While giving a patient a diagnosis of glioblastoma – the most aggressive of brain tumors – is difficult, Dr. Milan Chheda remains hopeful that research leading to a better understanding of this deadly and complex cancer is slowly improving chances of survival.
“Even though it is a terrible diagnosis, the bar is slowly changing and patients, on average, are doing better than they were 15 years ago,” says Chheda, a neuro-oncologist in the Department of Medicine at Washington University Medical School in St. Louis.
What exactly is glioblastoma? It is described as aggressive – meaning the tumor grows and divides uncontrolled in the brain — with nowhere to go but to push on and invade previously healthy parts of the delicate organ. It is difficult to treat, according to Chheda, because while cells can be removed during surgery, the remaining cells continue to multiply and spread in the brain. “It is just not possible to get every cell out,” says the clinician and researcher. This type of brain tumor starts in the brain and remains in the brain.
The surgery itself has risks because these tumors are adjacent to and invade the normal brain, including regions that control language, thinking, reading, speech and movement.
Treatment usually consists of surgery followed by radiation and chemotherapy. Chheda calls this a “one, two punch” to kill dividing cells. Unfortunately, a subpopulation of cells are resistant to treatment and continue to reproduce and spread. Finding out what drives these cells and how to kill them is an active area of research.
The current prognosis or outcome for this invasive type of brain tumor is not good. After diagnosis and treatment, the cancer recurs within about six months and most people die within two years, according to Chheda. Some of the symptoms include constant headaches, vomiting, seizures, personality changes, memory loss, double vision and difficulty speaking. Currently, about 10,000 cases of glioblastoma are diagnosed each year in the United States.
While it is difficult to generalize glioblastoma – because different patients respond differently to treatment – younger people tend to live longer and men are diagnosed more often than women. It is most common in adults ages 45 to 65 and at this time, cannot be prevented. While research into environmental causes have been studied, no definitive link has been discovered.
“As a clinician it is extremely challenging and frustrating,” Chheda says. There have been few breakthroughs since temozolomide chemotherapy became standard nearly twenty years ago, but there are reasons for hope. One recent promising approved therapy is a device that delivers low-level electrical fields to the tumor. In addition, there are a number of promising therapies under clinical study right now. “But we only continue to advance with publicly-funded research to understand the basic mechanisms of cancer. We need continued support,” says Chheda.
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