One of the most aggressive and most common malignant tumors of the brain is glioblastoma. Glioblastoma is diagnosed in half the cases of detection of primary tumors and in every fifth case of intracranial tumors. Without metastases, it still remains at the leading positions among the most dangerous and aggressive tumors. Despite treatment - the prognosis for patients remains unfavorable.
Brain tumor of 4th degree( glioblastoma)
Tumor neoplasm of glioblastoma arises as a result of abnormal reproduction of astrocytes - stellate glial cells.
Glioblastoma is characterized by a chaotic accumulation of tumor cells with polymorphic nuclei, interspersed with areas of proliferative vessels and foci of necrotic lesions.
This type of tumor is very dangerous due to overly active growth and the absence of a clear boundary between healthy and diseased tissues.
Causes of the disease
The exact causes of uncontrolled multiplication of glial cells and, as a consequence, glioblastoma growth, have not been revealed to date.
Risk groups:
- men of mature age
According to statistics, men from 40 to 60 years suffer from glioblastoma more often than at another age. In women, this disease is also less common. - astrocytomas presence
About 10% of the pilocitic and fibillar astrocytomas diagnosed in the early stages, which in themselves are not highly malignant, degenerate into glioblastomas. - neurofibromatosis
Neurofibromatosis disease increases the risk of developing glioblastoma due to genetic defects caused by it. - exposure to polyvinylchloride
chemicals, especially for polyvinyl chloride, have a negative effect on glial cells. The same negative impact has long-lasting ionizing radiation. - viral diseases
- hereditary predisposition of
- getting already infected antibodies in the cerebral cortex during natural blood flow.
Classification of tumors
Glyoblastomas are primarily classified according to the histological criterion .
A sample of the tissue is diagnosed with one of the tumor subspecies:
- Giant cell glioblastoma
The sample taken will be satiated with abnormally large cells, the nuclei of which will be polymorphic and easily distinguishable under a microscope. - Glioblastoma multiforme
In the case of multiform glioblastoma, the preparation will consist not only of malignant cells that are randomly arranged and do not have the same regular shape, but also from areas of proliferation of blood vessels. Also under the microscope, focal necrotic lesions will be discernible. This subspecies of the tumor is the most dangerous and malignant and belongs to the 4th degree. - Gliosarcoma
This subspecies of glioblastoma is characterized by bidermalnosti - mixing glial cells and cells of connective tissue( mesenchymal).
Neurosurgeon doctor on the problem of brain tumors:
Symptoms and Diagnosis
Symptomatic of glioblastoma of the brainstem is quite extensive.
Even at the earliest stage, if the tumor is located in close proximity to the brain centers responsible for speech or movement, fainting, sudden speech disorders, uncontrolled disruptions in coordination of movements may occur.
With such complaints, the tumor can be diagnosed at the earliest stages.
In addition, the alarming signs may be:
- persistent headaches that can not be removed with analgesics;
- vomiting in the morning after waking up;
- hallucination of smell( smell substitution);
- reduced visual acuity or memory.
Some localization of small tumors does not give such signs at all, since it does not exert pressure on the brain and active centers. In this case, only an accidental examination can detect a disease.
Diagnosis of glioblastoma is associated with the following procedures:
- MRI( magnetic resonance imaging) of the brain or computed tomography( CT) with contrasting - to assess the location of the tumor and its size;
- Biopsy( removal of a part of the tumor to determine its type and subspecies);
- Positron emission tomography( PET) can detect relapse of the disease.
In the picture the brain of a patient with glioblastoma:
Methods of treatment of a tumor
All methods of treatment of brain cancer are aimed at either removing the primary tumor or reducing its activity, since this type of malignant tumor does not give metastasis at all.
The entire course of treatment is divided into three stages:
- Neurosurgical intervention. Combination of radiation and chemotherapy.
- Supportive chemotherapy.
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Neurosurgical intervention: complete tumor removal by operative route
The longest life expectancy of patients is achieved if there is the possibility of complete removal of the primary tumor, since further complex effects on glioblastoma produce a noticeable result only after neurosurgical intervention.
Most recently, even the most experienced neurosurgeons could not perform the removal of glioblastoma qualitatively due to its ingrowth into the brain tissue and entanglement of important centers of the patient's vital activity. It was necessary to leave the tumor particles and terminate the operation without achieving the set goals.
Now, during neurosurgical operations to remove malignant tumors, a special substance is used - 5-aminolevulinic acid, which, under the influence of blue light, causes the malignant cells to glow in a special way.
Thus, during surgery, the surgeon can clearly see the boundary between healthy and diseased cells. The use of this method allows you to remove even those tumors that were previously considered completely inoperable.
Combined treatment: radiotherapy in combination with the preparation Temodal
After the operative intervention, the patient undergoes radiation therapy.
The stage is quite long - to achieve the optimal result it is necessary to subject the patient to a 6-week therapy( 5 times a week for 2 g / day).
Thus, the total dose of rays will be about 60 grays. This dose is considered optimally acceptable, as it effectively affects malignant cells, and does not cause unpleasant complications in the patient's body.
Simultaneously with the rays, the patient takes Temodal daily for the entire course of irradiation, a special antitumor drug.
Supportive chemotherapy: preparation Temodal
Repeated antitumor drug Temodal is prescribed not less than 4 weeks after the completion of the second stage of treatment. This stage of treatment is also quite long, since the drug is taken by courses lasting five days, between which there should be a break of 23 days. Usually 6 such courses are appointed.
Targeted Therapy: Avastin
Avastin is the newest drug that has a destructive effect on the tumor. Under its influence, destruction of tumor vessels occurs, and glial cells lose their ability to reproduce.
Avastin is currently not available for the treatment of primary tumors, since its ability to kill affected glial cells has only been confirmed. But this drug has already proved effective in the treatment of relapses.
Consequences and prognosis of
Unfortunately, due to the special glioblastoma malignancy, the prognosis for survival in patients who have even undergone treatment is extremely unfavorable. An important role here is played by the time of establishing a primary tumor of the brain.
The extremely dangerous form of the tumor - multiform glioblastoma - does not give patients a chance to live more than 40 weeks, even with a successful course of treatment.
There are almost no cases of a patient experiencing a five-year period after diagnosis.
An extremely low survival rate is associated with the following consequences of treatment with glioblastoma:
- , more than 80% of patients suffer relapse even if the primary tumor treatment is successful;
- because of the localization of the tumor in a particularly important place in the human body and the inability of private surgery, glioblastoma is actively expanding, exerting a life-threatening effect on the centers responsible for respiration and circulation;
- in most cases, the inability to completely remove the tumor leads to the appearance of neurological disorders up to complete paralysis of the patient's body.
The development of world medicine, including oncology and neurosurgery, does not stand still. After all, even the complete removal of glioblastoma was not considered to be practically impossible for a long time. It is possible that in the very near future with the help of drugs oncologists and neurosurgeons will be able to achieve a significant increase in the life span of patients with glioblastoma.
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