Most brain tumors are benign, meaning they’re not cancerous.
But about 25 percent of people who learn they have a brain tumor have one that’s malignant, or cancerous. A diagnosis of glioblastoma can be especially frightening.
“Glioblastomas are the most common malignant brain tumor, and the one that everyone is worried about because of the high mortality rate,” says UNC Health neurosurgeon Sivakumar Jaikumar, MD.
About 12,000 people in the United States are diagnosed with a glioblastoma each year. People tend to live about 15 to 18 months after diagnosis with treatment, Dr. Jaikumar says.
Glioblastomas are the most aggressive form of glioma, a tumor that is made up of glial cells, brain cells that support brain function. Doctors don’t know why these cells sometimes become tumors, but they do know that when they become glioblastomas, they spread quickly and aggressively through the brain, making treatment difficult.
While the prognosis is daunting, researchers and physicians are working to find ways to increase life expectancy and improve quality of life for people with glioblastomas. We talked to Dr. Jaikumar about this brain tumor and treatment options.
Glioblastoma Risk Factors and Symptoms
Most glioblastomas happen without any clear cause. They happen more often in older patients—65 is the median age at diagnosis—and are more common in men than women. Some genetic conditions, such as neurofibromatosis, Lynch syndrome and Li-Fraumeni syndrome, can increase the risk of a glioblastoma. You may be at higher risk if you had radiation on your head or neck for cancer as a child.
Symptoms vary depending on where in the brain your glioblastoma forms, but they tend to appear suddenly and progress rapidly because the tumor grows quickly and fluid around the tumor can cause swelling in the brain.
“The most common symptoms are headaches and seizures, but it depends on where it shows up in the brain,” Dr. Jaikumar says. “You could also have vision loss, weakness or language problems.”
Other symptoms can include changes in personality, memory problems, loss of sensation in your limbs and fatigue.
Your doctor will order imaging of your brain, typically a CT scan and an MRI scan, but the only way to know for sure that it’s a glioblastoma is to take a biopsy of the cells. That biopsy might be done as part of surgical treatment, or it can be done before surgery by making a small hole in the skull and using a needle to extract some of the tumor tissue.
Glioblastoma Treatment
Your doctor may prescribe you medications to help with symptoms such as seizures or brain swelling, but the typical first treatment for a glioblastoma is surgery.
“We start with surgery to take out as much as we can without affecting brain function,” Dr. Jaikumar says. “That’s followed by a tumor board discussion about treatment involving chemotherapy, radiation or additional surgery, depending on the biopsy of the tumor.”
If the biopsy shows it would be effective, you might have six weeks of daily radiation and chemotherapy. Dr. Jaikumar says this particular regimen has fewer side effects than other chemotherapy and radiation treatments.
“The chemotherapy is an oral medication, so you don’t have to go to an infusion center for an IV, and it’s very well-tolerated,” he says. “Depending on where the tumor was in the brain, we can usually do focused radiation, which is very targeted, maybe to just 3 or 4 centimeters. This targeted radiation doesn’t have as many side effects as whole brain radiation, which does affect brain function.”
Still, it’s difficult to remove an entire glioblastoma because these tumors form tentacles that can wrap around brain structures, so most of these tumors grow back. You’ll receive regular MRIs to monitor growth, and your doctor will use information from the tumor biopsy to determine next steps, as doctors have learned that certain genetic markers in the tumor will indicate which treatments will work best. Some treatments, including radiation and chemotherapy, can be repeated.
At UNC Health, a neuro-oncology tumor board made up of neurologists, neurosurgeons, medical oncologists, radiation oncologists and pathologists meets once a week to discuss the best options for each case.
“Any instance of glioblastoma is discussed by the entire tumor board, with everyone going over the next step for going forward,” Dr. Jaikumar says.
Clinical Trials for Glioblastoma
Sometimes, your next best step after surgery, radiation and chemotherapy will be enrolling in a clinical trial to access new treatments for glioblastoma. Dr. Jaikumar is optimistic about the promising results coming out of these trials.
“The most exciting thing in clinical trials right now is CAR T-cell therapy,” Dr. Jaikumar says. “The patient’s own cells are modified to target cancer cells.”
While this form of immunotherapy has proven effective in several cancers, a tumor in the brain presents unique challenges.
“The brain is a really privileged and protected organ,” Dr. Jaikumar says. “Treatments don’t penetrate the brain as well other parts.”
That means that instead of having a typical infusion of CAR T-cell therapy, you need to have a reservoir placed in your brain or under your scalp so that the T-cells can access the spinal fluid.
Other clinical trials are investigating devices that can be implanted to help chemotherapy reach the brain more directly.
“As we understand the genetic markers of these tumors better, I expect more targeted treatments,” Dr. Jaikumar says. “That’s why clinical trials are so important, because we’re learning how to best treat patients.”
As researchers and doctors work to find ways to extend quantity of life, Dr. Jaikumar encourages people to focus on their quality of life.
“I always recommend that people focus on a few days of pleasure outside of the clinic,” he says. “Focus on the positive things you want to do in the next year or two—what you want to accomplish and things you can look forward to. People tend to do better when they have things they’re looking forward to, and your medical team will work on supporting that.”
If you’re concerned about symptoms such as headache, talk to your doctor or find one near you.