Understanding Glioblastoma: A Deep Dive into Symptoms, Diagnosis, and Treatment
"Glioblastoma is one of the most challenging and aggressive types of brain tumors. Despite its grim prognosis, advancements in treatment and a positive attitude can make a significant difference," observes Dr. Shankar Ganesh, Senior Consultant – Neurosurgery at Apollo Cancer Centre, Chennai.
He recalls how a woman in her seventies arrived in a wheelchair at the Apollo Cancer Centre, Chennai, suffering from seizures and was diagnosed with a glioblastoma. Despite her advanced age and the malignancy of her condition, her response was not one of despair. She and her family were determined to pursue the best possible treatment. Following successful surgery, she underwent chemotherapy and radiation therapy, and even explored immunotherapy. Remarkably, she lived for nearly five years after her diagnosis, a testament to her resilience and the comprehensive care she received.
Glioblastoma is a type of primary brain tumour, meaning it originates directly within the brain. Classified by the World Health Organization as a grade four brain tumour, glioblastoma is highly malignant and has a poor prognosis.
The symptoms of glioblastoma vary depending on the tumour’s size and location. If the tumour is near the optic nerve, it can cause visual disturbances such as blurry or double vision. Tumours near motor control areas can lead to weakness in limbs, while those in the frontal lobe can alter behaviour and personality. Headaches and seizures are common symptoms due to the tumour’s irritation of brain tissue. Essentially, the tumour’s position in the brain dictates the specific symptoms experienced.
Unlike other cancers linked to lifestyle choices, glioblastoma does not have a clear lifestyle-related cause. However, certain inherited genetic conditions and prolonged exposure to carcinogenic chemicals or high doses of ionising radiation can increase the risk. For example, individuals with genetic defects leading to multiple tumours may develop glioblastoma. Additionally, those exposed to high radiation levels, whether through medical treatment or occupational hazards, may also be at increased risk.
Modern diagnostic techniques for brain tumours, particularly glioblastoma, have advanced significantly. Magnetic Resonance Imaging (MRI) is the gold standard, offering detailed information about the tumour’s location, size, and characteristics. Contrast-based MRI, functional MRI, and PET scans provide insights into the tumour's activity and blood flow, helping differentiate between benign tumours and aggressive glioblastomas. These diagnostic tools are crucial for planning effective treatment strategies.
The primary treatment for glioblastoma involves a combination of surgery, chemotherapy, and radiation therapy. Surgery is essential not only to remove as much of the tumour as possible but also to obtain tissue samples for accurate diagnosis and genetic testing. The goal is a gross total resection, meaning the removal of as much tumour tissue as possible without damaging surrounding healthy brain tissue. Post-surgery, patients undergo chemotherapy and radiation therapy to target any remaining cancer cells.
Advancements in surgical techniques have significantly improved glioblastoma treatment outcomes. Intraoperative imaging, such as MRI suites within operating rooms, allows surgeons to assess the extent of tumour removal. Intraoperative neuro-monitoring and awake surgery helps preserve critical brain functions during surgery, while fluorescence-guided surgery ensures precise differentiation between tumour and normal brain tissue. These innovations aim to maximise tumour removal while minimising damage to healthy brain areas.
Immunotherapy represents a promising frontier in glioblastoma treatment. This approach involves re-engineering a patient’s immune cells to recognize and attack cancer cells, similar to how vaccines work against infections. Although still in experimental stages, immunotherapy has shown potential in enhancing the body’s natural defences against glioblastoma.
Other areas of research include oncolytic virus therapy, where genetically modified viruses specifically target and kill cancer cells, and vaccine therapy, which aims to train the immune system to recognize and combat tumour cells. Whole genome sequencing has also advanced, allowing for personalised treatment plans based on the genetic makeup of both the patient and the tumour.
After surgery, patients typically stay in the hospital for three to five days, depending on their overall health and recovery progress. Follow-up care includes chemotherapy and radiation therapy over six to eight weeks, with regular MRI scans to monitor the tumour’s status. Side effects from treatment can vary, including weakness, brain swelling, and cognitive impairments, which are managed through tailored supportive care.
Glioblastoma is a highly aggressive cancer with a challenging prognosis. The average survival time post-diagnosis is about 12 to 18 months, even with comprehensive treatment. Only around 20% of patients survive beyond a year, and less than 5% live longer than five years. Factors such as the patient’s age, overall health, and response to treatment significantly influence survival rates. Younger patients generally fare better due to their physical resilience.
A cancer diagnosis can be devastating for patients and their families. Comprehensive support systems, including social workers and support groups, are crucial in helping them navigate the treatment journey. In India, organisations like the Brain Tumour Foundation of India provide valuable resources and emotional support. Online platforms and social media also offer connections to support groups, fostering a sense of community among those affected by glioblastoma.
The diagnosis of glioblastoma requires prompt and decisive action. Early treatment is crucial for better outcomes, and maintaining a positive outlook can significantly impact the patient’s journey. While a cure remains elusive, ongoing research and advancements in treatment continue to offer hope. The focus should always be on ensuring the best possible quality of life for patients and their families.
