Brain Tumors: What to Watch For and When to Get Help

What are brain tumors, who is at risk, and what symptoms should you never ignore? In this episode of Baptist Health Talk, we break down the most searched questions about brain tumors, including common warning signs, treatment options, myths about cell phones, and why there is more hope today than ever before.

Host Johanna Gomez is joined by Dr. Rupesh Kotecha, Chief of Radiosurgery at Baptist Health Miami Cancer Institute, and Dr. Evan Bander, neurosurgeon and co-director of the Pituitary Tumor Program at Baptist Health Miami Neuroscience Institute.

In this episode, you’ll learn:

• What brain tumors are and how common they are
 • The difference between benign and malignant brain tumors
 • Whether cell phones or AirPods increase brain tumor risk
 • Symptoms such as persistent headaches, nausea, vision changes and seizures
 • When surgery, radiation, CyberKnife or other treatments may be used
 • Why multidisciplinary care matters for brain tumor patients
 • What glioblastoma is and why it receives so much attention
 • How palliative care supports quality of life
 • Where doctors see hope in newer treatment approaches

Subscribe for more expert conversations on health, prevention and wellness from Baptist Health South Florida.

Host:
Johanna Gomez
Award-Winning Host & Journalist

Guests:
Rupesh Kotecha, M.D
Chief of Radiosurgery & Director of Central Nervous System Metastasis
Baptist Health Miami Cancer Institute

Evan Bander, M.D.
Neurosurgeon & Co-Director of the Pituitary Tumor Program
Baptist Health Miami Neuroscience Institute 

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Transcript

SPEAKER_02 0:00

But at least with cell phone usage over time, there has not been an increased risk of brain tumors. And typically because we would see that tumor being unilateral in one location versus another. And as people are one-handed versus another, you would see an incidence of brain tumors associated with that handedness. And we haven't seen that come across in the science.

SPEAKER_00 0:21

Welcome to Baptist Health Talk, a podcast on all things healthcare, powered by Baptist Health South Florida, your trusted source for healthcare prevention and wellness.

SPEAKER_03 0:31

Hi everyone, I'm your host, Joanna Gomez. Welcome back to a new episode of Baptist Health Talk, where we answer your most searched questions on health topics. Today we're breaking down what people are really asking about brain tumors. What are they? Who's at risk? The signs you shouldn't ignore, and how treatment has evolved to give patients more options and more hope than ever before. We are joined by Dr. Rupesh Kotecha, Chief of Radiosurgery at Baptist Health Miami Cancer Institute, and Dr. Evan Bander, neurosurgeon and co-director of the pituitary tumor program at Baptist Health Miami Neuroscience Institute. It is great to have you both here for such a great conversation that we're going to have. But what I love the most is that I said hope, because I think that's what we all need, a little bit of hope. But let's start at the basics, at the starting line. What are brain tumors? Go ahead and start with you.

SPEAKER_01 1:27

So brain tumors are really any growth within the brain. They can come in multiple different types. There's malignant brain tumors, which are sometimes considered brain cancers. And then there are benign brain tumors, which are tumors that are slower growing and less aggressive than a brain cancer or a malignancy.

SPEAKER_03 1:45

How common is it to have a brain tumor?

SPEAKER_01 1:50

They're actually quite rare. You know, less than 1% of the population actually has a brain tumor, most of which, about two-thirds of which are benign brain tumors when they're diagnosed, and about one-third is a malignant brain tumor.

SPEAKER_03 2:03

Okay. So they're different types, like there's with everything. Can you try to break down? And I know there are so many different types, but can you break them down as simple as possible so we can all understand?

SPEAKER_02 2:13

Absolutely. So Dr. Bander kind of introduced brain tumors from the sense of primary brain tumors. Those are tumors that start in the brain itself. The first thing we like to clarify for a patient is what's a brain tumor, something that actually started in the brain versus a tumor that went to the brain but came from a different part of the body. Those are actually metastasis. And so they're called brain tumors. They're treated by a brain tumor team such as ourselves, but they're not actually the primary brain tumors. They're probably what we'll talk about here today. But those are very common in our society. So anywhere from 150 to up to 400,000 patients a year diagnosed. But that's cancer that started in a different part of the body. For tumors that start in the brain, we really just upfront categorize them as those that are benign tumors. So as Dr. Bander mentioned, those that are just abnormal growths in the brain versus those that are true brain cancers, those are malignancies, and they require multimodality treatment. So there's two different types. Exactly.

