Things were looking up for Sudha Narasimhachari in 2004. After finishing her masters in science from Madurai Kamaraj University in Tamil Nadu, she left for Canada to pursue a doctorate at the University of Burnaby. Four years later, however, things went downhill. As Sudha was about to finish her thesis in the field of computation electrochemistry, she started experiencing throbbing headaches, accompanied by bouts of vomiting. “The doctor at the campus health centre diagnosed my condition as migraine, and prescribed a lot of medication. Despite taking those medicines, the unbearable symptoms persisted,” she says.
Sudha was only 30 then, and she says she was denied an immediate MRI scan of the brain because in Canada elderly patients are given preference to undergo investigations. She would have had to wait three months to get an MRI scan, and that, she says, would have been disastrous. “My elder sister, who at that time was in Bengaluru, advised me to come to India to get thoroughly investigated,” recalls Sudha, who was granted leave on medical grounds.
On her return, Sudha met Dr H.V. Madhusudan, a renowned neurosurgeon at Sagar Hospitals. A CT scan and an MRI of her brain revealed that she had glioblastoma multiforme, or grade 4 astrocytoma—a cancer that affects the brain (see box). Though Sudha accepted the diagnosis with calm and strength, her mother and sister broke down on hearing the diagnosis.
A craniotomy followed by total excision of the tumour was performed immediately. “Since Sudha was a student pursuing her PhD, we had to take utmost care during surgery to prevent future memory loss or speech loss,” says Madhusudan. “Sudha’s tumour was the size of a tennis ball. Because of her young age and determined mind, she could withstand the surgery well. After the surgery, she was advised to undergo chemotherapy and radiotherapy.”
In September 2008, about six months after the surgery and chemo-radio therapy sessions, a repeat craniotomy was performed to remove the dead tissues at the site of the original tumour. Again in 2009, Sudha developed subdural haematoma—collection of blood between the brain and its outermost covering—which was drained out using the burr hole technique.
In 2010, when the residual infiltrated cancer cells resulted in oedema around the brain, Madhusudan referred Sudha to Dr M.S. Belliappa of HCG hospital in Bengaluru. “Sudha underwent precision radiation by Cyberknife non-invasive technology. Cyberknife technology delivers radiation with the precision of a surgeon’s knife, thus destroying only the cancer cells and not harming the adjacent normal tissues,” says Madhusudan.
According to Madhusudan, while the blood-brain barrier prevents the spread of tumour cells to other parts of the body, it also poses a challenge for treating a brain cancer patient post operatively as most of the medications fail to cross the barrier to where the tumour originally existed.
“I have put her on anti-epileptic medication as a precautionary measure since fits or convulsions are common in patients with brain tumour even after the tumour removal,” he says. “I am following her progress through PET scan every six months to observe whether the tumour has recurred.”
The eight years since her cancer diagnosis have been rough, but Sudha endured it all. She then went on to realise her dream. “Though I was denied a visa to Canada,” she says, “I worked online for my thesis under the same German professor’s guidance and got my PhD in June 2015 through Jawaharlal Nehru Study Centre in Bengaluru.”
Today, the 38-year-old lives alone in her Bengaluru home. She is single by choice—a college mate wanted to marry her but she refused owing to the unpredictable nature of her disease. He, however, continues to be her friend, being by her side through illness and wellness. Her mother and sister are just a call away; they visit her whenever she needs them.
Glioblastoma multiforme (GBM) is a highly invasive tumour of the brain, occurring in about three per one lakh people.
Symptoms: Nausea, headache and vomiting. The patient may lose consciousness if the symptoms worsen.
Treatment: Surgery followed by chemo-radiotherapy. Immuno-therapy and stem cell therapy are being hailed as the future supportive line of treatment for GBM.
Survival rate: Even with proper surgical and palliative treatment, GBM is known to recur and only 3 to 5 per cent of patients survive beyond five years.