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Glioblastoma multiforme

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There are many types of brain tumors. One type is classified as primary brain tumors, which develop within the brain itself, as differentiated from other tumors which spread and multiply from its origins in other parts of the body.

GLIOBLASTOMA MULTIFORME DEFINITION

Primary brain tumors can either be benign or malignant. The benign kinds, like meningiomas, acoustic neuromas and pituitary gland tumors, are slow growing and are easily removed through brain surgery. The malignant kind, however, grows very fast and spreads quickly within the brain. These type of tumors, like Glioblastomas and anaplastic astrocytomas, are much more difficult to take out during surgery.

GLIOBLASTOMA MULTIFORME DIAGNOSIS

Glioblastoma multiforme, or GBM, is the most prevalent, aggressive and malignant form of primary brain tumors. Glioblastoma multiforme is diagnosed in over 50 - 60 %t of all primary brain tumor patients in the U.S. today. According to the World Health Organization, GBM falls under grade IV astrocytoma, which means it has been classified as an extremely malignant brain tumor that totally invades the brain and sometimes becomes massive in size before the patient actually starts to exhibit any symptoms.

Although there are cases where children between the ages of 3 and 12 are afflicted, Glioblastomas usually occur in adults between the ages of 40 and 70. Glioblastomas commonly develop in the area of the brain called the cerebrum, and particularly within the brain's temporal and frontal lobes. It is differentiated from other forms of fast-growing malignant brain tumors by the presence of dead tumor cells in some areas of the growth.

Glioblastoma multiforme most often affects men. In terms of race, GBM's are more common in Caucasians than in African-Americans, Latinos or Asians. It is a sporadic type of brain cancer that has no direct connection to a person's genes, smoking or diet, nor is it caused by viral infections, electromagnetic fields or cellular phones. At present, the primary cause of GBM's are yet unknown.

There is also secondary Glioblastoma multiforme which occurs in 40% of GBM cases, and afflicts patients younger than 45. This type of Glioblastoma can take from as long as ten years to as little as a year to progress.

GLIOBLASTOMA MULTIFORME SYMPTOMS

The kinds of symptoms exhibited by a GBM patient are dependent on the location of the tumor, the size of the growth, and the rate it is growing. There are times when symptoms appear immediately, but in some cases, symptoms only manifest themselves when the tumor has reached a considerable size.

Symptoms of Glioblastoma multiforme include headaches that differ in intensity, and usually peaks in the early mornings; seizures, nausea and vomiting; hemiparesis, or paralysis on one side of the body; motor weakness and loss of sensation (when the tumor develops in the frontal or parietal lobes of the brain); a feeling of increased pressure within the cranium; cognitive impairment, changes in mood, personality, concentration and mental capacity (usually exhibited in patients with GBM's in the brain's anterior frontal or temporal lobe); loss of vision, and aphasia (loss of ability to understand spoken language and to form words).

In some rare cases, Glioblastoma multiforme develops in the brainstems of adults. This results in progressive headaches, an altered form of consciousness, and weakness in one side of the body coupled with contralateral cranial nerve palsy.
glioblastoma multiforme
Image: Glioblastoma multiforme


In its early stages, Glioblastoma multiforme can be detected through magnetic resonance imaging (MRI) or a computed tomography (CT) scan, although it can also be misdiagnosed as a benign brain lesion at this point. A biopsy is the most reliable way to diagnose high-grade Glioblastomas. At the same time, a craniotomy can be performed to take out as much of the tumor as can be possibly taken out. This is not a guarantee that all of the tumor can be removed, but this procedure can prolong a GBM patient's life expectancy slightly.

Sometimes a positron emission tomography (PET) scan can pinpoint the more advanced cases of Glioblastoma multiforme, particularly when the tumor has been exposed to radiation or has caused hemorrhage.

Patients who have been diagnosed with Glioblastoma multiforme will need to be evaluated by several specialists, including neurologists, neurosurgeons, neuro-oncologists and radiation oncologists to effect a coordinated treatment regimen.

GLIOBLASTOMA MULTIFORME TREATMENT

There are different types for treatment for Glioblastoma multiforme. These treatments are considered pallative, which means that although they afford the patient a measure of relief from symptoms, they do not cure the GBM itself. For one, surgery cannot completely remove all of the invasive tumor cells, and secondly, most Glioblastoma cells may develop a resistance to radiation therapy or chemotherapy in the long run.

The three most common types of treatments for patients with GBM include chemotherapy, radiation therapy and surgery, although there are also alternative and experimental treatments available.

Glioblastoma multiforme tumors can grow very quickly, and treatment is recommended as soon as the disease has been diagnosed, or as soon as possible after surgery, when the surgical wound has had reasonable time to heal. Patients are usually subjected to chemotherapy or radiotherapy approximately a month after surgery.

The goal of surgery is to incise and remove as much of the tumor as possible, with follow up treatments with chemotherapy or radiation therapy to kill the remaining cells. Because these high-grade GBM cells immediately begin to divide, aggressive treatment will keep them from metastasizing (spreading) as much as possible, thereby prolonging a patient's survival rate. Several studies have suggested that patients' survival rate improved by 25% as a result of chemotherapy.

The downside to radiotherapy is that some patients will require additional surgery to remove previously healthy tissue damaged by radiation. The tumor cells immediately start growing again a year after treatment, effectively ending the remission and causing further deterioration in the patient.

To further treat the symptoms of Glioblastomas, the patient's primary physician may prescribe carbamazepine (Tegretol) or phenytoin (Dilantin) to treat accompanying seizures. To prevent edemas (swelling) from forming around the tumor, corticosteroids like dexamethasone, and an anti-ulcer agent like famotidine or ranitidine may be given.

Because the causes of Glioblastoma multiforme are as yet unknown, no method exists to prevent its occurrence.

GLIOBLASTOMA MULTIFORME PROGNOSIS

A study has shown that patients who have undergone surgery (gross total resection) have a 19% 2-year survival rate. Reoperation statistics peg survival rate from between 56 to 88 weeks. And while radiation therapy results in remission and a reduction in tumor size, the survival rate ranges from 27 to 47 weeks.


There have been no improvements in GBM treatments in the last two and a half decades, and even with surgery, chemotherapy and radiation therapy, the survival rate for patients suffering from Gliobastoma multiforme remain low. Patients who receive comprehensive therapy have a 25% survival rate of two years, and 10% even survive for up to 5 years. Survival rates will also depend on the age of the patient, the extent of the tumor, and the rounds of chemotherapy and radiotherapy administered.

At present, much research is being undertaken to explore better forms of therapy, like immunotherapy, biologic therapy, and antiangiogenesis, growth factor and second messenger inhibition, and even gene therapy.

There are also studies looking into molecular markers to predict a tumor's reaction to certain therapies. Other experimental radiation treatments are being studied where focal radiation is targeted directly into tumors via interstitial radiation from an implanted balloon.

In an ongoing study sponsored by the Eurpean Organization for Research and Treatment of Cancer, the experimental Boron neutron capture therapy is being used to isolate and eliminate tumor cells without affecting the surrounding healthy tissue.
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