SPEAKER_03 3:19

And two different ways of kind of helping patients go through this journey to be successful, correct?

SPEAKER_01 3:26

Yes. Okay, so broad classifications.

SPEAKER_03 3:29

Okay, so who gets brain tumors then? I mean, I'm assuming everyone and anyone, but is this something that is more genetic prone?

SPEAKER_01 3:38

So the reality is that's actually probably one of the most common questions that I get as a neurosurgeon when we talk to patients the first time about a diagnosis is how did this happen? Why did I get this? What's wrong with it? What did I do wrong? And the reality is that we that patients didn't do anything wrong. In most cases, we know that most brain tumors are sporadic. They're not genetically related. There are small populations of brain tumors which can be genetically related.

SPEAKER_04 4:04

Okay.

SPEAKER_01 4:04

But that's much more rare than sporadic brain tumors. You know, meningiomas, benign tumors, like pituitary adenomas. We know that these are mostly not related to genetics. These just happen by random chance.

SPEAKER_03 4:17

Aaron Powell Stress.

SPEAKER_02 4:19

Unfortunately, stress really isn't one of those risk factors. And as Dr. Bander is mentioning, I mean, there aren't specific risk factors that are associated with most of the brain tumors that actually we see. So for that reason, there aren't ways to screen patients. There aren't things that you would know about in advance. Unfortunately, it's just at some point a patient has symptoms that leads to a workup and a diagnosis. And ultimately we come to that arrived at the conclusion that they do have a brain tumor.

SPEAKER_01 4:48

Or they're diagnosed completely incidentally in the setting of workup for other symptoms that are completely unrelated. Yes, because I think a lot of the patients that we see are patients who had a an MRI or a CT scan for other reasons and got diagnosed with a brain tumor, which may be benign and means that you know doesn't necessarily require treatment.

SPEAKER_03 5:09

Okay. Phones. A lot of people are talking about it. It's all over the internet. We have our phones right here. We have AirPods. We've so many things. We sleep next to our cell phones. I do it all the time. Maybe does this have something to do with it? Just throwing it out there? What does the science say?

SPEAKER_01 5:29

The science is relatively inconclusive. There, you know, there's there's no support to suggest that, you know, cell phones actually do increase the risk of brain tumors. The reality is that we have our skull is thick enough that the any radiation, any minimal radiation that cell phones do emit is not going to get through the skull. And the reality is we don't see increased uh cancers of the skin around the ears. So we're not really seeing any evidence that these cell phones are causing any increase in malignant.

SPEAKER_03 5:59

So do both of you use AirPods? I'm just curious. I use AirPods.

SPEAKER_01 6:05

I'm meeting him on multiple meetings on AirPods.

SPEAKER_02 6:08

I probably have like seven different sets of AirPods.

SPEAKER_03 6:10

Okay, so is this a myth or it's just the science is not there to back it up?

SPEAKER_02 6:14

So they're looking at this in large registries. Actually, the best data and the best science is probably comes out of Europe because they have national health services. And so they're able to track patients over long periods of time. And you can have some association with the science to it. So, for example, if you're right-handed, I'm more likely to use my cell phone in one hand versus another hand. AirPods are a little bit more complicated because typically you put two AirPods in and or people are switching between them. So it's not easy to test this and to look at this over time in patterns. But at least with cell phone usage over time, there has not been an increased risk of brain tumors. And typically because we would see that tumor being unilateral in one location versus another. And as people are one-handed versus another, you would see an incidence of brain tumors associated with that handedness. And we haven't seen that come across in the science. I still agree with you. I mean, as our generations, you know, grow up more and more with technology, we have more exposure to these things. So we do have to carefully study this over time. But at present day, with the signs that we have, there is no association that we know of.

SPEAKER_03 7:19

That makes me feel so much better. Thank you for telling me that. But let's talk about the signs. The first signs that people should look out for if maybe they're not feeling well and they think that they might have a brain tumor.

SPEAKER_02 7:32

So typically the first signs for patients who are symptomatic are headaches.

SPEAKER_04 7:38

Okay.

