Glioblastoma
The content provided herein is for informational and educational purposes only. it does not constitute an endorsement or promotion of any specific diagnostic methods, treatments, or pharmaceutical products. This information is not a substitute for professional medical advice, diagnosis, or treatment from a qualified physician or pharmacist. It should not be used as a basis for self-diagnosis or for starting, modifying, or discontinuing any medical treatment. Always seek the advice of your physician or another qualified healthcare provider with any questions you may have regarding a medical condition or health concerns.
Glioblastoma is the most aggressive and most common primary brain tumor in adults. It belongs to the group of diffuse gliomas. It mainly develops in the white matter, especially in the cerebral hemispheres. It does not grow as a clearly defined lump. Instead, it spreads into nearby brain tissue like fingers. Other diffuse gliomas include astrocytoma and oligodendroglioma. According to the current WHO classification, glioblastoma is classified as an “adult type diffuse glioma, CNS WHO grade 4.” This means it is a highly malignant brain tumor with very aggressive growth and an unfavorable prognosis.
At the molecular level, glioblastoma is usually an IDH wild type tumor. This means there is no mutation in the isocitrate dehydrogenase gene. Such mutations are often found in other tumors with a better prognosis. This distinction is important. IDH mutated diffuse gliomas behave differently and are classified differently in treatment planning. Glioblastoma develops from neuronal and glial precursor cells. In a healthy brain, these cells support tissue structure and repair. Genetic changes can cause them to lose normal control over growth and development. As a result, they can divide without control and infiltrate nearby brain tissue.
Glioblastoma is relatively rare. It often occurs in middle aged and older adults. Because it grows diffusely into the brain, surgery cannot remove it completely. Glioblastoma also often develops in highly sensitive brain areas. Even small changes in volume can cause neurological problems, cognitive changes, seizures, or personality changes. Despite current research and multimodal treatment, glioblastoma remains a brain tumor with an overall poor prognosis.
Prof. Dr. med. Dipl.-Med. Holger Wehner
Glioblastoma requires a comprehensive and individually tailored treatment strategy. Combining modern oncological therapies with supportive approaches such as hyperthermia may help strengthen the body and support quality of life.
Glioblastoma Causes and Risk Factors
In most cases, the exact cause of glioblastoma is not clear. Genetic changes build up over time in certain precursor cells. These changes affect genes that control cell growth, cell division, DNA repair, and programmed cell death. When these control systems fail, cells can multiply without control. They can also form new blood vessels for their own nutrient supply and infiltrate nearby tissue. Over time, this can lead to a clinically visible glioblastoma.
Although the exact causes are not known, some risk factors can increase the risk of glioblastoma or glioma:
- Previous high dose radiation to the head, for example during radiotherapy
- Inherited tumor and DNA repair syndromes, such as Li Fraumeni syndrome, Turcot syndrome, or neurofibromatosis type 1
- Older age
- Male sex
These risk factors apply only to a small number of cases. In most people, there is no known inherited risk or previous head radiation. Glioblastoma usually develops through a combination of spontaneous, age related DNA damage and individual factors.
Glioblastoma Symptoms
Glioblastomas usually grow diffusely into nearby brain tissue. They often spread without clear borders. Symptoms are caused not only by the tumor itself. They are also strongly influenced by the surrounding brain edema. This swelling often forms around the tumor and increases pressure in the brain. The symptoms depend mainly on the tumor’s location, growth pattern, and size at diagnosis. Many early signs are rather unspecific.
Typical glioblastoma symptoms can include:
- Headaches
- Nausea and vomiting, especially in the morning or together with headaches
- Epileptic seizures
- Neurological deficits, such as weakness, paralysis, numbness, coordination problems, or balance problems
- Vision problems, such as visual field loss or double vision
- Speech problems
- Changes in personality or behavior
- Cognitive problems
- Severe tiredness and loss of performance
- Drowsiness or dizziness
These symptoms can occur alone or together. They may become stronger over time. It is important to take warning signs seriously. These include new sudden headaches with nausea or vomiting, a first epileptic seizure, or clear personality changes. Cognitive abilities can also change over several weeks.
