About Glioblastoma

So what is a glioblastoma? Most of us aren't familiar with it and don't have it stuck in our brains, unlike Steve. We have been searching the internet and asking questions since November 18th when a spot was found on Steve's CT scan. Here is some of what we have discovered:

Glioblastomas are also called glioblastoma multiforme or GBM or anaplastic (which means malignant) astrocytomas grade IV. In Steve's case there is no known cause and it is not hereditary (there are some rare exceptions which do not apply to Steve).  More men are affected than women, usually ages 45-55. Only 1% of the population gets malignant brain tumors.  High exposure to ionizing radiation increases the risk, but we don't believe Steve had much exposure. Research about cell phones has been been looking at a link with a different type of tumor (schwannoma), and the phones don't give off ionizing radiation.

Symptoms vary depending on the location of the tumors and usually include headaches, nausea and vomiting and drowsiness. Personality changes are expected. Steve's tumor is near the language center of the brain in the left temporal lobe but the swelling has spread into all the spaces on the left side and has pushed the brain over to the right so that the center line of the brain has shifted.

From the American Cancer Society:
tumors of the central nervous system (CNS) differ in some important ways from cancers in other parts of the body. The most deadly aspect of other cancers is their ability to spread throughout the body. Tumors starting in the brain or spinal cord can spread to other parts of the CNS, but they almost never spread to other organs. The most dangerous aspect of these tumors is that they can interfere with essential functions of the brain.  
In most cases, the first step in brain tumor treatment is for the neurosurgeon to remove as much of the tumor as is safe without affecting normal brain function. Tumors that tend to spread diffusely into nearby brain tissue such as anaplastic astrocytomas or glioblastomas are not cured by surgery. But surgery can reduce the amount of tumor that needs to be treated by radiation or chemotherapy, which can help these treatments work better. This may help prolong life even if all of the tumor can't be removed.


Did you know there is an American Brain Tumor Association? Who would have thought? They have a great, informative website. Some things from them: 
Generally, the first step in the treatment of these tumors is surgery. With today’s modern techniques,

surgery is generally safe for most patients. The goals of surgery are to obtain tumor tissue for diagnosis and treatment planning; to remove as much tumor as possible; and to reduce the symptoms

caused by the presence of the tumor.

A snippet from the UCLA glioblastoma site:



From Wikipedia:

World Health Organization (WHO) grading system is commonly used for astrocytoma. Established in 1993 in an effort to eliminate confusion regarding diagnoses, the WHO system established a four-tiered histologic grading guideline for astrocytomas that assigns a grade from 1 to 4, with 1 being the least aggressive and 4 being the most aggressive.

Glioblastoma multiforme is the deadliest and most common form of malignant brain tumor. Even when aggressive multimodality therapy consisting of radiotherapy, chemotherapy, and surgical excision is used, median survival is only 12–17 months. Standard therapy for glioblastoma multiforme consists of maximal surgical resection of the tumor, followed by radiotherapy between two and four weeks after the surgical procedure to remove the cancer. This is followed by chemotherapy. Most patients with glioblastoma take a corticosteroid, typically dexamethasone, during their illness to palliate symptoms.

Surgery is the first stage of treatment of glioblastoma. An average GBM tumor contains 10¹¹ cells, which is on average reduced to 10⁹ cells after surgery (a reduction of 99%). It is used to take a section for a pathological diagnosis, to remove some of the symptoms of a large mass pressing against the brain, to remove disease before secondary resistance to radiotherapy and chemotherapy, and to prolong survival.

The greater the extent of tumor removal, the better. Removal of 98% or more of the tumor has been associated with a significantly longer healthier time than if less than 98% of the tumor is removed.^[27] The chances of near-complete initial removal of the tumor can be greatly increased if the surgery is guided by a fluorescent dye known as 5-aminolevulinic acid.^[28] GBM cells are widely infiltrative through the brain at diagnosis, and so despite a "total resection" of all obvious tumor, most people with GBM later develop recurrent tumors either near the original site or at more distant "satellite lesions" within the brain. Other modalities, including radiation, are used after surgery in an effort to suppress and slow recurrent disease.

The median survival time from the time of diagnosis without any treatment is 3 months, but with treatment survival of 1–2 years is common. Increasing age (> 60 years of age) carries a worse prognostic risk. Death is usually due to cerebral edema or increased intracranial pressure.^[50]

I copied the parts I found most relevant for Steve and did you notice the repeated reference to removing the tumor? Did you see the part about only living 3 months without treatment as the median? That means half don't even make it 3 months! About dying from swelling (edema) and pressure? How can that feel? While gradually losing your ability to manage anything because your brain is dying in pieces EVERY DAY. 

We have known about Steve's tumor since November 18th, for 3 1/2 weeks. The only treatment he has had was to start the dexamethasone about November 30 to control swelling before the biopsy and  Dr. Sanchez had him diminish the dose after surgery. Is it effective? I know he is still having headaches. He hasn't had any follow up scans since the biopsy so what size is the tumor and surrounding area of swelling?