Glioblastoma: How Fast Do They Grow
A 57 year old female presented with new onset seizure. An MRI was obtained showing a lesion in the right frontal/parietal region. You can see there is some mass effect, slight effacement of the ventricle, and a whiff of enhancement. Needle biopsy returned astrocytoma, WHO Grade 3.
Surgical resection was recommended, but the patient chose instead to pursue external beam radiation and oral chemotherapy in the form of temozolomide.
Unfortunately, she now presents three months later with confusion, agitation, and left arm weakness. An MRI is again obtained. The tumor shows marked growth and different signal characteristics. You see that the mass is inhomogeneously enhancing, with marked mass effect, surrounding edema, ventricular effacement, and minimal midline shift.
At this time the patient requests craniotomy for surgical debulking. The final pathologic diagnosis is Glioblastoma, WHO Grade 4.
This shows how rapidly a glioma can grow and transform to a higher grade, in this case just three months.
What You Need To Know
- Metastatic brain cancer is caused by cancer cells spreading to the brain from a different part of the body.
- The most common types of cancer that can spread to the brain are cancers of the lung, breast, skin , colon, kidney;and thyroid gland.
- Metastatic brain tumors are five times more common than primary brain tumors .
- Metastatic brain tumors can grow rapidly, crowding or destroying nearby brain tissue. Sometimes a patient may have multiple metastatic tumors in different areas of the brain.
When To See A Gp
See a GP if you have these types of symptoms, particularly if you have a headache that feels different from the type of headache you usually get, or if headaches are getting worse.
You may not have a brain tumour, but these types of symptoms should be checked.
If the GP cannot identify a more likely cause of your symptoms, they may refer you to a doctor who specialises in the brain and nervous system for further assessment and tests, such as a brain scan.
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Questions To Ask Before Treatment
The following questions provide a starting point for what you may want to ask your healthcare professional.
Having Certain Genetic Syndromes May Increase The Risk Of A Central Nervous System Tumor
Anything that increases your chance of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesnt mean that you will not get cancer. Talk with your doctor if you think you may be at risk. There are few known risk factors for brain tumors. The following conditions may increase the risk of certain types of brain tumors:
- Being exposed to vinyl chloride may increase the risk of glioma.
- Infection with the Epstein-Barr virus, having AIDS , or receiving an organ transplant may increase the risk of primary CNS lymphoma.
- Having certain geneticsyndromes may increase the risk brain tumors:
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What Happens During Radiation Therapy
For conventional radiation therapy, your initial visit with the radiation oncologist is called a consultation. During this visit, the physician will review the history of your illness and perform a physical examination. Consultations with other members of your treatment team may also take place at this time.
After you and your physician have decided on a course of treatment, you will begin the first phasetreatment planning. During this planning phase of your treatment, a radiation oncologista physician who specializes in radiation therapywill simulate your radiation therapy treatment using either conventional radiographs or a computed tomography scan. In most cases, an MRI scan is required. These radiographic exams are used to plan the type and direction of radiation beams used to treat the cancer.
You will be asked to lie still on the treatment table during simulation, although no radiation therapy will be given at that point. An immobilization mask will usually be made at this time to hold your head in the same position. Typically, treatment begins one to two weeks after your treatment planning session. There is significant medical physics involvement in the planning and verification of the plan before it is actually delivered to the patient.
For more information about specific radiation therapy procedures and equipment, visit the following pages:
What Side Effects Does Chemotherapy Cause When Treating Brain Tumors
Many people have heard of the side effects chemotherapy can cause when treating other cancers nausea, vomiting, mouth sores, etc. But a number of the brain cancer chemotherapy drugs we use are a little different and may not cause such severe side effects. Your team will discuss the possibilities with you before you commit to a treatment plan.
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About Malignant Brain Tumours
A malignant brain tumour is a fast-growing cancer that spreads to other areas of the brain and spine.
Generally, brain tumours are graded from 1 to 4, according to their behaviour, such as how fast they grow and how likely they are to grow back after treatment. A malignant brain tumour is either grade 3 or 4, whereas grade 1 or 2 tumours are usually classed as benign or non-cancerous.;
Most malignant tumours are secondary cancers, which means they started in another part of the body and spread to the brain. Primary brain tumours are those that started in the brain.
These pages focus on high-grade brain tumours. For information about grade;1 or;2 tumours, read our pages on;low-grade brain tumours.
Primary Brain Cancer Is Rare
A;primary;malignant;brain;tumor is a rare type of cancer accounting for only about 1.4% of all new cancer cases in the U.S. ;The most common brain tumors are known as secondary tumors, meaning they have metastasized, or spread, to the brain from other parts of the body such as the lungs, breasts, colon or prostate.
