Glioblastoma – Diagnosis and Treatment

Diagnosis

Doctors start by doing a neurological exam. This helps check brain functions like vision, hearing, balance, and coordination.

Problems such as weakness, numbness, or changes in reflexes may point to certain areas in the brain being affected, like the frontal lobe, temporal lobe, or brain stem.

Doctors use imaging tests to find and measure the tumor. They most commonly order a magnetic resonance imaging (MRI) scan, often with a special dye to make the tumor stand out.

Sometimes they also use computed tomography (CT) scans or positron emission tomography (PET scans). Other advanced tools, like magnetic resonance spectroscopy, can give extra details about the tumor’s makeup.

If doctors find a brain mass, they usually perform a biopsy by taking a small piece of the tumor to examine under a microscope.

The biopsy helps confirm if the tumor is a glioblastoma or another kind of astrocytoma or glioma.

A table can help organize key steps:

Step	Purpose
Neurological exam	Checks symptoms and brain function
Imaging tests (MRI, CT)	Finds tumor size, type, and location
Biopsy	Confirms tumor type and grade

These tests help doctors figure out the best way to treat the brain tumor, based on its type, size, and location.

Treatment

Surgical Removal of the Tumor

In many cases, a neurosurgeon tries to remove as much of the glioblastoma as possible. This can involve a procedure called a craniotomy, where a part of the skull is taken out to access the brain.

Removing the whole tumor is often difficult because glioblastoma multiforme (GBM) cells tend to mix with healthy brain tissue. Even so, taking out as much of the tumor as possible can help lower symptoms and provide tissue for diagnosis.

After surgery, people often need other therapies to target remaining cancer cells. Some people may not be able to have surgery if the tumor is deep in the brain or in a sensitive area that controls important bodily functions.

For those who can’t have the tumor surgically removed, doctors often recommend other treatments such as chemotherapy and radiation.

New surgical techniques, like laser interstitial thermal therapy (LITT), are sometimes considered for tumors that are hard to reach or if standard surgery is too risky.

High-Energy Radiation

Doctors use radiation therapy to target and kill cancer cells with high-energy beams, such as X-rays or proton beams. Usually, they start radiation soon after surgery to address any cancer cells left behind.

They schedule treatments over several weeks, with each session targeting the tumor area and sometimes the tissue around it.

For those who are unable to have surgery, doctors may give radiation therapy on its own or in combination with other treatments like chemotherapy.

In some cases, they use stereotactic radiosurgery, which focuses precise beams at the tumor. Doctors sometimes pair this type of therapy with chemotherapy for added effectiveness.

Use of Chemotherapy Drugs

Doctors use chemotherapy to fight cancer by giving strong medicines that kill cancer cells or stop them from growing. Temozolomide (Temodar), the most common chemotherapy drug for GBM, can be taken by mouth as a pill.

Doctors often use it along with radiation therapy and continue it after radiation is finished.

During some surgeries, doctors may place small wafer-like discs filled with chemotherapy drugs in the brain. These wafers dissolve over time, releasing medicine directly to the tumor site.

If GBM returns, doctors may try additional drugs such as lomustine or procarbazine (Matulane). The care team manages side effects like tiredness, nausea, and low blood counts.

Electric Field Therapy

Tumor treating fields therapy (TTF) uses special pads placed on the scalp that generate low-intensity electrical fields. These fields can interfere with the division of GBM cells, slowing their growth.

The sticky pads connect to a portable device that needs to be worn for most of the day. Patients might need to shave their heads to allow the pads to stick properly.

Doctors often combine TTF with chemotherapy, especially after radiation is complete. This therapy is considered safe and does not cause pain, though some people may have mild skin irritation beneath the pads.

Targeted Drug Approaches

Doctors use targeted therapy medicines that attack specific features found in glioblastoma cells. These medicines aim at proteins or genetic changes that help cancer cells survive and grow.

Before starting targeted therapy, doctors may test the tumor to see if it has certain markers or mutations. Doctors sometimes give bevacizumab, a targeted drug, to people with recurring GBM.

Researchers are studying other drugs that may block different pathways in the tumor. Targeted therapies may help slow tumor growth or shrink the tumor, but their benefits depend on the traits of the individual cancer.

Access to Experimental Treatments

Doctors may offer clinical trials that test new therapies and treatment combinations. Some trials explore advanced options like immunotherapy, gene therapy, or new targeted medicines.

People with GBM may be able to join a clinical trial, especially if standard treatments are not effective or if the tumor returns.

Before joining a trial, participants receive information about possible risks and unknown side effects. Speaking with a healthcare team can help determine if a clinical trial is a good choice.

