Glioblastoma

Glioblastoma or Grade IV glioma is a term used to describe those primary brain tumors (i.e gliomas) that are the most aggressive and fast growing. Glioblastomas sometimes arise out of slower growing gliomas (Grade II or Grade III gliomas) but can also appear without a preceding slow growing phase. Glioblastomas often occur in the cerebral hemispheres of the brain and can interfere with many of the brains normal functions including speech, movement, thinking and emotions.  Glioblastomas also cause brain irritation and swelling (i.e. edema) that can lead to the brain cells misfiring and causing seizures. 

Glioblastomas typically grow as a central mass that is visible on MRI, however there are also microscopic cells that are spread diffusely throughout the brain.

There is no known environmental or behavioral cause for these tumors and the majority of them appear to be “sporadic” which means they are not passed down to the patient’s children.  As people age, the DNA tends to accumulate errors.  In rare cases, these errors lead to the break-down of genes that prevent cancer (e.g. PTEN, p53) or turn on genes that cause cancer (EGFR, IDH1).  These events are random and hard to predict.  No method is known for preventing gliomas or other brain tumors.

Symptoms depend mainly on where the tumor is in the brain. These are common symptoms:

• Headaches.

• Seizures.

• Nausea and vomiting.

• Vision or hearing problems.

• Balance problems such as dizziness and trouble with walking.

• Slurred speech.

• Muscle or nervous system problems such as weakness or paralysis.

Many of these may be caused by other health problems. But it’s important to see a healthcare provider if you have these symptoms. Only a healthcare provider can tell if you have cancer.

Your healthcare provider may notice some symptoms of neurological or brain dysfunction (weakness, confusion, speech problems, or emotional changes) and decide to order some CT or MRI images of the brain.  After a diagnosis of glioblastoma, you'll likely need other tests. Depending on the location of the tumor, your provider can order additional tests to determine the precise location of vital brain functions such as vision, movement and language so they can be identified and protected during a potential surgery.

The following treatments may be used for glioma:

Surgery.

This is often the preferred first treatment for glioblastoma. If the tumor can be removed without risking nervous system damage, your doctor may remove a part of your skull and remove as much of the tumor as possible.  If the tumor is located within areas that are essential for important brain function, your doctor may just take a small piece of the tumor (biopsy).  The goal of the surgery is to remove as many tumor cells as possible and to provide tissue for the pathologists to analyze.  The results of that analysis will determine future treatments and overall prognosis.  Removing the tumor may also improve your symptoms.  

Awake Surgery.

In rare cases, if the tumor is near a language or movement area, your doctor may have you awake for part of the surgery to monitor for brain function while the tumor is removed.  This is surprisingly painless (the brain does not feel pain) and most patients do not remember it afterwards.

Radiation therapy.

This can be used to destroy any tumor cells that remain after surgery. In some cases glioma can’t be operated on. This means that it can’t be removed without risking brain damage. If this is the case, then radiation can also be used to treat the tumor and ease your symptoms.

Chemotherapy.

This treatment uses medicines that stop the growth of abnormal cells. Chemo medicines can be given by mouth (oral), through an IV (intravenous line), applied in the tumor, or placed at the site of your tumor through a shunt.

Glioblastomas can be hard to treat. If you or a family member has been diagnosed with a glioblastoma, you may want to ask your doctor if there are clinical trials of newer treatments that you should consider.

Talk with your healthcare providers about your treatment options. Make a list of questions. Think about the benefits and possible side effects of each option. Discuss your concerns with your healthcare provider before making a decision. You may want to consider getting a second opinion, if there is time. A second opinion can give you peace of mind about your treatment decision.

While there is no cure for glioblastoma, survival is better if the tumor is treated aggressively.  This will typically begin with a surgery to remove as many tumor cells as safely possible and to identify the unique characteristics of your tumor (sometimes called “tumor markers).  The full analysis of the tumor may take up to two weeks.  Following surgery there will be some scalp pain that is treated with IV or oral pain medication.  If your motor skills, balance, or other functions have been affected by the treatment of your glioma, your doctor may advise physical therapy and occupational therapy. These can help you to regain your strength and relearn some skills. Occupational therapy can also help you learn new ways of doing everyday tasks.

Once the results of the tumor analysis are complete and your incision has sufficiently healed you will undergo chemotherapy and radiation.  The chemotherapy is a pill (Temodar) and is given weekly for several months and compared to other chemotherapy drugs has relatively few side effects.  The radiation is given in small doses over many sessions (once a day for approximately six weeks).  Each session is approximately thirty minutes and you can go home after each session.  These treatments will delay the tumor from growing back.  Your doctor will order MRI scans every few months to monitor for the tumor growing back.  There are additional treatment options for when the tumor grows back and your doctor will work with other specialists to design a personalized treatment plan that is specifically designed for your tumor.

This diagnosis carries a major emotional blow for both the person and their family. Ask your healthcare team for mental health resources to help deal with the complex emotions that go along with this condition.