 cm seen on the x-ray. I was instantly petrified! It could be reoccurrence of the glioblastoma or brain necrotic cells! There was a moderately big patch of Oedema (Water) around the tumor site also.
On 6th march, we saw Dr Lee F.C. at Sunway Hospital. He said it was a residual tumor! As t is impossible to remove 100% of the tumor due to its infiltrative character, there is bound to be some tumor left in the brain. We breath a big sigh of relieve! The odema was also due to the Radiation. Norman now needs to go back on steroids, dexamethazone 2mg twice daily for 2 weeks.
For the past few weeks, Norman have been complaining that he feels cold most of the time esp in an air con room. His pulse rate is exceptionally low at about 50 beats per minute! Inactive thyroid? Well, to be on the safe side, he is put on thyroxine to activate his thyroid for 2 weeks. I really hate this chain of medication that he has to swallow daily.
Norman’s 2nd cycle of chemo starts on the 19th of march. The routine round of blood test will be done first to check his lymphocyte and platelets level. Poor Norman! Sob!
The next MRI will be about 3 months time. If the lesion increases in size, an MRS will need to be done. Will tell you all about MRS later.
Quote: Even though I walk through the valley of the shadow of death, I will fear no evil, for you are with me;your rod and staff, they comfort me. Psalm23:4
Radiation is a powerful weapon against cancer cells, but sometimes it kills healthy brain tissue as well, resulting in a severe side effect called radiation necrosis. Necrosis can cause headaches, seizures, or even death.
Radiation necrosis is a focal structural lesion that usually occurs at the original tumor site. It is a potential long-term central nervous system complication of radiotherapy.
Regular follow-up treatment is extremely important after treatment for a brain tumor. Besides regular physical and neurological exams, Norman need periodic magnetic resonance (MRI)or computed tomography (CT)and regular blood test.
On March 1st, Norman had his 1st MRI check up. There was a lesion measuring 1.9cm by 1.2 cm seen on the x-ray. I was instantly petrified! It could be reoccurrence of the glioblastoma or brain necrotic cells! There was a moderately big patch of Oedema (Water) around the tumor site also.
On 6th march, we saw Dr Lee F.C. at Sunway Hospital. He said it was a residual tumor! As t is impossible to remove 100% of the tumor due to its infiltrative character, there is bound to be some tumor left in the brain. We breath a big sigh of relieve! The odema was also due to the Radiation. Norman now needs to go back on steroids, dexamethazone 2mg twice daily for 2 weeks.
For the past few weeks, Norman have been complaining that he feels cold most of the time esp in an air con room. His pulse rate is exceptionally low at about 50 beats per minute! Inactive thyroid? Well, to be on the safe side, he is put on thyroxine to activate his thyroid for 2 weeks. I really hate this chain of medication that he has to swallow daily.
Norman’s 2nd cycle of chemo starts on the 19th of march. The routine round of blood test will be done first to check his lymphocyte and platelets level. Poor Norman! Sob!
The next MRI will be about 3 months time. If the lesion increases in size, an MRS will need to be done. Will tell you all about MRS later.
Quote: Even though I walk through the valley of the shadow of death, I will fear no evil, for you are with me;your rod and staff, they comfort me. Psalm23:4
Saturday, February 2, 2008
A Birthday Celebration
To all our trekkers friends,
Thank you so much for celebrating Norman's birthday with us on the 20th january. This year is indeed special as it is his 51st birthday. The journey of life is now extra tough for us as we face the unknown future. But with good friends like you all, it will make our journey happier as we share time together. Knowing that we have such supportive friends empowers us to be stronger mentally and emotionally. Thank you.
Dorothy
Quote: It is not so much our friend's help that helps us as the knowledge that they will help us.
Thank you so much for celebrating Norman's birthday with us on the 20th january. This year is indeed special as it is his 51st birthday. The journey of life is now extra tough for us as we face the unknown future. But with good friends like you all, it will make our journey happier as we share time together. Knowing that we have such supportive friends empowers us to be stronger mentally and emotionally. Thank you.
Dorothy
Quote: It is not so much our friend's help that helps us as the knowledge that they will help us.
Friday, February 1, 2008
Completion of radiotherapy
Yippy!! Finally norman’s radiation therapy is completed. All 30 fractions of this damn rays bombarding into his brain and making him look like an uneven kojak!! What’s next? Well, we will have an MRI on the 3rd March to check on the effects of the radiation. Adjuvant chemo (Temodar 250mg for 5 days per month) will begins on 26th February. A blood test need to be done to determine if his body is fit enough for chemo.
Sunday, January 20, 2008
Glioblastoma Multiforme
Playing golf after glioblastoma surgeryDear friends,
Below is a write up of different types of brain tumors. I find it very educational and would like to share it with you all.
Astrocytomas and oligodendrogliomas are the most common primary tumors of the adult brain. Both tumors are types of gliomas. Primary brain tumors arise from cells of the brain itself rather than traveling, or metastasizing, to the brain from another location in the body. Gliomas can be slowly growing (low-grade, grades 1 and 2), or rapidly growing (high-grade, grades 3 and 4). This material will give important facts about the diagnosis and treatment of high-grade gliomas.
