Glioblastoma

Glioblastoma is an aggressive type of cancer that can occur in the brain or spinal cord. Glioblastoma forms from cells called astrocytes that support nerve cells.

Glioblastoma can occur at any age, but tends to occur more often in older adults. It can cause worsening headaches, nausea, vomiting and seizures.

Glioblastoma, also known as glioblastoma multiforme, can be very difficult to treat and a cure is often not possible. Treatments may slow progression of the cancer and reduce signs and symptoms.

Diagnosis

Tests and procedures used to diagnose glioblastoma include:

  • Neurological exam. During a neurological exam, your doctor will ask you about your signs and symptoms. He or she may check your vision, hearing, balance, coordination, strength and reflexes. Problems in one or more of these areas may provide clues about the part of your brain that could be affected by a brain tumor.
  • Imaging tests. Imaging tests can help your doctor determine the location and size of your brain tumor. MRI is often used to diagnose brain tumors, and it may be used along with specialized MRI imaging, such as functional MRI and magnetic resonance spectroscopy.

    Other imaging tests may include CT and positron emission tomography (PET).

  • Removing a sample of tissue for testing (biopsy). A biopsy can be done with a needle before surgery or during surgery to remove your glioblastoma, depending on your particular situation and the location of your tumor. The sample of suspicious tissue is analyzed in a laboratory to determine the types of cells and their level of aggressiveness.

    Specialized tests of the tumor cells can tell your doctor the types of mutations the cells have acquired. This gives your doctor clues about your prognosis and may guide your treatment options.

Treatment

Glioblastoma treatment options include:

  • Surgery to remove the glioblastoma. Your brain surgeon (neurosurgeon) will work to remove the glioblastoma. The goal is to remove as much of the tumor as possible. But because glioblastoma grows into the normal brain tissue, complete removal isn't possible. For this reason, most people receive additional treatments after surgery to target the remaining cells.
  • Radiation therapy. Radiation therapy uses high-energy beams, such as X-rays or protons, to kill cancer cells. During radiation therapy, you lie on a table while a machine moves around you, directing beams to precise points in your brain.

    Radiation therapy is usually recommended after surgery and may be combined with chemotherapy. For people who can't undergo surgery, radiation therapy and chemotherapy may be used as a primary treatment.

  • Chemotherapy. Chemotherapy uses drugs to kill cancer cells. In some cases, thin, circular wafers containing chemotherapy medicine may be placed in your brain during surgery. The wafers dissolve slowly, releasing the medicine and killing cancer cells.

    After surgery, the chemotherapy drug temozolomide (Temodar) — taken as a pill — is often used during and after radiation therapy.

    Other types of chemotherapy may be recommended if your glioblastoma recurs. These other types of chemotherapy are often administered through a vein in your arm.

  • Tumor treating fields (TTF) therapy. TTF uses an electrical field to disrupt the tumor cells' ability to multiply. TTF involves applying adhesive pads to your scalp. The pads are connected to a portable device that generates the electrical field.

    TTF is combined with chemotherapy and may be recommended after radiation therapy.

  • Targeted drug therapy. Targeted drugs focus on specific abnormalities in cancer cells that allow them to grow and thrive. The drugs attack those abnormalities, causing the cancer cells to die.

    Bevacizumab (Avastin) targets the signals that glioblastoma cells send to the body that cause new blood vessels to form and deliver blood and nutrients to cancer cells. Bevacizumab may be an option if your glioblastoma recurs or doesn't respond to other treatments.

  • Clinical trials. Clinical trials are studies of new treatments. These studies give you a chance to try the latest treatment options, but the risk of side effects may not be known. Ask your doctor whether you might be eligible to participate in a clinical trial.
  • Supportive (palliative) care. Palliative care is specialized medical care that focuses on providing relief from pain and other symptoms of a serious illness. Palliative care specialists work with you, your family and your other doctors to provide an extra layer of support that complements your ongoing care. Palliative care can be used while undergoing other aggressive treatments, such as surgery, chemotherapy or radiation therapy.
Aug. 10, 2017
References
  1. Central nervous system cancers. Fort Washington, Pa.: National Comprehensive Cancer Network. http://www.nccn.org/professionals/physician_gls/f_guidelines.asp. Accessed March 9, 2017.
  2. Winn HR, ed. Malignant gliomas: Anaplastic astrocytoma, glioblastoma, gliosarcoma and anaplastic oligodendroglioma. In: Youmans and Winn Neurological Surgery. 7th ed. Philadelphia, Pa.: Elsevier; 2017. https://www.clinicalkey.com. Accessed March 9, 2017.
  3. Adult central nervous system tumors treatment (PDQ). National Cancer Institute. https://www.cancer.gov/types/brain/patient/adult-brain-treatment-pdq. Accessed March 9, 2017.
  4. Avastin (prescribing information). South San Franciso, Calif.: Genentech; 2016. https://www.gene.com/patients/medicines/avastin. Accessed March 21, 2017.
  5. Batchelor T. Initial postoperative therapy for glioblastoma and anaplastic astrocytoma. https://www.uptodate.com/home. Accessed May 1, 2017.
Aug. 10, 2017
References
  1. Central nervous system cancers. Fort Washington, Pa.: National Comprehensive Cancer Network. http://www.nccn.org/professionals/physician_gls/f_guidelines.asp. Accessed March 9, 2017.
  2. Winn HR, ed. Malignant gliomas: Anaplastic astrocytoma, glioblastoma, gliosarcoma and anaplastic oligodendroglioma. In: Youmans and Winn Neurological Surgery. 7th ed. Philadelphia, Pa.: Elsevier; 2017. https://www.clinicalkey.com. Accessed March 9, 2017.
  3. Adult central nervous system tumors treatment (PDQ). National Cancer Institute. https://www.cancer.gov/types/brain/patient/adult-brain-treatment-pdq. Accessed March 9, 2017.
  4. Avastin (prescribing information). South San Franciso, Calif.: Genentech; 2016. https://www.gene.com/patients/medicines/avastin. Accessed March 21, 2017.
  5. Batchelor T. Initial postoperative therapy for glioblastoma and anaplastic astrocytoma. https://www.uptodate.com/home. Accessed May 1, 2017.