Therapies to Manage Symptoms

Living with glioblastoma can cause a range of symptoms depending on the tumor’s size and location. Doctors often give medicines to control these problems and improve comfort.

Common symptom-relief treatments include:

• Steroids to reduce swelling in the brain.
• Anti-seizure drugs if the tumor causes seizures.
• Pain medications for headaches or other discomfort.

Doctors may also use physical, occupational, or speech therapy to help with movement, speech, or daily activities.

Comfort and Quality of Life Care

Palliative care focuses on helping those with a serious illness feel as comfortable as possible. The goal is to improve quality of life for the person with GBM and their loved ones.

This care can be provided during any stage of treatment and is not limited to end-of-life care.

Palliative care teams may include doctors, nurses, and other experts skilled in managing pain, symptoms, and stress. These specialists work with the patient and the regular medical team to offer extra support.

Other Approaches to Treatment

Alternative medicine does not cure glioblastoma, but some approaches can work alongside standard treatments to help manage symptoms.

Many people use these methods to cope with stress and improve their emotional well-being. They may also make it easier to handle the side effects of cancer treatment.

Some supportive options include:

• Art therapy
• Exercise
• Massage therapy
• Meditation
• Music therapy
• Relaxation exercises
• Spiritual practices

People interested in these options should speak with their healthcare team. The team can provide advice and help decide which therapies might be helpful.

Coping and support

Get Informed to Take Part in Care Choices

Asking doctors about test results, possible treatments, and the likely outcomes lets patients and their families make choices with more confidence.

Organizations such as the American Brain Tumor Association can also provide clear guides and updates.

Stay Connected With Loved Ones

Close relationships bring both practical and emotional support. Family and friends can help with daily activities, organize rides to appointments, and give encouragement during hard times.

Having people around may lower feelings of loneliness and worry.

Ways to keep ties strong:

• Ask for help with housework or meals when needed.
• Share your feelings openly with those you trust.
• Set regular times to connect, even if just by phone or video.

Reach Out for Someone to Listen

Talking about hopes, concerns, and daily struggles is important. This can be with a friend, a family member, or a trained professional. Joining a support group gives people a chance to share experiences and learn from others.

Healthcare teams, the National Cancer Institute, and the American Brain Tumor Association can help find counseling or support groups nearby.

Getting Ready for Your Visit

Steps to Take Before Your Appointment

Getting organized before meeting with a healthcare professional can make the visit go more smoothly and help patients get the answers they need.

• Check for Special Instructions: When setting up the appointment, ask if there are any rules to follow, such as fasting or stopping certain medicines before any tests.
• Make a List of Symptoms: Write down all noticeable changes, such as headaches, trouble with memory, or changes in movement, even if they do not seem important.
• Gather Personal Information: Include stressful life events or big changes that could be relevant to health.
• List Current Medicines: Note any medications, vitamins, and supplements, along with how much is taken each time.
• Bring a Support Person: It can be useful to have someone along who can take notes and help remember the information discussed.
• Prepare Questions: Write down any questions for the healthcare team. Start with the most important questions first.

Common Questions Might Include:

Question	Purpose
Where is the tumor located in the brain?	To understand the tumor site.
Has it spread to other body parts?	To know the stage of the illness.
Will more tests be needed?	To prepare for further evaluations.
What treatment choices are available?	To discuss possible plans.
What are the side effects for each treatment?	To weigh the risks and benefits.
How will this affect my daily activities?	To plan for needed support.
Is there a recommended treatment?	To learn about expert opinions.
Should a specialist be seen?	To discuss advanced care options.
Are there printed resources or helpful websites?	To find more information.
What will determine my need for follow-up visits?	To understand ongoing care.

It is a good idea to arrange these questions by importance. This way, if time runs short, the most pressing concerns are covered.

How to Prepare for Your Doctor’s Questions

A healthcare provider asks many questions about symptoms and medical history to better understand the condition.

If you prepare clear answers, the medical team can decide on the best tests, such as neurological exams or brain scans.

Some topics the doctor may ask about include:

• When did the symptoms start?
• Do the symptoms happen all the time or only sometimes?
• How strong or serious are the symptoms?
• Are there actions or medicines that help improve the symptoms?
• What makes the symptoms worse?

The healthcare team also wants details about any past neurological exams or problems with the brain and nerves.

If you provide honest and clear answers, the doctor can make an accurate diagnosis and guide the next steps, such as ordering imaging or referring you to a neurologist, oncologist, or neurosurgeon.

Having information ready makes the visit more productive and less stressful for everyone involved.