Diagnosis And Treatment Of Glioblastoma
Glioblastoma is an grade IV, aggressive malignant brain tumor. It affects the glial cells in the brain, which make up upto 90% of the cells present in the central nervous system (CNS) and provide nutrients and support to the neurons. Glial cells are of four major types namely: astrocytes, oligodendrocytes, ependymal cells and microglia. Glioblastomas are usually made up of abnormal astrocytic cells but affects a variety of cells. The type of glioma is diagnosed based on the glial cell it affects.
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WHO IS THIS FOR
Patients who have received a diagnosis of glioblastoma.
The prognosis of a glioblastoma is usually 11-18 months, but varies on a case by case basis.
If a surgery is feasible, it will last anywhere from between 4-6 hours, but depends on the complexity of the tumor.
Radiation therapy lasts up until 7 weeks.
Chemotherapy is prescribed alongside radiation therapy, and is also taken post that for around 6 months.
The treatmens will vary from patient to patient and largely depends on your age, the type and severity of the tumor and your medical history.
POTENTIAL RISKS & SIDE EFFECTS
General risks associated with surgery include: bleeding, infection, iatrogenic stroke, as well as neurological complications such as cognitive abilities being impaired.
Radiation and chemotherapy can cause fatigue, dermatological problems, nausea/vomiting, loss of hair, headaches, muscle weakness, and infertility. Long term side effects include - increased risk of other cancers, hearing loss, weakening of the bones/muscles.
Diagnosis, symptoms & treatment of Glioblastoma
There has been as of yet no evident cause found for glioblastomas. There are several risk factors that may increase your chances of having a glioblastoma and these include your age, your sex (males are more susceptible), and exposure to radiation. Genetic disorders such as neurofibromatosis or Turcot syndrome have been shown to have an increased risk of glioblastomas.
Symptoms associated with glioblastomas are:
Changes in personality
Not all symptoms may occur in every case, and each case may have its own specific symptoms based on the location of the tumor.
The tumor is diagnosed based on the following factors:
MRI and CT scans, for locating the position of the tumor
Biopsy where a small section of your tumor tissue is removed and thoroughly examined under a microscope. This gives information on the tumor composition, so the best line of treatment can be devised.
In addition to these two main types of diagnosis, a detailed medical history is taken and a neurological and physiological exam that tests your memory, vision, balance, coordination amongst other physical and cognitive abilities is also carried out.
What are the treatments for glioblastoma?
The first line of defense against a glioblastoma is surgery. The aim of the surgery is to remove as much of the tumor as possible and relieve the pressure that it exerts on the brain. The glioblastoma surgery is commonly performed under general anaesthesia. Here’s an overview of the procedure:
The surgeon will first perform a craniotomy, which is the removal of a part of the bone from the skull to have access to the brain.
The surgeon will then proceed to remove the tumor, as much as is feasible, using specified surgical equipment and tools. Glioblastomas are infiltrative tumors which makes them hard to completely remove.
If the tumor is located in a vital brain area or is particularly difficult to locate, then intraoperative MRI or brain mapping will be used whilst performing the surgery.
The surgeon will finish the operation by replacing the skull bone and suturing the cut on the scalp.
Radiation Therapy and Chemotherapy
Radiation and chemotherapy are employed following the surgery, or directly in case the surgery is not possible. The main aims of these therapies are to kill any remaining cancerous cells that were not removed during surgery, and shrink the tumor.
Radiation therapy works by aiming high energy rays at the tumor to kill cancerous cells. Chemotherapy, on the other hand, is a pharmacological treatment which is most often taken orally during and after radiation therapy. The most commonly prescribed chemotherapy drug for glioblastoma is temozolomide or Temodar.
Tumor treating field (TTF) therapy
TTF therapy is a relatively new form of treatment for glioblastomas. It works by blocking cell division using low-intensity electrical fields that have alternating frequencies. Adhesive pads are applied to the scalp, which are attached to a patient controlled device that generates the necessary electrical fields.
What should I expect from this procedure?
Glioblastomas are a high grade brain tumor, which grow quickly to affect neighbouring brain tissue. They can arise spontaneously at the grade IV level or develop from a lower grade astrocytoma.
Treating these tumors is difficult because they are heterogenous i.e., made up of different cells. Some of these cells react to the treatments and some do not, which subsequently grow further and spread across the brain. Hence, the success of the various treatments is short lived. Furthermore, as the disease occurs in the brain, there is the added disadvantage of working around the blood brain barrier which severely restricts the kind of medications that can be prescribed.
As an end note, the prognosis is mostly dire but in many cases patients may be referred to a clinical trial which could prove to be extremely helpful. Having family and friends around, keeping up with activities that you enjoy and taking care of your emotions are an integral part of the treatment.
Scientific advancements: Immunotherapy as a possible treatment for Glioblastoma?
Our immune system is our body’s own defense mechanism. It provides resistance against unknown or foreign bodies and damaged cells. Mutations occur constantly in our cells and this is another concern that our immune system usually takes care of. This being said, sometimes the occurrences of mutations ‘outruns’ our immune system and the cell becomes malignant and can develop into a tumor. As mentioned earlier, glioblastomas are one of the most aggressive brain tumors. A hallmark of the disease is to actively suppress the brain’s immune system. The brain has its own immune environment of which the blood-brain barrier is a vital component.
Immunotherapy is a developing field that aims to provide treatment for cancer by supporting or boosting your immune system, so it can better fight the disease. Whilst it has proven benefits for certain types of cancer such as lung or skin cancer, the research for its use against glioblastoma is still ongoing. The mechanisms that are involved in the regulation of the brain’s immune system are not fully understood, but current scientific advances are being made in developing individualised vaccines for patients. It is important to know that there are immense challenges that have to be overcome, and the future of its application to glioblastoma is still uncertain. Any progress will require time and the joint effort of scientists from different fields.