Glioblastom: definitie, simptome, cauze, diagnostic, tratament - PlusMedical

Glioblastoma is the most common and aggressive form of malignant brain tumor in adults, but it can also occur in children. According to the National Cancer Institute, nearly 23,000 people were diagnosed in 2015 with different types of brain cancer. Regarding the incidence of glioblastoma, it affects 2-3 people per 100,000 each year and accounts for 52% of all types of brain cancer.

Glioblastoma, also called glioblastoma multiform, is born from glial cells of the brain and can be of two types: primary glioblastoma (de novo - the most frequent and aggressive brain malignancy) or secondary glioblastoma (is less commonly encountered and has a slower evolution) ).

Depending on the symptoms, the type of glioblastoma found and the patient's health, the treatment consists of surgical removal of the tumor, radiotherapy, chemotherapy, immunotherapy or therapies that are still in the experimental phase, but which offer promising results.

The manifestations of glioblastoma are severe and appear suddenly, as a result of the rapid development of cancer cells in the brain. However, the symptoms may be different depending on the location and size of the tumor. Among the most common signs of glioblastoma are:

  • Severe headaches (caused by increased intracranial pressure)
  • Nausea and vomiting
  • Muscle weakness
  • Balance and memory disorders
  • confusion
  • hemiparesis
  • Increased irritability
  • Urinary incontinence
  • Epilepsy seizures
  • Vision problems (fog view, double view)
  • Speech disorders (aphasia, dysarthria, anomie, etc.)
  • Lack of appetite
  • tremor
  • Dizziness
  • vertigo
  • insomnia

All of these symptoms can be caused by other conditions and do not necessarily indicate the presence of a brain tumor.

The cause of glioblastoma is not currently known, but experts suspect that genetic abnormalities may play a role. They also draw attention to factors that may favor the risk of this form of brain cancer, such as:

  • Age - glioblastoma mainly occurs in people between 45 and 65 years of age. However, there are cases among children.
  • Exposure to toxic substances or ionizing radiation - including radiation therapy may increase the risk of glioblastoma.
  • Family history of brain cancer - although there is insufficient evidence to this effect, the risk of transmission of certain genes that favor the occurrence of glioblastoma may be higher among those who have had such cases in the family.

If the family doctor suspects that there is a brain tumor, it is most likely to refer the patient to a neurologist. Depending on the results obtained after the neurological examination (verification of hearing, sight, balance, coordination, reflexes and symptoms), the doctor may recommend a series of tests. These include:

  • MRI (magnetic resonance imaging) brain with contrast substance
  • CT with contrast substance (CT scan)
  • PET / CT (positron emission computed tomography)
  • Brain biopsy - involves harvesting a tumor fragment, using a special needle
  • The diagnosis of certainty is established only on the basis of the anatomopathological and immunohistochemical examination performed on the tumor fragment harvested by biopsy.

Depending on the type, location and extent of the tumor, the neurologist will evaluate the prognosis, as well as the optimal treatment method.

The median survival rate for people with glioblastoma is 15 months, if the treatment recommended by the doctor is observed. The median rate means that almost half of the patients die within this range, but each individual is different and there have been cases of survival even 5 years after diagnosis, even though they are rarely encountered.

The prognosis of glioblastoma depends a lot on the age of the patient (the glioblastoma diagnosed earlier than the age of 50 has a better response rate to the treatment, and therefore the patients survive longer), but also on its genetic characteristics. For example, the methylation status of the MGMT enzyme may influence the body's response to cytostatic treatment. When the gene responsible for MGMT production is inactivated, the malignant cells become sensitive to cytostatic action. This mutation is present in 20-25% of glioblastoma cases and is a favorable prognostic factor.

The treatment of glioblastoma depends on the type, size, degree and location of the tumor, as well as on the age, general health and patient's choice.
The main treatment method is surgical resection of the tumor, followed by radio- and chemotherapy, as well as drugs that reduce intracranial pressure or prevent epileptic seizures and associated symptoms.

In some cases, the tumor is small in size and compact, so it can be easily removed and without side effects. Sometimes, however, the surrounding tissues are affected, and the doctors find it much more difficult to remove the entire tumor mass, and the operation is risky, because the malignant cells are located in sensitive areas of the brain and the patient may remain with severe sequelae (it seems, hearing loss, of vision or ability to speak) or may even die during the intervention.

As with any surgery, there may be a risk of infection or bleeding.

It should be remembered, however, that surgery is the only method by which glioblastoma symptoms can be relieved. Currently, brain operations are performed while the patient is awake and aware, the technology is advancing enormously and offering new high-precision surgery methods with minimal risks.

Due to its infiltrating nature, doctors cannot perform complete ablation, but it is possible to remove the solid and compact portion. In other words, the smaller the tumor tissue, the greater the chances of survival, but only if the tumor is removed by at least 90%.

In order to eliminate these tumor residues, radiation therapy is continued, which lasts, on average, 6 weeks (5 sessions per week). The adverse effects of radiation therapy differ depending on the dose and type of irradiation and consist of: headaches, fatigue, irritation of the scalp, hair loss, dizziness.

