Neurosurgeon: My Patients Show Me Real Heroism and Resilience

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According to the American Cancer Society, there were approximately 25,400 cancerous tumors of the brain or spinal cord diagnosed in 2023 in the United States. The diagnosis comes with a variety of emotions for patients who may be looking for the best treatment options. 

During Brain Awareness Week, Alexander Khalessi, MD, MBA, chair of the Department of Neurological Surgery at UC San Diego School of Medicine and neurosurgeon at UC San Diego Health, describes how he navigates the diagnosis and treatment plan options with patients, as well as highlighting how UC San Diego Health is shifting the paradigm of treatment, providing the most advanced neurological cancer care to the community.

How do you approach sharing a brain cancer diagnosis with a patient and customizing their care?

The discovery of a brain tumor dramatically impacts a patient and their loved ones. It brings understandable fears of death, dependence, and a loss of self. My first responsibility as the responding surgeon is to provide space for those feelings and to breakdown what feels like an insurmountable obstacle into achievable component parts. It’s not one conversation, but the beginning of a journey and relationship.

The patient and their family feel empowered in stepwise decisions that allow for frank considerations of healthspan and lifespan. Most importantly, there is a relentless optimism in executing each stage of treatment and holding measured options in reserve should the secondary progression of disease necessitate further care. You can be clear eyed about the journey and still enjoy and celebrate all the successes along the way.

Beyond that perspective, it is important to inspire trust in the surgical moment. Preparing patients for that event, their hospital course and timeline for recovery turn the unfamiliar into progress against a disease. My patients show me real heroism and resilience every day in those quiet moments.

Part of the joy of academic medicine is seeing the progress in all we have to offer to keep patients safe and offer real hope. Our patients drive the research for a healthier tomorrow.

What are causes and symptoms of brain cancer, especially those that may often get overlooked, and what screening options are used to diagnose the disease?

The biology of primary and metastatic brain cancer remains varied and complex. The causes of cancer therefore reflect this diversity. Risk factors such as gender, age, family history and environmental factors may contribute to its development. With the complexities of brain tumors, it’s essential to seek care from a team of recognized experts who combine leading-edge, surgical techniques with the latest technology.

Common symptoms of brain cancer can range from headaches, seizures, nausea, and weakness to loss of balance, loss of hearing, vision changes and memory loss. However, symptoms can vary depending on the location, type, and size of the cancerous tumor.

At UC San Diego Health, you receive a timely and accurate diagnosis with the most advanced imaging procedures designed specifically for brain tumors. Our suite of neurosurgical operating rooms offers intraoperative MRI and full 3D/4K technology, which allows us to integrate sophisticated imaging, such as functional MRI and diffusion tensor tractography, an imaging technique that measures the rate of water diffusion between cells to create a map of internal structures of the body.

Early diagnosis helps us deliver the treatment you need with improved outcomes.

What differentiates neurological cancer care at UC San Diego Health from other health care systems? 

Innovation requires going beyond the state-of-the art. Moores Cancer Center at UC San Diego Health provides the highest quality cancer care in a highly reliable, patient-centered way. Beyond these everyday achievements and milestones, our cancer experts are not satisfied with the limits of conventional treatments, and design research studies that bring the most advanced therapies to our region.

Integrating clinical trials into a treatment plan is critical to providing comprehensive care that maximizes positive long-term outcomes for patients. Our top-ranked medical, surgical and radiation medicine programs unite around each of our patients in a multispecialty way, offer integrated care plans, and inform patients of their eligibility for any active research protocols in a highly personalized manner.

As a neurosurgeon, I’ve seen systemic treatments redefine the prognosis for metastatic intracranial cancers and tumors of the nervous system. In addition, integrated teams are able to collaborate around the biology of the specific cancer in more effective ways.

The combination of surgical optics with high-fidelity navigation and real-time ultrasound keeps patients safe in decisive surgical moments. Aside from these improved safety profiles, the role of surgery with other adjuncts; including radiation, systemic chemotherapy, and immunotherapy, becomes clearer as we develop tailored surveillance schedules to monitor for secondary progression. These tools turn cancer care into a staged series of opportunities for teams to intervene on behalf of the patient with a clear eye to developing treatments and clinical trial eligibility.

Many areas of Moores Cancer Center at UC San Diego Health utilize a Molecular Tumor Board. This team includes expert physicians, world-class scientists, medical oncologists, surgeons, radiation therapists, geneticists and pathologists who meet to discuss and advise on the best treatment plans for individual patients with cancer whose tumors have been analyzed with advanced genomic diagnostic tests. 

