Cancer researcher Leah Banks noticed her vision was impaired as she drove at night. Car lights were blindingly bright, and the problem made her wonder whether driving after sunset was in the best interest of safety.
“I also noticed that my peripheral vision was blurry, so I scheduled an appointment with my optometrist,” said Banks, 34, a postdoctoral fellow at Cold Spring Harbor Laboratory. She didn’t initially think her visual disturbances were serious. She thought she needed new glasses. Her optometrist thought likewise and suggested she probably had astigmatism, a curvature in the cornea, the clear outer windshield of the eye.
The optometrist prescribed new lenses. The diagnosis, however, was incorrect.
Banks’ dogged search for a precise diagnosis consumed much of last year and only for the past six months has she resumed her research at the lab. She found her visual disturbances were not caused by astigmatism but by a brain tumor that had put pressure on a key juncture where the optic nerves from both eyes intersect. The discovery resulted in a daring four-hour surgery during which the tumor was removed through her nose.
The monthslong medical odyssey temporarily rocked the young scientist’s world.
Her tumor, although benign, was defined as pituitary adenoma, a type of abnormality that affects 9 percent to 12 percent of people diagnosed annually in the United States with a brain tumor. A surprising 1 in 4 Americans are estimated to have a tumor in the pituitary gland without knowing it because there are no symptoms, according to researchers at Memorial Sloan-Kettering Cancer Center in Manhattan.
Pituitary adenomas can cause excruciating headaches — and, as was for Banks, they also can steal eyesight.
More than 120 different kinds of tumors are known to infiltrate the central nervous system, ranging from benign to malignant. The tumor that claimed the life of Sen. John McCain last year was the most lethal form of brain tumor, a malignant glioblastoma. But among the 86,000 people in the United States diagnosed annually with a brain tumor, an estimated 69 percent have growths that, like Banks’ tumor, are found to be benign, data from the American Brain Tumor Association show.
Benign means cells from the growth — when viewed through a microscope — appear normal and have zero hallmarks that are consistent with cancer. Despite being noncancerous, the growths can still produce consequences, studies have found.
“I decided to explore my options online and look for different types of eye doctors,” said Banks, who holds a doctorate in cancer biology. A native of Vacaville, California, near the state capital in Sacramento, she has concentrated on cancer research because of a promise she made to her grandparents. Both developed colon cancer and died of it. She vowed to pursue a career that would seek answers on why healthy cells go awry and become malignant, and to explore methods of effective treatment.
She didn’t initially suspect an abnormal growth in her brain would interfere with the pursuit of her dreams.
“I work long hours doing bench experiments with lab tools,” she said of working in a laboratory at a long, equipment-filled countertop known in research as a bench, “so my vision is vitally important.
“My laboratory work requires precise observation of samples and other data," Banks added. "As my eyesight worsened, I noticed that it was not only interfering with my work, but when I drove at night. I was not perceiving light in my right eye. Lights from oncoming traffic made it quite difficult to drive. This is when I knew that my eye condition was getting worse.”
Her search for a physician who might help led her to an ophthalmologist, who performed a series of tests.
“When he shined a bright light in my eye, I couldn’t see the light,” Banks recalled, noting that the eye specialist recommended she see a neuro-ophthalmologist.
Her next step was to the offices of Dr. Howard Pomeranz, chief of neuro-ophthalmology at Northwell Health in Great Neck.
“From an ophthalmological standpoint, one of the first things we think of when a patient complains of bright lights while driving is cataracts. But she was too young for that,” Pomeranz said.
After examining his patient’s eyes, he suggested the problem might be a tumor. But Banks would need confirmatory imaging tests.
“I am in a subspecialty of ophthalmology that deals with any neurological disorder, any problem in the brain — from a brain tumor to multiple sclerosis — that can affect vision,” Pomeranz said, noting that in his arcane area of medicine he frequently sees patients who have the kind of tumor he suspected had infiltrated Banks’ brain.
“There are two types of pituitary tumors,” Pomeranz said. “There are secreting tumors that secrete pituitary hormones. The other type is called non-secreting.”
Banks had a non-secreting tumor.
Pomeranz said pituitary tumors usually produce no symptoms until they become large enough to put pressure on the optic chiasma, an X-shaped structure in the brain where the optic nerve from each eye meets at a central point — the midsection of the X.
When results from the MRI were in, Pomeranz knew his initial hunch of a tumor was correct. Banks was stunned by the finding, as a thousand thoughts raced through her mind.
“We went through all of the tests and pictures of the optic nerve and I knew right away it was something severe,” Banks said. “I was definitely in a state of shock.
"As a cancer researcher, it was also shocking because in my lab some of us are working on neuroblastoma,” she said of a nervous system tumor.
Assurances that it was likely benign were of little solace, she said, because her eyesight was at stake and her future seemingly in jeopardy. A key question was how the growth began in her pituitary.
The pituitary gland, about the size of a pea, is situated in the brain just behind the bridge of the nose. It is part of the endocrine system, which secretes hormones and long has been called the master gland because it controls hormones throughout the body, including those secreted by the thyroid and adrenal glands.
Pituitary tumors can occur at any age, but they are more common in older people. Women are more affected than men, particularly during the childbearing years, the American Brain Tumor Association has found.
Banks was hospitalized the evening that all of her medical tests were in and confirmed. She would next meet with Dr. Mark Eisenberg, Northwell Health’s director of the Skull Base Center and Pituitary Neuroendocrine Disorders Center.
He told Banks that because of the size and location of her tumor, it was best to remove it endoscopically through her nose. An endoscope is a thin flexible tube and light that allows a surgeon access to parts of the brain without making large incisions or removing parts of the skull.
“We do this endoscopically right through the nostril to reach the pituitary,” Eisenberg said. “The approach used to be an incision under the lip. With endoscopes, we can see a lot better because the camera and visualization are right there. We can look around corners and see important structures.”
Eisenberg was assisted in the operation by otolaryngologist Dr. Margherita Bruni. Removing the tumor from Banks’ pituitary took four hours, the doctors said.
“We were able to get a really complete resection,” Eisenberg said of removing the entire tumor. “When I am able to get a complete resection, the likelihood of it recurring is very, very low. We will follow her over the next 10 to 12 years.”
Banks said she’s pleased the diagnosis, tumor and hospitalization are behind her. The entire affair frightened a lot of people — her parents, who flew in from California, and her boss, Dr. Alea Mills, discoverer of a gene called Chd5, which suppresses cancer growth. Mills and Banks’ lab colleagues came to visit her in the hospital.
“At first, I had wanted to be a doctor because doctors save lives. But after I got to graduate school, I knew that I wanted to focus on cancer research,” said Banks, who also tutors Long Island high school students and encourages them to pursue careers in science.