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Observation

(indented text by AN patients)

Observation, commonly called "wait-and-watch", is the most conservative option for AN patients.  The Patient Directory of the AN Archive lists many "wait-and-watchers";  you are welcome to read their stories, and to contact them with questions.

Historically, observation was not an attractive option, since ANs were typically not discovered until their size dictated a more active approach. As a result, surgeons have been trained to recommend surgery for all patients, and some still do

Nowadays, with MRIs, most ANs are discovered long before that stage. ANs grow slowly, 1 mm (.1 cm) per year on the average, and sometimes not at all. Also, ANs are "well-behaved":  they never send off cells to form other tumors, never "engulf" nearby tissues, and do not send tentacles into them. They just push against them as they grow bigger.  As a result, when an AN is discovered so small that the its symptoms are somewhat bothersome, but very manageable, observation is believed to be the best option for most such patients.  The latest research article confirming this can be found at the JHU "What's New in AN research" site.

Every patient should be aware of the exact size of their AN, down to 1/10th of a centimeter (cm) before making any treatment decisions. Please make sure the number you get is exact:

I had three neurosurgeons tell me mine was a 2 cm because they tend to ballpark the dimensions. A much more experienced neurotologist told me mine was "what the radiologist had written on the report - a 1.4 cm." Doctors may round it up to make numbers simpler for the patient, and we need to watch out... Did you radiology report say 2 cm (or 3 or 4) or did your surgeon call it that size?

It is also a good idea for patients with small to medium ANs to know their tumor's rate of growth before making a decision; two MRIs spaced 6 months apart are sufficient to figure it out.  Unless the patient experiences a sudden increase in symptoms such as hearing difficulty, this is recommended.

The rate of AN growth is correlated with age.  It's slower in older patients, for whom wait-and-watching is particularly attractive.  In fact, there are many more ANs around in older people than we know about, since the ones that do not cause any symptoms are almost never diagnosed. In the Scandinavian countries, every death results in an autopsy, and these "silent ANs" are found and recorded.  Their statistics indicate that about 1% of all people have ANs, at least at the time of their death.

There are even a few AN patients whose ANs have actually declined over time with no treatment. They are rare, but you may be one of the lucky ones.

I know one of these individuals and over a total period of 10 years, that person's AN has gone down from around 1.4cm to 8 mm and then back up to 1.2 and is still 1.2 (for the past 3 years).

For those considering waiting and watching, there are three tests to be done along with the MRI:  the vestibular function test, the BSER test, and the facial nerve test (see descriptions here), just to keep track of things.  The point is to know what you're watching, and that's more than the physical size of the tumor itself, it's watching what effect the tumor has on the rest of you. So get a baseline established so you know if there's any deterioration.

Alternative medicine may help you with controlling your tumor or maybe shrinking it.  The AN Archive has many tips on alternative techniques for controlling ANs.

Last Edited: Friday, November 01, 2002