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A 58 y.o. patient presented with a 1-week history of progressively worsening left-sided upper and lower extremity weakness, described as an inability to hold objects in her left hand and frequent falls secondary to a left foot drop. The weakness eventually culminated in an episode where the patient fell out of bed and could not get up. MRI revelaed a right frontoparieto mass. Biopsy reveled the mass to be a glioblastoma. The tumor was treated with the cancer drug temozolomide (Temodar). This is a small, lipophilic drug that is taken orally.
1. Based on the patient's symptoms, what specific area of the right cerebrum was the tumor affecting?
2. Why did the patient exhibit symptoms on her left side (rather than her right side)?
3. The biopsy would have revealed the tumor to be composed of what cells?
4. Normally, the blood brain barrier prevents the delivery of chemotherapy drugs to the brain. How are the capillaries of the brain different from capillaries perfusing other organs?
5. Why can temozolomide cross the BBB?
6. What cells must the temozolomide pass through to reach the ECF surrounding the tumor?
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