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Q&A: Understanding glioblastoma

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degroot213.jpgBy John de Groot, M.D. 


Ever heard of gliomas? These primary brain tumors arise within the brain, but we don't know the cell of origin.

There are multiple grades of gliomas -- grade II, III and IV, with grade IV being the most malignant. 

Grade IV tumors are called glioblastoma. They are the most aggressive and are very infiltrative - they spread into other parts of the brain quickly. Glioblastomas don't metastasize outside of the brain.  

Glioblastomas can occur in any lobe of the brain and even the brain stem and cerebellum, but more commonly occur in the frontal and temporal lobes. Below, I've answered some common questions I get about glioblastoma.

1. Are there any known causes or risks factors for glioblastoma? 
Glioblastoma are more common in males, persons older than 50, and people of Caucasian or Asian ethnicity.  There are a few very rare familial syndromes that are associated with brain tumors. One of the only known risk factors that we have for brain tumors is radiation exposure. 

2. What are common symptoms of glioblastoma? 
The symptoms for any brain tumor are related to the locations from where the brain tumor originates and the rate of tumor growth. Symptoms can vary widely. Some are silent and only found incidentally when a brain scan is done for another reason.  

The most common symptoms include headaches, nausea, vomiting and seizures. Tumors frequently cause subtle personality changes and memory loss or, again, depending on location, muscle weakness and disturbances in speech and language.  

3. How is a glioblastoma diagnosed? 
Most patients with glioblastoma undergo a CT scan, followed by MRI. The actual pathological diagnosis has to be made at the time of surgery (tissue is removed and examined by a neuropathologist). 

4. What are the treatment options for a glioblastoma? And why, typically, is it hard to treat? 
The standard treatment for glioblastomas is maximal safe resection (surgery), followed by concurrent radiation and an oral chemotherapy called temolozomide over a 6-week period. Upon completion of radiation, 6-12 cycles of adjuvant temolozomide are given to the patient five days in a row every four weeks. 

Glioblastomas are not surgically curable, but there is good evidence that the more tumor that can be removed, the better the prognosis. The radiation and chemotherapy are designed to target the infiltrative component of the glioblastoma and delay tumor progression. 

5. What clinical trials are available for glioblastoma? 
We have multiple clinical trials for glioblastoma, depending on the disease's stage. We have clinical trials for newly diagnosed patients before they have radiation, as well as newly diagnosed patients after they finish chemotherapy and radiation.  

Most of our clinical trials are for patients with recurrent tumor, after failing temolozomide.  Unfortunately, the recurrence rate for glioblastomas is near 100%, with an average time to recurrence of six to seven months. 

6. What glioblastoma research is being done at MD Anderson? 
The Department of Neuro-Oncology and the MD Anderson Brain Tumor Center are looking at new drugs that haven't made it into the clinic yet and drugs that doctors are prescribing, but for other diseases. We're trying to determine whether they'd be effective for glioblastoma. 

We're very interested in identifying subgroups of patients that might benefit from a specific drug. I'm very interested in targeting angiogenesis (the process of blood vessel formation), which plays a critical role in the ability for brain tumors to grow quickly. 

7. What advice would you give someone who has just been diagnosed with a glioblastoma?
One of the most important things that you can do is to seek care or even a second opinion by people that spend all of their time treating this disease. Glioblastoma is a very complicated disease. There are a lot of nuances to both the diagnosis and the treatment, and you want an expert to help you work through the treatment process. 

Also look for a physician who will give you the undivided time and attention you deserve. Your doctor shouldn't be rushing through your visit. I talk to patients about their diagnosis, explain to them all the aspects of the treatment as well as the impact of the tumor on their quality of life. I also spend as much time answering questions as the patient requires. 

