Glioblastoma is an aggressive type of cancer that can occur in the brain or spinal cord.
What is glioblastoma?
Glioblastoma is a malignant tumor that arises from glial cells, which are the supportive cells of the brain. It's the most common and aggressive type of primary brain tumor in adults. Glioblastomas are characterized by rapid growth and the ability to invade surrounding brain tissue, making them challenging to treat.
The National Brain Tumor Society states glioblastomas account for 14.2% of all brain tumors and 50.1% of all malignant brain tumors. A glioblastoma diagnosis can be an emotionally challenging diagnosis. Treatment for glioblastoma is complex and typically involves a multidisciplinary approach, combining several therapies to manage the aggressive nature of the tumor. The primary goals are to remove as much of the tumor as safely possible, slow its growth, alleviate symptoms, and improve quality of life.
AHN Neuro-Oncology Center of Excellence
Our experts in the AHN Neuro-Oncology Center of Excellence offer some of the newest, most innovative care for patients with benign and malignant brain tumors. We use the latest tools and procedures to make the diagnosis process as minimally invasive as possible. You can get numerous tests done on the same day and in one location, to reduce your wait and travel time. We know this is a difficult and stressful time. Our understanding staff is by your side, guiding you and answering your questions. We also offer robust support services to treat the whole person.
Why choose AHN for your brain cancer treatment?
Our highly experienced team of neuro-oncologists (brain cancer specialists) and neurosurgeons (brain surgeons) performs treatments that are only available at the very best hospitals in the country. By choosing AHN for your care, you will find:
- Improved survival rates: We use aggressive treatments while making sure you are feeling as well as you can. Helping you live a longer, more comfortable life is our priority.
- Advanced technology: Sophisticated tools, such as ChemoID®* and genome analysis, allow us to understand how the tumor will respond to different treatments before we prescribe them. You will not waste time on treatments that will not be effective for you.
- Minimally invasive treatments: Many of our treatment options are outpatient procedures that involve a short recovery time. Instead of spending all of your time in a hospital, you can live your life and enjoy your family and friends.
- A collaborative approach: We discuss all of our patients in a weekly meeting with our brain cancer experts. You benefit from the combined experience of a team that includes neuro-oncologists, radiation oncologists, neurosurgeons, medical oncologists, and neuroradiologists. Because we are always up to date on your progress, we are able to give you the best possible care.
- Robust support: We invite all patients with brain cancer to join our weekly support group to share feelings, discuss symptoms, and help one another cope. It may help you feel better during treatment and experience an improved state of mind.
- A convenient, after-hours cancer clinic: If you experience side effects from treatment, call your physician’s office first, then visit our After Hours Oncology Clinic, conveniently located at West Penn Hospital. We treat you quickly, without exposing your compromised immune system to the germs you may encounter at a traditional emergency room. Plus, our clinic is more affordable than a visit to the ER. And since our oncology specialists have access to your records, they may even be able to advise you over the phone and save you from making a trip.
- Clinical trials: If you meet the eligibility requirements, you may be able to participate in an experimental clinical trial. You could gain access to a ground-breaking treatment before it is widely available. Learn more about our clinical trial program.
Glioblastoma symptoms and signs
Glioblastomas, like other brain tumors, produce symptoms primarily by putting pressure on parts of the brain, irritating brain tissue, or blocking the flow of cerebrospinal fluid. The specific symptoms can vary greatly depending on the size, location, and rate of growth of the tumor. Symptoms and signs of glioblastomas can include:
- Headaches: These are often persistent, can be severe, and may worsen over time. They might be more pronounced in the morning or wake a person from sleep. They may not be relieved by typical pain relievers.
- Seizures: The tumor irritates the brain tissue, leading to abnormal electrical activity. Seizures are a common initial symptom for many brain tumors.
- Nausea and vomiting: This is often accompanied by headaches and is caused by pressure in the brain.
- Personality change: These can be subtle at first and may include apathy, irritability, depression, confusion, or difficulty with judgment. Family members often notice these changes first.
- Weakness of numbness on one side of the body: Feeling a sensation of weakness or numbness in an arm, leg, or both—usually on one side of the body—can be a sign of glioblastoma.
- Speech difficulties: Trouble finding the right words, speaking clearly, understanding spoken language, or reading/writing.
- Vision changes: Blurred vision, double vision, loss of peripheral vision, or even blindness in one eye. Swelling of the optic nerve (papilledema) due to increased intracranial pressure can also be seen on examination.