SPEAKER_02 7:39

And they can be associated with nausea and then sometimes vomiting. Those are different than headaches. For example, you skipped lunch today and then you have a headache later in the afternoon, or just a headache that comes upon just randomly. These are things that are persistent and they get worse with time. So they're not getting better. Those are something that kind of should be brought to medical attention. Now, patients sometimes have symptoms with tumors in certain locations. So, for example, we had a priest diagnosed because he started having difficulty raising his left hand when he was going into prayer. So that was a very specific symptom. He had an MRI scan that showed that he had a tumor in the right side, so the opposite side of the brain, that controls that hand, that arm position. We've had patients who have tumors in the back part of the brain where vision comes from. And so they have changes with their vision, or the very bottom part of the brain where patients' balance comes from. So symptoms can be generalized, things like headaches, fatigue, or they could be or nausea, or they could be more specialized based on the actual location.

SPEAKER_04 8:47

Okay.

SPEAKER_02 8:47

Now, if these continue and they're not addressed, then sometimes we get more urgent symptoms, like if a patient passes out, or something that we see commonly is patients have a seizure event. They were doing fine, maybe had some non-specific symptoms and ultimately then had an event that brought them to the hospital.

SPEAKER_03 9:06

Yeah, but one of the biggest questions that we found online were people saying, like, is there something wrong with me? Like, what is wrong with me? Because I am nauseous. I'm throwing up, and not everyone has a seizure, like you just mentioned.

SPEAKER_02 9:19

Absolutely. I mean, it's it's hard. I think there are patients, again, who come symptomatic to us. There are also patients, as Dr. Banner kind of mentioned, that come asymptomatic to us that are incidentally diagnosed. We have patients, somebody who got into a car accident. Somebody hit them. They didn't do anything wrong, but they ended up getting a CT and an MRI scan, and that led to a diagnosis of a tumor. So there are patients, especially now in the modern era where patients have access to scans and patients get scanned more frequently. We're picking up tumors in the brain. Now, unfortunately, the tumors that we're picking up are actually probably benign tumors. We're not picking up the high-grade tumors or the cancers in the brain. Those are the tumors that we really want to detect at an earlier stage.

unknown 9:58

Right.

SPEAKER_02 9:59

But we are picking up tumors more commonly in the brain. Right.

SPEAKER_03 10:02

Just because I think maybe that's why we hear so much of it. And there's such a difference. Speaking of difference, uh, is there a difference of symptoms with men and women? We are just naturally more hormonal than men, us women. And so a lot of times we just feel different than what you guys do. Is there something that we should look out for, women and men, that we should kind of be aware of?

SPEAKER_01 10:23

You know, I would say that most brain tumors don't distinguish in terms of symptoms between men and women. You know, there are certain brain tumors like meningiomas, one of the benign brain tumors that are more common in women. Um, but that's not to say they present differently. Uh, and and going back to what Dr. Kotecha was saying, you know, many patients have a lot of these headaches, you know, nausea, vomiting that may be completely unrelated. And, you know, in many cases, it can be very hard for patients to know when do I need to seek help? Or when do I need to see a doctor. And, you know, I think what's important for patients to realize is if your symptoms are, as Dr. Kotecha was saying, progressive or persistent, are not getting better, those are really signs that you want to see somebody and get evaluated. You know, whether that's your primary care doctor or a neurologist, you know, having somebody do the appropriate workup and helping you work through those symptoms to see if there's any appropriate imaging that's necessary. That's what I think is very important. You know, patients can go on Google all the time and Google their symptoms, and you can absolutely find something concerning if you Google specific symptoms, you know, but that doesn't necessarily mean you have a brain tumor.

SPEAKER_03 11:28

And hence why we are here, because we are trying to debunk all those things that we read and we hear online, you have a brain tumor. I would automatically think I need to have surgery. Is that the case?

SPEAKER_01 11:41

So, no, in many cases, many of the patients that I see, I we don't operate on. So, particularly for benign brain tumors, you know, uh meningiomas, pituitary adenomas, many of these tumors, when they're diagnosed, especially incidentally, they can be watched and observed on repeat imaging. Once you're diagnosed, you form a relationship with your neurosurgeon or your physician. And it is something that you do watch and follow over time, but that doesn't necessarily mean that everybody needs surgery.

SPEAKER_03 12:09

Radiation, how does that look like? Chemotherapy is are those options as well?

SPEAKER_02 12:14

So they're all options, but it depends on the type of tumor. So, as Dr. Banner mentioned, so if a patient is diagnosed with an incidental benign tumor and then it is followed over time, and then it does grow or does cause symptoms, then we have options. And those options could include surgery to remove them. It could include radiation therapy to treat that tumor as well. Often for benign tumors, we do not offer chemotherapy or targeted therapies or any form of systemic therapies.

