Glioblastoma: complex medical issues in simple words
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Glioblastoma is a malignant neoplasm arising from brain cells. This diagnosis sounds threatening due to a number of reasons. First of all, even benign intracranial tumors have certain risk regarding the life and neurological status. Another thing is that the neoplasm grows fast and invades surrounding tissue. The World Health Organization determines this type of cancer as the grade IV one, with the highest degree of malignancy. Early beginning of therapy and use of the latest medical and technical developments give a chance to overcome this aggressive disease. Curing glioblastoma is a common aim of scientists and doctors in all countries worldwide.
Content
- Why and how does glioblastoma arise?
- How does glioblastoma influence one`s general state?
- How can glioblastoma be revealed?
- What kind of therapy is the most effective?
- Where is it better to treat glioblastoma?
Why and how does glioblastoma arise?
Cells of gray matter of the brain, or neurons, are highly specialized cells that can`t reproduce. That is they don`t give origin to the new cells and can`t be the source of malignant malformations. Cells of neuroglia, or Kolliker's reticulum, are the other thing. Neuroglia is an auxiliary tissue of the central nervous system that facilitates work of neurons, protects them and supplies with nutrients.
Neuroglia cells are functionally active; they divide and can acquire oncological features. Under certain conditions neoplasms from astrocytes, the type of glial cells, become transition ones and finally transform into malignant glioblastomas. Precise clinical diagnosis sounds like “multiform glioblastoma”, which indicates presence of several types of cells, but astrocytes still form its basis.
In absence of treatment the tumor mass grows rapidly and compresses nearby brain tissue. The same time new blood vessels are formed (this process is called angiogenesis), as the neoplasm requires nutrients and “material” for such growth. Fragile additional blood vessels often rupture, which causes intensive bleedings and necrosis of the cerebral tissue. Another danger is spreading of atypical cells to healthy areas of the cerebrum. There is no distinct border between the oncological focus and normal tissue.
Unfortunately, the sole and exact cause of the disease is not established. Therefore, there are no preventive measures. Nevertheless, doctors point out few common traits in this type of cancer development:
- It is more often diagnosed in men
- It is typical for people over 50 years old
- It is more common among the Caucasians and Hispanic Americans
- It is associated with the influence of ionizing radiation and chemicals (polyvinyl chloride)
- It is associated with genetic factors, namely, presence of a similar type of cancer or neurofibromatosis in family members
The hypothesis regarding the association of mobile communication with the development of neuroglia neoplasms was investigated in few clinical trials and, finally, rejected.
How does glioblastoma influence one`s general state?
Clinical manifestations of brain tumors have few peculiarities:
- At the early stages clinical signs are absent, the tumor is asymptomatic and can be revealed only by chance, during the examination for another reason
- Initial manifestations are nonspecific and can be found in dozens of diseases, from respiratory infections to neurological pathology
- And even manifestations of the advanced disease stages don`t make the clinical picture more clear, as they differ depending on the localization of the tumor, its size and speed of growth
However, it is better to be familiar with the symptoms of the disease. Cerebral manifestations develop due to increased intracranial pressure and compression of healthy cerebral tissue:
- Headache. Pain doesn`t have precise localization, it can appear in all areas of the head. The feeling is not alleviated by the use of analgesics or physical means (massage, cold or heat, aromatherapy, etc.).
- Nausea and vomiting that occur without obvious cause and don`t relieve general state. Constant nausea and vomiting lead to excessive sleepiness, apathy, and loss of strength.
- Seizures, which are caused by the direct influence of the tumor and poisoning of the brain by its decay products. Anticonvulsants are not that effective in this case.
Local symptoms depend on the involvement of specific cerebral areas:
- Shaky walk and dizziness appear in affection of the cerebellum.
- Visual impairment is a sign of the occipital part of the cerebral cortex involvement.
- Violations of the emotional sphere and memory are connected with dysfunction of the hippocampus and corpus callosum.
- Changes in speech are associated with impairment of the frontal lobe function.
- Changes in the sensitivity or motor function of certain parts of the body appear when the neoplasm is located near the cranial nerves.
Symptoms don`t reflect severity of the disease or size of the tumor directly, as all manifestations are strictly individual. In addition, symptoms will change in further progression of the neoplasm or during the treatment course.
How can glioblastoma be revealed?
If a general practitioner suspects a brain tumor, he will refer a person to the neurologist and neurosurgeon. After assessing the neurological status, doctors move on to instrumental diagnostic methods. The technical advances of modern medicine allow investigating structure of the brain in minute detail and evaluating its functions.
Visualization studies (MRI, CT, PET, SPECT) demonstrate structure of the brain and presence or absence of neoplasms. In addition, it is possible to assess state of the skull bones and, if necessary, get prepared for further radiosurgical interventions – determine the location of the tumor according to the frame of stereotaxic coordinates. Such frame is placed on the patient's head before the procedure and provides clear landmarks for determining localization of the pathological locus in the cerebral tissue. Another informative type of visualization studies is angiography. Angiography “highlights” blood vessels of the healthy cerebrum and tumor, so they are perfectly visible on the image. This allows avoiding massive blood loss during surgery.
Functional investigations include the following ones:
- Functional MRI, which determines the type of blood flow inside the neoplasm
- Magnetic resonance spectroscopy, which determines the intensity of metabolism in the cerebral tissue
- Electroencephalography (EEG), which registers the electrical activity of the brain and reflects possibility of seizures development
Biopsy is considered to be the “golden standard” in the diagnosis of all cancer types. Only biopsy allows examining the suspicious tissue under a microscope and establishing its nature. In case of glioblastoma pathological tissue is always located inside the skull, so biopsy implies neurosurgical intervention.