13 Comments

Dr de Groot thank you for helping my father in law Philip Larry Parish from KY. He fought 34 months. You are a wonderful doctor and we still keep in touch with Carolyn Lock. I was so surprised to see your article on my facebook this morning. Thanks for all you do in the world of brain cancer. The Parish family from KY

My wife has just past one year after having a Glioblastoma partially resected, (90%), RadioChemo and Chemo Maint (temador)). she was doing real well regaining use of right arm and right leg and most speech , however - she fell and fractured her right femur (at the hip). she has made very little progress with walking, talking and using the right arm after that (about 6 months). Is there anything we can do ?

We're so sorry to hear this. It sounds like your wife has been through so much. Please call 1-877-632-6789 or visit this webpage: http://bit.ly/XkBA1A. They'll be able to answer your questions.

This is Darshika Panchal and currently residing in united states.My Father got operated for GBM grade 4 in may 2013 in India.He is 60 years old.

After radiation and he is on tablet chemotherapy ( temozolomide)but still he developed a tumor.We want to take an opinion on second surgeory.

Please reply as soon as possible.

I'm so sorry to hear about your father. To make an appointment or ask any questions, please call our International Center, 001-713-745-0450. Please let me know if you have any other questions.

Hi this is mayur residing in india (Gujarat).recently my father in law has been diagnosed IV 'GBM in FTP lesion. Neuro surgeon has advice to recect tumor and further managemebt by radiotherapy and chemotherapy. They have adviced for CT PET. Is it really needed. ? Tomorrow we are going to scan for PET. Also please advice for further precautions and care. Please reply ASAP.

We're so sorry to hear about your dad. Unfortunately, we can't answer medical questions via the Internet. It's best to talk to a doctor about this.

My wife had emergency resection on a stage 4 glioblastoma on January 17, 2014. She is a few days from finishing her radiation and every day temolozomide pill (March 18). We might be interested in a clinical trial if she qualified.

Good afternoon Dr. De Groot, My brother is 60 yrs. of age and was diagnosed on 2/5/2014 through biopsy & MRI with stage IV GBM in the left frontal lobe and I believe 4 cm in size. the MRI showed the significance of size due to the movement of the brain pushing over to the right side of his head. I could visibly see this when I saw him the last weekend for the first time after 13 radiation treatments and oral chemo maint. w/ temodor. He was told his tumor is inoperable and received steroids immediately but has since been tapered off due to side effects and his desire for quality of life. he takes Avasitin (sp???) through IV admin. My brother explained to me that he is looking for an 85% reduction of the tumor - he has 30 treatments of radiation in total and has about 12 to go. He will not continue treatment unless that goal is reached due to his desire for quality of life. I completely understand but want to understand what the likelihood of that goal is. Also, are head trauma injuries associated with this kind of cancer? Thank you for any guidance you can provide.

Good afternoon...My father (70 yeras old), heart patient, ex-smoker with lungs infection has been giasnosed with Grade IV gliobastoma. His biopsy was done on 15 May 2014 at Karcahi Pakistan. He is on 24hrs oxygen due to lungs infection and low oxygen saturation level. Hid Co2 was 48% as diagnosed in AVG. Dr do plan to have radiation and chemo for him, but they are waiting to get him settled from this lungs infection. What is the normal survival rate with this disease at the age of 70yr.

Hi Fati, we're so sorry to hear about your father. He's in our thoughts and prayers. Every case is different, so it's best to speak with a doctor. Here's some information about our International Center, in case you would like to speak with a health information specialist: http://bit.ly/1hJbyjc.

I am a 67 year old female in excellent health. My maternal grandmother and great aunt died of glioblastoma in 1963 and 1964. (This was not the term assigned to the tumor at that time but symptoms were the same.) Since then, my 42 year old brother succumbed to glioblastoma in 1987 and my mother in 2004. Presently, my 44 year old niece has been diagnosed ... hers is considered inoperable by three different medical opinions. Are you conducting any type of genetic study? If so, would it be possible to participate in the study remotely (Tallahassee, FL)?

Hi Linda, please call 1-877-632-6789 to speak with an MD Anderson health information specialist. They can answer your questions. You're in our thoughts and prayers.

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