Glioblastoma Multiforme(GBM) is the term for a brain tumor, that is the most aggressive and most diagnosed of brain tumors. The collective term for these brain tumors is gliomas. GBM is also known as grade 4 astrocytoma, it is diagnosed in fifty-two percent of primary brain tumor patients and approximately twenty percent of all intracranial tumors (between the brain and the cranium). Even though it accounts for such a high percentage of primary brain tumor diagnosis, only two to three cases are diagnosed per 100,000 people in North America and Africa per year.
This cancer has an extremely low survival rate, less than three percent of patients survive past five years of initial diagnosis. This survival rate has not changed for the past thirty years.
Symptoms for Glioblastoma Multiforme depend on where the tumor is located in the brain and the size of the tumor. Common symptoms for this disease are seizure, nausea, vomiting, heading, and partial paralysis. The most specific symptom is progressive decrease in mental functioning, personality/behavior and neurological functioning – especially when the temporal and frontal lobes are involved. Symptoms can be produced quickly by a tumor, or a patient may have no symptoms until the size of the tumor increases to impact the functioning of the brain. Symptoms depend on the location of the tumor.
Glioblastoma Multiforme is first identified with medical imaging, either via CT scan or MRI. Diagnosis should be confirmed by a stereotactic biopsy or a craniotomy. A stereotactic biopsy is neurological surgery that involves the insertion of extremely delicate instruments that are guided to the tumor by using specialized three dimensional scanning techniques. Craniotomy is neurosurgery that cuts open the skull to expose the brain and the tumor for biopsy. It is impossible to remove this type of tumor completely because of its shape and nature, these types of tumors spread out like tendrils. A neurosurgeon can thin out or resection the tumor which may slightly increase the patient’s life.
This disease comes from astrocytes which when function normally are structural and supportive cells within the brain. What causes these cells to grow out of control and become malignant is not known. GBM occurs a little more in men and women, affects Caucasions, Latinos and Asians slightly more than other ethnic groups. Some genetic disorders cause a slight predisposition to glioma. These disorders are Von Hippel-Landau, Li-Fraumeni and Turcot’s syndromes and neurofrbromatosis.
Patients who receive no treatment die within three months of diagnosis. There are two categories of treatment available: palliative and symptomatic. Treatment of primary brain tumors and brain metastases consists of both symptomatic and palliative therapies.
Symptomatic therapy is treatment to provide support to the patient and increase or slightly improve the patient’s neurological functioning. Supportive substances or agents are corticosteroids and anticonvulsants. Corticosteroids are used to reduce peritumoral edema – (blood surrounding the tumor in the brain), lower pressure in the cranium, decrease headache and drowsiness. Twenty-five percent of GBM patients have seizures and receive anticonvulsants.
Palliative therapy is used increase the survival time of patients. The increase is small, the therapy includes radiation, chemotherapy and surgery. Thinning out the tumor via surgery is combined with external beam radiation and chemotherapy. Total cranial irradiation with a boost at the tumor site has been shown to increase survival time by five months.
Regardless of the treatment, almost all gliomas return or regrow in the patient. Relapses may benefit from a re-thinning of the tumor, radio surgery and alternative chemotherapy agents – depending on what was used during the initial round of chemotherapy.
There are not many well known long term survivors of glioblastoma multiforme, the most famous, however is Dr. Ben Williams. He has been cancer free for over ten years. He became highly involved in his own treatment and created a cocktail of drugs to treat the tumor, which eventually disappeared altogether.
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