- Balance and coordination issues: Dizziness, clumsiness, unsteady gait, or difficulty with fine motor skills.
- Memory problems: Difficulty concentrating, short-term memory loss, or problems with executive functions like planning and problem-solving.
- Fatigue: Persistent and overwhelming tiredness not relieved by rest.
Causes and risk factors
Glioblastomas are complex tumors, and unfortunately, the exact causes are largely unknown. Unlike many other cancers, there are very few established risk factors, and in most cases, glioblastomas develop without any clear identifiable cause. This is often referred to as "sporadic" occurrence.
Glioblastomas arise from glial cells (astrocytes) in the brain. Their development is thought to involve a series of genetic mutations and changes within these cells. These changes disrupt normal cell growth, division, and death pathways, leading to tumor formation.
Glioblastoma screening and diagnosis
Currently, there are no routine screening programs for glioblastoma. Glioblastoma is typically diagnosed based on a combination of neurological examination, imaging studies, and biopsy.
We begin with a thorough assessment of the patient's neurological function, including mental status, cranial nerve function, motor and sensory function, coordination, and reflexes.
Imaging studies
Imaging studies are absolutely crucial in the detection, diagnosis, treatment planning, and monitoring of glioblastomas. They are often the first step in identifying a suspected brain tumor and providing critical information to your AHN care team. Some of the imaging studies used to identify glioblastomas include:
- Magnetic resonance imaging (MRI): MRI is the primary imaging modality used to diagnose glioblastoma. It provides detailed images of the brain and can help identify the location, size, and characteristics of the tumor. Contrast-enhanced MRI is often used to better visualize the tumor and assess its blood supply.
- Computed tomography (CT) scan: CT scans may be used as an initial imaging study, particularly in emergency situations, to rule out other conditions such as stroke or hemorrhage. However, MRI is generally preferred for evaluating brain tumors.
- Advanced imaging techniques: In some cases, advanced imaging techniques such as magnetic resonance spectroscopy (MRS), perfusion MRI, or positron emission tomography (PET) may be used to further characterize the tumor and differentiate it from other types of brain lesions.
Biopsy
A biopsy is essential to confirm the diagnosis of glioblastoma. During a biopsy, a small sample of tumor tissue is removed and examined under a microscope by a neuropathologist. This is often done using:
- Stereotactic biopsy: A minimally invasive procedure in which a needle is guided into the tumor using imaging guidance (MRI or CT). In some cases, an open surgical procedure may be necessary to obtain a larger tissue sample; this is called an open biopsy.
Molecular testing
Molecular testing of tumor tissue is now a standard part of the diagnostic process for glioblastoma. These tests can identify specific genetic mutations or other molecular abnormalities that may have prognostic and therapeutic implications.
- MGMT methylation status: MGMT is a DNA repair gene. Methylation of the MGMT promoter region is associated with improved response to temozolomide chemotherapy.
- IDH mutation analysis: Mutations in the isocitrate dehydrogenase (IDH) genes are rare in glioblastomas but can help differentiate between primary and secondary glioblastomas.
- Other genetic mutations: Other genetic mutations, such as EGFR amplification, PTEN loss, and TERT promoter mutations, may also be analyzed.
Types and stages of glioblastoma
The different types of glioblastomas are based on their molecular characteristics. These differences because they tell us a lot about how the tumor might behave and what treatments might work best. Your AHN neuro-oncologist will help you understand the type of glioblastoma that may be affecting you and design a treatment plan that will deliver tailored outcomes.
Glioblastomas are not staged in the same way other cancers are staged. The World Health Organization (WHO) Classification of Tumors of the Central Nervous System is used, which assigns grades based on microscopic features and molecular characteristics, rather than stages. Glioblastoma is by definition a WHO Grade 4 tumor, meaning it is the most aggressive and malignant type.
Glioblastoma treatment
Given the aggressive nature of glioblastoma, your treatment may involve various methods. AHN uses a multidisciplinary approach to care, so you can achieve the best outcomes. This means multiple doctors, specialists, and health care providers will work together to create a treatment plan that’s designed for your specific and unique needs.
Surgery
Surgery is usually the first step in treating glioblastoma, if possible. The primary goal is to remove as much of the tumor as safely as can be done without damaging critical brain functions. This is often referred to as maximal safe resection. Removing a significant portion of the tumor can alleviate symptoms caused by pressure on the brain, improve the effectiveness of subsequent treatments, and potentially prolong survival.
