Glioblastoma

 

Welcome to PT 635 Pathophysiology of Complex Patient Problems This is a wiki created by and for the students in the School of Physical Therapy at Bellarmine University in Louisville KY. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!

Original Editors - Simone Potts from Bellarmine University's Pathophysiology of Complex Patient Problems project.

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Definition/Description

An astrocytoma is a glioma that develops from star-shaped glial cells (astrocytes) that support nerve cells. A glioblastoma multiforme is classified as a grade IV astrocytoma. It is also referred to as a glioblastoma or GBM

Glioblastoma multiforme (GBM) is by far the most common and most malignant of the glial tumors. Attention was recently drawn to this form of brain cancer when Senator Ted Kennedy was diagnosed with glioblastoma and ultimately died from it.
Gliomas comprise a heterogeneous group of neoplasms that differ in location within the central nervous system, in age and sex distribution, in growth potential, in extent of invasiveness, in morphological features, in tendency for progression, and in response to treatments. 
GBM can spread through the brain tissue, but rarely spreads to other areas outside of the central nervous system.
All GBM tumors have abnormal and numerous blood vessels, a common feature of a fast-growing tumor. These blood vessels deliver necessary oxygen and nutrients to GBM tumors, helping them grow and spread. In addition, these blood vessels easily mix with normal brain tissue and travel away from the main tumor, which makes GBM tumors a challenge to treat.

Prevalence

Of the estimated 17,000 primary brain tumors diagnosed in the United States each year, approximately 60% are gliomas.
Glioblastoma multiforme is the most frequent primary brain tumor, accounting for approximately 12-15% of all intracranial neoplasms and 50-60% of all astrocytic tumors. In most European and North American countries, incidence is approximately 2-3 new cases per 100,000 people per year.

Characteristics/Clinical Presentation

• Most invasive type of glial tumor
• Commonly spreads to nearby tissue
• Grows rapidly
• Includes distinct genetic subtypes
• May be composed of several different kinds of cells (i.e., astrocytes, oligodendrocytes)
• May have evolved from a low-grade astrocytoma or an oligodendroglioma
• Common among men and women in their 50s-70s
• More common in men than women
• Accounts for 17 percent of all primary brain tumor

The most common presentation of patients with glioblastomas is a slowly progressive neurologic deficit, usually motorweakness. However, the most common symptom experienced by patients is headache.

Alternatively, patients may present with generalized symptoms of increased intracranial pressure (ICP), including headaches, nausea and vomiting, and cognitive impairment.

Seizures are another common presenting symptom.

General symptoms include headaches, nausea and vomiting, personality changes, and slowing of cognitive function.

Headaches can vary in intensity and quality, and they frequently are more severe in the early morning or upon first awakening.

Changes in personality, mood, mental capacity, and concentration can be early indicators or may be the only abnormalities observed.

Focal signs include hemiparesis, sensory loss, visual loss, aphasia, and others.

Seizures are a presenting symptom in approximately 20% of patients with supratentorial brain tumors.

o Increased Intracranial Pressure
o Headache, especially retroorbital; sometimes worse upon awakening, improves during the day
o Vomiting (with or without nausea)
o Visual changes (blurring, blind spots, diplopia, abnormal eye movements)
o Changes in mentation (impaired thinking, difficulty concentrating or reading, memory or speech)
o Personality change, irritability
o Unusual drowsiness, increased sleeping
o Sensory changes
o Muscle weakness or hemiparesis
o Bladder dysfunction
o Increased lower extremity reflexes compared with upper extremity reflexes
o Decreased coordination, gait changes, ataxia
o Positive Babinski reflex
o Clonus (ankle or wrist)
o Vertigo, head tilt

Associated Co-morbidities

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Medications

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Diagnostic Tests/Lab Tests/Lab Values

T1-weighted axial gadolinium-enhanced magnetic resonance image demonstrates an enhancing tumor of the right frontal lobe. Image courtesy of George Jallo, MD.

Image taken from: http://emedicine.medscape.com/article/340870-overview

Etiology/Causes

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Systemic Involvement

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Medical Management (current best evidence)

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Physical Therapy Management (current best evidence)

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Alternative/Holistic Management (current best evidence)

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Differential Diagnosis

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Case Reports/ Case Studies

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Resources

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Recent Related Research (from Pubmed)

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References

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