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A Day in the Life of a Neuro-Oncologist

June 12, 2014

What is neuro-oncology? Sounds pretty complex, right? It’s what Dr. Nick Avgeropoulos—or Dr. Nick, as he prefers to be called—does every day at the UF Health Cancer Center – Orlando Health. Dr. Nick is a specially trained doctor who treats cancer of the brain and spine. He works with patients who are facing the biggest challenge of their lives to provide them with the treatment and care they need.

So, what’s it like to be Dr. Nick for a day? We asked him a few questions to find out:

Q: As a neuro-oncologist, what types of conditions do you treat?

Neuro-oncology focuses on treating cancer that affects the nervous system, which is made up of the brain, spinal cord and peripheral nerves. The tumors that we treat can directly affect the nervous system, or it can indirectly affect it through other types of cancers, such as lung cancer or breast cancer.

As a neuro-oncologist, I not only treat the cancer itself, but I help treat conditions related to the tumor as well. So, for example, this might include seizures or memory disorders that are caused by a brain tumor.

I also help coordinate physical or cognitive rehabilitation for the patient. Unfortunately, many of these tumors can affect a patient’s speech or ability to do simple tasks like drive, walk and read. So, while my main job is to treat the tumor itself, I often work with other doctors to make sure that we are integrating every aspect of the patient’s care.

Q: Are you the only doctor who is involved in treating your patients?

No, definitely not. I would be pretty overwhelmed if I was! We’ve got an entire team of people involved, from neurosurgeons to nutrition specialists. For us, it’s all about teamwork. It’s not about diffusing responsibility. It’s about a privilege of sharing responsibility. When it comes to solving a problem, the more minds we can bring together, the better. We want to exhaustively research and consider all the treatment options for a patient. Everyone’s experience needs to come together to make the best possible decision.

Q: How is your job different from that of a neurosurgeon?

My job is actually quite different from what a neurosurgeon does. I am a medical neuro-oncologist, so that means I am trained in chemotherapy and pharmacology. As I mentioned earlier, I also help treat other conditions that are caused by a brain or spinal tumor, like memory disorders. In essence, you can think of me as the “glue.” I usually play a large role in managing the patient’s care as a whole, not just one specific aspect of it.

However, one of the things I don’t do is surgery. Some of the other doctors here at the Cancer Center like to joke that I wouldn’t be very good at it. But anyway, as you might have guessed, surgery is typically performed by a neurosurgeon. These doctors are trained to do surgery for all kinds of brain and spinal conditions — not just cancerous tumors.

Q: How do you detect and diagnose a brain or spinal tumor?

Typically, a person will have symptom or sign that is unusual, such as a seizure or persistent headaches. Their memory or behavior might suddenly change, or they may experience weakness or numbness on one side of the body.

Once the person sees a general doctor or goes to the emergency room, an MRI of the brain is usually performed. But an MRI is only so accurate. You can never be 100 percent sure what you’re dealing with based on an MRI. So usually, a neurosurgeon will need to remove a piece of the tumor so that it can be analyzed.

Then, that’s where I come in. I work with the other doctors involved to review what we’ve found and make a decision about the patient’s treatment plan.

Q: Is surgery the most common option for treating someone with a brain or spinal tumor?

Most of the time, yes. Surgery is typically the first line of defense, and then chemotherapy and radiation will come in after that. But let’s say that the tumor is located in the part of the brain that controls your speech. If that’s the case, then the surgeon won’t be able to remove the entire tumor because it’s too dangerous. So, the goal then becomes to remove as much of the tumor as possible.

Other times, the risk of surgery may not always be necessary. Instead, it may be better for the patient to undergo chemotherapy or radiation to treat the tumor. The key is always to make sure we’re making the right diagnosis so that we can develop the right treatment plan.

Q: You also co-direct the Brain and Spine Tumor Support Group at the UF Health Cancer Center – Orlando Health. Why is that role so important to you?

For me, how a patient faces this battle in their lives is hugely important. That’s what these families are thinking about — and after they leave the clinic, they need support. Our support group is a great way of helping patients learn more about their specific condition and how to cope with it.

But even more importantly, it’s about connecting with people who are going through a similar experience. Sometimes just being able to talk about what you’re going through can make a huge difference. It helps patients and their families deal with the struggles that they’re facing and find a way to overcome them. For me, it’s not only about treating what we see on the scan, but it’s about treating the patient as a whole.