The Fountain (2006) and a Terminal Brain Tumor

Three strands braid together. In the sixteenth century, a conquistador is sent by his queen to find the Tree of Life. In the present, a medical researcher named Tommy Creo works in a laboratory. He is testing a compound from a Guatemalan tree on a primate with a brain tumor. The tumor shrinks. The animal seems to age backward. In a far future, a bald traveler carries a dying tree through space toward a nebula.

The present-day thread is the spine. Tommy's wife Izzi is dying of a brain tumor. She has reached acceptance. He has not.

He buries himself in work. He skips her appointments and her walks. She writes a book called The Fountain and asks him to finish the last chapter. She collapses, and dies. He plants a seed at her grave. In the closing vision the traveler lets go, merges with the tree, and the tree blooms.

Spoilers throughout. This page says how The Fountain ends.

This is what the film is actually about, and it is sharp about it.

It catches an asymmetry clinicians see constantly. The patient often arrives at acceptance well ahead of the family. Izzi wants to finish her book, get outside, see the first snow. Tommy cannot sit still in a waiting room.

It also catches how terror turns into a project. He is physically present and emotionally absent, and the work is the place he hides.

And it is quietly honest about timing. A laboratory discovery and one dying person's calendar never line up. No amount of effort closes that gap.

Medically the film is almost abstract.

There is no diagnosis. No radiotherapy. No chemotherapy. No seizure management, no steroids, no palliative care team. No oncologist ever has a real conversation with the couple.

Izzi stays lucid, articulate and physically capable until the moment she collapses. That is not how most brain tumors end. NCI records that among all patients with brain tumors, 70 percent of those with primary parenchymal tumors develop seizures at some point in the clinical course. For metastatic brain tumors the figure is 40 percent.

The lab shortcut is the other fiction. A compound tested in one primate does not become a patient's treatment. That path runs through years of safety work, trials and regulatory review.

NCI's general list of signs and symptoms is short: headaches, seizures, visual changes, gastrointestinal symptoms such as loss of appetite, nausea and vomiting, and changes in personality, mood, mental capacity and concentration.

Which of those appear depends on location. NCI frames the whole presentation as a question of anatomy.

Seizures deserve their own line. They are the presenting symptom in about 20 percent of supratentorial brain tumors. In slow-growing tumors they may come months or years before the diagnosis.

Imaging comes next, and the two scans do different jobs. NCI describes contrast-enhanced CT and MRI as complementary. CT is fast, which matters when someone is unstable, and it is better for calcification, skull lesions and bleeding less than 24 hours old. MRI has better soft-tissue resolution and picks up edema, older bleeding and subtle enhancement. For spinal cord lesions, high-quality MRI is the study of choice.

Then tissue. NCI calls biopsy confirmation critical, because radiological patterns can mislead and because abscesses, arteriovenous malformations and infarctions can look similar. CT- or MRI-guided stereotactic technique can place a needle safely into almost any location in the brain.

There is no screening test. No scan or blood test is recommended for people without symptoms.

One detail is worth flagging, because it affects anyone reading that summary for guidance.

NCI's adult central nervous system tumors summary includes a grading table, reprinted with permission from the World Health Organization Classification of Tumours of the Central Nervous System, IARC, Lyon, 2007.

IARC published the 5th edition of that classification in 2021, as Volume 6 of the WHO Classification of Tumours series. That edition is the one that put molecular markers at the center of how these tumors are named and graded.

NCI's own text elsewhere acknowledges the shift, saying the WHO approach incorporates cytogenetics, molecular genetics and immunological markers. But the table it reprints predates that change by fourteen years. A pathology report today will not match it.

NCI is blunt here: few definitive observations have been made about environmental or occupational causes of primary CNS tumors.

The named candidates are narrow. Vinyl chloride exposure may be a risk factor for glioma. Epstein-Barr virus is implicated in primary CNS lymphoma, and transplant recipients and people with AIDS have a substantially increased risk of that specific tumor.

A set of inherited syndromes carries risk: neurofibromatosis types 1 and 2, von Hippel-Lindau disease, tuberous sclerosis, Li-Fraumeni syndrome, Turcot syndrome types 1 and 2, and nevoid basal cell carcinoma syndrome.

Cancer Explained is free and ad-free, and you can support this work if this was useful. For what a symptom means in general, see symptoms of cancer. For how staging works elsewhere in the body, see cancer staging.

• NCI PDQ — Adult Central Nervous System Tumors Treatment (Health Professional Version)
• IARC — WHO Classification of Tumours: Central Nervous System Tumours, 5th edition (2021)

This page discusses The Fountain for education. It is not medical advice, and nothing here is a judgement of anyone's real medical care.