Case study 67 answer - Glioblastoma
Glioblastoma (GBM), also referred to as a grade IV astrocytoma, is a fast-growing and aggressive brain tumor. In adults, GBM occurs most often in the cerebral hemispheres, especially in the frontal and temporal lobes of the brain. GBM is a devastating brain cancer that can result in death in six months or less, if untreated; hence, it is imperative to seek expert neuro-oncological and neurosurgical care immediately, as this can impact overall survival.
Glioblastoma is the most common malignant brain and other CNS tumors accounting for 47.7% of all cases. Glioblastoma has an incidence of 3.21 per 100,000 population.
Median age of diagnosis is 64 years and it is more common in men as compared to women. Survival is poor with approximately 40% survival in the first year post diagnosis and 17% in the second year.
The mainstay of treatment for GBMs is surgery, followed by radiation and chemotherapy. The primary objective of surgery is to remove as much of the tumor as possible without injuring the surrounding normal brain tissue needed for normal neurological function. However, GBMs are surrounded by a zone of migrating, infiltrating tumor cells that invade surrounding tissues, making it impossible to ever remove the tumor entirely. Surgery provides the ability to reduce the amount of solid tumor tissue within the brain, remove those cells in the center of the tumor that may be resistant to radiation and/or chemotherapy and reduce intracranial pressure. Surgery, by providing a debulking of the tumor, carries the ability to prolong the lives of some patients and improve the quality of remaining life.
In most cases, surgeons perform a craniotomy, opening the skull to reach the tumor site. This is done frequently with computer-assisted image-guidance and at times using intra-operative mapping techniques to determine the locations of the motor, sensory and speech/language cortex. Intraoperative mapping often involves operating on a patient while they are awake and mapping the anatomy of their language function during the operation. The doctor then decides which portions of the tumor are safe to resect.
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