Glioblastoma multiforme (GBM) also referred to as a grade IV astrocytoma,is an aggressive type of cancer that can occur in the brain or spinal cord. Glioblastoma forms from cells called astrocytes that support nerve cells.

GBMs can arise in the brain de novo or evolve from lower-grade astrocytoma.

Glioblastoma can occur at any age, but tends to occur more often in older adults. GBM occurs most often in the cerebral hemispheres, especially in the frontal and temporal lobes of the brain.

GBM is a devastating brain cancer that can result in death in six months or less, if untreated; hence, it is important to seek expert neuro-oncological and neurosurgical care immediately, as this can impact overall survival.

GBMs present unique treatment challenges due to:

·         Localization of tumors in the brain

·         Inherent resistance to conventional therapy

·         Limited capacity of the brain to repair itself

·         Migration of malignant cells into adjacent brain tissue

·         The variably disrupted tumor blood supply, which inhibits effective drug delivery

·         Tumor capillary leakage, resulting in an accumulation of fluid around the tumor, (peritumoral edema) and intracranial hypertension

·         Tumor-induced seizures

·         The resultant neurotoxicity of treatments directed at gliomas

SYMPTOMS

Symptoms vary depending on the location of the brain tumor, but may include any of the following:

·         Persistent headaches

·         Double or blurred vision

·         Vomiting

·         Loss of appetite

·         Changes in mood and personality

·         Changes in ability to think and learn

·         New onset of seizures

·         Speech difficulty of gradual onset.

DIAGNOSIS:

Tests and procedures used to diagnose glioblastoma include:

·         Neurological exam. During a neurological exam, your doctor will ask you about your signs and symptoms. He or she may check your vision, hearing, balance, coordination, strength and reflexes. Problems in one or more of these areas may provide clues about the part of your brain that could be affected by a brain tumor.

·         Imaging tests. Imaging tests can help your doctor determine the location and size of your brain tumor. MRI is often used to diagnose brain tumors, and it may be used along with specialized MRI imaging, such as functional MRI and magnetic resonance spectroscopy.

Other imaging tests may include CT and positron emission tomography (PET).

·         Removing a sample of tissue for testing (biopsy). A biopsy can be done with a needle before surgery or during surgery to remove your glioblastoma, depending on your particular situation and the location of your tumor. The sample of suspicious tissue is analyzed in a laboratory to determine the types of cells and their level of aggressiveness.

Specialized tests of the tumor cells can tell your doctor the types of mutations the cells have acquired. This gives your doctor clues about your prognosis and may guide your treatment options.

TREATMENT:

Glioblastoma treatment options include:

·         Surgery to remove the glioblastoma.  Neurosurgeon will work to remove the glioblastoma. The goal is to remove as much of the tumor as possible. But because glioblastoma grows into the normal brain tissue, complete removal isn't possible. For this reason, most people receive additional treatments after surgery to target the remaining cells.

·         Radiation therapy. Radiation therapy uses high-energy beams, such as X-rays or protons, to kill cancer cells. During radiation therapy, you lie on a table while a machine moves around you, directing beams to precise points in your brain.

Radiation therapy is usually recommended after surgery and may be combined with chemotherapy. For people who can't undergo surgery, radiation therapy and chemotherapy may be used as a primary treatment.

·         Chemotherapy. Chemotherapy uses drugs to kill cancer cells. In some cases, thin, circular wafers containing chemotherapy medicine may be placed in your brain during surgery. The wafers dissolve slowly, releasing the medicine and killing cancer cells.

After surgery, the chemotherapy drug temozolomide, taken as a pill is often used during and after radiation therapy.

Other types of chemotherapy may be recommended if your glioblastoma recurs. These other types of chemotherapy are often administered through a vein in your arm.

·         Tumor treating fields (TTF) therapy. TTF uses an electrical field to disrupt the tumor cells' ability to multiply. TTF involves applying adhesive pads to your scalp. The pads are connected to a portable device that generates the electrical field.

TTF is combined with chemotherapy and may be recommended after radiation therapy.

·         Targeted drug therapy. Targeted drugs focus on specific abnormalities in cancer cells that allow them to grow and thrive. The drugs attack those abnormalities, causing the cancer cells to die.

Bevacizumab targets the signals that glioblastoma cells send to the body that cause new blood vessels to form and deliver blood and nutrients to cancer cells. Bevacizumab may be an option if your glioblastoma recurs or doesn't respond to other treatments.