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GLIOBLASTOMA – A DEADLY BRAIN TUMOR

Posted May 03 2010 9:21am

          Glioblastoma multiforme (GBM) is by far the most common and most malignant of the glial tumors.  Attention was recently drawn to this form of brain cancer when Senator Ted Kennedy was diagnosed with glioblastoma and ultimately died from it.  It is a deadly brain tumor.  Of the estimated 17,000 primary brain tumors diagnosed in the United States each year, approximately 60% are gliomas.  GBM is an aggressive malignant brain tumor that grows in the glial cells, affecting the nervous system.  According to the National Brain Tumor Society, glioblastoma accounts for approximately 23 percent of all primary brain tumors diagnosed in the U.S.  The prognosis for individuals with glioblastoma depends upon how early the tumor is detected and how quickly treatments begin.  The exact cause of glioblastomas is uncertain, but some factors increase the possibility of developing a tumor.  Glioblastoma is more common in men than women, and the chances of developing a tumor are highest between the ages of 45 and 55.  The presence of other brain tumor types, currently or in the past, increases glioblastoma risk as well.  Certain genetic disorders such as neurofibromatosis and tuberous sclerosis are also risk factors.

          Neurologic symptoms and signs affecting patients with glioblastomas can be either general or focal and reflect the location of the tumor.  General symptoms include headaches, nausea and vomiting, personality changes and slowing of cognitive function.  Headaches can vary in intensity and quality, and they frequently are more severe in the early morning or upon first awakening.  Changes in personality, mood, mental capacity and concentration can be early indicators or may be the only abnormalities observed. Focal signs include hemiparesis, sensory loss, visual loss, aphasia and others.  Seizures are a presenting symptom in approximately 20% of patients with supratentorial brain tumors.  A neurologic evaluation should be done if a patient has slowly increasing signs of mental dysfunction, new seizures, persistent headaches or evidence that there is pressure inside the skull, such as vomiting or swelling or protrusion of the blind spot at the back of the eye.

          Glioblastomas and other brain tumors are diagnosed through a series of tests.  A neurologist will examine an individual to determine motor skill, cognitive and nervous system responses.  Computerized tomography (CT) and magnetic resonance imaging (MRI) scans are performed to positively identify the presence, location and size of the tumor.  A biopsy is often performed to identify the type of tumor involved.  Surgery is often the first step in treating glioblastoma.  A surgeon will remove as much of the tumor as possible without compromising connected tissue.  Due to glioblastoma’s invasive nature, surgery will not remove the tumor completely.  Radiation and/or chemotherapy treatments often follow surgery to both shrink the remaining tumor and prevent the growth from spreading further. 

          Glioblastoma has a very poor prognosis, despite multimodality treatment consisting of open craniotomy with surgical resection of as much of the tumor as possible, followed by concurrent or sequential chemoradiotherapy, antiangiogenic therapy with bevacizumab, gamma knife radiosurgery and symptomatic care with corticosteroids. Other than the brainstem gliomas, it has the worst prognosis of any CNS malignancy and is known as a deadly brain tumor.  The median survival time from the time of diagnosis without any treatment is 3 months, but with treatment survival of 1-2 years is common.  Increasing age (over 60 years of age) carries a worse prognostic risk.  Death is usually due to cerebral edema or increased intracranial pressure.  Glioblastoma prognosis is usually given in months – not years.  I had a very dear friend and patient that was diagnosed with this type of tumor in March a few years ago.  Despite all of the treatment received, she lost her fight in middle August of the same year.

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