Debulking
Hello again. Today we will discuss debulking.
What is debulking? Debulking is the word used in the medical community to describe a surgery that removes as much as possible of the glioblastoma. It is of utmost importance that you have an excellent surgeon. If they can remove all of the tumor that they can see it may increase your chance of survival. A skilled and more experienced surgeon may make a large difference in your treatment and ultimate survival. Depending upon the location of your tumor you may not be able to have surgery or you may have to make some tough decisions about the risks of the surgery. Be prepared for this potential situation and understand your position. Examples may mean the loss or possible loss of vision, hearing, speech, or other difficult decisions.
To prepare for the surgery which is typically done very soon after diagnosis it is common to undergo a contrast MRI Magnetic Resonance Imaging. An MRI is an exceptionally large machine. The machine uses powerful magnets, radio waves, and a computer to make detailed pictures inside your body. The magnetic field temporarily realigns water molecules in your body. Radio waves cause these aligned atoms to produce faint signals, which are used to create cross-sectional MRI images — like slices in a loaf of bread.
The computer reconstructs these images into a 3-Dimensional image that can be read by radiologists. It gives them a clear look inside your head. They use it so they can plan the surgery and also as a reference for images after the surgery. A low-grade glioma or astrocytoma may show only a low-density area which will appear as a dark area. Whereas high-grade gliomas (Glioblastoma) usually show more contrast enhancement which will show up as white on the outside and black on the inside. The black areas on the inside are usually dead cells which are called necrosis.
Once the surgery is completed and you have had a short period to recover, they will usually conduct another contrast MRI to see the results of the surgery.
Please watch the video I have linked below about MRI’s.
Your doctor can use these ongoing MRI tests to diagnose you or to see how well you’ve responded to treatment as well as how your brain may be recovering from the surgery. Unlike X-rays and computed tomography or CT scans, MRIs do not use the damaging ionizing radiation of X-rays.
Sometimes the surgeon can get almost all of the tumor, while other times they can only get some or none if the tumor is inoperable. Even if they get almost all, or all of the visible tumor it is extremely likely due to the nature of Glioblastoma that some of the cancer cells remain. Glioblastoma is different from many forms of cancer. Instead of it being in a single location and growing outward in for example a sphere shape, it grows out in all directions and can look similar to the roots of a tree. This is why the tumor may appear that it is gone; meanwhile, some cells have migrated away from the central mass. This is one of the reasons why additional treatments such as radiation therapy and chemotherapy are typically necessary.
Go easy after the surgery and let your body begin to recover. Follow your medical team’s advice and keep an eye on yourself and have anyone who is with you keep an eye on you as well. You may wish to inform your medical team of anything that doesn’t seem quite right, seems unusual to you, or is something your medical team mentioned for you to watch.
If the surgery was successful you will have staples and or stitches in your head. The staples will be removed by your family doctor or possibly by someone else in your medical team. By the way, it does not hurt very much. I was a bit worried about that as the area was tender but it was not bad when it was done to me. They used a small tool that the hospital provided to me to bring to the staple removal appointment and the doctor was familiar with the tool. They cut the staple in half at the mid-point and then they just gently pull the two halves of the staple out which did not cause me any pain.
The area of the surgery will be tender and you will need to be careful. I was told to get some pillows and prop up my head for a prescribed time which was a couple of weeks in my case. This keeps the head above the heart and keeps any pressure off the area of surgery. This included during sleep. It will take a long time for the area to completely heal. Note that the area may bleed a bit and that if you have a nice pillowcase you may want to replace it with an older one until any possible bleeding has ended. If you have excessive or increased bleeding you should contact your medical team or your closest hospital Emergency department ASAP.
The surgeon will come to check on you after the surgery. They will likely know at that point from experience what type of tumor you have. They will usually send the tumor to pathology where they will do some testing to confirm the tumor type and some of its characteristics that can dictate the next steps to take and some prognostic information.
Ask your surgeon any questions you have about what they found and what they think about their findings. You may also want to ask them when you will go home and what has to happen for you to go home. As an example, due to the surgery and the anesthesia, they will likely want to monitor you and check you have fully recovered from the anesthesia. They will also likely want to make sure you have a bowel movement and see if you can eat and drink. They will also likely check if there are any issues with your vision or hearing and movement. Also, ask them if they have a booklet for you to take home to review how you and anyone caring for you should prepare and provide for your needs. Examples may include how you should clean yourself, avoiding water on your head for a while, not to submerge your head for some time, medications, and symptoms of concern.
You just finished brain surgery and you are through the other side so congratulations on that and I wish you all the best in the findings of the pathology to come as well as your healing. Do not rush this phase and let your body recover. Please remember to watch the video I have linked below about MRI’s.
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Remember, we are in this boat together and I will see you in the next video. Until next time, God Bless you.