Prognosis and survival for brain and spinal cord cancer
People with brain and spinal cord cancer may have questions about their prognosis and survival. Prognosis and survival depend on many factors. Only a doctor familiar with a person’s medical history, type of cancer, stage, characteristics of the cancer, treatments chosen and response to treatment can put all of this information together with survival statistics to arrive at a prognosis.
A prognosis is the doctor’s best estimate of how cancer will affect a person, and how it will respond to treatment. A prognostic factor is an aspect of the cancer or a characteristic of the person that the doctor will consider when making a prognosis. A predictive factor influences how a cancer will respond to a certain treatment. Prognostic and predictive factors are often discussed together and they both play a part in deciding on a treatment plan and a prognosis.
The following are prognostic and predictive factors for brain and spinal cord cancer.
Low-grade tumours have a more favourable prognosis than high-grade tumours.
The type of brain or spinal cord tumour is an important prognostic factor. Some types have more favourable prognoses than others. For example, most gliomas have a more favourable prognosis than primary central nervous system lymphoma (PCNSL). Of the glioma subtypes, oligodendrogliomas and ependymomas have a more favourable prognosis than astrocytomas.
People younger than 65 years of age have a more favourable prognosis.
People with a high performance statusperformance statusThe measure of how well a person is able to perform ordinary tasks and carry out daily activities. (Karnofsky score of 70 or greater) before treatment have a better prognosis than those with a lower performance status.
Location and size of the tumour
The location and size of the tumour are important prognostic factors because they determine whether the tumour can be completely removed by surgery. Easily accessible and smaller tumours have a more favourable prognosis.
Tumours that can be completely removed by surgery generally have a more favourable prognosis.
If a tumour spreads to other areas of the central nervous system (CNS), the prognosis is less favourable.
Neurological function before surgery is a strong prognostic factor for how well the person will function after surgery.
- Severe neurological problems, which show changes to the way the nervous system functions, are less favourable prognostic factors than mildly to moderately severe problems.
- In general, people with severe neurological problems do not tolerate treatment as well.
- Tumours that grow rapidly and cause immediate neurological problems have a less favourable prognosis.
- For people with spinal cord tumours, the severity of weakness is the most important prognostic factor for neurological recovery. Severe weakness and paralysis in the lower part of the body (paraplegia) are less favourable prognostic factors.
About 80% of oligodendrogliomas have a chromosome abnormality. These tumours have a more favourable prognosis than oligodendrogliomas that do not have the change to the chromosome. Tumours with a deletion of the “p” arm of chromosome 1 and the “q” arm of chromosome 19 are more responsive to chemotherapy.
Establishing a national caregivers strategy
The Canadian Cancer Society is actively lobbying the federal government to establish a national caregivers strategy to ensure there is more financial support for this important group of people.