There are multiple grades of gliomas -- grade II, III and IV, with grade IV being the most malignant.
Grade IV tumors are called glioblastoma. They are the most aggressive and are very infiltrative - they spread into other parts of the brain quickly. Glioblastomas don't metastasize outside of the brain.
Glioblastomas can occur in any lobe of the brain and even the brain stem and cerebellum, but more commonly occur in the frontal and temporal lobes. Below, I've answered some common questions I get about glioblastoma.
Glioblastoma are more common in males, persons older than 50, and people of Caucasian or Asian ethnicity. There are a few very rare familial syndromes that are associated with brain tumors. One of the only known risk factors that we have for brain tumors is radiation exposure.
2. What are common symptoms of glioblastoma?
The symptoms for any brain tumor
are related to the locations from where the brain tumor originates and the rate of tumor growth. Symptoms can vary widely. Some are silent and only found incidentally when a brain scan is done for another reason.
The most common symptoms include headaches, nausea, vomiting and seizures. Tumors frequently cause subtle personality changes and memory loss or, again, depending on location, muscle weakness and disturbances in speech and language.
3. How is a glioblastoma diagnosed?
Most patients with glioblastoma undergo a CT scan, followed by MRI. The actual pathological diagnosis has to be made at the time of surgery (tissue is removed and examined by a neuropathologist).
4. What are the treatment options for a glioblastoma? And why, typically, is it hard to treat?
The standard treatment for glioblastomas
is maximal safe resection (surgery), followed by concurrent radiation and an oral chemotherapy
called temolozomide over a 6-week period. Upon completion of radiation
, 6-12 cycles of adjuvant temolozomide are given to the patient five days in a row every four weeks.
Glioblastomas are not surgically curable, but there is good evidence that the more tumor that can be removed, the better the prognosis. The radiation and chemotherapy are designed to target the infiltrative component of the glioblastoma and delay tumor progression.
5. What clinical trials are available for glioblastoma?
We have multiple clinical trials
for glioblastoma, depending on the disease's stage. We have clinical trials for newly diagnosed patients before they have radiation, as well as newly diagnosed patients after they finish chemotherapy and radiation.
Most of our clinical trials are for patients with recurrent tumor, after failing temolozomide. Unfortunately, the recurrence rate for glioblastomas is near 100%, with an average time to recurrence of six to seven months.
6. What glioblastoma research is being done at MD Anderson?
The Department of Neuro-Oncology
and the MD Anderson Brain Tumor Center
are looking at new drugs that haven't made it into the clinic yet and drugs that doctors are prescribing, but for other diseases. We're trying to determine whether they'd be effective for glioblastoma.
We're very interested in identifying subgroups of patients that might benefit from a specific drug. I'm very interested in targeting angiogenesis (the process of blood vessel formation), which plays a critical role in the ability for brain tumors to grow quickly.
7. What advice would you give someone who has just been diagnosed with a glioblastoma?
One of the most important things that you can do is to seek care or even a second opinion by people that spend all of their time treating this disease. Glioblastoma is a very complicated disease. There are a lot of nuances to both the diagnosis and the treatment, and you want an expert to help you work through the treatment process.
Also look for a physician who will give you the undivided time and attention you deserve. Your doctor shouldn't be rushing through your visit. I talk to patients about their diagnosis, explain to them all the aspects of the treatment as well as the impact of the tumor on their quality of life. I also spend as much time answering questions as the patient requires.