Not every one of these symptoms means that glioblastoma is the cause. Still, new, persistent, or quickly worsening neurological symptoms should always be checked by a doctor.
Glioblastoma Diagnosis
The diagnosis of glioblastoma is usually based on a clinical examination, imaging, and tissue confirmation through a biopsy. The suspicion often arises because of typical signs. These include new headaches, epileptic seizures, neurological deficits, or cognitive changes. MRI with contrast agent is then used to detect the tumor. A typical glioblastoma appears as an irregular tumor that often takes up contrast in a ring shaped pattern. It may also show central tissue death and surrounding brain edema. This edema is one reason for symptoms such as headaches, nausea, and focal deficits. MRI also helps show the exact location and spread of the tumor.
A final diagnosis can only be made through neuropathological examination. Tissue is examined under the microscope after surgical removal or biopsy. A biopsy may be used when surgery carries a high risk. The examination focuses on tumor cells, cell division, tissue death, and changes in blood vessels. Today, molecular markers are also almost always tested. These include IDH status and MGMT promoter methylation. They help classify the glioblastoma according to the current WHO classification. They also support prognosis and treatment planning.
Depending on the location and complexity of the tumor, further methods may be used. These include functional MRI or diffusion tensor imaging. They help identify areas for language and movement, as well as important nerve pathways, before surgery.
Glioblastoma Treatment and Prognosis
Glioblastoma treatment usually follows a multimodal concept. This means that different treatment approaches are combined. Surgery is often the first major step. If the tumor location and the patient’s neurological condition allow surgery, doctors try to remove as much tumor tissue as possible. At the same time, they aim to protect important functions such as speech, movement, and vision. Modern methods can support safe and extensive removal. These include neuronavigation, intraoperative monitoring, and in selected cases awake surgery. Because glioblastoma grows diffusely and infiltrates the brain, complete removal is not possible. Still, reducing the tumor mass can improve symptoms and create better conditions for radiotherapy.
After surgery, combined radiotherapy and chemotherapy usually follow. The tumor area is treated with targeted radiation over several weeks. At the same time and afterwards, a chemotherapy drug is given. It is intended to slow tumor cell division. In selected cases, tumor treating fields may also be used after radiochemotherapy. This method uses electrodes placed on the scalp. They generate weak alternating electric fields that are intended to disturb tumor cell division. Recurrences are common in glioblastoma. If the tumor returns, options may include renewed radiotherapy, different chemotherapy regimens, repeated use of tumor treating fields, or targeted therapies in selected cases. Despite intensive treatment options, glioblastoma remains a disease with an overall poor prognosis.
Alongside conventional medical treatment, supportive complementary medicine may also be used. Psycho oncological support, exercise therapy, and qigong are among the better studied supportive approaches. They may help with anxiety, stress, and subjective well being. Acupuncture may also be used as a supportive method for nausea, pain, fatigue, or sleep disorders.
Another supportive approach in holistic glioblastoma care is local hyperthermia. Targeted heating may affect tumor tissue and may make it more sensitive to radiotherapy or chemotherapy. Preclinical and clinical studies have also examined high dose intravenous antioxidants, such as vitamin C, for possible effects on cancer cells. Such effects have not been shown with oral intake, even at high doses, because absorption through the intestine is limited.
Another approach is the ketogenic diet. Glioblastoma cells strongly depend on glucose as an energy source. A high fat and low carbohydrate diet can lower blood sugar levels. This may potentially slow tumor growth. Resveratrol has also shown effects on glioblastoma cells in preclinical studies. In these studies, resveratrol enhanced the effect of chemotherapy. In combination with copper, it also reduced tumor aggressiveness.
The basis of therapy is therefore a combination of safe surgery, radiotherapy, chemotherapy, and, where appropriate, further specialized methods. Holistic approaches may help patients cope better with intensive treatment. They may also help relieve symptoms and improve quality of life.
Dr. med. Karsten Ostermann M.A.
In glioblastoma care, all available treatment options should be carefully evaluated and adapted to the individual situation. An integrative approach with interdisciplinary support can help optimize treatment goals and maintain quality of life.
Further information
The information listed contains relevant topics and serves to improve understanding.