What is Glioblastoma multiforme cancer?

Glioblastoma multiforme (GBM) is an aggressive (malignant) type of tumor that affects the brain or spinal cord. It is also known as Glioblastoma. Glioblastomas can occur at any age, but they most commonly occur in adults, especially males. Picture Courtesy: medindia   Picture Courtesy: Mayoclinic  

What does grade 4 GBM mean?

(GBM) Glioblastoma multiforme is one of the groups of tumors called astrocytomas. Glioblastoma is sometimes called grade 4 Glioblastoma tumors. With reference to their attributes, tumors are graded on a scale of 1 to 4 based on their differences from the normal cells in the body. The grade shows how fast the tumor is likely to grow and spread. The most aggressive and fastest-growing type of tumor is the Glioblastoma multiforme. It is a grade 4 or stage 4 tumor. They can quickly spread throughout the brain. GBM originates from glial cells (astrocytes and oligodendrocytes) which are shaped like stars.  

What are the most common types of GBM?

There are two types of Glioblastoma multiforme. Picture Courtesy: medrxiv

• • • Primary (De Novo)

They start from the brain. This is the most common type and the most aggressive.

• • • Secondary Glioblastoma (Metastatic)

It is less common and slower growing. It is a type of cancer that starts in another part of the body and spreads to the brain. Such cancers include lung cancer, breast cancer, kidney cancer, colon cancer, melanoma, and leukemia.  

What are the most common risk factors for GBM?

Individuals who have undergone radiation therapy during treatment for previous brain cancers, leukemia, and fungal infections of the scalp have a high risk of developing Glioblastoma. Adults are more at risk, especially those 50 years and above. Other high-risk groups are those with chromosomal abnormalities on chromosome 10 or 17. Genetic disorders such as neurofibromatosis, Turcot syndrome, Li Fraumeni syndrome, and patients with a history of radiation therapy have chances of having GBM. Patients getting exposed to certain chemicals and other cancer-causing agents may increase the risk of genetic mutations. The incidence is more common in white people than among Black, Asians, and Indigenous groups.  

What are the most common complications associated with GBM?

Glioblastoma is an aggressive and fast-growing brain tumor that resists almost every treatment approach with possible fatal complications if left untreated. Given a short time, GBM grows rapidly and spread through the brain. This can cause functional loss and increase intracranial pressure. Seizures, personality and mood change, thinking and learning inabilities, and gradual loss of speaking ability are common. Treatment may also lead to complications. These may include:

• • • Depression
    • Recurrence; the tumor can come back after treatment.
    • A side effect of chemotherapy, such as an increased risk of bleeding or infection
    • Radiation can cause dysfunctional brain changes.
    • Side effects of steroid treatment include trouble while sleeping, increased risk of infection, weight gain, and mood swings.

SPECIALISTS: Oncologist, neurologist, a neurosurgeon.

How to diagnose GBM?

Diagnosis of GBM may follow a few or all of these procedures:

• • • The doctor records the complete medical history of the patient, its associated signs and symptoms, etc.
    • The doctor records the personal and family history of the patient.
    • Physical examination

Exams will be done to check the patient’s vision and hearing, sensations of touch, strength, and reflexes.

• • • Questions to assess the patient’s memory and learning ability.
    • The patient may be asked to walk or do other activities to test their gait, balance, and coordination.

Other tests may include:

• • • Molecular Magnetic Resonance Imaging (MMRI)

This is used to locate tumors, especially swollen areas or areas of blood build-up and stroke-affected areas.

• • • CT Scan

A CT scan is utilized in finding areas of fresh bleeding, areas in the skull with abnormalities and calcium deposits.

• • • Magnetic Resonance Spectroscopy (MRS)

This evaluates different parts of the brain for chemical processes.

• • • Needle Biopsy

Use a needle, guided by a CT scan or MRI, into the tumor to take out a small piece of it for testing.

• • • Blood Tests

To know how well other organs are working and get an idea of the patient’s overall health.

• • • Positron Emission Tomography (PET Scan)
    • Tumor Biomarkers

To detect tumor recurrence.  

How to treat Glioblastoma multiforme?

Picture Courtesy: sciencedirect GBM treatment usually involves a combination of many healthcare providers from lots of specialties. It also includes other medical personnel, like social workers, nurses, occupational or physical therapists, and dieticians. This team helps figure out the best way to treat and manage the patient’s Glioblastoma multiforme. Treatment for Glioblastoma usually involves:

• • • Surgery

Much of the tumors can be surgically removed. MRI is used as a guide by the surgeon during the surgical operation. The surgeon may put chemotherapy wafers during surgery to release the chemo medicine right where the brain needs it. Picture Courtesy: Mayoclinic

• • • Radiation

To kill any cancer cells that were left behind after surgery. Picture Courtesy: Mayoclinic

• • • Chemotherapy with the drug temozolomide (Temodar)

Picture Courtesy: Medindia Other medications to treat GBM include:

• • • Bevacizumab (Avastin)
    • Polifeprosan 20 with carmustine implant (Gliadel)
    • Lomustine (Ceenu)

What are the new treatment options to cure GBM?

Modern Treatment for Glioblastoma Multiforme (yet to be approved)   New treatments are being tested in clinical trials. If approved, these treatments will pave a way for a major breakthrough in GBM treatment. The treatments will enhance the outlook of people living with Glioblastoma. These new clinical trials include:

• • • Immunotherapy

This technique uses the patient’s body’s immune system to kill cancer cells.