SPEAKER_03 12:43

Only with cyber knife is can you explain that? Because that's very popular. Also, a lot of people have spoken about that.

SPEAKER_02 12:50

Absolutely. So, cyber knife is one of the technologies that we can use to deliver what's called stereotactic radiosurgery. So, radiosurgery is like surgery in that it's very precise to treat a tumor in the brain, but it is completely non-invasive. The machine rotates around the patient, it delivers beams of radiation, but we don't actually have to cut into the patient. So it's in a sense kind of like a surgery, but it's a radio surgery. It's using radiation to be like surgery. That procedure is done by Dr. Bander and myself. So we do it together. You have two physicians that do it, along with a medical physicist, because this is high precision radiation in the brain. That is just one of the different technologies that can be used to deliver radiation in the brain. So cyber knife being one of them, for example, gamma knife being another one, Dr. Bander and I are going to do a case tomorrow. Uh a Zap X is a different machine that does that. A case on Monday. And so these are different technologies that we can use to personalize the treatment for any particular patient.

SPEAKER_03 13:50

It's different from like a conventional radiation.

SPEAKER_02 13:53

It is different than conventional radiation. So conventional radiation is typically delivered over weeks of time. So anywhere from four and a half weeks for a certain tumor type up to about seven and a half weeks. Uh the majority of cases are delivered over weeks and weeks of therapy, where it's Monday through Friday, Monday through Friday. Radiosurgery, when it's delivered using, for example, a cyber knife, a gamma knife, or a zap, those treatments are typically only one treatment or even up to five treatments because they're so precise, we can give very high doses of radiation. So basically weeks of treatment that we can shorten in just days.

SPEAKER_03 14:27

How about those side effects? This is for whichever one of you wants to answer that question. How does life look like?

SPEAKER_01 14:35

Well, I think just to follow up on that first, you know, I think what's really important is finding a team that, you know, answers the question of do I need surgery or do I need radiosurgery or some other type of radiation? You know, I think that's really what distinguishes Miami Neuroscience and Miami Cancer Institute, is that we work as a team. Once the patient is diagnosed, we have conversations on a daily basis, phone calls, text messages. Maybe hourly to make sure that the patient is getting the optimal treatment for them.

SPEAKER_03 15:06

But that is the hardest part, probably as a patient, trying to find the right dual that works. So now that we are talking about this, we'll get back to the treatments and the side effects that people have to deal with. But how do we look for what should we be looking for when it comes to building the right team? Obviously, we want something that's gonna be a collaboration, that's gonna work well, that's gonna talk nicely all the time, like you say. But what should we be looking out for?

SPEAKER_01 15:31

Well, I think multidisciplinary care is extremely important for brain tumors. You know, we've already talked about there are lots of different types of brain tumors and there are multiple different types of treatment, whether it's surgery, radiation, chemotherapy, systemic therapy, immunotherapy, all of these different types of therapies, they need to be coordinated. And the care needs to be coordinated. Some patients with the same tumor in the same location may benefit from surgery, while others may benefit from radiosurgery. So having that conversation between a radiation oncologist and a surgeon is extremely important. Decisions shouldn't be made individually in a single bubble. You want people and teams that are working together to make those decisions jointly. And that's really how patients get optimal care because every patient is different and multiple factors need to be taken into consideration for when those decisions are made.

SPEAKER_03 16:20

And I'm assuming that because the science is just expanding as rapidly as it is, that you guys are constantly just trying to stay ahead of it.

SPEAKER_02 16:30

We are. Yeah, it's a completely non-invasive treatment. So we have patients come in and they leave the same day because we give them medicine to make them comfortable. We don't want them to drive themselves. But otherwise, they don't really have restrictions, precautions from our standpoint. Typically, again, with fractionated radiation over multiple weeks, you get things like fatigue, some tiredness, some headaches, a little bit of nausea. You can get some hair loss in the area that we're treating with radiation. But those are typically the short-term side effects afterwards. Now, long-term, we have to think about neurocognitive function for those patients. And so that adds into that complexity as you do long-term follow-up for those patients. So we do monitor that over time, and our neurocologists do keep that into mind. There's also the emotional aspect to it as patients get followed. So it's not a true side effect of our treatment, but things like anxiety, obviously, you're going to get scanned every couple of months potentially if you have a brain tumor. And so that does add to that as well.

SPEAKER_03 19:08

If your diagnosis is really far along, um, what does life look like for you living with the diagnosis?

