Glioblastoma Multiforme

Playing golf after glioblastoma surgery

Dear friends,
Below is a write up of different types of brain tumors. I find it very educational and would like to share it with you all.


Astrocytomas and oligodendrogliomas are the most common primary tumors of the adult brain. Both tumors are types of gliomas. Primary brain tumors arise from cells of the brain itself rather than traveling, or metastasizing, to the brain from another location in the body. Gliomas can be slowly growing (low-grade, grades 1 and 2), or rapidly growing (high-grade, grades 3 and 4). This material will give important facts about the diagnosis and treatment of high-grade gliomas.
High-grade gliomas are diagnosed by a biopsy

Once a brain tumor is detected on a CT or MRI scan, a neurosurgeon obtains tumor tissue for examination by a neuropathologist (a biopsy). The neuropathologist then gives the tumor a name and grade. The exact name and grade of the tumor determine treatment options, and also give important information about prognosis.

When neuropathologists analyze tumor tissue under a microscope, there are two main questions being asked:
-first, what type of brain cell did the tumor arise from? The answer to this question gives the tumor a name, for example, astrocytoma.
-second, do the tumor cells show signs of rapid growth? This involves assigning the tumor a grade, such as grade 3 or 4 (see below).
These two pieces of information are then combined, as in "grade 4 astrocytoma". Once a tumor has been given a name and a grade, brain tumor specialists can give advice about treatment choices, prognosis, and provide useful health-care information to brain tumor patients and their families.

Tumor name: from what type of brain cell did the tumor arise?
Astrocytomas arise from brain cells called astrocytes. Normal astrocytes are star-shaped cells that give the brain its shape. Astrocytes are the most common cell type to become tumors. Oligodendrocytes are brain cells that provide insulation around the electrically-active neurons. Tumors of oligodendrocytes are less common than astrocytomas. Many tumors contain a mixture of astrocytoma and oligodendroglioma cells. Tumors of other cell types in the brain are less common. For instance, tumors of neurons are very rare in adults.

Tumor grade: how aggressive does the tumor appear under the microscope?
Astrocytomas and oligodendrogliomas come in four grades, with grade 1 being the most benign and grade 4 being the most malignant. The neuropathologist looks at the brain tumor tissue under the microscope for signs that the tumor is growing rapidly. Examples of these features include cells undergoing division (mitosis), the presence of newly-formed blood vessels, and evidence that the tumor is outgrowing its blood supply (necrosis). The more features that are present, the higher the grade assigned to the tumor.

Gliomas have more than one name in everyday usage. The Table gives the common names of high-grade gliomas:
Synonyms for high-grade Gliomas
Anaplastic astrocytoma = grade 3 astrocytoma
Glioblastoma multiforme = grade 4 astrocytoma
Anaplastic oligodendroglioma = grade 3 oligodendroglioma (oligodendrocytoma)
Anaplastic oligoastrocytoma = grade 3 oligoastrocytoma = anaplastic mixed glioma

Why do brain tumors occur?
Tumors form because of the abnormal, unregulated growth of cells. After the human brain completes it development soon after birth, the vast majority of its cells enter a resting state in which they never divide again. One exception to this rule is when a brain tumor develops. The abnormal brain cells re-enter the "cell-cycle" because of alterations in any of a large number of genes that control cell division and growth. Although much is known about the alterations in these genes in brain tumors, the reason why the gene alterations arise in the first place is poorly understood. The MGH has a very active research program in this area.

Are brain tumors hereditary?
The use of the word ‘gene’ invariably brings up the important question of whether brain tumors are hereditary. The answer for almost all patients is no. Although there are conditions in which brain tumors can occur in families, these syndromes are very rare and usually known prior to the development of an individual family member’s tumor.

Types of therapy
There are three standard types of treatment for patients with high-grade gliomas: surgery, radiation therapy, and chemotherapy.
Because grade 3 and 4 tumors have a tendency to grow rapidly, treatment must be started as soon after surgery as is feasible, allowing time for the surgical incision to heal. Generally, this means that patients should be undergoing either radiation therapy or chemotherapy within 2 to 4 weeks after surgery.

While therapies for high-grade gliomas are helpful, at present these treatments cannot cure these tumors. The two major reasons for this are that tumor cells infiltrate into surrounding brain and thus cannot be completely removed by the surgeon, and that most glioma cells are at least partially resistant to radiation and chemotherapy.

The goals of treatment are to:
-remove as many tumor cells as possible (with surgery)
-kill as many as possible of the cells left behind (with radiation and chemotherapy)
-put remaining tumor cells into a nondividing, sleeping state for as long as possible (with radiation and chemotherapy)

High-grade glioma cells almost always start to grow again at some point in time. Patients receive aggressive treatment in order to delay this regrowth as long as possible. Regrowth does not necessarily imply loss of control of the tumor, but it does mean that a new series of treatments should be considered because the tumor is becoming more aggressive.

Norman have just finish his 22nd radiation today. He is feeling fine except for a bee sting on his left fore head. It is slightly swollen and painful to the touch. The Dr suggest to take an anti-histamine.

On another note, I would like to say a big thank you to all our trekkers friends who celebrated Norman's birthay on sunday 20th January. (His actual birthday is on the 22nd). All the ladies are fantastic cooks!! I always look forward to any of our pot luck gathering. Whose birthday is next? I will post the photos another day as it is still in Nicky's camera.

Quote: A merry heart is good medicine, but a crushed spirit dries up the bone. Proverbs17:20