What is glioblastoma multiforme?
Glioblastoma multiforme (GBM) is the most common and aggressive brain tumor in adults. GBMs are a type of astrocytoma. They develop from cells called astrocytes. Normally, these cells form the blood brain barrier. The barrier determines which substances can get into the brain and which can’t. Astrocytes also help support nerve cells and deliver nutrients to them.
Brain tumors are graded based on their aggressiveness. Grade I brain tumors are the least aggressive, and grade IV are the most aggressive. GBMs are grade IV astrocytomas. They grow quickly and often spread into nearby brain tissue.
Treatment for GBM is aggressive. It usually involves surgery, radiation, and chemotherapy. GBMs tend to occur between ages 45 and 70, but it can happen at other ages.
What causes glioblastoma multiforme?
Experts are still trying to understand what causes GBM. Astrocytes are usually very controlled and organized cells. Something happens that allows them to start multiplying and forming disorganized sheets of cells. Although it is not clear what causes this, research has shown a number of changes, or mutations, in genes within the tumor cells. Some of these mutations affect the ability of the cells to regulate themselves.
Most GBMs start as glioblastomas. On occasion, a lower-grade tumor will transform into a GBM.
What are the symptoms of glioblastoma multiforme?
Your brain controls your thoughts, emotions, and actions. It also interprets information from your senses. Different areas control different functions. Some of the symptoms of GBM have to do with the specific location of the tumor. If it grows in an area that controls your arm movements, your arm may become weak. If it grows in an area that controls your speech, you may have difficulty forming words.
As the tumor continues to grow, it starts to take up space. This increases the pressure within the skull. Some of the symptoms of GBM are caused by the increased pressure in the brain.
Many GBM symptoms develop gradually and worsen over time. These may include:
- Learning difficulties
- Loss of appetite
- Mood swings
- Nausea or vomiting
- Personality changes
- Problems speaking
- Problems with memory
- Sensation changes
- Trouble concentrating
- Vision changes
How is glioblastoma multiforme diagnosed?
Your doctor will likely begin with a medical history, asking you about your recent symptoms and your past medical conditions. Next, your doctor will do an exam, checking your vision and hearing, sensations of touch, strength, and reflexes. Your doctor may also ask questions to assess your memory and learning ability. He or she may have you walk around to take a look at your gait, coordination, and balance.
If your doctor thinks you might have a brain tumor, you will need more tests. These tests can help tell the difference between tumors from infections, abscesses, strokes, and other potential causes of your symptoms. They might include:
- MRI. This test can help find tumors, areas of swelling, blood, and areas affected by stroke.
- CT scan. This test can help find areas of fresh bleeding, skull abnormalities, and calcium deposits.
- Magnetic resonance spectroscopy (MRS). This test can help evaluate chemical processes occurring in different parts of the brain.
- Needle biopsy. This test uses CT scan or MRI to get a sample of the tissue to look at under the microscope.
- Blood or other tests.
Your doctor will probably refer you to a specialist to help make the diagnosis. This can include a neurologist or neurosurgeon. There may be other specialists that help plan your treatment, such as oncologists or neuro-oncologists.
How is glioblastoma multiforme treated?
Treatment of GBM usually involves doctors from multiple specialties. It also includes other medical personnel, such as social workers, nurses, and occupational or physical therapists. They all work together to figure out the best way to treat and manage your GBM.
Your treatment will depend on your age, your general state of health, your treatment preferences, and the size and location of your tumor. Another important factor is whether the tumor has spread from its original location to other parts of your body. Some people choose to receive only palliative care. This involves therapies to maintain comfort and the best quality of life possible without active treatment of the cancer.
Many people, especially those who are younger and without disability, choose active cancer treatment. This typically starts with surgery to remove as much of the tumor as possible while maintaining as much brain function as possible. Your surgeon may use MRI during the surgery to help guide what areas to take out. The tumor then goes to a pathologist, who can confirm whether it is GBM or let your doctors know if it is something else.