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Infection High Blood Pressure Or Loss Of Fluid
Infection, high blood pressure and dehydration can increase the pressure inside your brain . Raised intracranial pressure might cause headaches and feeling or being sick.
Drink plenty of fluids to stop you from getting dehydrated. And let your doctor know if you think you have an infection or high blood pressure. They can give you treatment.
Radiation Therapy For Metastatic Brain Tumors
Radiation therapy treats metastatic brain tumors by using X-rays and other forms of radiation to destroy cancer cells or prevent a tumor from growing. It is also called radiotherapy.
These painless treatments involve passing beams of radiation through the brain, which can treat cancers in areas that are difficult to reach through surgery. Procedures may include any one or a combination of the following:
- External beam radiation therapy delivers radiation from a machine and through the body to reach metastatic tumors.
- Whole-brain radiation targets the entire brain to hit multiple tumors or any metastatic disease that hides from an MRI scan.
- Stereotactic radiosurgery; directs a high dose of radiation targeted to the specific shape of the tumor, sparing surrounding healthy tissue from unnecessary radiation exposure.
- Proton therapy uses protons to treat metastatic brain tumors. Like stereotactic radiosurgery, proton therapy minimizes harm to healthy tissue surrounding a tumor.
These procedures may be performed after surgery to prevent tumors from recurring at the surgical site and growing into other brain tissue.
Because radiation therapy has been so successful in treating brain metastases and because many live long lives after treatment studies are now looking at how to manage the long-term effects of treatment.
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Signs That Warrant An Immediate Trip To A Doctor
Some common cancer signs that should result in a visit to the emergency room or to a doctor as soon as possible include:
- coughing up mucus tinged with blood
- blood in stools or urine
- lump in the breast, testicles, under the arm, or anywhere that it didnt exist before
- unexplained but noticeable weight loss
- severe unexplained pain in the head, neck, chest, abdomen, or pelvis
These and other signs and symptoms will be evaluated. Screenings, such as blood and urine tests and imaging tests, will be used if your doctor thinks its appropriate.
These tests are done both to help make a diagnosis as well as rule out various causes of your signs and symptoms.
When seeing a doctor, be prepared to share the following information:
- your personal medical history, including all symptoms you have experienced, as well as when they began
- family history of cancer or other chronic conditions
- list of all medications and supplements you take
Who Is Most At Risk For A Brain Tumor
Brain tumors occur in all age groups. Therefore, we all carry some risk for developing a tumor at any age. The very young, meaning less than 2 years old, and the elderly are at particular risk for having tumors, which will significantly shorten their life. Interestingly, the types of tumors seen in the different age groups vary substantially. For example, the high-grade malignant glioblastoma is the most prevalent in the elderly while the medulloblastoma is most prevalent in infants. Both tumors can be life threatening, but behave very differently clinically.
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Overview Of Brain Tumor Surgery
The specific procedure you undergo will depend on the type of brain tumor you have been diagnosed with, as well as its size and location. Your surgeon may remove all or part of the tumor, depending on the proximity of nearby structures and whether or not you will be having adjunct therapy following your surgery.
Generally speaking, there are two reasons for brain tumor surgery: biopsy and resection. In a biopsy, your surgeon will take a small section of tumor and send it to a pathologist, who will look at it under a microscope to make or confirm a brain tumor diagnosis. Resection is the surgical removal of all or part of the tumor itself. Surgeons will often perform a biopsy and resection at the same time.
To access your brain tumor, a craniotomy is usually completed at the start of surgery. This is the removal of a small section of skull to allow the surgeon to reach the tumor. Your surgeon will remove as little bone as possible, which will be replaced following surgery and secured using a plate and/or screws. Sometimes the surgeon can limit the craniotomy to a keyhole-sized incision in the skull and use specialized instruments to remove the tumor, utilizing a minimally invasive approach.
What Percentage Of Brain Tumors Is Cancerous
When I describe the type of tumors that we see in the brain to patients, I try to give a feeling for two major aspects: First of all, some tumors can be “benign” in terms of their growth potential, but behave very “malignantly” because of their location making them difficult to treat. The other aspect is how fast will these tumors grow despite our best treatments. Brain tumors in general do not tend to spread throughout the body, but are a problem due to their continued growth inside the brain. If you think of the potential for re-growth, approximately 50 to 70 percent of all intercranial tumors will require additional treatment other than surgery alone.
