This week’s episode of Holby City revealed that Ric’s worrisome memory problems and vile temper are not in fact a result of dementia, but are instead the consequence of a brain tumour. There are two types of brain tumours: benign (non-cancerous) and malignant (cancerous).  Here we explain the what, the how, and the why of cancerous brain tumours.  

Holby City; Ric Griffin
Ric Griffin – will he survive what’s to come?

Cancer is an ancient disease. The first written record of cancer hails from 1500 B.C, with descriptions inked onto Egyptian papyrus. It was Hippocrates who coined the term karkinos, the Greek word for crab, later translated into the Latin, cancer. The physician posited the earliest theory of cancer, the humoral theory, in which an imbalance between the four ‘humours’ – blood, phlegm, yellow bile, and black bile – was thought to be the cause.

This may have confounded cancer medicine for centuries to come, but, in a sense, Hippocrates was correct. Cancer is the result of an imbalance, not in humours, but in cell cycle control. Normal, somatic (non-reproductive) cells undergo mitosis, a cycle where they replicate in order to grow, repair and replace old, dead, or damaged cells. Apoptosis, or more crudely ‘cell suicide’, is a process by which cells self-destruct, either because they are in excess, virally infected, or, indeed, cancerous in nature.

Cancer occurs when there is too much replication, and too little cell death. This imbalance produces cells that divide uncontrollably, some of which will travel to distant parts of the body, seed, and continue to grow (metastasis). The disturbance in this equilibrium between division and death is the consequence of several damaging mutations to the cell’s DNA that went unrepaired. These can be caused by environmental insults, such as the chemicals in cigarettes or the ultraviolet light in sun rays, but mostly occur randomly over time.

This has damning implications for modern humans. As we age, cells accumulate more and more DNA damage that may one day tip the balance towards cancer. And because we are generally living longer than our ancient ancestors ever did, our cells have the time to amass these mutations.

There are several different types of cancer, breast and lung having the highest frequency worldwide. Primary cancer is where the cancer first grows in your body. It is then called a secondary cancer if it spreads elsewhere (metastasis). Primary brain cancers, in comparison to the likes of breast and lung and gut cancers, are rare, and are around four times less common than secondary brain tumours.

Over series 12-13 of Holby City, Ric Griffin battled cancer for the first time. However, it is often the case that microscopic cancer cells – cells so small that surgeons cannot see them – are left in the body after treatment. These are the cells that cause relapse – re-occurrence of the cancer, sometimes even in a different place than where it had started originally. Is this what has happened to Ric?

As we saw in the episode, a concerned Ric asked for a frontal-temporal and full-brain MRI (Magnetic Resonance Imaging), which is a scanning device that uses magnetic fields and a quantum physics idea called magnetic spin to form highly detailed images. Frontal-temporal is a reference to two specific lobes of the brain – (there are four: frontal, temporal, parietal and occipital) – that are responsible for the things that seem to be plaguing Ric – personality changes and poor memory.

Henrik Hanssen saved Ric’s life back in 2010, despite the chances being as low as 5 percent. Let’s hope that the new consultant neurosurgeon and hospital CEO Max McGerry can pull off another miraculous operation.