Not only is brain cancer very rare, affecting less than 1 percent of the population, brain tumors can be both difficult to diagnose and to treat.
There are more than 120 different types of brain tumors that can have varying symptoms ranging from a headache to memory loss or seizures, depending on the tumor’s location in the brain. These symptoms often mimic other neurological conditions.
Brain tumors also have one of the least favorable outcomes. But Nicole Shonka, MD, neuro-onocolgist at Nebraska Medicine, says that is starting to change. While advancements in the treatment of brain cancers have been slow, there has been progress in small steps and Dr. Shonka is confident new advancements are just around the corner.
Dr. Shonka is the only fellowship-trained neuro-oncologist in the state specializing in brain tumors. An assistant professor in oncology/hematology at the University of Nebraska Medical Center (UNMC), she joined the staff in 2010. Dr. Shonka received her medical degree from UNMC where she also completed her residency and general oncology fellowship. She completed an additional neuro-oncology fellowship at MD Anderson Cancer Center, one of the top cancer centers in the nation and a highly respected neuro-oncology fellowship – one of a few programs in the country. The program draws from a large population base that allows doctors to see up to 3,000 primary brain tumors a year. “Completing my training there allowed me to see many more brain tumors, including the rarer ones,” notes Dr. Shonka.
This is important, notes Dr. Shonka, “As there are many nuances in this field that you may not be aware of unless you have that additional training.”
Treatment for brain tumors typically involves surgery followed by radiation therapy and/or chemotherapy. Pseudo-progression and radiation necrosis are two conditions that can develop during cancer treatment that can be misinterpreted by the untrained eye and change the treatment regimen.
“Glioblastomas (the most common type of malignant brain tumor in adults) often develop pseudo-progression the first several months after treatment,” explains Dr. Shonka. “Pseudo-progression could easily be misinterpreted by someone unfamiliar with these cancers as evidence that the treatment is ineffective.”
Some patients may also develop radiation necrosis, which can appear to be additional tumor growth, she says.
Chemotherapy has been a big area of advancement for brain tumors. “In the past 10 years, we have developed better chemotherapies for treating brain cancers which have helped improve survival rates for nearly all brain cancer patients,” says Dr. Shonka.
Other advances lie in the realm of personalized medicine, in which cancer treatment is based on a person’s unique genetic makeup. In brain cancers, this includes the discovery of molecular markers which can provide both prognostic and predictive data. Scientists have also discovered variances in the molecular features of glioblastomas that have allowed them to classify them differently. This is spurring the development of personalized therapies based on these classifications.
“We are currently studying certain enzymes which can help predict a patient’s response to therapy or provide us information about their prognosis,” says Dr. Shonka. “This will help us determine what therapies to use and how aggressively to treat a patient.”
Dr. Shonka says she expects research to reach a new level at Nebraska Medicine with the creation of the new Fred & Pamela Buffett Cancer Center, which is expected to be open in 2017.
“With the new cancer center, we will all be housed in greater proximity which I believe will foster more collaboration among clinicians and researchers and should help to expedite moving new advances from basic sciences research to the bedside,” she says.
“This is an exciting time to be a neuro-oncologist and I’m increasingly optimistic about the future for patients with brain tumors,” says Dr. Shonka.