Question

Mrs. Frances presented to the emergency department following a grand mal seizure. Her family reports that she has never had a seizure before, but over the past several months, she has complained of multiple headaches and has become more irritable. She has a CT scan of her head, which showed a large brain tumor in her frontal lobe with multiple small tumors in other areas of her brain. There is concern that she may have a grade IV glioblastoma multiforme. A neurosurgeon is called who explains that to treat this condition she will need surgery, radiotherapy, and chemotherapy. He also explains that these tumors are difficult to treat and the median survival time is approximately 1 year. Explain why this type of tumor is so difficult to treat.

Answer 1

Over the past 60 years cancer pateints survival has gone from 25% to 62%.But not all cancers have seen this this increase and survival.Hard to treat cancers include lung,pancreatic, oseophageal and brain cancers.Brain cancers are different types which includes medulloblastoma,neuroblastoma,pineoblastoma and glioblastoma.Glioblastoma is the most common brain tumor and is associated with poor prognosis even with surgery,radiation and chemotherapy.Glioblastoma multiforme is a malignant,fast growing tumor of glial cells.It is considered to be infiltrative tumor of astrocytes classified as a grade IV astrocytoma.It is the most common type of the glial tumors.Glioblastoma multiforme is also a most common malignant primary brain tumor.Survival is generally less than 1 year after diagnosis.Glioblastoma can occur in any lobes of the brain.More commonly occurs in frontal temporal lobes. This tumor is present in the cerbral hemisphere also known as butterfly glioma.Due its ability to cross collosum in pattern resembeling a butterfly.Histologically this tumor is characterized by its alternating areas of necrosis and hemorrhage.Anaplastic tumor cells can be seen bothering an area of central necrosis known as pseudo palasading tumor cells.Since this tumor is derived from glial cells it stains positive for glial fibrillary acidic protein(GFAP)in immuno histochemical studies.

Standard care treatment for glioblastoma includes maximal safe resection of the tumor followed by concurrent radiation and chemotherapy..Radiation and chemotherapy are designed to target the infiltrative component of the glioblastoma.Glioblastoma are not surgically curable tumor cells can invade healthybrain tissue and can cause tumors to grow again even after treatment.The median survival time is 12 to 16 months.Only 10% patients can live upto 5 years.Research is going on in the department of neurooncology for the drugs which could be effective for glioblastoma treatment.