Glioblastoma Multiforme, Glioblastomas or GBM, in short, are tumors which arise from astrocytes. Astrocytes are star-shaped cells which make the ‘glue-like’ supportive tissue of the brain. GBM tumors are generally highly cancerous (malignant) because these cells are found to reproduce quickly & are also supported by a large network of blood vessels. Glioblastomas are usually found within cerebral hemispheres of the brain but can also be found elsewhere inside the brain or the spinal cord. These cancerous tumors are typically found to contain a mix of cell types. It is however not unusual for these tumors to contain calcium deposits, cystic mineral, blood vessels and/or mixed grade of cells. These glioblastoma tumors are highly malignant & where a large number of tumor cells are found reproducing at any given time. They are also well nourished by an ample supply of blood. Dead cells are also found here, especially within the center of the tumor. Since GBM tumors originate from normal brain cells, it is, therefore, easy for them to invade & live within the normal tissue of the brain. Nevertheless, glioblastomas are rarely found to spread to any other parts of the body.
There are two main types of Glioblastomas.
Since glioblastomas can rapidly grow, most common signs & symptoms are usually caused by increased pressure within the brain. Common symptoms of GBM tumors include drowsiness, vomiting, nausea & headache. GBM tumor patients can develop a variety of other symptoms like visual changes, weakness on one side of the body & memory and/or difficulties in a speech which will depend upon the location of the tumor. Moreover, clinical history of GBM patients is usually very short, less than 3 months in 50 percent of the patients.
Common presenting symptoms of glioblastoma patients include the following.
Neurological signs & symptoms can either be general or focal & reflect the location of the tumor.
Glioblastoma tumors represent about 15.4 percent of all primary brain tumors & about 60 – 75 percent of all astrocytomas. The incidence of GBM tumors increase in frequency with age of the patient & are found to affect more men than women. Moreover, only about 3 percent of childhood brain tumors are found to be glioblastomas.
Like many other types of tumors, the exact cause of development of glioblastoma tumor is not yet known. Although etiology of GBM tumors is unknown in most cases, suggested causes, however, include the following.
No specific laboratory studies have so far been helpful in diagnosing GBM tumors. Tumor genetics are however useful in predicting response to adjuvant therapy. Imaging studies of the brain are therefore extremely essential for diagnosing including the following.
Other diagnostic methods which can also be considered include the following.
However, in most GBM tumor cases, complete staging is neither possible nor practical. GBM tumors do not have clearly defined margins, therefore they tend to locally invade & spread along the white matter pathways & create an appearance of multiple multicentric gliomas or GBMs on imaging studies.
No present treatments for glioblastomas are curative. Some standard treatments for glioblastoma tumors consist of the following.
Key points regarding radiotherapy for GBM tumors include the following:
Optimal chemotherapeutic regimen for glioblastoma tumors is not defined yet, but adjuvant chemotherapy is found to yield significant survival benefits in more than 25 percent of GBM tumor patients. Agents which are commonly used for chemotherapy include the following.
Since GBM tumors cannot be surgically cured, surgical goals, however, remain as follows.
Stereotactic biopsy in some cases is followed by radiation therapy, especially for patients with GBM tumors located in eloquent areas of the brain, among patients whose tumors have minimal mass effect & in patients with the poor medical condition who cannot bear to undergo general anesthesia for surgery.
Glioblastoma tumors can be difficult to treat mainly because these tumors contain many different types of cells. While some of these cells might respond well to certain therapies; others show no kind of response. This is generally why treatment plans for GBM tumors may often combine several approaches. The first step towards treatment for glioblastoma involves a procedure which is meant to make a diagnosis, relieve pressure on brain & thereafter safely remove as much of tumor as is possible through surgical intervention. However, it is very difficult to completely remove glioblastomas since they contain finger-like tentacles. This fact is particularly true in cases where GBM tumors are growing near parts of the brain which control important functions like language & coordination. Chemotherapy & radiation are commonly used to slow growth of GBM tumors which cannot be removed through surgery. Chemotherapy is also used to delay the need for radiation therapy among young children with glioblastoma tumors. Some newer types of glioblastoma treatments are also available through research studies conducted on GBM patients medically termed as clinical trials.
Prognosis of glioblastoma tumors is generally reported in years of ‘median survival’. This is usually the time at which an equal number of patients do better while an equal number of patients worsen. Median survival for adults with anaplastic astrocytoma is between 2 – 3 years, while for adults with far more aggressive glioblastomas treated with concurrent radiation therapy & temozolomide is about 14.6 months & 2-year survival is about 30 percent. However, some studies have reported that almost 10 percent of the patients suffering from glioblastoma may be able to live 5 years or longer. Children who are down with high-grade tumors like grade III & grade IV, tend to do much better than adults & have reported 5-year survival in about 25 percent of child cases of glioblastoma. Additionally, glioblastoma tumor patients who have shut-off their MGMT gene through a process called methylation also have prolonged rates of survival. MGMT gene is thought to be a significant predictor of response. However, not all glioblastoma tumors are found to have the same kind of biologic abnormalities. This could be a good reason as to why different patients are found to respond differently to similar treatments & also why different GBM patients with similar tumors have different outcomes. Researchers, however, continue to study common characteristics of long-term brain tumor survivors & as to how targeted & personalized glioblastoma treatments may be optimally utilized in order to treat patients with brain tumors.
There are several biomarkers or molecular signatures, which hold a potential to contribute to prediction, diagnosis & prognosis of a response to therapy in dealing with glioblastoma tumors. GBM or Glioblastoma Multiforme is by far the most common & most malignant of glial tumors. Among the estimated 17,000 primary brain tumors which are diagnosed in the United States every year, approximately 60 percent of these are found to be gliomas. Gliomas generally comprise of a heterogeneous group of neoplasms which differ in age & sex distribution, location within the central nervous system, in the potential for growth, the extent of invasiveness, in the tendency for progression, morphological features & in response to treatment procedures.
Glioblastomas are generally composed of a heterogeneous mix of poorly differentiated neoplastic astrocytes which primarily affect adults & which are preferentially located within cerebral hemispheres. However, less commonly GBM tumors can also affect the brainstem, especially among children, & the spinal cord in general. These GBM tumors may also develop from lower-grade astrocytomas (grade II) or anaplastic astrocytomas (grade III), while more frequently they manifest de novo, without providing any evidence of a lesser malignant precursor lesion. Treatment of glioblastomas is usually palliative & generally includes chemotherapy, radiotherapy & surgery.
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