Dark Victory (1939) and a Malignant Glioma

Judith Traherne is a rich Long Island socialite in her twenties. She rides, drinks and throws parties. She also ignores months of headaches, dizziness, double vision and small lapses of memory.

A fall on a staircase and a riding accident push her to see Dr Frederick Steele, a brain surgeon on the point of quitting practice for research. He operates and finds a malignant glioma he cannot fully remove.

He tells Judith the operation was a success. He tells her secretary Ann the truth: less than a year, ending with a sudden loss of vision and death within hours. Judith later finds her own file. She marries Steele anyway. Months later, planting bulbs, she notices the light going, sends him off to a conference, and goes upstairs alone.

Spoilers throughout. The cancer story is the plot.

The early picture holds up. Months of headache, dizziness, double vision and memory lapses in a young adult, all put down to stress and hangovers, is a recognizable way for a slow-growing tumor to announce itself.

NCI's health-professional summary makes the point about timing sharply. Seizures are the presenting symptom in about 20 percent of tumors above the tentorium, and in slow-growing tumors they can precede the diagnosis by months to years. Something can be wrong for a long time before anyone names it.

The film is also right that a glioma often cannot be removed completely, and that surgery may buy time rather than a cure.

Here the film invents. Sight fails, and death follows within a few painless, punctual hours. That is not how advanced glioma goes.

What NCI describes instead is a picture built from where the tumor is and what it is doing: headaches, seizures, visual changes, nausea and vomiting, loss of appetite, and changes in personality, mood, mental capacity and concentration. NCI also reports that 70 percent of people with a primary tumor of the brain tissue itself develop seizures at some point. Judith has none. She stays glamorous, steady and articulate to the last frame.

Glioma covers tumors arising from glial cells, the supporting cells of the brain. NCI reports that anaplastic astrocytomas and glioblastomas together account for 38 percent of primary brain tumors, and that the combined incidence of brain and other central nervous system tumors in the United States was 6.2 cases per 100,000 people per year for 2017 to 2021.

Grade describes how aggressive the tissue looks. But grade alone no longer decides much. NCI names three molecular findings that now guide management: changes in IDH1 or IDH2, codeletion of chromosome arms 1p and 19q, and methylation of the MGMT gene promoter. A change in IDH is a strong prognostic factor, with longer survival independent of grade or subtype — and most grade 2 and 3 diffuse gliomas carry one.

For a young adult like Judith, that testing would be the point of the operation as much as the removal itself. In 2024 the FDA approved vorasidenib, an IDH1 and IDH2 inhibitor, for grade 2 astrocytoma or oligodendroglioma with an IDH mutation after surgery, at 40 mg once daily. There was nothing to offer in 1939 beyond the knife.

That amount is the licensed one for adults. Anyone actually taking vorasidenib should follow the prescription their own neuro-oncology team wrote.

Worth flagging for anyone reading the source. The classification table in NCI's adult central nervous system summary is reprinted from the 2007 WHO classification, and still uses retired terms such as anaplastic astrocytoma and oligoastrocytoma.

The fifth edition of the WHO classification, published in 2021, reorganized these diagnoses around molecular markers and changed both naming and grading. A pathology report written now will not match NCI's printed table. That is a gap in the source, not in the report.

There is no screening test for brain tumors. NCI's list of screening tests considered effective runs to four: mammography, HPV and Pap testing, colorectal screening, and low-dose CT for people with a heavy smoking history. All four are for adults with a specific risk, and none looks at the brain.

Scanning people without symptoms would find far more harmless abnormalities than tumors. So diagnosis follows symptoms. NCI describes CT and MRI as complementary — CT is fast and better for calcification, skull lesions and very recent bleeding, MRI better for soft tissue, swelling and enhancement — and then calls biopsy confirmation critical, because imaging patterns can mislead. One imaging point matters later on. NCI notes that SPECT and PET scans can help tell a regrowing tumor from radiation damage after treatment, a distinction an ordinary MRI often cannot make. NCI also puts the death rate from brain and other central nervous system tumors at 4.4 per 100,000 people per year for 2018 to 2022. For the wider logic, see cancer screening and the symptoms that do get investigated.

The deception is the largest departure of all. Steele decides what Judith may know, and tells her employee instead.

MedlinePlus states the current position plainly: by law, health care providers must explain a person's health condition and treatment choices to them. A patient may still say they would rather not hear a prognosis, and that preference can be recorded. What cannot happen is a surgeon making that choice on their behalf. Judith's rage at finding her own file is the most modern thing in the picture.

The film never answers the question a real patient would ask, so here it is.

• Call 911 and ask for an ambulance if someone has a seizure for the first time, a seizure runs past five minutes, one seizure follows another without them waking up in between, or they cannot breathe properly afterwards. The NHS lists all of these as reasons to call for an ambulance (NHS).
• Call 911 or go to an emergency department if weakness on one side, slurred speech, sudden loss of vision, or a very severe headache comes on quickly, or if someone becomes hard to rouse.
• Call your care team the same day if headaches are getting worse week by week, vomiting starts in the mornings, or personality, mood or concentration have shifted in a way people around you notice.

• https://www.cancer.gov/types/brain/hp/adult-brain-treatment-pdq
• https://www.nhs.uk/symptoms/what-to-do-if-someone-has-a-seizure-fit/
• https://www.cancer.gov/about-cancer/screening/screening-tests
• https://medlineplus.gov/ency/patientinstructions/000445.htm
• https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=31405fee-55b7-4857-987e-2724ee76be84
• https://eutils.ncbi.nlm.nih.gov/entrez/eutils/efetch.fcgi?db=pubmed&id=34185076&rettype=abstract&retmode=text

This page discusses Dark Victory for education. It is not medical advice, and nothing here is a judgement of anyone's real medical care. Spotted an error? Please email [email protected].