The Tumor

Last updated
The Tumor
The Tumor (book) cover.jpg
Author John Grisham
CountryUnited States
LanguageEnglish
Genreshort story
PublisherFocused Ultrasound Foundation
Publication date
December 4, 2015
Media typePrint, eBook
Pages48
ISBN 978-1-4951-7940-2 (Paperback)

"The Tumor" is a short story by John Grisham, telling about the focused ultrasound process through the case of a fictional character named Paul. This story was not released through Grisham's usual publisher, but instead was published for a free eBook on the website of the Focused Ultrasound Foundation, [1] on whose board Grisham serves. [2] Grisham's purpose in writing this short story was to increase awareness about the promising new medical therapy. [3] The use of focused ultrasound is not yet approved for use on brain tumors, but The Tumor takes place in a time when the therapy is in regular use. Unlike most short stories, the story is as much informational as narrative, and includes medical illustrations and brain scan images. [4] The book's cover includes the subtitle A Non-Legal Thriller. On Grisham's website, in a letter introducing The Tumor, Grisham states "It's the most important book I've ever written." [5]

Contents

Plot

Paul is a 35-year-old man with a family, who is in good health. His brain develops a tumor, which causes gradual impaired function of his left side, and eventually a complete blackout. He is diagnosed with glioma, the severity unknown. Paul undergoes the most effective treatment currently available, which involves brain surgery to remove the tumor, followed by chemotherapy and radiation treatments. Following the surgery his tumor is diagnosed as malignant cancer, a full-on glioblastoma. Paul's doctor informs him that the average life expectancy after this diagnosis is approximately 12 months. Side effects of the cancer treatments prevent Paul from fully resuming his daily life, including his inability to go into work. In 6 months, the tumor reappears, treatments become ineffective, and Paul dies 9 months after the initial diagnosis.

Paul's story is then retold, supposing that he had been born 10 years later. At the time of the discovery of his brain tumor, in 2025, medical treatment has advanced such that his glioblastoma is immediately diagnosed, and focused ultrasound treatment is available for treating it. Paul receives the treatment as a non-invasive outpatient procedure. The treatment is so effective, he is able to return to work and resume his normal activities. Three years later, the tumor returns, and Paul gets the focused ultrasound therapy again, with similarly positive results. Four years after that, the tumor regrows again, and Paul receives the treatment a third time.

At this point, the narrative ends and Grisham acknowledges that eventually, the cancerous brain tumor will kill Paul. But the extension of Paul's life and greatly reduced medical bills is worth it. Following this, Grisham explains the details of focused ultrasound therapy, including how it works, how far along the research and testing is for its application in various medical diagnoses, and what obstacles remain for its widespread adoption. The book concludes with an introduction to the Focused Ultrasound Foundation and an appeal for support from the reader.

Reception

Because The Tumor was not released through a traditional publisher, nor a typical novella or short story, few literary reviews of the story are available. However, several reviews from the medical community have been received. Ed Miller, M.D., of Johns Hopkins, stated "[Grisham] has pulled an exciting new medical technology out of the labs of academic research and onto the pages of an enlightening book. He paints a great picture of how sound waves may shape the future of medicine." [6] CBS news stated the book is more likely to be found shelved with the medical texts than with mystery novels. [3]

Some readers felt misled by the story's subtitle A Non-Legal Thriller, one calling the story "a 50 page sales pitch." [7] Grisham's publisher, editor, and agent all advised him not to publish the free short story, fearing it would tarnish his image as a writer of thriller novels. Grisham published it anyway because of his belief that increased awareness could speed up research and approval of focused ultrasound, helping many patients. [4] [8] He has stated "If it finds a much bigger market, if it finds people to push our research to get us there, that's the purpose of the book." [3]

Related Research Articles

<span class="mw-page-title-main">Brain tumor</span> Neoplasm in the brain

A brain tumor occurs when abnormal cells form within the brain. There are two main types of tumors: malignant (cancerous) tumors and benign (non-cancerous) tumors. These can be further classified as primary tumors, which start within the brain, and secondary tumors, which most commonly have spread from tumors located outside the brain, known as brain metastasis tumors. All types of brain tumors may produce symptoms that vary depending on the size of the tumor and the part of the brain that is involved. Where symptoms exist, they may include headaches, seizures, problems with vision, vomiting and mental changes. Other symptoms may include difficulty walking, speaking, with sensations, or unconsciousness.

<span class="mw-page-title-main">Oligodendroglioma</span> Medical condition

Oligodendrogliomas are a type of glioma that are believed to originate from the oligodendrocytes of the brain or from a glial precursor cell. They occur primarily in adults but are also found in children.

