Primary brain cancers such as glioblastoma multiforme (GBM) are one of the least treatable forms of cancers and the most aggressive type of brain cancer being a grade IV glioma. GBM is a particularly aggressive and fast-growing tumor and is difficult to treat and manage. Highlight links Despite medical improvements, glioblastoma is still one of the hardest cancers to treat because of its complicated biology and light responsiveness to conventional therapies.
This article will cover the basic information on glioblastoma multiforme, such as the causes, signs and symptoms, how it’s diagnosed and treatment options. We’ll also explore ongoing research and possible future avenues that could offer hope for patients living with this aggressive cancer someday.
What is the Glioblastoma Multiforme?
It constitutes approximately 15% of all primary brain tumors and is by far the most common inherently malignant tumor of the brain, known as glioblastoma, multiforme in adults. The most common malignant adult brain tumor, GBM, derives from glial cells (primarily astrocytes, which support and protect neurons). But, unlike ordinary glial cells, glioblastoma cells proliferate quickly and invade surrounding brain tissue, creating finger-like extensions that render surgical excision difficult.
Age: Adult: The disease is most often diagnosed between the ages of 45 and 70 but can be found at any age. Unfortunately, GBM is a destructive and rapidly growing tumor, with average life rate of about 15-18 months even with ideal management.
Causes and Risk Factors:
There is several risk factor for glioblastoma multiforme but the real cause of glioblastoma is still unknown.
- Age: GBM mostly found in above 45 of age but it can affect any age.
- Genetic factors: some hereditary alteration, for example alteration in TP53, EGFR and IDH1 genes, it can be cause and contribute to develop of glioblastoma.
- Previous radiation therapy: if someone earlier expose to the radiation specially to the head it will increase the threat of raising of brain tumor.
- Family history: commonly it is very rare but a family with the history of GBM or some heredity condition for example Li-Fraumeni syndrome, neurofibromatosis may a little chance to enhance the threat.
Symptoms of Glioblastoma Multiforme
GBM signs and symptoms depends on the grade, stage, location and its growth. Some mutual symptoms include:
- Persistence headache: usually headache started with waking up and worse in the waking time, when the tumor growth increases the headache will be more frequent and intense.
- Seizures: when the normal activity of brain disrupts the patient experienced on set seizures.
- Cognitive changes: GBM affects cognitive region of the brain, which cause difficulty in concentration, confusion and memory loss.
- Personality and mood changes: mood swings and changes in personality are not uncommon in GBM
- Motor function impairment: first it depends on the location of the tumor, there may be paralysis, numbness and weakness in one part of the body.
- Speech difficulties: it may cause complication in finding words, speaking and understanding the language when the tumor affect the areas which control the speech.
Diagnosis of Glioblastoma Multiforme
The diagnostic process for glioblastoma typically involves a combination of imaging studies and biopsy procedures:
Combination of biopsy procedure and imaging studies is typically involving in the process of the diagnosis of glioblastoma.
Magnetic resonance imaging(MRI): it helps to identify the brain tissue and its surrounding from the tumor. MRI with contrast boost primary imaging tools for identifying glioblastoma.
Computed tomography (CT) scan: CT scan helps to point out the tumor’s location and evaluate the possible injury to adjoining brain construction.
Biopsy: A neurosurgeon performs a small procedure to get the small sample from the brain cells to examine under the microscope it is essential to confirm the diagnosis of glioblastoma from brain biopsy. Pathologist examine the brain cells for the unique cellular structures of GBM to confirm the diagnosis and may done some other genetics examination to initiate the treatment.
Treatment Options for Glioblastoma Multiforme
Treatment typically includes a combination of surgery, radiation therapy and chemotherapy. Basically the treatment of GBM requires a multidisciplinary approach, involving neurosurgeons, oncologists, radiation therapist and supportive care team.
Surgery: to treat the GBM first step is surgery to remove the tumor but unfortunately complete resection of tumor is challenging due to infiltrative nature, but debulking (resection as much as possible) can subside signs and symptoms and improve survival.
Radiation therapy: radiation therapy may include conventional external beam radiation or more innovative procedures like stereotactic radiosurgery (SRS) which permits for exact aiming. Radiation is pointed at the tumor site and adjoining area to destroys residual tumor cells. Post-surgical radiation therapy is standard for glioblastoma.
Chemotherapy: temozolomide (TMZ) is the regular chemotherapy medications for GBM. TMZ is taken orally and works by destructing the DNA of the tumor cells, stopping their reproduction. Due to GBM’s confrontation to many medicines, TMZ is often associate with radiation therapy to increase results.
Targeted therapy: Bevacizumab, a monoclonal antibody aiming vascular endothelial growth factors (VEGF), may be used for recurring GBM cases. By stopping blood vessel creation, it goals to decrease the tumor’s blood supply, potential decelerating its evolution.
Tumor treating fields (TTF): TTF is innovative treatment that uses electrical ground to interrupts tumor cells division. A wearable device carries these grounds to the brain, aiming GBM cells without upsetting normal cells.
Prognosis and Challenges in Treatment
The blood brain barrier, a protective mechanism that prevents harmful substances from entering the brain limits the effect of many chemotherapeutic drugs. With the aggressive medication, GBM remains challenging to treat due to its extremely aggressive nature. Even the surgery, radiation and chemotherapy, the tumor often reoccurs.
GBM is usually have poor prognosis with a survival rate of five years less than 10%. However, some factor can increase or influence survival the GBM patients, such as younger age, better functional status and specific genetic alteration.
Research and Future Directions
Developing innovative treatment, enhancing medicine entering to the brain and identifying novel treatment targets is focus of ongoing research. Research area includes:
Immunotherapy: CAR T cell treatment to stimulate the immune system to attack GBM cells and RCT are examining immune check point inhibitor.
Gene therapy: to transform tumor cells and stop their production, researcher is exploring gene-editing procedure such as CRISPR.
Nanotechnology: Nanoparticle is important to enhance medicine distribute across the blood brain barrier, possibly permitting more effective medicine to influence the tumor site.
Personalized medicine: one of the individualized approach to treatment is genetic profiling of GBM tumor which can help tailor treatment based on each patient’s specific tumor alteration.
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Conclusion
GBM is a complicated and destructive brain cancer that poses important challenges to healthcare provider and patients similar. With advancement of treatment have improved clinical manifestation management and excellence of life, treatment remain unidentified. However, the researcher tries to find novel treatment to improve the outcome in the future.
It very difficult for families, patients and healthcare provider to make sure the diagnose of glioblastoma. The complicated nature of this tumor demands for wide range treatment approach, attached with psychological and emotional support for the patient and their family. As the scientific community carry on to unravel the secrecies of GBM, but there is still hope for more effective therapy and possibly even a cure will be available