High-grade gliomas are diagnosed by a biopsy
Once a brain tumor is detected on a CT or MRI scan, a neurosurgeon obtains tumor tissue for examination by a neuropathologist (a biopsy). The neuropathologist then gives the tumor a name and grade. The exact name and grade of the tumor determine treatment options, and also give important information about prognosis.
When neuropathologists analyze tumor tissue under a microscope, there are two main questions being asked:
-first, what type of brain cell did the tumor arise from? The answer to this question gives the tumor a name, for example, astrocytoma.
-second, do the tumor cells show signs of rapid growth? This involves assigning the tumor a grade, such as grade 3 or 4 (see below).
These two pieces of information are then combined, as in "grade 4 astrocytoma". Once a tumor has been given a name and a grade, brain tumor specialists can give advice about treatment choices, prognosis, and provide useful health-care information to brain tumor patients and their families.
Tumor name: from what type of brain cell did the tumor arise?
Astrocytomas arise from brain cells called astrocytes. Normal astrocytes are star-shaped cells that give the brain its shape. Astrocytes are the most common cell type to become tumors. Oligodendrocytes are brain cells that provide insulation around the electrically-active neurons. Tumors of oligodendrocytes are less common than astrocytomas. Many tumors contain a mixture of astrocytoma and oligodendroglioma cells. Tumors of other cell types in the brain are less common. For instance, tumors of neurons are very rare in adults.
Tumor grade: how aggressive does the tumor appear under the microscope?
Astrocytomas and oligodendrogliomas come in four grades, with grade 1 being the most benign and grade 4 being the most malignant. The neuropathologist looks at the brain tumor tissue under the microscope for signs that the tumor is growing rapidly. Examples of these features include cells undergoing division (mitosis), the presence of newly-formed blood vessels, and evidence that the tumor is outgrowing its blood supply (necrosis). The more features that are present, the higher the grade assigned to the tumor.
Gliomas have more than one name in everyday usage. The Table gives the common names of high-grade gliomas:
Synonyms for high-grade Gliomas
Anaplastic astrocytoma = grade 3 astrocytoma
Glioblastoma multiforme = grade 4 astrocytoma
Anaplastic oligodendroglioma = grade 3 oligodendroglioma (oligodendrocytoma)
Anaplastic oligoastrocytoma = grade 3 oligoastrocytoma = anaplastic mixed glioma
Why do brain tumors occur?
Tumors form because of the abnormal, unregulated growth of cells. After the human brain completes it development soon after birth, the vast majority of its cells enter a resting state in which they never divide again. One exception to this rule is when a brain tumor develops. The abnormal brain cells re-enter the "cell-cycle" because of alterations in any of a large number of genes that control cell division and growth. Although much is known about the alterations in these genes in brain tumors, the reason why the gene alterations arise in the first place is poorly understood. The MGH has a very active research program in this area.
Are brain tumors hereditary?
The use of the word ‘gene’ invariably brings up the important question of whether brain tumors are hereditary. The answer for almost all patients is no. Although there are conditions in which brain tumors can occur in families, these syndromes are very rare and usually known prior to the development of an individual family member’s tumor.
Types of therapy
There are three standard types of treatment for patients with high-grade gliomas: surgery, radiation therapy, and chemotherapy.
Because grade 3 and 4 tumors have a tendency to grow rapidly, treatment must be started as soon after surgery as is feasible, allowing time for the surgical incision to heal. Generally, this means that patients should be undergoing either radiation therapy or chemotherapy within 2 to 4 weeks after surgery.
While therapies for high-grade gliomas are helpful, at present these treatments cannot cure these tumors. The two major reasons for this are that tumor cells infiltrate into surrounding brain and thus cannot be completely removed by the surgeon, and that most glioma cells are at least partially resistant to radiation and chemotherapy.
The goals of treatment are to:
-remove as many tumor cells as possible (with surgery)
-kill as many as possible of the cells left behind (with radiation and chemotherapy)
-put remaining tumor cells into a nondividing, sleeping state for as long as possible (with radiation and chemotherapy)
High-grade glioma cells almost always start to grow again at some point in time. Patients receive aggressive treatment in order to delay this regrowth as long as possible. Regrowth does not necessarily imply loss of control of the tumor, but it does mean that a new series of treatments should be considered because the tumor is becoming more aggressive.
Norman have just finish his 22nd radiation today. He is feeling fine except for a bee sting on his left fore head. It is slightly swollen and painful to the touch. The Dr suggest to take an anti-histamine.
On another note, I would like to say a big thank you to all our trekkers friends who celebrated Norman's birthay on sunday 20th January. (His actual birthday is on the 22nd). All the ladies are fantastic cooks!! I always look forward to any of our pot luck gathering. Whose birthday is next? I will post the photos another day as it is still in Nicky's camera.
Quote: A merry heart is good medicine, but a crushed spirit dries up the bone. Proverbs17:20
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