At UC San Diego Health, your cancer care is led by a multidisciplinary team of doctors who specialize in your type of cancer and help develop the guidelines for brain tumor and brain cancer care nationally. This skillful team consists of neuro-oncologists, neurosurgeons, radiation oncologists, neuropsychologists, neuroradiologists and neuropathologists.

What new and advanced treatment options do patients with brain cancer have access to at UC San Diego Health?

The advances that have been achieved over the last decade in the treatment of cancers is transformative, and a testament to the work being done at UC San Diego Health. Extensive research of the human genome, advanced imaging, refined surgical approaches and massive patient data collection capabilities will continue to personalize cancer care.

Surgical advances in diagnostic imaging, visualization, navigation, robotics and intra-operative MRI have dramatically improved the range of operable tumors, recovery and safety profile. A patient’s care plan may include one or a combination of therapeutics, including surgery and radiation or systemic treatments like chemotherapy. 

Immunotherapy is an approach that continues to show tremendous promise by harnessing the body’s own immune system to treat cancer. In fact, immunotherapies have been so effective at treating primary cancer that they have changed how physicians think about the disease. In one example, the rate-limiting step for cancer growth historically has been its spread, or metastasis, to the brain and spine. A decade ago, two-thirds of craniotomies removed primary brain cancer. Now it is the converse — two-thirds of craniotomies remove metastatic brain cancer — because our ability to treat primary cancer has improved dramatically due to immunotherapies. 

These advances allow our focus to shift from not just extending life but maintaining meaningful quality of life. Physicians at UC San Diego Health are examining treatment strategies that reduce treatment-related side effects. These approaches include monoclonal antibodies and antibody drug conjugates — precision-guided “biological missiles” that can destroy cancer cells while protecting healthy cells. These novel therapies may be developed in concordance with biological indicators, called biomarkers, to inform treatment efficacy or response.

I am particularly excited about these advancements as our ability to deliver biologic and drug treatment to the brain has improved to sub-millimeter precision over the past decade, offering new approaches that could make lasting impacts on the treatment of brain tumors, epilepsy and other difficult-to-treat neurological conditions.

For decades, UC San Diego Health has brought hope to thousands of patients with brain cancer and their families. We have the only board-certified specialists in adult neuro-oncology in the region, who are highly specialized in diagnosing and treating common and rare cancerous brain tumors, including: acoustic neuroma, metastatic brain tumors, glioblastoma, glioma, meningioma, pineal and pituitary tumors. As the only academic health system in San Diego, we are at the forefront of advancing comprehensive, personalized brain cancer treatment with immunotherapy, anti-tumor virus therapy, vaccine therapy, drug therapy, advanced surgical techniques, and precision-based cognitive-sparing radiation therapy.

Additional Background on Moores Cancer Center at UC San Diego Health 

Beginning April 1, 2024, Diane M. Simeone, MD, will serve as the director of Moores Cancer Center and the principal investigator for the NCI-sponsored Cancer Center Support Grant. Simeone’s visionary leadership and expertise will drive transformational cancer care by providing intellectual direction in clinical and scientific research and expanding access to leading-edge care for more patients, families, and communities.

As the region’s only National Cancer Institute (NCI)-designated Comprehensive Cancer Center, Moores Cancer Center at UC San Diego Health delivers lifesaving, highly specialized cancer care and groundbreaking research to the community. 

Comprehensive NCI designation is reserved for cancer centers with experts in every medical subspecialty, who are pushing boundaries to improve approaches for preventing, diagnosing, and treating cancers.

Moores Cancer Center unites research laboratories, clinical trials, prevention and outreach programs and clinical care. The focus is on the discovery and testing of new therapies, as well as a strong emphasis on translational oncology, drug development, community outreach, rehabilitation services, and support and counseling services for patients and their loved ones.

Approximately 25,000 patients are treated for cancer at UC San Diego Health annually. Patients have access to physicians who provide personalized care and are setting treatment standards nationwide for more than 200 types of cancer. Patients also have access to clinical trials, with a dedicated team that supports more than 250 open research studies. 

In the 2023-2024 U.S. News & World Report “Best Hospitals” survey, cancer services at UC San Diego Health ranked No. 20 in the nation. 

Learn more about cancer services at UC San Diego Health.