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Neurology and Women's Health: Brain Tumors

Monday, May 13, 2019
K Peters

Subtle but important differences between men and women exist throughout the body--even within the brain and nervous system. For International Women’s Health Week (May 12-18) we spoke with several Duke Neurologists about these differences mean for women with different neurological conditions.

In our first entry for 2019, Katy Peters, MD, PhD, talks about brain tumors and women. Peters discusses how the most malignant type of brain tumor is not only slightly less common for women than it is for men, but it tends to develop in an entirely different fashion. She also discusses fertility concerns for women dealing with a diagnosis, as well as how a team of neuropsychologists neuropsychiatrists social workers, and child-life specialists work with patients of all genders to cope with work-life balance, fertility, their own fears, and getting the best possible care.

(Read our the rest of our neurology and women's health series, which includes discussions of multiple sclerosis, Alzheimer's disease, and other conditions, here.)

What gender differences, if any, exist for who gets brain tumors?
Gender differences do exist for patients with brain tumors. The most common type of primary brain tumor is a meningioma, a tumor of the meningeal layers of the central nervous system. Females more commonly develop these types of tumors and they can express both estrogen (30% roughly) and progesterone (70% roughly) receptors. Growth of meningiomas can increase during hormonal changes such as pregnancy, changes in menses, menopause, and also exogenous use of hormones (fertility medications).

Glial tumors, in particular the most malignant tumor glioblastoma, are slightly more common in men. It has long been known that female GBM patients do slightly better than males. It appears that this “sex” difference is due to the tumor itself as tumors from female patients have better prognostic characteristics than male patients. This (and more information) was recently published in this article.

Are there any gender differences associated with symptoms or progression of disease? What about health concerns unique to women as they go through treatment?
The article by Yang and colleagues above not only showed that female patients with GBM enjoy a better survival than male patients but also showed that the pathways responsible for the development of GBM are different based on the one’s gender. Tumors in female patients are more likely to be driven by integrin regulated signaling pathways and tumors in male patients are more likely to be driven by cell cycle regulating signaling pathways. This points that treatment options could be different for different genders.

Fertility is a concern for both males and females undergoing chemotherapy and radiation therapy, standard treatments for GBM. If a female patient is in her reproductive years, we find it paramount to discuss fertility concerns for our patients. Radiation, chemotherapy, and targeted therapies such as avastin can all cause ovarian failure. We work with our colleagues in reproductive endocrinology to help support and educate our female patients.

Unfortunately, we often do not recommend pregnancy to our patients with high-grade or even low-grade gliomas as we have shown in our own publications that tumor progression and transformation to a higher grade can be promoted by pregnancy. This likely occurs because of the surge of growth hormones that leads to fetal growth can in turn lead to tumor growth. It is critical to have a personalized one-on-one conversations with your female patients with brain tumors about pregnancy and fertility. Even though there are challenges, I have been able to inform and care for my patients that has allowed life decisions such as having happy healthy children.

Women often have to balance many roles, including their professions, maintaining a household, raising children, and caring for others. How does a diagnosis or treatment of brain tumors affect these areas? How can women help balance these responsibilities while dealing with treatment?
This is definitely challenging for our female patients with brain tumors. Multi-tasking is key to balancing all of these roles and our patients, after surgery, radiation, and/or chemotherapy, most often have challenges with multi-tasking. Again, this is where the personalized one-on-one care is needed. We utilize a team consisting of a neuropsychologist, neuropsychiatrist, social workers, and a child-life specialist to assist our patients in these very important areas.

How has our knowledge or treatment of brain tumors increased over the past decade? How do you think your knowledge and treatment will change over the next decade?
Personal genomics is challenging cancer treatments, including brain tumor treatments. We are at the cusp of understanding the drivers of the development of these tumors and hopefully we can tailor therapies that target this cancer drivers. As we know more about the personal genomics of the tumor, we hopefully avoid the harmful effects of chemotherapy and radiation therapy and design treatments that are not only tolerable but also effective.   

What’s one thing you wished more of your patients knew about brain tumors?
The one thing that I wished more patients knew about brain tumors is that while it is an isolating and scary diagnosis that specialty centers like the Preston Robert Tisch Brain Tumor Center at Duke can improve not only your survival but also your quality of life.