• • • Gene Therapy

Fixing defective genes to treat cancer.

• • • Vaccine Therapy

The patient’s body’s immune system is strengthened to fight off cancer.

• • • Stem Cell Therapy

This involves stem cells (early cells) to treat cancer. These stem cells can replace or repair cells that are damaged, and they can also rejuvenate cells.

• • • Personalized Medicine

It is also called targeted therapy.

• • • Innovations in drug delivery technology for the treatment of Glioblastoma Multiforme

Picture Courtesy: sciencedirect

Dieting and GBM

Results published recently in the journal – Clinical Cancer Research, some researchers have found that a high-fat, low carbohydrate diet that includes a coconut oil derivative helped reduce the growth of Glioblastoma tumors by 50%. These findings have created hope and caused a new twist on the old idea. For nearly 90 years, the so-called Ketogenic Diet has been used to reduce epileptic seizures. This research points to diet intervention for patients with Glioblastoma Multiforme. It is hoped that these results will be promising enough that the next step to test in humans will yield great positivity.  

What is the prognosis rate of GBS?

Glioblastoma Multiforme Prognosis The most invasive and aggressive of all existing brain tumors is the glioblastoma multiforme. While many people see it as a death sentence for any unfortunate individual with Glioblastoma, some medical researchers strongly believe there is hope for this deadly disease. Glioblastoma patients who have had surgery, chemotherapy, and radiation treatment are likely to survive for 15 to 16 months. This is to say that half of all patients with this tumor survive this length of time. Everyone with Glioblastoma multiforme differs in morphological, etiological, and disease resistance. Some people don’t survive this long, while some may exceed this benchmark. About 2% of patients survive for 3 years.

Symptoms

What are the signs and symptoms of GBM?

Glioblastoma multiforme symptoms can vary depending on where they are located but may include the following:

• • • Persistent headaches
    • Blurred or double vision
    • Vomiting
    • Mood or personality changes
    • Loss of appetite
    • Changes in ability to think or learn
    • Speech difficulty of gradual onset
    • Nausea
    • Drowsiness
    • Seizures

Causes

What are the causes of GBM?

There are typically two types of GBM: the primary and the metastatic.

The primary start in the brain (de novo), and the cause of these tumors is unknown. However, many risk factors can play a role:

• • • Radiation Therapy

This is used to treat brain cancers and increases the risk of brain tumors later in life.

• • • Inherited Conditions

Some inherited conditions increase the risk of brain tumors, such as neurofibromatosis, Turcot syndrome, Von Hippel-Lindau syndrome, and Li-Fraumeni syndrome.

• • • Infection

People with a weakened immune system are prone to infection, like the Epstein-Barr virus responsible for lymphomas.

Metastatic brain tumors migrate from another part of the body to the brain. Such tumors that commonly spread to the brain include the lung, breast, kidney, and colon cancers, melanoma, and leukemia. Some tumors tend to extend to the brain from undetermined locations.

FAQ

• Is Glioblastoma multiforme the worst cancer?

The most common form of malignant brain cancer, called Glioblastoma. Glioblastoma, is considered the deadliest human cancer. Glioblastoma is a grade iv brain tumor that has defied all medical treatments, holding individuals with GBM to threat and hopelessness.

 

• Is Glioblastoma multiforme always fatal?

GBM can be difficult to treat and has a high recurrence rate. There appears to be no cure for it. The treatment may slow down the progression and reduce symptoms. Glioblastoma is often incurable and fatal.

 

• Is there pain with Glioblastoma multiforme?

Symptoms of Glioblastoma include persistent headaches, pains, vomiting, nausea, seizures, mood and personality changes, weakness, and loss of appetite.

 

• What happens as Glioblastoma multiforme progresses?

Glioblastoma is a fast-growing brain cancer. It develops into an infiltrative tumor that spreads from the primary site. This resembles threads in a spider’s web. If left untreated, GBM can be fatal within a few months.

 

• Glioblastoma multiforme, who is most affected?

The risk groups are males, those who have undergone radiation treatment for previous cancer, and people aged 50 years and above. People with chromosome abnormalities of chromosomes 10 and 17 are another risky group.

 

• Is Glioblastoma multiforme hereditary and genetic?

Glioblastoma tumors are considered to be highly aggressive and fast-growing tumors. However, in most cases, GBM occurs sporadically in people who have no family history of brain tumors. Scientific evidence suggests that GBM is not hereditary in a majority of the cases. At the same time, the risk of GBM appears to be high in patients who are diagnosed with certain genetic cancer syndrome. Hence, GBM tends to have more genetic abnormalities than the cells of other types of brain cancers.

 

• What is the recurrent rate of GBM?

Patients diagnosed with GBM have a high recurrent rate, despite early treatment and care.

 

• What is the most common location of GBM?

GBM is most commonly located in the Supratentorial (frontal lobe, parietal lobe, temporal lobe, and occipital lobe), with the highest incidence in the frontal lobe, followed by the temporal and parietal lobes of the brain.

 

• What is the prognosis of GBM without treatment?

There is no permanent cure for GBM disease. However, the current treatment plans help patients prolong their quality of life. Without the treatment, the patient might die within 3 months.