“And all I ask of myself is that I hold together”
Neds Atomic Dustbin, Brainbloodvolume 1995
At every post-MRI results day appointment so far it has been a question of how much – if at all – my brain tumour has grown.
Low grade brain tumours grow very slowly, so any indication of more than a few millimetres growth over six months could show things have been changing up there. At my last results meeting in April there was no change in size.
But a few weeks later, my doctor called to tell me some extra results had come in. My tumour hadn’t grown, but it had an unexpectedly high vascularity.
As I wrote here at the time:
“I know not what that means, but I know it’s not good.”
And so I had a biopsy.
And during it, despite their best efforts, surgeons didn’t retrieve any grade III cells. My tumour, on a microscope slide at least, was still a grade II.
In other words, not yet malignant.
But the vascularity of my tumour was enough for my neurologist to err on the side of caution. He recommended I start radiotherapy and chemotherapy.
But, I thought, if the tumour hasn’t grown, and if they’ve retrieved no grade III cells, and I feel good, then why start treatment?
Ahead of my MRI two weeks ago, and my results day this coming Tuesday, I’ve been trying to find out what’s so special about this vascularity.
I discovered one of the things that strikes most concern among oncologists is a tumour’s ability to create its own blood vessels: angiogenesis.
The more angiogenesis that has taken place, the more blood the tumour can take up into the blood vessels it has created. And that means a higher tumour vascularity.
In brain tumours, vascularity is a good indicator that grade II brain tumours are transforming or are about to transform into grade III malignant ones.
A grade III isn’t totally bad news, but its certainly worse than grade II.
One 2006 paper analysed a group of low grade tumour patients, measuring their tumour’s base vascularity at the start of the study. It then looked at when the patient’s tumour transformed from grade II into grade III.
It concluded the tipping point for low grade tumours turning into higher grade ones was when a patient had a base vascularity of above 1.75.
In other words, of all those who had a vascularity lower than 1.75 when they entered the study, only 50% had transformed into high grade tumours a full 12 years later.
Of those who had a base vascularity above 1.75, that vital 50% (called the median) had transformed into high grade tumours just eight months later.
A 2008 study, written by my own neurologist with others, looked at the rate of change in the vascularity in tumours over a period of 36 months.
It concluded that when patients’ vascularity hardly changed from MRI to MRI their tumour didn’t transform into a higher grade during the period of the study.
But when the vascularity increased from MRI to MRI during the study, it was a strong indicator that transformation had or was about to take place.
In fact, this increase in vascularity was a far stronger predictor of transformation than a tumour’s growth, the side effects it creates or its intensity on the MRI images.
So even if your tumour isn’t growing or if your seizures aren’t getting worse, if your vascularity is increasing there’s a good chance transformation is underway.
I’m beginning to see why this week’s results meeting is an important one. And why my neurologist gave me that urgent call when those late test results came through.
Since diagnosis, my tumour has not grown any significant amount. My seizures have been extremely up and down.
But after my last MRI results appointment I was given my base vascularity score, its brain blood volume.
The score was 4.8.
This Tuesday I’ll learn for the first time whether that already high score has increased.