Glioblastoma Is the Best Known Brain Cancer, But It Is Rare

Just the words “brain cancer” and “glioblastoma” can strike fear into anyone’s heart. And it is very scary to receive such a diagnosis. But despite their high visibility because of the famous people who have had them—including the late U.S. senators Ted Kennedy and John McCain—glioblastomas are actually quite rare. In fact, 4 out of 5 brain cancers are not glioblastomas.

Still, glioblastomas are the most common primary cancer of the brain, meaning they originate in the brain rather than somewhere else in the body before migrating to the brain, such as breast or lung cancer. Glioblastoma is a type of astrocytoma, a cancer formed from star-shaped cells in the brain called astrocytes. They usually start in the cerebrum, the brain’s largest part, and are fast growing because they make their own blood supply. All glioblastomas are classified as grade IV brain tumors in that they contain the most abnormal-looking cells, are the most aggressive, and recur even after treatment.

We spoke about glioblastomas with an expert on understanding and treating glioblastoma. Neurosurgical oncologist Edjah K. Nduom, MD, associate professor in the Department of Neurosurgery at Emory University School of Medicine, specializes in the surgical management of brain and spinal cord tumors at the Brain Tumor Center, one of the longest-standing multidisciplinary clinics at Winship Cancer Institute of Emory University. His research focuses on modulating the immune system for the treatment of malignant brain tumors.

Are There Risk Factors for Glioblastoma?

Nduom says that when he talks to people who are faced with glioblastoma, or their families, their first questions usually are why they or their loved one got this cancer and whether they could have done something to prevent it. Outside of a very few rare circumstances, Nduom says that nothing we know of increases the risk for someone to have a glioblastoma. Those rare circumstances include getting radiation treatment for another type of brain tumor and very rare familial cancer syndromes. Even then, says Nduom, there is no suspected familial connection unless two or more primary relatives (parents, siblings or children) also have glioblastoma. Although glioblastoma can affect children and adults alike, they are far more likely to appear in those aged 60 to 85.

Despite the popular view that cell phone use is a risk for glioblastoma, Nduom says that, “so far, there’s no convincing evidence that would suggest increased cell phone usage, living near cell phone towers, using Bluetooth headsets or anything like that, would increase the risk of glioblastoma.” He says that the energy used to transmit cell phone waves and signals is not strong enough to create the kind of breaks in DNA that you see with treatment radiation, which is known to increase the risk of having brain tumors like glioblastoma.

Can Glioblastoma Be Prevented?

Because most brain tumors are not linked with any known risk factors and have no obvious cause, we can’t say for sure how to prevent them.

What Are the Symptoms of Glioblastoma?

• Intense headache that does not go away
• Headaches that are worse in the morning when you wake up, or worse when lying down or coughing
• Seizures
• Changes in vision, hearing, or speech
• Changes in personality, behavior, cognitive ability, or activity level
• Loss of balance and trouble walking
• Weakness or numbness in the arms or legs

Any of these symptoms could be early indications of the presence of tumorous growth in either the brain or spinal column.

How Is Glioblastoma Treated?

Nduom says it’s a difficult conversation to have with someone newly diagnosed with glioblastoma because of its difficult prognosis. His first step is to assure the patient that he is a neurosurgeon who focuses specifically on these types of tumors, and that he is part of a team who also are focused on finding better ways to treat these tumors safely. He sees his first job as getting the patient through the diagnosis period. “The good news,” he says, is that Winship has all the tools needed to provide the best surgical treatment of glioblastoma, and to determine the tumor’s level of susceptibility to radiation and chemotherapy.

After determining the tumor’s molecular characterization, the conversation shifts to prognosis and treatment. Armed with all the information gathered about the tumor, the next step is an appointment with the patient’s team, which includes neurosurgeons, to talk about recovery; neuro-oncologists, the doctors who treat brain tumors with medicine; and radiation oncologists, whose role is to focus on delivering safe and effective radiation to further control these lesions.

Nduom says that sometimes the multidisciplinary team will also include palliative care. He hastens to point out that palliative care should not be confused with hospice. Hospice is comfort care provided at the end stage of life, while palliative care is given anytime, as early as at the time of diagnosis, to help manage symptoms and side effects.  “Our palliative care specialists are doctors who are just focused on making sure that the patient is as comfortable as possible and having the best quality of life while they are facing a diagnosis of cancer.” This can mean providing pain control, controlling nausea and vomiting while on chemotherapy, and keeping up the patient’s energy levels while they are doing radiation.

“The most important thing that I tell them,” says Nduom, “is there’s something we can do to help. No matter what type of tumor they’re dealing with, no matter whether they’re facing some further health challenges, there’s something we can do to make them more comfortable, there’s something we can do to slow down the lesion.”

Looking Ahead

Despite the challenges presented by glioblastoma, Nduom says, “At Winship Cancer Institute, in my own laboratory and the laboratories of several of my collaborators, we are constantly coming up with new ways to approach these lesions and treat them better.” He is aware that patients facing glioblastoma are likely to have seen bad news about patients facing an average survival time of 15 months to a year and a half. “One thing I tell them is those studies were done on other patients,” he says. “Whenever you see a median survival, that means that unfortunately about half the patients did worse than that, but half the patients did better.”

Nduom says that if he is sitting with a patient to talk about enrolling them in a clinical trial, their prognosis already positions them for a potentially better outcome. He points out that looking at advances in cancer care and reductions in the cancer death rate, particularly over the last 20 years, “there was a period just like this for many cancers that we now consider treatable, where we didn’t have really great treatments right then that we could offer patients, but we had some clinical trials that were testing promising new treatments. Some patients got enrolled in those clinical trials, and then we saw some dramatic results. And then six months later, a year later, all of a sudden there’s a brand new standard of care for how we treat these patients.”

In Nduom’s experience, he says patients with the best prospects tend to be those who know what’s going on at any given time with their neurologic status, are involved in the decision-making process, have a support network who are informed and aware of everything that’s going on, and feel like they have a strong team around them—which he notes “our multidisciplinary clinic is designed to do.”

About Winship Cancer Institute of Emory University