SPEAKER_01 19:17

You know, it depends on the diagnosis because as we talked about, there are so many different types of brain tumors. Uh, you know, each different type may have a different prognosis, meaning, you know, how patients, you know, do from surgery, what their expectations are for how frequently they need to be scanned, or how frequently they need surveillance imaging, you know, and and what the expectations are. So everybody's a little bit different. And it's hard to say, you know, every patient goes back to normal the first day after surgery, or you know, some people need a little bit longer. And some people, you know, we scan yearly, other patients we scan every few months again, depending on the type of diagnosis.

SPEAKER_02 19:54

I mean, you have some patients, for example, a grade one meningioma patient. That patient, if they're treated with surgery or with stereotic radiation therapy, have a very long-term life expectancy. I mean, if they have a two centimeter size tumor that Dr. Bander removes completely, their survival is measured in years and years and years. If you have a high grade brain tumor, glioblastoma, that's a survival that's much shorter. And so they're scanned typically every one to two months. So life is gonna be very different for that patient. They're always gonna be on some sort of therapy, whether it's you start with surgery, then you get radiation, then you get chemotherapy, then you get chemotherapy, then you're gonna get additional chemotherapy, and you keep switching chemotherapies. You may go back to surgery, you may get another course of radiation. Their life is involved with multiple treatments at all times, essentially, for those patients.

SPEAKER_03 20:44

You just brought up glioblastoma. Uh that's when we hear about that the most. What is it like for someone that has been diagnosed and the focus? Why so much focus on that?

SPEAKER_02 20:56

There's a lot of focus, I think, about glioblastoma because it is a very aggressive brain tumor. Um, the survival typically in the United States is between 14 to 18 months for a newly diagnosed glioblastoma patient. And so, as we mentioned, essentially their entire life um will revolve around that diagnosis and our our care will be multimodal into how we manage and treat them. So they will meet an entire team. And that includes neuro oncology, neuroradiation oncology, neurosurgery, but obviously there's other members too that are key to their care. So, for example, our uh palliative medicine or symptom support services and those physicians, our physical medicine and rehab physicians to ensure that if the patients have neurologic deficits or there are things that they can improve. So there's an entire team that takes care of those patients. That treatment paradigm is really surgery, chemotherapy, and radiation. And that really has remained unchanged, unfortunately, since two thousand five.

SPEAKER_01 21:59

I I will Say that, you know, one of the things that is really important, you know, even for patients with most aggressive brain tumors, is finding, again, the balance of, you know, treating the tumor and quality of life. And that is really what focus, you know, what our multidisciplinary teams focus on, is that, you know, it's not just getting the patient to the next treatment, but it's figuring out what is best for them, what their goals are, and how we achieve that. You know, from a surgical standpoint, we have seen a lot of advances in the surgery for these tumors. You know, we have a lot more information about the molecular and genetics of these tumors from after surgery and between surgery and treatment. We also, you know, have a lot of new tools that we use to try to maximize patients' functions after treatment or after surgery. You know, we now have things like fluorescence-guided surgery, neuronavigation. Um, you know, we do awake craniotomies to try to preserve function. Um, you know, all of these things, all of these tools we now have to be able to maximize, you know, our oncologic benefit, meaning take out as much tumor as we safely can while also preserving function and focusing on, you know, return to work, you know, getting back to their normal daily life. These are really the goals that we have, you know, throughout care. But as patients you know progress through their care, it's always re-evaluated what they need and what would be best for them.

SPEAKER_03 23:28

Yeah. So what I take, my takeaway from this is you guys really focus on the quality of life.

SPEAKER_01 23:33

We focus on we focus on the patient.

SPEAKER_02 23:34

We have to balance exactly for the patient. I mean, we want to control the tumor as much as possible, but we also want to balance the quality of life aspect. So as Dr. Bander mentioned, I mean, we are studying every way that we can. And when we offer any patient any additional treatment, we're obviously balancing the risks and benefits to any intervention that we would do in a particular patient.

SPEAKER_03 23:56

You mentioned you had a young patient that you just saw. So I was curious at what age should we start wondering and asking? Because we all go down that rabbit hole. That's the reality. Like, oh my gosh, my vision or am I not feeling well? Is, you know, is this, is it me? Is this going to be, am I gonna be that one person that's going to have it? What age should we start really thinking about this?