After carrying out all the necessary investigations a multidisciplinary team of healthcare specialists elaborates individual treatment plan.
What kind of therapy is the most effective?
The basic scheme includes a neurosurgical intervention followed by radiation and chemotherapy. Therapeutic approaches vary significantly depending on the clinical situation. For example, sometimes a patient can`t tolerate chemotherapy due to the side effects of drugs, or the location of the tumor makes surgical intervention impossible. Therefore, an individual, maximally beneficial approach is selected.
Neoplasms from glial tissue arise inside the skull and don`t spread beyond its borders. That is why surgical treatment always implies work of the neurosurgeon. During the intervention a doctor additionally uses the fluorescent contrast (5-aminolevulinic acid), which is accumulated by cancer cells, makes them visible and allows complete surgical removal of a malignant neoplasm. In oncological surgery doctors usually remove certain amount of the presumably healthy tissue around the tumor margins. This increases chances of full recovery and absence relapses. Unfortunately, such approach is impossible in case of brain tumors, as every millimeter of the cerebral tissue is important for preserving neurological functions. That is why modern neurosurgery gives preference to sparing operations – precise detection of cancer cells and preserving healthy brain tissue.
Radiation therapy helps to control proliferation and division of cancer cells after surgical intervention. The course of dosed irradiation lasts up to 1-1.5 months, with radiotherapy sessions performed 5 days a week. In a number of cases radiotherapy is prescribed as the sole treatment method, e.g., in patients with inoperable tumors larger than 30 mm.
Cyber knife and Gamma knife techniques are somewhat intermediate between surgical intervention and radiotherapy. In fact, these techniques are based on killing malignant cells with a high dose of ionizing radiation. Before the start of interventions radiologists determine exact location of the oncological formation using a stereotaxic frame – a three-dimensional coordinate system. Such a technique provides “surgical accuracy” of irradiation, when cells of the neoplasm receive maximum radiation load, and healthy tissues remain safe. The robot, which controls the source of ionizing radiation during the procedure, directs the beam with accuracy up to a few tenths of a millimeter. Among all available state-of-art options, the Gamma knife technique is considered to be the “golden standard” in the treatment of glioblastoma.
Chemotherapy is administered after surgery at the high risk of relapse or incomplete resection of the tumor (more than 90% of the volume). Patients can receive chemotherapy in form of pills or injections. Another effective option is implantation of plates with chemotherapeutical drugs directly in the cerebrum, next to the main mass of neoplasm. After the implantation the drug is released gradually, during few weeks. Due to this high local dosage chemical destroys cancer cells.
New methods, namely, immunotherapy and targeted therapy are effectively used along with the conventional ones. Mandatory symptomatic treatment (painkillers and anticonvulsant drugs, remedies against cerebral edema) is performed in order to improve general sense of wellbeing. In addition, cancer counselors help to overcome fears and look in the future with confidence and positive attitude.
Where is it better to treat glioblastoma?
We shouldn`t deny that glial neoplasm is a serious condition, which requires expert knowledge and qualifications from the medical team. The technical side is no less important, as it is the basis of using neuronavigation, stereotactic techniques and radiosurgery. Availability of modern drugs for the chemotherapy and targeted therapy is important, as well. Only the comprehensive approach allows achieving the goal of therapy – increase life expectancy and improve quality of life.
Nowadays possibilities of medical care are not limited by the borders of one`s native country. This is important, as the health system in developing countries often can’t offer decent level of help. Whenever we talk about an integrated approach to the glioblastoma curing, impressive technical equipment of clinics, effective neurological rehabilitation and reasonable cost of therapy, the best option is choosing therapy in Germany.
The experience of German neurosurgeons is vast and comprehensive: specialists offer professional workshops for colleagues from other countries, develop new techniques and demonstrate best rates of successful interventions. German pharmaceutical market offers recently approved drugs for chemotherapy and targeted therapy. Which is the most important, German medicine offers the latest models of the gamma knife. This is the best possible way to avoid invasive and traumatic surgery. Thus, specialists of the Gamma Knife and Radiotherapy Center in Krefeld and Gamma Knife and Radiotherapy Center in Hannover annually admit thousands of people for the radiosurgical treatment.
It is quite natural that providing medical services to international patients has certain peculiarities and differs from the treatment of German citizens. As a result, international patients apply for medical help with the assistance of a medical tourism operator – the company Booking Health. Specialists of the company annually help hundreds of people with glioblastoma to receive timely treatment by experienced healthcare professionals.
In order to start preparing for the medical journey you need to leave a request with medical documents on the official website of Booking Health. After receiving the application, a patient case manager will contact you to discuss the details and help you in such important moments as:
- Recommending the best doctor and clinic in your case
- Sending an invitation for a quick medical visa issuing
- Booking an appointment on the convenient date
- Organizing comprehensive preliminary examination and choosing the most appropriate treatment scheme on the basis of its results
- Providing you with transfer from the airport to clinic and back to the airport after the completion of therapy
- Providing you with services of the interpreter and medical coordinator, if necessary
- Providing help in further neurosurgical intervention, if necessary
- Issuing medical insurance in case of complications during the treatment (amount of coverage is 200 000 euros);
- Preparing all the medical reports and further recommendations from your treating physician
- Providing help in further communication with your treating physician, including distant follow-up consultations by means of the state-of-art medical document management system E-doc
Specialists of the company empathize with each patient, provide sincere support and inspire faith in the recovery. We rejoice successes together with you and help to maintain health for many years.
Choose treatment abroad and you will for sure get the best results!
Authors:
The article was edited by medical experts, board certified doctors Dr. Vadim Zhiliuk, Dr. Sergey Pashchenko. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!
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