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How Fast Does Cancer Grow
Over the years, I’ve found that many people don’t seem to realize that the vast majority of malignancies aren’t palpable and don’t create symptoms for several years and sometimes decades. This is a critical point to understand, as our choices today are unmistakeably what determine our risk for cancer and most chronic diseases in the years ahead – even thirty, forty, fifty years ahead.
When looking to understand the pace at which cancer grows and spreads, the main concept to consider is doubling time, which is the amount of time it takes for one cell to divide or for a group of cells to double in size.
Doubling time is different for various tumours, but if you know the size of a tumor at two different points in its lifespan, you can calculate doubling time with the following online resource: Doubling Time.
To put this idea into numbers, let’s say that a 1 millimeter mass is detected within lung tissue on a CT scan. If this same mass is measured to be 15 millimeters two years later, doubling time for this mass is 62 days.
Here’s the take-home point: a 1 millimeter cluster of cancerous cells typically contains somewhere in the ball park of a million cells, and on average, takes about six years to get to this size. Generally, a tumor can’t be detected until it reaches the 1 millimeter mark.
So to develop a mass that is likely to be problematic , make no mistake in understanding that this is a journey of many years.
Limit intake of refined sugar.
What Happens When Cancer Spreads To The Brain
Cancer cells can break away from the primary tumor and travel to the brain, usually through the bloodstream. They commonly go to the part of the brain called the cerebral hemispheres or to the cerebellum, where they form a mass.
Some metastatic brain tumors appear many years after the primary cancer. Others metastasize so quickly that they are identified before the primary cancer.
When the cancer cells reach the brain and form a tumor, it may lead to a variety of symptoms that can be shared by nonmetastatic brain tumors as well.
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Chemotherapy For Metastatic Brain Tumors
Because traditional chemotherapy cannot cross the blood-brain barrier, newer treatments called targeted therapy are used as the primary type of chemotherapy for treating metastatic brain tumors.
These drugs identify and attack cancer cells with minimal harm to normal cells while preventing the growth and spread of cancer cells. Targeted therapy can be administered after surgery or in conjunction with radiation therapy to destroy remaining cancer cells.
Targeted therapies used to treat metastatic brain tumors include:
- Trastuzumab for breast cancer that has spread to the brain
- Erlotinib for the most common type of lung cancer that has spread to the brain
Possible Symptoms Caused By A Meningioma
- The most common symptoms are pain for weeks to months, weakness or paralysis, visual field reduction and speech problems.
- Specific symptoms depend upon the location of the tumor. See the chart below:
;Most Common Sites and Symptoms for Meningiomas in the Head:
Location – Convexity Common Symptoms – Seizures, headache, extremity weakness, difficulty speaking, visual field deficit.
Location – Parafalcine Common Symptoms – Seizures, lower extremity weakness, headache, personality changes, dementia, increasing apathy, flattening of affect, unsteadiness, tremor.
Location – Sphenoid Ridge Common Symptoms – Eye-bulging, decreased vision, paralysis of eye movement, seizures, memory difficulty, personality change, headache.
Location – Posterior Fossa Common Symptoms – Unsteadiness and incoordination, hydrocephalus , voice and swallowing difficulties.
Location – Cerebellopontine angle Common Symptoms – Loss of hearing. Facial muscle weakness. Dizziness. Unsteadiness and incoordination, hydrocephalus , voice and swallowing difficulties.
Location – Olfactory Groove and sella Common Symptoms – Loss of smell , subtle personality changes, mild difficulty with memory, euphoria, diminished concentration, urinary incontinence, visual impairment.
Optic Sheath – Decreased vision in one eye. | Other – Variable depending on location.
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What Is The Treatment For Brain Tumors
Every person we see and every tumor we treat is a little different. Potential options for brain tumor treatment include surgery, laser therapy, chemotherapy and radiation therapy. We also evaluate everyone we see for participation in clinical trials, which may test immunotherapy and other new treatment approaches.
Treatment options depend on:
- Need to balance treatment with protection of brain function
Outlook And Survival Rates
Many things can affect how well someone does when they have cancer, including glioblastomas. Doctors often canât predict what someoneâs life expectancy will be if they have a glioblastoma. But they do have statistics that track how large groups of people whoâve had these conditions tend to do over time.
For glioblastoma, the survival rates are:
- One year: 40.2%
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A Meningioma Diagnosis May Occur When The Doctor Is Looking For Something Else
Brain tumor diagnosis is often incidental that is, the doctor discovers a tumor on a CT or MRI while examining the individual for another reason such as a head injury or another neurologic problem.
When a doctor diagnoses a meningioma, you will get further tests to find out how the tumor is likely to behave. Based on these data, a neurosurgeon will recommend removing the tumor or just watching it to see if it grows.