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Laura Seitz, Deseret Morning News
Dr. Ali Choucair, the state's only neuro-oncologist, studies images at LDS Hospital Thursday. He'll answer questions about brain cancer on hotline Saturday.

It's a tricky thing, telling people the symptoms of brain cancer, says Dr. William T. Sause. They're fairly common and nonspecific — "Everybody has headaches, right?" —and you don't want to send the entire world in for expensive scans and tests since "brain tumors are relatively rare."

That's one of the more minor challenges posed by brain cancer, says Sause, director of Cancer Services for Intermountain Healthcare and chief of oncology of the Jon and Karen Huntsman Cancer Center at Intermountain Medical Center.

"Symptoms tend to be very subtle," says Sause. "And they tend to occur over a protracted period of time.

"Oftentimes, we see someone come to the ER with severe headaches. They're driving and don't see the car parked in the street next to them, so they hit the car. It tends to be fairly insidious, subtle changes in cognitive ability and personality that we all experience periodically in our life."

Cancers of the brain — and there are various types and stages — are the subject of Saturday's Deseret Morning News/Intermountain Health Hotline. From 10 a.m. to noon, Sause and Dr. Ali Choucair, who is Utah's only neuro-oncologist and practices at LDS Hospital, will field called-in questions. All calls are confidential.

The most common symptoms, Choucair says, are personality, behavioral or memory changes, headaches, seizures and numbness or weakness on one side of the body. Depending on a tumor's location, vision can also be affected. And, in fact, symptoms are more dependent on the tumor's location in the brain than on the specific type of tumor, he adds.

Brain tumors have no established genetic link, the two specialists agree. Choucair said that in the 22 years he's been practicing medicine, he's seen only two examples of a brain cancer repeated in a family. There is a genetic link where brain tumors and colon cancer happen together in families. But that's "really, really, rare."

And no one's sure what, if anything, in the environment may cause most brain cancers. Suspects change periodically and have included the electromagnetic fields around power lines, cell phones and other things. Studies have failed to back those suspicions up. Right now, pesticides are being investigated because some researchers believe that farmers have more than their share of malignant brain tumors, but the jury's still out on that one.

There are "peaks" in incidence among children and among senior citizens, but brain tumors affect all ages.

Most people take their symptoms to their primary care physician, and that's a very good starting point, Sause and Choucair agree. They do a good job of assessing who needs further screening and then referring cases when it's appropriate.

Sause says early detection is important for certain benign tumors because they can be removed when they're relatively small, but for most malignant brain tumors, "it's not clear how well it works."

The brain is different than some parts of the body, because every cell in the brain has the potential to become malignant, although the most common brain cancers are those involving connective tissue and the glial cells, which are not surprisingly also the most abundant cells in the brain. Also different from some cancers, most brain cancers stay in the brain and don't metastasize elsewhere.

Brain cancers are sorted by grades. Grade 1 is more common in the younger age group, says Choucair. "They tend to be very, very slow growers." Grade 2 also usually grows quite slowly. Grade 3 is faster; if left untreated, a tumor could double in size in about three months, while grade 4 could double in as little as two. As a brain tumor grows, it displaces or infiltrates normal brain tissue.

The higher-grade tumors have much lower cure rates. But that, too, depends on the type of tumor.

Tomorrow: Treating brain cancer

E-mail: lois@desnews.com