Radiation therapy
Radiation therapy is often used after surgery to target any remaining cancer cells. It involves using high-energy rays to kill cancer cells and shrink tumors. The most common type used for glioblastoma is external beam radiation therapy, often delivered as fractionated radiotherapy (daily treatments over several weeks). Techniques like intensity-modulated radiation therapy (IMRT) and stereotactic radiosurgery (SRS) may also be used to precisely target the tumor while sparing healthy brain tissue. Radiation therapy is frequently combined with chemotherapy, particularly with temozolomide, which is given daily during radiation treatment and then in cycles afterward. This combination has been shown to improve outcomes for glioblastoma patients.
Targeted therapy
Targeted therapies are drugs designed to specifically attack cancer cells with certain genetic mutations or protein overexpression, while minimizing harm to healthy cells. While research in this area for glioblastoma is ongoing, it's a more challenging space compared to other cancers due to the tumor's complex genetic landscape and the blood-brain barrier. These therapies work by blocking specific pathways that promote tumor growth and survival, or by inhibiting angiogenesis (the formation of new blood vessels that feed the tumor).
Glioblastoma FAQs
A glioblastoma diagnosis will bring with it questions, concerns, and heightened emotions. AHN is here to help. Our expert neurosurgeons, oncologists, specialists, and health care providers are dedicated to helping patients navigate this tricky disease. Your AHN care team will be with you to help answer your questions and work with you, so you feel confident in your treatment plan. To help you wade through the information, we’ve included answers to patients’ most frequently asked questions. You can use these to inform your conversations with your care team.
What is the life expectancy of a person with glioblastoma?
The life expectancy for a person with glioblastoma can vary significantly, but generally, it is quite challenging due to the aggressive nature of the tumor. The median survival for glioblastoma patients is typically around 12 to 18 months with standard treatment, which includes surgery, radiation, and chemotherapy. However, this is an average, and some individuals may live longer, especially with optimal treatment and favorable prognostic factors. Factors influencing life expectancy include age, performance status, extent of tumor removal, and molecular characteristics of the tumor.
Can glioblastoma be cured if caught early?
Unfortunately, glioblastoma is generally considered incurable with current treatments, even if caught at an early stage. While early detection and aggressive treatment can extend life expectancy and improve quality of life, the infiltrative nature of glioblastoma cells into surrounding healthy brain tissue makes complete eradication extremely difficult. Microscopic tumor cells almost always remain after surgery and can lead to recurrence. The goal of treatment is to control the disease for as long as possible and manage symptoms, rather than to achieve a complete cure.
What is the cause of glioblastoma?
The exact cause of glioblastoma is largely unknown in most cases. It is thought to arise from the brain's glial cells or their progenitor cells, and its development is often sporadic, meaning it occurs without a clear inherited genetic predisposition or environmental exposure.
While no single cause has been identified, some factors that have been studied include:
- Genetic mutations: Glioblastoma is characterized by a complex array of genetic and molecular alterations within the tumor cells themselves, such as mutations in genes like EGFR, PTEN, and TP53. These mutations accumulate and drive uncontrolled cell growth.
- Age: The risk of glioblastoma increases with age.
- Previous radiation exposure: A very small percentage of glioblastomas may be linked to previous high-dose radiation therapy to the head, though this is rare.
- Genetic syndromes (rare): Extremely rarely, glioblastoma can be associated with certain inherited genetic syndromes, such as Neurofibromatosis Type 1, Li-Fraumeni syndrome, and Turcot syndrome. However, these account for a very small fraction of all glioblastoma cases.
What is the survival rate for glioblastoma?
The survival rates for glioblastoma reflect its aggressive nature. Here are some general statistics:
- One-year survival rate: Approximately 39 – 40% of patients are alive one year after diagnosis.
- Two-year survival rate: This drops significantly to about 15 – 17%.
- Five-year survival rate: The five-year survival rate is very low, typically around 6 – 7%.
These statistics represent averages across a broad patient population and do not account for individual prognostic factors mentioned earlier. It's crucial to remember that these are population-level statistics and individual outcomes can vary.
Contact us
To schedule an appointment or learn more about AHN neuroscience services, call 412-359-6200 in Pittsburgh or 814-452-7575 in Erie.
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If you want a second opinion regarding a cancer diagnosis, treatment options, or prognosis, our team of oncology specialists can review your medical records at AHN. To get started, fill out our Second Opinion Request form. Our Navigation Team will contact you within the next 24-48 hours to discuss next steps and schedule.
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