Because radiation therapy can cause cerebral edema, concomitant administration of certain drugs that have the active substance dexamethasone or methylprednisolone is recommended.

Oral or intravenous chemotherapy with cytostatics should be performed concurrently with radiotherapy and then for another 3 months, in 3-day treatments each month. The most common cytostatic side effects include symptoms such as nausea, vomiting, headaches, hair loss, fever and muscle weakness, but these can be controlled with the help of specific medications.

Unfortunately, the risk of recurrence is quite high, so scientists are constantly looking for new therapy methods, currently included in clinical trials to which the patient can enroll, after a discussion with the attending physician. These experimental treatments for glioblastoma are immunotherapy, stem cell therapy, targeted therapy or personalized therapy. Although the results are promising, these therapies do not offer very high efficacy, with an extension of life expectancy of only 3 months in excess of the median rate in the case of standard treatment.

Glial tumors are divided into astrocytomas (derived from astrocytes, the most numerous glial cells and the most frequent tumors) and oligodendroglio (derived from oligodendrocytes, a less numerous subtype of glial cells).

From the point of view of aggression, there are four degrees:

  • Grad I – tumorile benigne – astrocitomul pilocitic. Apare in special la copii si are un prognostic foarte bun.
  • Grade II - benign tumors, but with potential for malignancy - fibrillar and gemistocytic astrocytoma, oligodendroglioma, pleomorphic xantoastrocytoma. They are tumors that infiltrate normal brain tissue and, over time, develop into malignant tumors
  • Grade III - anaplastic astrocytoma and anaplastic oligodendroglioma. They are malignant tumors, but not as aggressive as glioblastoma
  • Grade IV - glioblastoma - malignant tumor, the most aggressive form of adult brain tumor.

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Medipol University Hospital is the Turkey’s largest private health investment as a university hospital incorporating General, Cardiovascular Surgery, Oncology and Dental hospitals, Medipol University Hospital attracts attention with its modern architecture intelligent building technology and advanced medical equipment and bears the distinction of being one of Turkey’s best hospitals with a new generation of technology. Medipol University Hospital, is a new reference center in the health sector in both national and international arenas. Medipol University Hospital, being the justifiably proud of Medipol Education and Health Group in Turkey and in the world, resulting in this spirit, is a health complex having JCI standards accepting patients from all over the world. Medipol University Hospital takes firm steps forward with the big investments and advances in preventive / curative health services to improve the community’s quality of life. Medipol University Hospital has capacity of 470 beds 133-bed Intensive Care Units (General, Coronary, CVC, Neonatal Intensive Care) all serving with an infrastructure equipped with intelligent systems and technology. Medipol University Hospital , having the highest number of departments within the hospitals in Turkey, presents patient-centered superior service approach. The hospital is also is configured with a new generation of technology being capable of performing simultaneous operations in 25 operating rooms. Away from the usual hospita architecture, Medipol University Hospital is a complex which may become an example in the world with its “Healing Hospital Architecture” and original scape in order to make patients and their relatives feel better. Medipol University Hospital has 15 acres of gardens, 26 thousand square meters of 5 storey under ground car park, 100 thousand square meters of indoor area and 1,500 people of employment capacity. Holding the comfort and convenience of the patients at the forefront, Medipol University Hospital host patients and their relatives in the comfort of home environment. There are totally 470 beds involving spacious and modern physical areas, terrace garden suites, suites and normal rooms. Patients can benefit from multimedia services (TV, DVD, internet) in rooms equipped with LCD screen . In addition to the any kind of comfort of modern life that the patient and their relatives may need, a high – quality meal service is also supplied.

Acibadem Healthcare Group, Turkey's first-ever healthcare institution, has been providing quality medical services since 1991 with state-of-the-art technology. 

Acibadem has nearly 12,000 employees, of whom 2,200 are physicians, in various locations in the network of 22 general hospitals, 19 medical centers and central laboratories. 

It is an internationally accredited health care group located in the central part of Turkey, with preponderance in the beautiful city of Istanbul. 

Acibadem, which, through its current investments, is continuously expanding its health care institutions, has reached a total of 85 operating rooms and a capacity of 2,200 hospital beds in 400,000 square meters.

Spitalul Acibadem Altunizade

An institution that fueled dozens of worthwhile projects in Turkey, Anadolu Foundation made another dream real by founding Anadolu Medical Center. Relying on the valuable heritage of Anatolia that boasts of thousands of years of medical knowledge and was home to many valuable people of medicine, our hospital uses this knowledge to contribute to human health. Working in strategic cooperation with Johns Hopkins Medicine for the improvement of education and quality, our hospital provides services in all branches including in particular, oncologic sciences, cardiovascular health, gynecology and IVF, neurological sciences, surgical sciences, internal medicine, diagnosis and imaging. Established on an area of 188.000 square meters and an indoor area of 50 thousand square meters with a capacity of 201 beds, our hospital provides services with JCI (Joint Commission International) accreditation, ESMO (European Society for Medical Oncology), ISO (18001, 14001 and 9001) certifications. Anadolu Medical Center continues to provide healthcare services also at Ataşehir with its Outpatient Clinic. Procedural archives of patients who receive services at the Outpatient Clinic are kept in the virtual environment. Having started to render service in June 2010 within the structure of the hospital, the Bone Marrow Transplantation Center performs bone marrow transplants for 22 patients at the same time. Our patients are always the number one priority at our hospital. For this reason, we give value to the needs and expectations of our patients, and make every effort to ensure that they have a peaceful treatment process and feel at home.

