Grace, a 71-year-old mother, grandmother and resident of Sugar Land, hadn’t felt sick. Originally from Taiwan, Grace moved to Texas as a young woman, pursuing education and a career in Austin and San Antonio. When she retired, Grace moved to Houston because many of her friends live there. She worked out regularly, spent time with friends and family, and was in good health generally speaking. She had even worked at MD Anderson under contract as a medical interpreter in Mandarin Chinese.
But her daughter, Rita, noticed subtle changes in her behavior. For instance, when Grace orders a salad at a restaurant, she usually has the dressing on the side. But when she started pouring dressing all over her salad, Rita took note. Still, Grace felt perfectly healthy and didn’t see any reason for concern.
However, Rita noticed that she was missing events she would have otherwise been punctual for, and she had some mental confusion, Worried, Rita and her brother, Eddie, suggested that Grace go to an emergency room. A CT scan showed a lesion on her brain, and the doctor recommended Grace see a neurosurgeon.
5-ALA enables precise fluorescence-guided brain surgery
Grace had an appointment with Dr. Weinberg at MD Anderson within days. He recommended surgery. “I thought, ‘Oh my gosh, he’s going to open my head! I only have one head!’” Grace recalls. “But he was very thorough and explained in layman’s terms. He made me feel at ease.” With a laugh, she adds, “I asked him where he was going to cut, and after he explained, I asked, ‘Can you do a facelift too?’”
Dr. Weinberg performed fluorescence-guided surgery using 5-ALA. In this procedure, the patient drinks the 5-ALA medication before surgery. During surgery, cancerous tumor areas of the brain glow pink under a fluorescent light the surgeon shines on the operating area.
“Whoever came up with this medication needs to taste it first,” Grace laughs. “Dr. Weinberg didn’t tell me it tastes terrible!” Still, despite the salty taste, the medication helped MD Anderson’s surgery team more precisely identify cancerous areas of the brain and resect them.
“There was extra fluorescent tissue which we removed,” says Weinberg. But “the surgeon must be mindful of the anatomy and the risks with removing additional tumor when visible fluorescence remains.”
After the successful surgery, Grace had a headache. Fortunately, it was manageable with a common oral medication – acetaminophen with codeine. She went home after a few days.
Because of pandemic restrictions, Grace could only have one visitor during her appointments and after her surgery. Her husband drove her to her appointments and remained by her side, while her adult children joined by FaceTime every chance they got. And with friends from many different faiths — Buddhists, Baptists, Catholics and Muslims — Grace says, “I had a lot of people praying for me.”
Promising treatments enhance quality of life
Analysis of the removed tumor revealed that Grace had glioblastoma, an aggressive form of brain cancer. “There is no cure for glioblastoma, but treatment that includes surgery, radiation, and chemotherapy has been shown to prolong survival,” says neuro-oncologist Shiao-Pei Weathers, M.D.
Grace’s treatment after surgery followed the standard of care for glioblastoma: chemoradiation with a medication called temozolomide. “I tolerated treatment pretty well,” says Grace. She took the oral medication in cycles: five days on, then 23 days off. “I just picked up the medication from the MD Anderson pharmacy,” she says. Every cycle, she came in for a blood test and an MRI.
After recently completing her 12th and final treatment, she now comes to MD Anderson every two months for an MRI. Grace didn’t let treatment stop her from living her life. She and her family traveled overseas to Copenhagen during one of her 23-day breaks in the treatment cycle. “I traveled and was active before the tumor was discovered,” says Grace. “Travel and staying active during the treatment helped me forget that I am a patient. My spirit was never down.”
Grace also points out the value of MD Anderson’s research programs. “If they can’t treat you in a traditional way, there are always options for a clinical trial,” she says. “And the doctors work as a team to come up with the best plan for their patients.”
Thriving after brain tumor treatment
Grace is not just surviving, but thriving, nearly 18 months from her diagnosis and surgery. She works out up to two hours a day, doing strength training and Zumba, and of course, playing Sudoku. “I started yoga now that I’ve finished treatment. But when I do downward facing dog, I’m worried my brain will fall into the cavity left behind from the surgery!” Drs. Weinberg and Weathers have assured her she has nothing to fear.
“I think I am the best-case scenario,” Grace says. “I don’t know if I’m lucky.” But as she told her children: “Don’t worry; I have all the gods looking out for me.”