Taking out even part of the tumor can help relieve pressure in the brain. Some people have surgery even if there is a significant portion of the tumor that they can’t have removed.
An MRI after surgery can help find any remaining tumor or swelling. In some cases, a magnetic resonance spectroscopy (MRS) may also be used. This technique does not replace an MRI, but it can provide additional information on the chemical nature of the tumor.
Even with the best surgical techniques, some tumor cells remain, requiring additional treatment. During surgery, your surgeon may place wafers where the tumor was. The wafer slowly releases a chemotherapy drug right where your brain needs it. Having these wafers can affect your ability to participate in clinical trials later.
Depending on your age and state of health, you may undergo additional treatments. They may include:
- Medicines to reduce swelling in the brain, such as steroids
- Medicines to stop seizures, if needed
- Palliative care
- Participation in a clinical trial, which may offer you more treatment options
- Radiation therapy
You will need regular follow-up to see how you are responding to treatment and to watch for signs of recurrence of the GBM. This will include regular exams and MRIs. Your doctor may send you for a PET scan if he or she suspects recurrence. PET scans can help distinguish between recurrences and changes in the brain related to treatment.
If your GBM returns, you will have the option of additional treatment, which may include:
- Additional surgery, which may include placement of wafers
- Alternating electrical field therapy (the use of low-energy electrical fields to treat the cancer)
- Palliative care
- Participation in a clinical trial
- Repeat radiation therapy
A number of clinical trials are taking place to investigate some promising treatment options. Some people decide to participate in clinical trials because they may receive the newest treatments available and they may help people who have the same problem in the future. Current areas of research in GBM treatment include:
- Cancer vaccines
- Gene therapy
- Highly focused radiation therapy
- Medicines to prevent blood vessel growth in tumors
- Other types of chemotherapy
- Targeted therapy
What are the complications of glioblastoma multiforme?
If untreated, GBM can continue to grow and spread through the brain. This can lead to ongoing functional loss and increasing intracranial pressure. Seizures, personality changes, and unstable moods are common.
Complications can also occur after treatment. These may include:
- Side effects of steroid treatment to ease brain swelling, such as insomnia, increased risk of infection, weight gain, and mood swings
- Treatment side effects, such as increased risk of infection or bleeding due to chemotherapy and changes in brain function from the surgery and radiation
GBM is an aggressive cancer that tends to recur. Survival is usually less than a year, even with treatment.
Coping with glioblastoma multiforme
You will be seeing doctors and other medical personnel from a variety of specialties. Ask them any questions you may have. If you are experiencing side effects, having difficulties making your appointments, or facing challenges in your personal life, make sure they know about them. Also, recognize that depression is a common problem. Get a referral to a psychologist or psychiatrist if you need one. They can help you cope with what is going on. Family members may also suffer from depression and need referrals for mental health services.
- GBM is the most common brain tumor in adults.
- It is an aggressive cancer.
- You will see many medical specialists for treatment. Be sure to ask them questions and, if you are facing challenges in your personal life, make sure they know about them.
- Treatment often involves surgery, radiation, and chemotherapy.
- Depression is common with this diagnosis. Don’t hesitate to ask for a referral to a psychiatrist or mental health counselor for yourself and family members.
- It is important to continue follow-up after you receive treatment.
Tips to help you get the most from a visit to your healthcare provider:
- Know the reason for your visit and what you want to happen.
- Before your visit, write down questions you want answered.
- Bring someone with you to help you ask questions and remember what your healthcare provider tells you.
- At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
- Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
- Ask if your condition can be treated in other ways.
- Know why a test or procedure is recommended and what the results could mean.
- Know what to expect if you do not take the medicine or have the test or procedure.
- If you have a follow-up appointment, write down the date, time, and purpose for that visit.
- Know how you can contact your healthcare provider if you have questions.
March 22, 2017
Brain and Spinal Cord Tumors. National Institute of Neurological Disorders and Stroke (NINDS), Clinical manifestations and initial surgical approach to patients with high-grade gliomas. UpToDate.
Fraser, Marianne, MSN, RN,Shelat, Amit, MD