Glioblastoma: The Well-Known Brain Cancer That’s Rare But Aggressive

Just hearing the words “brain cancer” or “glioblastoma” can be frightening. Although the diagnosis is serious, glioblastomas are rare despite their visibility in the news — particularly the cases involving late U.S. senators Ted Kennedy and John McCain. In fact, four out of five brain cancers are not glioblastomas.

What is glioblastoma?

Glioblastomas are the most common primary brain cancer, meaning they start in the brain rather than spreading from another part of the body (metastatic). They belong to a group of tumors called astrocytomas, which develop from star-shaped cells known as astrocytes. These tumors typically form in the cerebrum and grow quickly because they create their own blood supply.

All glioblastomas are classified as grade IV brain tumors — the most aggressive category. They contain abnormal cells, grow rapidly and often recur even after treatment.

To learn more about glioblastoma, we spoke with Edjah K. Nduom, MD, a neurosurgical oncologist and associate professor in the Department of Neurosurgery at Emory University School of Medicine. Dr. Nduom treats brain and spinal cord tumors. He leads the Brain Tumor Center at Winship Cancer Institute of Emory University. His research focuses on activating the immune system to fight malignant brain tumors.

Discussing treatment with a newly diagnosed patient is challenging due to the tumor’s aggressive nature. Dr. Nduom begins by reassuring patients that he is part of a dedicated team specializing in glioblastoma. Emory Winship's Brain Tumor Center has all the tools needed for advanced surgical care and for analyzing how the tumor may respond to radiation and chemotherapy.

After the tumor’s molecular features are identified, the patient meets with a multidisciplinary team that may include:

• Neurosurgeons
• Neuro-oncologists (specializing in medical treatments)
• Radiation oncologists

Palliative care specialists may also join the team. Dr. Nduom emphasizes that palliative care is not hospice. While hospice focuses on end-of-life comfort, palliative care can begin at diagnosis and helps manage symptoms like pain, nausea and fatigue.

“The most important thing I tell them,” he says, “is there’s something we can do to help. No matter what type of tumor they’re facing, there’s something we can do to make them more comfortable or slow down the lesion.”

The team may also include neuroplastic surgeons, rehabilitation oncologists and neuropsychologists. Neuroplastic surgeons help wounds heal after complex surgeries, including repeat procedures and surgeries on tissue that has been exposed to radiation. Rehabilitation oncologists help patients improve movement and daily function before and after brain tumor treatment. Neuropsychologists work to improve thinking and memory before and after brain surgery and help plan for procedures that require patients to be awake.

Clinical research: Looking ahead

Despite the challenges, ongoing research gives reason for hope. “At Emory Winship’s Brain Tumor Center, in my own laboratory and the labs of several collaborators, we are constantly finding new ways to approach these lesions and treat them better,” Dr. Nduom says.

Researchers are advancing new treatment options with immunotherapy and cellular therapies, targeted molecular agents and new radiation sensitizers. They are also developing strategies to help maintain brain function for vital abilities, such as memory and attention.

Patients may read that the average survival time is 15 to 18 months, but Dr. Nduom reminds them that a median means half of patients do better than that. Many of today’s treatments grew out of clinical trials that once offered only early promise. Some patients in those trials went on to benefit from breakthroughs that soon became standard care.

Dr. Nduom notes that patients with the best outlook often:

• Understand their neurologic status
• Participate in decisions about their care
• Have strong support systems
• Feel confident in their medical team

The multidisciplinary team at Emory Winship's Brain Tumor Center is designed to provide that support.