Jan's story

Brain Tumor, Craniectomy, Metastatic Disease

When Jan went to see her doctor with some minor issues with her balance in 2018, she had already experienced her share of health challenges. She was three years past breast cancer surgery at St. Elizabeth hospital in Edgewood and had been through dozens of chemotherapy treatments.

On vacation in Hawaii that summer, she started noticing trouble maintaining her balance. That led to a trip to an oncologist and a radiation oncologist, Dr. Dan Flora and Dr. Susan Feeney of St. Elizabeth Physicians, and an MRI scan.

When Jan came face-to-face with the scan of her brain, it became clear that the cancerous tissue had spread, or metastasized, to her brain. There it was on the screen – a brain tumor.

"It was really scary," remembers Jan, 69, a retired real estate worker. "When someone tells you that you have a brain tumor, it's pretty scary. I hadn't really been having any big problems, then all of a sudden I had this huge brain tumor and I had to go see a brain surgeon."

"He said," Jan recalls, "that we had to remove it right away."

That brain surgeon was Dr. Brad Skidmore, a neurosurgeon at Mayfield Brain & Spine, who removed Jan's tumor in October 2018. He says it's not uncommon for tissue from lung cancer or breast cancer to spread to the brain.

In Jan's case, the brain tumor was in a tight area, a small cavity that houses the cerebellum, the area of the brain that controls coordination. That caused Dr. Skidmore to take a skull base approach, removing additional bone to access the tumor, with minimal disruption to the brain.

"It can be hard to get to," Dr. Skidmore says. "A little bit of swelling can lead to a poor outcome with increased neurologic injury. We were able to remove the tumor successfully."

Following the surgery and three nights in the hospital, Jan spent more than a week at an inpatient rehabilitation center before heading home. She never experienced some of the loss of neurologic symptoms common in brain tumor patients, including memory loss or emotional changes.

"I was so thankful that I was still alive and that I could move all of my limbs," she says now. "I made a pretty quick recovery."

But the cancer cells inside Jan weren't done metastasizing, and her health challenges weren't done. In mid-2019, she became concerned about her vision. Another MRI showed spots on her brain, possibly a progression of the cancer inside her skull, leading to several radiation treatments.

Dr. Skidmore said there was some evidence that Jan's tumor was still growing, even though she was not suffering from any severe symptoms.

The question: Was this new concern from Jan's extensive radiation or additional tumor growth? The answer: Tumor regrowth.

To help reach that conclusion, Dr. Skidmore consulted with Mayfield's multidisciplinary Tumor Board, which includes neuropathologists, neuroradiologists, nurse practitioners and oncologists from St. Elizabeth and OHC, a group of local cancer specialists. The Tumor Board meets weekly to review cases and get input from all specialties to form a consensus on the most effective treatment plan.

"It moves patients along more quickly to get the care they need," Dr. Skidmore says. "In Jan's case, there is always the possibility of recurrence, and we wanted to confirm that as quickly as possible."

The Tumor Board recommended surgery to remove the additional tumor, and Jan agreed. Dr. Skidmore performed that surgery at St. Elizabeth in November 2020.

Now Jan is doing well again, with few symptoms. She undergoes regular scans to monitor any reoccurrence of the cancerous tissue. And she concentrates on staying positive, grateful to her physicians at Mayfield and St. Elizabeth.

"I haven't had a lot of bad things happen to me," Jan says. "I can tolerate the treatments. I feel like I'm lucky to still be alive."

~Cliff Peale

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