<span class="mw-page-title-main">Glioblastoma</span> Aggressive type of brain cancer

Glioblastoma, previously known as glioblastoma multiforme (GBM), is the most aggressive and most common type of cancer that originates in the brain, and has a very poor prognosis for survival. Initial signs and symptoms of glioblastoma are nonspecific. They may include headaches, personality changes, nausea, and symptoms similar to those of a stroke. Symptoms often worsen rapidly and may progress to unconsciousness.

<span class="mw-page-title-main">Astrocytoma</span> Medical condition

Astrocytoma is a type of brain tumor. Astrocytomas originate from a specific kind of star-shaped glial cell in the cerebrum called an astrocyte. This type of tumor does not usually spread outside the brain and spinal cord and it does not usually affect other organs. After glioblastomas, astrocytomas are the second most common glioma and can occur in most parts of the brain and occasionally in the spinal cord.

The Focused Ultrasound Foundation (FUF) is a 501(c)(3) non-profit organization based in Charlottesville, Virginia, United States, that promotes the use of image-guided focused ultrasound. The foundation is primarily funded through philanthropic donations.

Microbubbles are bubbles smaller than one hundredth of a millimetre in diameter, but larger than one micrometre. They have widespread application in industry, medicine, life science, and food technology. The composition of the bubble shell and filling material determine important design features such as buoyancy, crush strength, thermal conductivity, and acoustic properties.

<span class="mw-page-title-main">Plus Therapeutics</span> U.S. healthcare company

Plus Therapeutics, Inc. is a clinical-stage pharmaceutical company developing innovative, targeted radiotherapeutics for adults and children with rare and difficult-to-treat cancers. The company is headquartered in Austin, Texas, United States.

<span class="mw-page-title-main">Temozolomide</span> Cancer medication

Temozolomide, sold under the brand name Temodar among others, is an anticancer medication used to treat brain tumors such as glioblastoma and anaplastic astrocytoma. It is taken by mouth or via intravenous infusion.

<span class="mw-page-title-main">Neutron capture therapy of cancer</span> Nonsurgical therapeutic modality for treating locally invasive malignant tumors

Neutron capture therapy (NCT) is a type of radiotherapy for treating locally invasive malignant tumors such as primary brain tumors, recurrent cancers of the head and neck region, and cutaneous and extracutaneous melanomas. It is a two-step process: first, the patient is injected with a tumor-localizing drug containing the stable isotope boron-10 (10B), which has a high propensity to capture low energy "thermal" neutrons. The neutron cross section of 10B is 1,000 times more than that of other elements, such as nitrogen, hydrogen, or oxygen, that occur in tissue. In the second step, the patient is radiated with epithermal neutrons, the sources of which in the past have been nuclear reactors and now are accelerators that produce higher energy epithermal neutrons. After losing energy as they penetrate tissue, the resultant low energy "thermal" neutrons are captured by the 10B atoms. The resulting decay reaction yields high-energy alpha particles that kill the cancer cells that have taken up enough 10B.

The University of Miami Division of Surgical Neurooncology is the neurological surgery center at the University of Miami's Leonard M. Miller School of Medicine and one of the largest and most comprehensive programs for brain tumor treatment in the United States. It is located in Miami.

Alternating electric field therapy, sometimes called tumor treating fields (TTFields), is a type of electromagnetic field therapy using low-intensity, intermediate frequency electrical fields to treat cancer. TTFields disrupt cell division by disrupting dipole alignment and inducing dielectrophoresis of critical molecules and organelles during mitosis. These anti-mitotic effects lead to cell death, slowing cancer growth. A TTField-treatment device manufactured by the Israeli company Novocure is approved in the United States and Europe for the treatment of newly diagnosed and recurrent glioblastoma, malignant pleural mesothelioma (MPM), and is undergoing clinical trials for several other tumor types. Despite earning regulatory approval, the efficacy of this technology remains controversial among medical experts.

<span class="mw-page-title-main">Sonodynamic therapy</span>

Sonodynamic therapy (SDT) is a noninvasive treatment, often used for tumor irradiation, that utilizes a sonosensitizer and the deep penetration of ultrasound to treat lesions of varying depths by reducing target cell number and preventing future tumor growth. Many existing cancer treatment strategies cause systemic toxicity or cannot penetrate tissue deep enough to reach the entire tumor; however, emerging ultrasound stimulated therapies could offer an alternative to these treatments with their increased efficiency, greater penetration depth, and reduced side effects. Sonodynamic therapy could be used to treat cancers and other diseases, such as atherosclerosis, and diminish the risk associated with other treatment strategies since it induces cytotoxic effects only when externally stimulated by ultrasound and only at the cancerous region, as opposed to the systemic administration of chemotherapy drugs.

