Dr Sandeep Vaishya is a senior neuro oncosurgeon from Fortis memorial Research Institute Gurugram. He has over 25 years of experience with expertise in neurological cancer. He was trained at AIIMS, New Delhi and Mayo Clinic, USA. You can book an appointment with him by clicking here.
Glioblastoma is a very aggressive type of brain tumour. It is also known as glioblastoma multiforme (GBM). It is the most common type of malignant (cancerous) brain tumour in adults.
It is more common among men than women.
To understand the symptoms, causes and treatment for glioblastoma, it is important to first understand what glioblastoma is.
What is Glioblastoma?
Glioblastoma or grade IV tumour is a fast-growing, aggressive tumour that occurs in the brain or spinal cord. This type of tumour originates from a specific type of brain cell, known as astrocyte. These cells support and nourish the nerve cells of the brain (neurons).
The tumour can invade the nearby brain tissue, but generally does not spread to distant organs in the body.
Usually, the tumour occurs in the cerebral hemispheres of the brain in adults, particularly the frontal and temporal lobes of the brain. However, it can be found in any part of the brain.
What are the causes or risk factors of glioblastoma?
The exact underlying cause of glioblastoma is not known in most cases. However, there are certain risk factors that increase the possibility of developing glioblastoma:
- Age: Glioblastoma can develop at any age, but it is common among older adults in the age of 45 to 70. The average age at diagnosis is 64.
- Gender: The incidence of glioblastoma is higher in males than females.
What are the symptoms of glioblastoma?
The symptoms of glioblastoma vary depending on the location and size of the tumour. The common symptoms may include:
- Persistent headaches
- Nausea and vomiting
- Confusion or a decline in brain function
- Double or blurred vision
- Changes in mood and personality
- Difficulty with balance
- Memory loss
- Speech difficulty
- New onset of seizures
- Weakness on one side of the body
How is Glioblastoma diagnosed?
Glioblastoma is typically diagnosed by neurological examination, scans, and biopsy:
Neurological examination
A neurological examination is performed, where the doctor may check vision, hearing, balance, coordination, strength and reflexes. Any problems in these areas may provide clues about the location of tumours in the brain.
Imaging tests (Scans)
Imaging studies can provide information regarding the location and size of the tumour. The commonly used scan to diagnose brain tumours is MRI, which can be combined with specialized MRI imaging, such as perfusion MRI and magnetic resonance spectroscopy.
Other imaging studies may include computerized tomography (CT) scan.
Biopsy
Depending on the location of the tumour, a biopsy may be performed with a needle before treatment, or as part of an operation to remove the brain tumour.
A stereotactic needle biopsy may be done for tumours in very sensitive areas within the brain that might be damaged by a more extensive operation. During a stereotactic needle biopsy, tissue is removed through the needle, which is frequently guided by CT or MRI scanning.
Biopsy test helps to confirm the diagnosis, gives an idea about prognosis, and provides the suitable treatment options.
What are the treatment options for Glioblastoma?
Treatment of newly diagnosed glioblastoma requires a multidisciplinary approach.
Current standard treatment includes surgery (maximal safe surgical resection, which means to safely remove as much of the tumour as possible), followed by radiation therapy with concurrent (means given along with radiation therapy) and adjuvant (means given after completing radiation therapy) temozolomide (TMZ), an oral chemotherapy drug.
Surgery
Neurosurgeon will safely remove as much of the tumour as possible.
In some cases, tumours are small and easy to separate from surrounding healthy brain tissue, and hence can be completely removed.
In other cases, tumours can’t be separated from surrounding tissue, or maybe they are located near sensitive areas in the brain and in such situations neurosurgeons remove as much of the tumour as is safe.
Radiation therapy
In this treatment, high-energy beams are used to kill the tumour cells; the energy beams may include X-rays or protons. This therapy is often recommended after surgery, and is combined with chemotherapy.
For patients who cannot undergo surgery, radiation therapy and chemotherapy can be used as a primary treatment.
Chemotherapy
This treatment involves administering drugs to kill the tumour cells. The oral chemotherapy drug temozolomide is usually given along with radiation therapy, and after completing radiation therapy.
Targeted therapy
This treatment involves using drugs that focus on specific abnormalities in cancer cells, which contribute to their uncontrollable growth. An example of a drug used in targeted therapy is Bevacizumab.
Not all patients with glioblastoma will respond well to certain therapies. The treatment plan usually includes a combination of several approaches.
The best treatment options for each patient depends on various factors including the size and location of the tumour, the extent to which the tumour has grown into the surrounding normal brain tissues; and age and the overall health of the patient.
What is the possible outcome of such treatment?
Individuals with glioblastoma have a poor long-term outlook. Glioblastoma (GBM) is an aggressive cancer that is difficult to treat.
Treatments ease symptoms and help prolong life. Without treatment, on an average patients can survive for only 3 months.
Despite treatment, many patients live less than a year after the initial diagnosis.
Better prognosis in glioblastoma patients is associated with the following factors:
- younger age
- higher Karnofsky performance score at diagnosis (a standard measure of the ability of the patients to perform daily tasks)
- treatment with chemotherapy and radiation therapy
- the extent to which the tumour can be surgically removed (complete removal associated with better prognosis).
Will the disease come back even after treatment?
Despite maximum removal of the tumour during initial surgery and multimodality therapy, about 70% of glioblastoma patients will experience disease progression within one year of diagnosis, and less than 5% survive five years after diagnosis.
Recurrence of glioblastoma can be treated by another surgery, radiation therapy, and other chemotherapy drugs.
