ABOUT GLIOBLASTOMA

What is Glioblastoma?

Glioblastoma, also known as glioblastoma multiforme or GBM, is a Grade 4 astrocytoma that occurs in the brain or spinal cord. It is the most common primary brain tumor in adults, characterized by rapid growth and a tendency to invade surrounding brain tissue.

It is one of the most complex, deadly, and treatment-resistant cancers.

14,000

estimated people in the United States will receive a glioblastoma diagnosis in 2024, with significantly higher global estimates.

48.6%

of all malignant brain tumors are glioblastomas, making it the most common and aggressive type of brain cancer.

64

is the mean age at diagnosis. While glioblastoma is more common in older adults, it can occur at any age,

6.8%

is the 5-year survival rate, with median survival time at just 14-16 months, and only 25% of patients surviving past 1 year.

Survival and mortality statistics for glioblastoma have been virtually unchanged for decades.

Since first being recognized in scientific literature in the 1920's, only one medical device and four drugs have ever been approved by the FDA for the treatment of glioblastoma. Not one has succeeded in extending patient lives beyond a few months. The decades of research and advancements in the treatment of cancer has not extended to glioblastoma.

For a century, it has been overlooked, as research and treatment continue to be vastly underfunded.

Glioblastoma is classified as a Grade 4 astrocytoma by the World Health Organization.

This grading indicates a highly malignant tumor that arises from astrocytes, the star-shaped cells that form part of the supportive tissue of the brain. GBM is known for its heterogeneity, meaning it contains a variety of different cell types within the same tumor, which contributes to its complexity and resistance to treatment.

Grade 1 & 2

Benign

Non-cancerous tumors that grow slowly, tend to have distinct, even borders and unlike malignant tumors, won’t spread to other parts of the body.

Grade 3 & 4

Malignant

Cancerous tumors that grow rapidly and uncontrollably. They can metastasize, or spread through the body, via the blood or lymph systems.

Tumor Location

The location of a glioblastoma brain tumor can affect what symptoms manifest as well as which treatment options will be the most effective. The presence of a brain tumor can cause damage to healthy brain tissue, disrupting the normal functions of that area.

Frontal

Lobe

Symptoms may cause changes in personality, loss of inhibitions, difficulty planning, or weakness on one side of the body.

Occipital

Lobe

Symptoms may include blurry, double, or partial vision, trouble seeing colors, loss of vision, and abnormal pupil reactions.

Parietal

Lobe

Symptoms may include sudden difficulty with speech, problems with writing or math, and spatial disorientation.

Cerebellum

Symptoms may lead to problems with controlling one's balance, maintaining coordination, and performing fine motor skills.

Temporal

Lobe

Symptoms may include sudden deficiencies in memory, speech, and general understanding of language.

Brain

Stem

Symptoms may include difficulties breathing, abnormal heart rate and blood pressure, and may lead to paralysis.

Symptoms

Symptoms of glioblastoma can vary depending on the tumor’s size, location, and growth rate. Common symptoms include the following:

Headaches

Often severe and persistent, and particularly ones that hurt more in the mornings or after long periods of sleep.

Seizures

The most common presenting symptom of GBM is a tonic-clonic (formerly known as grand-mal) seizure, especially in someone with no former or family history.

Weakness & Numbness

Muscle weakness, numbness, and a reduced sensation of touch that often effects one side of the body, most commonly in the face, arms, or legs. Sudden trouble with balance or coordination is also common.

Vision Changes

Blurred, double, or patrial vision, loss of peripheral vision, or trouble seeing colors. Other visual symptoms may include loss of visual acuity, visual field deficits or abnormal pupil reactions in the ipsilateral eye (the eye on the same side of the tumor).

Nausea & Vomiting

Often due to increased intracranial pressure.

Cognitive Changes

Difficulty with memory, speech, and understanding, as well as other cognitive functions. Sudden changes in personality or behavior, like irritability, déjà vu, or confusion are also common.

Glioblastoma Risk Factors

Most people diagnosed with glioblastoma have no family history of cancerous brain tumors, and the causes glioblastomas is largely unknown. Despite that, several risk factors have been identified.

Genetics

Some inherited syndromes like Lynch syndrome and Li-Fraumeni syndrome may increase the risk of glioblastoma.

Age

Glioblastoma is most common in adults, particularly in those over 50, but it can develop in persons of any age, including children.

Gender

Men are slightly more likely to develop glioblastoma than women, with approximately 61.5% of glioblastoma patients being men.

Radiation

Patients that have a history of radiation therapy, specifically targeting their brain, can have an increased the risk of developing glioblastoma

Diagnosis

Tests and procedures used to diagnosis GBM include the neurological exams, imaging, biopsies, and molecular testing.

MRI Imaging

An MRI both with and without contrast is the most common and important imaging study for astrocytoma. As a rule of thumb, if the tumor picks up the contrast (i.e., becomes bright on the images), it’s an indication of a higher-grade astrocytoma.

Other imaging sequences provide clues as to tumor cellularity, brain swelling and brain infiltration. Low-grade tumors usually do not show much contrast enhancement, while GBMs display strong contrast enhancement and frequent central necrosis.

Molecular Subtypes of Glioblastoma

IDH Mutation

IDH is a gene that produces proteins that help repair damaged DNA. In general, patients whose tumor has an IDH mutation have a better prognosis than those who do not have the mutation (known as IDH wildtype). Doctors believe this is because the mutation limits the ability of IDH proteins to repair cancer cell DNA.