<span class="mw-page-title-main">Ferenc A. Jolesz</span> Hungarian-American physician

Ferenc Andras Jolesz was a Hungarian-American physician and scientist best known for his research on image guided therapy, the process by which information derived from diagnostic imaging is used to improve the localization and targeting of diseased tissue to monitor and control treatment during surgical and interventional procedures. He pioneered the field of Magnetic Resonance Imaging-guided interventions and introduced of a variety of new medical procedures based on novel combinations of imaging and therapy delivery.

Dr. Matthias Gromeier is a Professor in the Department of Neurosurgery at Duke University Medical Center, who has developed a way to re-engineer a poliovirus to inspire the human immune system to kill cancer cells in a specific set of cancers. The re-engineered virus, called PVSRIPO, cannot replicate itself in normal cells, but can replicate itself in cancer cells that have an overabundance of the protein marker that the poliovirus targets.

John Howard Sampson is an American neurosurgeon who was formerly chief of the department of neurosurgery at Duke University where he serves as a professor of surgery, biomedical engineering, immunology, and pathology.

Depatuxizumab mafodotin is an antibody-drug conjugate designed for the treatment of cancer. It is composed of an EGFR IGg1 monoclonal antibody (depatuxizumab) conjugated to the tubulin inhibitor monomethyl auristatin F via a stable maleimidocaproyl link.

Misty Rayna Jenkins is an Australian scientist known for her research into lymphocytes and cancer treatment.

<span class="mw-page-title-main">Duane Mitchell</span> American physician and research scientist

Duane A. Mitchell is an American physician-scientist and university professor. He is currently employed at the University of Florida College of Medicine, in Gainesville, Florida as the Assistant Vice President for Research, Associate Dean for Translational Science and Clinical Research, and Director of the University of Florida (UF) Clinical and Translational Science Institute. He is the Phyllis Kottler Friedman Professor in the Lillian S. Wells Department of Neurosurgery. and co-director of the Preston A. Wells Jr. Center for Brain Tumor Therapy. Mitchell is also the founder, President, and Chairman of iOncologi, Inc., a biotechnology company in Gainesville, FL specializing in immuno-oncology.

<span class="mw-page-title-main">Focused ultrasound for intracranial drug delivery</span> Medical technique

Focused ultrasound for intracrainial drug delivery is a non-invasive technique that uses high-frequency sound waves to disrupt tight junctions in the blood–brain barrier (BBB), allowing for increased passage of therapeutics into the brain. The BBB normally blocks nearly 98% of drugs from accessing the central nervous system, so FUS has the potential to address a major challenge in intracranial drug delivery by providing targeted and reversible BBB disruption. Using FUS to enhance drug delivery to the brain could significantly improve patient outcomes for a variety of diseases including Alzheimer's disease, Parkinson's disease, and brain cancer.


Focused-ultrasound-mediated diagnostics or FUS-mediated diagnostics are an area of clinical diagnostic tools that use ultrasound to detect diseases and cancers. Although ultrasound has been used for imaging in various settings, focused-ultrasound refers to the detection of specific cells and biomarkers under flow combining ultrasound with lasers, microbubbles, and imaging techniques. Current diagnostic techniques for detecting tumors and diseases using biopsies often include invasive procedures and require improved accuracy, especially in cases such as glioblastoma and melanoma. The field of FUS-mediated diagnostics targeting cells and biomarkers is being investigated for overcoming these limitations.

References

  1. Grisham, John. "READ - THE TUMOR BY JOHN GRISHAM". Focused Ultrasound Foundation. Retrieved 9 November 2016.
  2. "Board of Directors". Focused Ultrasound Foundation. Retrieved 9 November 2016.
  3. 1 2 3 "John Grisham on why he's giving his new book away for free". CBS News. 20 April 2016. Retrieved 10 November 2016.
  4. 1 2 Rosenwald, Michael (22 February 2016). "John Grisham thinks his new book is so important he's giving it away for free". Washington Post. Retrieved 9 November 2016.
  5. Grisham, John. "Please read this letter". www.jgrisham.com. Retrieved 9 November 2016.
  6. "The Tumor: A Non-Legal Thriller". Barnes & Noble. Retrieved 10 November 2016.
  7. Sweeney, Darren (24 February 2016). "John Grisham offers latest book to readers for free". fox8.com. Retrieved 10 November 2016.
  8. Tierney, McAfee (23 February 2016). "John Grisham Publishes The Tumor, New Book About Focused Ultrasound". People. Retrieved 10 November 2016.