The Reach and Remedies of Glioblastoma Multiforme (GBM)

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There are numerous variants of malignant or cancerous brain tumors. Usually, a brain tumor is named after the cell type it originates from. The most commonly occurring brain tumors are called gliomas, named after the glial cells, which nourish and safeguard neurons. An astrocytoma is a glioma that builds up from the star-shaped glial cells (astrocytes).

A Glioblastoma Multiforme is categorized as a grade IV astrocytoma and is also called a alioblastoma or GBM.

Coronal MRI with contrast of a Glioblastoma WHO grade IV

 Characteristics

  • Most invasive type of glial tumour
  • Generally spreads to tissues nearby
  • Huge potential for rapid growth
  • Comprises discrete genetic subtypes
  • Could be made up of quite a few dissimilar types of cells (i.e., astrocytes, oligodendrocytes)
  • Might have developed from an astrocytoma or an oligodendroglioma at its initial stage
  • Generally occurs among people in their fifties to seventies
  • The average age of diagnosis is 64
  • More frequent in men as compared to women
  • Rare in children, constituting about 3% of pediatric brain tumours
  • 17 % of major brain tumours are of this type

The Occurrence of GBM

GBMs usually initiate in the cerebral hemispheres of the brain, however they can also arise in the brainstem — the posterior part of the brain connecting with the spinal cord structurally, the cerebellum, which plays a significant role in motor control or the spinal cord.

 

 The Human Brain

 

 The Human Brain with the Cerebellum in Purple

 Symptoms

GBMs may surface as frequent intense headaches due to the rise in intracranial (inside the skull) pressure, recurring memory loss, convulsions, personality disorder and difficulty in synchronization. GBM is hardly ever known to spread to different parts of the body.

The Causes

Currently the exact causes of the occurrence of a GBM are unknown. Extensive research has shown exposure to radiation, continuous contact with electromagnetic fields, extensive use of cell phones, hazardous chemicals and heredity as possible factors.

Identification

A brain tumor is primarily identified with the aid of MRI (Magnetic Resonance Imaging) and a CT (Computerized Tomography) Scan. As well, a sample of the brain tissue is tested for the possibility of GBM. The GBM has a distinct form, so it is easy for an oncologist to identify it in an MRI; however, a biopsy and a subsequent pathological report is a must for confirmation.

If the doctor feels that the tumor is operable, a biopsy is carried out at the same time as the surgery. For inaccessible tumors, a stereotactic or needle biopsy is used as an alternative.

 Glioblastoma Multiforme

 The Recent Research

Latest research has revealed that there are various subtypes of GBM based on the intensity of their aggression. Studies are being undertaken to devise effective personalized treatment of GBM for each sub-type.

Treatment

The treatment of a brain tumor depends on the form, extent and position of the tumor. Typically, a surgical treatment is carried out, and the patient is subsequently treated with radiation therapy or its combination with chemotherapy. Removal of the tumor by surgery cannot cure the patient completely because by the time a tumor is detected, the malignant cells may have rapidly spread to other parts of the brain and started to multiply.

If the doctor deems it appropriate, surgery may not be considered as an option. Instead, administration of radiation therapy in conjunction with or followed by chemotherapy is carried out. These methods are executed to destroy the cells that may have spread to other tissues in the brain.

Many clinical experiments using radiation, chemotherapy, or the right mix of both are carried out for preliminary and recurrent GBM.

Medical trials employing molecularly targeted remedies, successful in the treatment of other forms of cancer, are also being tried on GBM patients.

A standard procedure to treat GBM includes administration of radiation therapy five days a week for six weeks, along with oral chemotherapy with a drug named Temozolomide for five days a month. Dosage and frequency of these therapies are at the discretion of the oncologist.

Along with this treatment, patients’ blood counts are periodically scrutinized and MRIs are executed periodically to observe the tumor’s reaction to treatment.

The process of treatment is aimed at curbing further spread of the tumor and alleviating symptoms with a minimum of side effects.

Facts about Surgery

There are various factors which determine whether a tumor is operable or not. The position of the tumor, its propinquity to critical organs, the extent of its spread and its connection to blood supply within the brain are the major determining factors.

Advanced technologies employed in operating procedures enable neurosurgeons to perform surgery on the smallest patch of tissue with the greatest precision. Sophisticated surgical microscopes, interactive MRIs and brain mapping techniques are employed to perform surgery with maximum accuracy.

Though the idea of a brain surgery is quite frightening, talking out one’s anxiety and discussing doubts openly with the doctor can provide relief, and contacting other brain tumor survivors can also be of great help.

 

 GBM Post Successful Surgery

 Facts about Radiation Therapy

A suitable course of radiation therapy is planned by a radiation oncologist and a neurosurgeon. The aim is to destroy the cancerous cells without damaging the normal brain cells.

The current radiation therapy technologies being used are 2D coplanar treatment, 3D conformal treatment, intensity modulated therapy and stereotactic radiosurgery.

 

 Radiation Therapy

        

Facts about Chemotherapy

Under Chemotherapy, a neuro-oncologist prescribes drugs orally or as venous injections to destroy the maximum number of remaining tumor cells. Chemotherapy can also be directed at the tumor site during surgery in the form of biodegradable polymer wafers.

 GBM after treatment

Possible Side-Effects

Though chemotherapy and radiation therapy are aimed at destroying malignant cells, they can end up wiping out healthy cells as well.

These treatments may cause increased fatigue, hair loss and dryness of scalp, nausea and a certain extent of  immunity loss.

Currently, many drugs are available on the market to assuage the possible side-effects of the heavy drugs used in the treatment of GBM.

A patient can conduct an open discussion about treatment and drug administration, its possible side-effects, potential benefits and future course of life with the treatment team. This will provide the patient with insight on the treatment and will relieve anxiety and stress.

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