MGMT Promoter

MGMT is an enzyme that can make cancer cells more resistant to therapy. When the DNA associated with producing this enzyme is mutated through a process called methylation, less MGMT is made. Glioblastoma with the MGMT promoter methylation mutation may respond better to treatment. Testing for the MGMT mutation is required for many brain tumor clinical trials.

EGFR Mutation

The most common EGFR mutation in glioblastoma is the in-frame deletion of exons 2–7, known as EGFRvIII, which occurs in about 50% of all EGFR-amplified glioblastoma cases. The EGFR (epidermal growth factor receptor) gene produces a protein that helps cells grow and survive. When the EGFR gene or protein is mutated, it can cause cancer cells to grow and spread.

Treatment

Treatment for glioblastoma often starts with surgery, though it may not always be possible. In some cases, if the tumor is located deep within the brain, removing all of it could be too dangerous. In those situations, other options like radiation therapy and chemotherapy may be recommended as the initial course of treatment.

The best treatment approach for you will depend on your specific circumstances. Your healthcare team will consider factors like the size and location of the tumor, as well as your overall health and personal preferences when developing your treatment plan.

Surgery to Remove the Tumor

A neurosurgeon aims to remove as much of the tumor as possible.

However, glioblastomas often grow into surrounding healthy brain tissue, making it difficult to remove all the cancer cells.

Most patients undergo additional treatments after surgery to target any remaining cancer cells.

Chemotherapy

Chemotherapy treats cancer with strong medications. After surgery, chemotherapy in pill form is often used during and after radiation therapy.

In cases where glioblastoma returns, chemotherapy administered through a vein may be an option. During surgery, thin wafers containing chemotherapy medicine can sometimes be placed in the brain, where they slowly dissolve and release the medication to target cancer cells.

Radiation Therapy

Radiation therapy uses powerful energy beams, like X-rays or protons, to treat cancer. During treatment, you lie on a table while a machine moves around you, directing radiation to specific parts of the brain.

Radiation therapy is typically recommended after surgery to kill remaining cancer cells, often combined with chemotherapy. For those who can't have surgery, radiation therapy and chemotherapy may serve as the main treatment.

Tumor Treating Fields Therapy

Tumor treating fields therapy, or TTF, uses electrical energy to disrupt glioblastoma cells, making it harder for them to multiply. Sticky pads are attached to the scalp, which may require shaving for proper adhesion. These pads connect to a portable device that generates an electrical field targeting the cancer cells.

TTF is often used alongside chemotherapy, typically after radiation therapy.

Palliative Care

Palliative care focuses on improving quality of life for individuals with serious illnesses. For cancer patients, it helps manage pain and symptoms. A team of healthcare professionals—including doctors and nurses—works together to provide extra support alongside your cancer treatment.

You can receive palliative care while undergoing surgery, chemotherapy, or radiation therapy. When combined with other treatments, palliative care can help people with cancer feel better and live longer.

Research Advancements

Ongoing research is crucial for improving glioblastoma outcomes. For the latest updates and information curated by The Morizzo Foundation, visit our News page.

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Citations

American Association of Neurological Surgeons. (2024). Glioblastoma multiforme. AANS. https://www.aans.org/patients/conditions-treatments/glioblastoma-multiforme/

American Cancer Society. (2020). Understanding Cancer. ACS. https://www.cancer.org/cancer/understanding-cancer.html

Johnson, D. R., & O’Neill, B. P. (2012). Glioblastoma survival in the United States before and during the temozolomide era. Journal of Neuro-Oncology, 107(2), 359-364.

Louis, D. N., et al. (2016). The 2016 World Health Organization Classification of Tumors of the Central Nervous System: a summary. Acta Neuropathologica, 131(6), 803-820.

Mayo Clinic. (2024). Glioblastoma. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/glioblastoma/symptoms-causes/syc-20569077

MD Anderson Cancer Center. (2024). Glioblastoma. MD Anderson Cancer Center. https://www.mdanderson.org/cancer-types/glioblastoma.html

Ostrom QT, Cote DJ, Ascha M, Kruchko C, Barnholtz-Sloan JS. Adult Glioma Incidence and Survival by Race or Ethnicity in the United States From 2000 to 2014. JAMA Oncol. 2018;4(9):1254–1262. doi:10.1001/jamaoncol.2018.1789

Stupp, R., et al. (2005). Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. New England Journal of Medicine, 352(10), 987-996.

Wen, P. Y., & Kesari, S. (2008). Malignant gliomas in adults. New England Journal of Medicine, 359(5), 492-507.

What is Glioblastoma?

Survival and mortality statistics for glioblastoma have been virtually unchanged for decades.

Glioblastoma is classified as a Grade 4 astrocytoma by the World Health Organization.

Grade 1 & 2

Grade 3 & 4

Tumor Location

Symptoms

Headaches

Seizures

Weakness & Numbness

Vision Changes

Nausea & Vomiting

Cognitive Changes

Glioblastoma Risk Factors

Diagnosis

MRI Imaging

Molecular Subtypes of Glioblastoma

Treatment

Surgery to Remove the Tumor

Chemotherapy

Radiation Therapy

Tumor Treating Fields Therapy

Targeted Therapy

Clinical Trials

Medications to Control Symptoms

Palliative Care

Research Advancements

Resources

Citations