Anadolu Medical Center

Hisar Hospital Intercontinental based in İstanbul, is one of the nation’s largest and most comprehensive private hospitals, with offers highest quality diagnosis and treatment in the most comfortable, safe and patient oriented environments, employing the latest and best medical technologies.

The Hospital was founded on closed area of 35,000 square meters and it offers services in Ümraniye, İstanbul. That is only 20 minutes to Sabiha Gökçen International Airport, 5 minutes to Bosphorus and at the joint of the continents, Asia and Europe. It’s aimed to supply the patient satisfaction at the highest level with its diagnosis and treatment units using advanced medical technology. With 170 patient bed capacity and 7 operating rooms where all kinds of specialized operations including Cardiovascular Surgery can be carried out and a total of 36 Intensive Care beds that can provide special care to each patient in single rooms. 

Since 1992, Medicana Health Group sustains its progression on the way to determine the standards of future healthcare services. Today, Medicana Health Group, which carries on its activities especially in Istanbul and Ankara, constantly provides the most advanced healthcare services in all aspects of health in Konya, Samsun, Sivas and Bursa through its 13 hospitals and 6500 employees on average. Medicana Health Group not only pioneered the development of health tourism in our country, it also became one of the important centers in treatment of international patients in multidisciplinary healthcare. In order to provide sustainable healthcare services, many offices have been established at important locations of the world.

Israel's Herzliya Medical Center (HMC) is a state-of-the-art medical institution offering a wide range of medical services to all international peacekeeping organizations in Israel: UNDOF, UN, UNIFIL, UNTSO & MFO. 

Herzliya Medical Center cooperates with organizations in the U.S. and other organizations worldwide since 1984. The latter have chosen to cooperate with the Herzliya Medical Center for the latest generation of medical services including: state-of-the-art diagnostic facilities, modern laboratories, advanced imaging institutes, reputable physicians and highly trained surgeons , exclusive hospitalization standards, first class rehabilitation services. 

Since 1999, U.N. and UNDOF chose the private hospital at Herzliya Medical Center (HMC), Israel's first healthcare provider. The assessment includes the level of medical assistance provided, physician qualifications, operating room standards, and intensive care unit. Herzliya Medical Center is located in Herzliya, an attractive seaside town with a stunning beach. The convenient location of the hospital allows employees in U.N. to arrive in southern and northern Israel in a few hours.

Centrul Medical Herzliya Israel

A symbol of excellence in medicine, Liv Hospital Istanbul combines the quality of care services with the high level of training of the team experienced by specialists, surgeons and nurses.
The center has the most advanced methods of diagnosis and treatment, using the latest equipment and technology.

Wiener Privatklinik, the largest private hospital in Vienna, dating back to 1871, set the goal of providing patients with first-class medical expertise and an individualized care center for patients – all delivered in a sophisticated ambience. Due to the proximity of the University Hospital, WPK is the seat of the most renowned medical experts who teach and practice at the University Clinics. This guarantees our patients evidence-based services, state-of-the-art technology and personalized care. The hospital has 145 beds, an operator block with 4 operating rooms, advanced imaging services (the only private hospital in Vienna with PET CT and nuclear medicine), physiotherapy and medical recovery at international standards. The medical team consists of over 250 reputable Viennese experts who apply an interdisciplinary approach to each case.

wiener privatklinik 2

Assuta is Israel’s largest and leading private medical services center, comprising eleven clinics and hospitals across Israel and providing innovative surgeries and diagnostic procedures in all fields of medicine, including cardiology, oncology, gynecology, urology and more. Assuta Hospital in Tel-Aviv was established in 1934, and over the past 70 years has become renowned as the most advanced hospital in the Middle East. Assuta specialists and surgeons undergo a thorough selection process, which means at Assuta you can expect the highest medical and professional standards. Assuta employs the latest cutting-edge technologies both from Israel and abroad. Our senior physicians possess solid experience in the implementation of modern technologies and techniques, so you have a choice of the most advanced treatment that is suitable for you. The use of modern technologies, devices and prosthetic materials minimizes both the duration of the surgery and the recovery period, adding further to the patient’s quality of life.
Spitalul Assuta din Tel-Aviv a fost infiintat in 1934, iar in ultimii 70 de ani a devenit renumit ca fiind cel mai avansat spital din Orientul Mijlociu.

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