The People of Arizona should begin demanding that Governor Doug Ducey immediately press

forward with recalling Senator John McCain on the grounds of Physical or mental lack of fitness

So Mr. McCain can focus attention on his medical treatment for GBM.

1 Globlastoma (GBM) is terminal enough and the prognosis of his symptoms are dire conditions-

enough for the people in AZ to demand he step down -, retire, immediately and take care of his

health.

2 Arizona's governor must demand this, and begin the process to hold a special election.to seat

someone else in accordance to Arizona's State Constitution.

The Cause for Senator John McCain's recall.

Glioblastomas are usually highly malignant, a large number of tumor cells are metastasizing

within the CNS "Metastasis of intracranial GBM to the spinal cord has been described with

increasing frequency in recent years. Autopsy series suggest that approximately 25% of patients

with intracranial glioblastoma have evidence of spinal subarachnoid seeding" (1,2)

Case 1

A 51-year-old right handed male presented with headache, behavioral changes, and

forgetfulness. A neurological examination revealed the patient to be disoriented to place and

person with impairment of recent memory. He was unable to name objects and also had mild

slurring of speech. Magnetic Resonance Imaging (MRI) revealed a solid and cystic lesion in the

left temporal lobe with heterogenous contrast enhancement [Figure 1a]

FIGURE 1A

(GBM is nourished by an ample blood supply. Dead cells may also be seen, especially toward

the center of the tumor. Because these tumors come from normal brain cells, it is easy for them

to invade and live within normal brain tissue.

FIGURE 2A
There are two types of glioblastomas:

Primary, GBM : tend to form and make their presence known quickly. This is the most

common form of glioblastoma; it is very aggressive and it grows quickly.

Secondary: These tumors have a longer, somewhat slower growth history, but still are very
aggressive. They may begin as lower-grade tumors which eventually become higher grade. They
tend to be found in people 45 and younger, and represent about 10% of glioblastomas.

Glioblastoma has an unfavorable prognosis mainly due to its high propensity for tumor

recurrence. It has been suggested that GBM recurrence is inevitable after a median survival time

of 32 to 36 weeks.1,2 . median duration of patient survival is estimated to be between 12 and 18

months with maximal treatment, but those without any intervention die soon after diagnosis.

Gliolastoma prognosis gives him around 2 years. It is not clear what stage he is in. however are

what he can expected without undergoing radical treatment that will have a huge impact on his

mental capacity as well as his physical state during the treatment up to the last 3 months of his

life is why I say he needs to step down.

Symptoms related Brain Cancer include increased intracranial pressure (headache and

drowsiness is something he has already likely to be encountering) as well as progressive

neurological deficits, epileptic seizures, confusion/delirium, fatigue, and dysphagia.( difficulty in

swallowing) he won't feel much pain due to the pain sensory portion of the brain is not affected.

Fall risks along with increasing weakness on the affected side difficulty walking Urinary/bowel

incontinence. His cognitive thought process will diminish rapidly. Confusion and memory loss

and more difficulty holding a conversation. Saying things that ill border on being senile "

Increasingly tired, more easily "wiped out" after simple activities or outings along with

disphoria- a state of unease or generalized dissatisfaction with life.

Headaches due to increased swelling of the brain

More likely to phase in and out of sleep

Urinary/Bowel problems that will occur include

liquid intake decreasing, output also decreasing

Constipation and a frequent need for stool softeners and progressing to needing enema's due to

the bowel becoming quite sluggish and fewer/no bowel movements

Cognitive/Personality/Speech

He will begin sentences but not be able to finish them

He will say things that are impossible to make out or things that don't make sense

Chant something ("Ohboyohboyohboy..." or "Ohmyohmyohmy...")

become more restless and fidgety, as if late for something

Be irritated by strong sounds or odors

Physical

Taking only minimal amounts of food (a spoonful or two, here and there); some, however,

continue to eat well until about 48 hours before death

Decreasing intake of fluids

Administration of meds becomes harder or impossible

Dosing of meds becoming sporadic due to sleep schedule

Be increasing with attempting to clear the throat as mucus increases

The voice may lower and deepen

May have a wet cough

Vital signs often still good

Increase in sleeping or resting

May be uncomfortable being moved during clothing or linen changes

Dramatic withering of the legs due to inactivity (skin 'n' bones)

May have a low-grade fever

Very difficult to rouse from sleep or elicit a response from

May have no response or only nonverbal communication (eg, winks, waves, or nods)

May seem relaxed and comfortable

and End Stage the above symptoms will increase. along with Usually minimal or no urine output

Reaches a point of unresponsive sleep (coma), which can last from 1 hour to most of the day

No longer any involuntary movement during sleep (no fidgets or eye movements)

Mouth may slacken and eyes may remain partially open during sleep, as voluntary muscle

control is lost

Vital signs may be OK until just hours before death

Blood pressure may drop significantly

Heart rate may be twice-normal (120-180 beats per minute) 3,4,5

Resources

1. Davis FG, Freels S, Grutsch J, Barlas S, Brem S. Survival rates in patients with primary

malignant brain tumors stratified by patient age and tumor histological type: An analysis

based on Surveillance, Epidemiology, and End Results (SEER) data, 1973-1991. J

Neurosurg. 1998;88:110.

2. McLendon RE, Halperin EC. Is the long-term survival of patients with intracranial

glioblastoma multiforme overstated? Cancer. 2003;98:17458.

3 Erlich SS, Davis RL. Spinal subarachnoid metastasis from primary intracranial glioblastoma

multiforme. Cancer. 1978;42:285464.

4 Lam CH, Cosgrove GR, Drislane FW, Sotrel A. Spinal leptomeningeal metastasis from

cerebral glioblastoma.Appearance on magnetic resonance imaging. Surg Neurol.

1991;35:37780. [PubMed]

5 Psychiatric symptoms in glioma patients: from diagnosis to management

Florien W Boele,1 Alasdair G Rooney,2 Robin Grant,2 and Martin Klein1