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Learn about this rare form of advanced brain tumour and the treatments that are helping patients live longer, fuller lives.

GLIOBLASTOMA IS ONE OF THE MOST AGGRESSIVE FORMS OF BRAIN CANCER. Its fast-growing nature presents challenges, but advancements in treatment and research continue to offer new possibilities for managing its impact.

Glioblastoma develops from glial cells, which support the brain and spinal cord. It is classified as a Grade IV tumour, meaning it is highly aggressive and fast-growing, with a tendency to spread quickly to other parts of the brain. While there is currently no cure, treatments are available to slow its growth and manage symptoms. On average, patients live for about two years after diagnosis, with the possibility of relapse. Prognosis is better in younger patients and those with cancer cells that have a specific genetic characteristic called MGMT methylation. In Singapore, approximately 100 people are diagnosed with glioblastoma annually.

Risk Factors

The exact cause of glioblastoma remains unclear, though certain factors can increase the risk. It is most commonly diagnosed in individuals between 50 and 70, and men are slightly more at risk than women. Other risk factors include prior radiation therapy to the head, exposure to certain chemicals and genetic conditions such as Lynch syndrome and Li-Fraumeni syndrome.

Signs and Symptoms

Glioblastoma symptoms often appear quickly due to the tumour’s pressure on the brain. These include worsening headaches, seizures, blurred or double vision, difficulty speaking and balance issues. Additional symptoms may include personality changes, memory loss, muscle weakness, nausea and vomiting. If you experience any of these, seek medical attention immediately.

Treatment Plans

When doctors suspect glioblastoma, patients will be asked to undergo a computed tomography (CT) or magnetic resonance imaging (MRI) scan to check for brain tumours. A biopsy, which examines a sample of the tumour under a microscope, confirms the diagnosis.

Treating glioblastoma can be complex due to its location in the brain and fast-growing nature. Surgery to remove as much of the tumour as possible is the standard approach, often followed by radiation and chemotherapy to slow its progression. With improvements in surgical tools such as intraoperative surgical navigation, operative microscopes, intraoperative nerve monitoring and ultrasonic aspirators, removal of these difficult tumours has become safer. The use of tumour visualisation tools such as fluorescein and 5-ALA intraoperatively has also allowed for better tumour clearance. After surgery, patients will require follow-up treatment with chemotherapy, such as temozolomide, to slow progression and prevent recurrence.

Advanced radiation therapies are also available:

• Intensity-Modulated Radiation Therapy (IMRT): A technique that adjusts the radiation beams to conform closely to the shape of the tumour, allowing for precise targeting and reducing harm to nearby healthy tissue.
• Image-Guided Radiation Therapy (IGRT): Real-time imaging taken during treatment helps ensure the radiation is accurately delivered to the tumour, improving precision and effectiveness.

While these treatments can slow the tumour’s growth, the choice of therapy depends on the tumour’s location, as well as the patient’s age and overall health.

Hope for the Future

While current treatments aim to ease symptoms and slow cancer progression, finding a cure remains challenging. However, ongoing research offers promising possibilities. Clinical trials in the United States and Europe are exploring new therapies for glioblastoma. In Singapore, researchers are developing new diagnostic tools and treatment options, including the possibility of personalised drug therapies. These advancements could improve long-term survival rates and bring renewed optimism to patients and their families.