SPEAKER_02 24:18

And again, given, as Dr. Banner mentioned at the very beginning, these are so rare that it's it's not any age that somebody should start to think that they do have a brain tumor or they should consider it. It's only in the setting of having these symptoms that are progressive and worsening. And even if they have those symptoms, there's a lot of reason for having those symptoms. Myself, when I get progressive headaches and I get vision changes, it's because it's time for a prescription change for myself. So if I go two weeks of having headaches nonstop and I don't normally get headaches, I know I need a change in my prescription, right? So there are there's no age that you can start to think this, think about this. But um typically, especially GBMs and those types of brain tumors, they're seen in more elderly patients, typically around the 65 to 70 age in the United States. Now, obviously, we're a brain tumor center, and so we see this from all over. And there are patients that come from all over the state and all over the region for us. So we do see younger patients. We see unusual cases, we see cases that are referred to our center. We have cases that are escalated to our center from inpatient hospitals from other centers as well.

SPEAKER_03 25:24

Do you see a lot of young patients? Do you see that number rising?

SPEAKER_01 25:28

I think that's, you know, in the, you know, in really throughout the country, we're seeing a lot of focus on tumors in younger patients. You know, not necessarily just brain. Right, correct. Exactly. You know, colon cancer, breast cancer in younger patients. You know, these are all becoming, you know, a very big focus of research and and and treatment strategies. It's not so much in brain tumors that we see an increase in younger patients, although secondary tumors like malignant um like brain metastases, we can see in younger patients now as they're diagnosed with these other tumors. But for the most part, primary brain tumors, we're not really seeing a shift in the age. It's really these uh metastatic tumors that we're seeing more commonly in younger patients.

SPEAKER_03 26:14

I need you both to educate me and everyone else on palliative care. What is it? What does it look like?

SPEAKER_01 26:23

So palliative care is really a focus on quality of life and you know, treatment of pain. So, you know, sometimes when patients hear palliative care, they think, I'm dying. That is not what palliative care is about. Palliative care is really a focus on making sure somebody is comfortable, that they're not suffering in pain, that, you know, if they are having pain, it's appropriately treated, and that they are maximizing, again, their function. And that's what palliative care is really about. And also caregiver support. You know, it's not just the patient with the diagnosis, but their entire families that can suffer from a diagnosis. And so having palliative care teams involved doesn't mean, you know, I'm dying. It means I need support and I need my entire, you know, care team to be supporting me. And that's really what the focus is on palliative care.

SPEAKER_03 27:14

And you guys are a great start, I think, for everyone to kind of understand like if I'm in this position, this is kind of like the standard of what I need to look out for and kind of have. Before I let you go, let's end on a high note.

SPEAKER_04 27:31

Yes.

SPEAKER_03 27:32

Do you have any hope? What's your takeaway for patients? What should we be conscious of?

SPEAKER_01 27:38

I mean, I think I have a lot of hope. You know, I think as we continue to research and as we optimize all of our treatments, we are seeing improvements in care. Okay. You know, some diagnoses are difficult. And the important thing is to make sure you have the appropriate teams and the appropriate people supporting you. And that's really what is important, you know, and making sure that we focus on quality of life.

SPEAKER_02 27:59

I think my hope lies in the fact that we are constantly working on making our treatments better. So the standard treatment, going back to glioblastoma, is to have a standard surgery. You do a post op scan, you plan radiation for a couple of weeks later, you give six weeks of radiation, and then they get chemotherapy. That's the standard treatment. For example, what what we do on a daily basis is before the patient has surgery, you have involved imaging of the bane so that we know exactly what is going to be removed from a tumor sense and what somebody like Dr. Bander can actually spare to improve function as much as possible. This is detailed imaging to plan the surgery. But then another thing he mentioned is at the time of surgery, he can do extra imaging to ensure that as much tumor is removed as possible. So that's another first step. But then at the time of radiation planning, we do specialized MRI scans and specialized PET scans to plan radiation. Then we have high dose radiation therapy that we can offer. And we also have things like particle therapy, which have most recently been studied to potentially improve outcomes. Then finally, with regards to the systemic therapy piece, we are now offering precision therapy based on the original surgical pathology, or we have clinical trials that are now offering new systemic therapies. So again, although this survival may be what it is, yeah, we don't accept that. And we're trying to push that as much as we can every single day.

SPEAKER_03 29:30

And we love to hear that. Thank you so much for your time and for this wonderful conversation, for sharing all your knowledge with us. And remember, viewers, be sure to hit that subscribe button on our channel here to keep up with the latest health and wellness information and tips from our experts. Thank you so much for watching and be safe.

SPEAKER_00 29:47

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