Symptoms

The symptoms of glioma vary by tumor type as well as the tumor's size, location and rate of growth.

Common signs and symptoms of gliomas include:

• Headache
• Nausea or vomiting
• Confusion or a decline in brain function
• Memory loss
• Personality changes or irritability
• Difficulty with balance
• Urinary incontinence
• Vision problems, such as blurred vision, double vision or loss of peripheral vision
• Speech difficulties
• Seizures, especially in someone without a history of seizures

When to see a doctor

Make an appointment with your doctor if you have persistent signs and symptoms that concern you.

Causes

Like most primary brain tumors, the exact cause of gliomas is not known. But there are some factors that may increase your risk of a brain tumor.

Risk factors

Risk factors include:

• Your age. Your risk of a brain tumor increases as you age. Gliomas are most common in adults between 60 and 80 years old. However, a brain tumor can occur at any age. Certain types of gliomas, such as ependymomas and pilocytic astrocytomas, are more common in children and young adults.

• Exposure to radiation. People who have been exposed to a type of radiation called ionizing radiation have an increased risk of brain tumor. Examples of ionizing radiation include radiation therapy used to treat cancer and radiation exposure caused by atomic bombs.

  More-common forms of radiation, such as electromagnetic fields from power lines and radiofrequency radiation from cellphones and microwave ovens, have not been shown to increase the risk of glioma.

• Family history of glioma. It's rare for glioma to run in families. But having a family history of glioma can double the risk of developing it. Some genes have been weakly associated with glioma, but more study is needed to confirm the link between these genetic variations and brain tumors.

Alternative medicine

Little research has been done on complementary and alternative brain tumor treatments. No alternative treatments have been proved to cure gliomas. However, complementary treatments may help you cope with your brain tumor and its treatment. Talk to your doctor about your options.

Some complementary treatments that may help you cope include:

• Acupuncture
• Hypnosis
• Meditation
• Music therapy
• Relaxation exercises

Coping and support

A diagnosis of a brain tumor can be overwhelming and frightening. It can make you feel like you have little control over your health. But you can take steps to cope with the shock and grief that may come after your diagnosis. Consider trying to:

• Learn enough about gliomas to make decisions about your care. Ask your doctor about your specific type of brain tumor, including your treatment options and, if you like, your prognosis. As you learn more about brain tumors, you may become more confident in making treatment decisions.
• Keep friends and family close. Keeping your close relationships strong will help you deal with your brain tumor. Friends and family can provide the practical support you'll need, such as helping take care of your house if you're in the hospital. And they can serve as emotional support when you feel overwhelmed by cancer.

• Find someone to talk with. Find a good listener who is willing to listen to you talk about your hopes and fears. This may be a friend or family member. The concern and understanding of a counselor, medical social worker, clergy member or cancer support group also may be helpful.

  Ask your doctor about support groups in your area. Or check your phone book, library or a cancer organization, such as the National Cancer Institute or the American Cancer Society.

Preparing for an appointment

See your doctor if you have any signs or symptoms that worry you. If you're diagnosed with a glioma, you may be referred to specialists, such as:

• Doctors who specialize in brain disorders (neurologists)
• Doctors who treat cancer (oncologists)
• Doctors who use radiation to treat cancer (radiation oncologists)
• Doctors who specialize in nervous system cancers (neuro-oncologists)
• Surgeons who operate on the brain and nervous system (neurosurgeons)
• Rehabilitation specialists

It's a good idea to be well-prepared for your appointment. Here's some information to help you get ready, and what to expect from your doctor.

What you can do

• Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Write down key personal information, including any major stresses or recent life changes.
• Make a list of all medications, vitamins or supplements that you're taking.
• Consider taking a family member or friend along. Sometimes it can be difficult to remember all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions can help you make the most of your time together. List your questions from most important to least important in case time runs out. For a brain tumor like glioma, some basic questions to ask your doctor include:

• What type of brain tumor do I have?
• Where is my brain tumor located?
• How large is my glioma?
• How aggressive is my brain tumor?
• Is my glioma cancerous?
• Will I need additional tests?
• What are my treatment options?
• Can any treatments cure my glioma?
• What are the benefits and risks of each treatment?
• Is there one treatment you feel is best for me?
• Is there a clinical trial available to treat my type of glioma? Is it appropriate for me?
• How will treatment affect my daily activities, like walking, talking and speaking?
• Should I see a specialist? What will that cost, and will my insurance cover it?
• Are there brochures or other printed material that I can take with me? What websites do you recommend?
• How often should I see my doctor for checkups?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask other questions that occur to you.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may allow time later to cover other points you want to address. Your doctor may ask:

• When did you first begin experiencing symptoms?
• Have your symptoms been continuous or occasional?
• How severe are your symptoms?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?

Overview

Glioblastoma is an aggressive type of cancer that can occur in the brain or spinal cord. Glioblastoma forms from cells called astrocytes that support nerve cells.

Glioblastoma can occur at any age, but tends to occur more often in older adults. It can cause worsening headaches, nausea, vomiting and seizures.

Glioblastoma, also known as glioblastoma multiforme, can be very difficult to treat and a cure is often not possible. Treatments may slow progression of the cancer and reduce signs and symptoms.

Diagnosis

Tests and procedures used to diagnose glioblastoma include:

• Neurological exam. During a neurological exam, your doctor will ask you about your signs and symptoms. He or she may check your vision, hearing, balance, coordination, strength and reflexes. Problems in one or more of these areas may provide clues about the part of your brain that could be affected by a brain tumor.

• Imaging tests. Imaging tests can help your doctor determine the location and size of your brain tumor. MRI is often used to diagnose brain tumors, and it may be used along with specialized MRI imaging, such as functional MRI and magnetic resonance spectroscopy.

  Other imaging tests may include CT and positron emission tomography (PET).

• Removing a sample of tissue for testing (biopsy). A biopsy can be done with a needle before surgery or during surgery to remove your glioblastoma, depending on your particular situation and the location of your tumor. The sample of suspicious tissue is analyzed in a laboratory to determine the types of cells and their level of aggressiveness.

  Specialized tests of the tumor cells can tell your doctor the types of mutations the cells have acquired. This gives your doctor clues about your prognosis and may guide your treatment options.

Treatment

Glioblastoma treatment options include:

• Surgery to remove the glioblastoma. Your brain surgeon (neurosurgeon) will work to remove the glioblastoma. The goal is to remove as much of the tumor as possible. But because glioblastoma grows into the normal brain tissue, complete removal isn't possible. For this reason, most people receive additional treatments after surgery to target the remaining cells.

• Radiation therapy. Radiation therapy uses high-energy beams, such as X-rays or protons, to kill cancer cells. During radiation therapy, you lie on a table while a machine moves around you, directing beams to precise points in your brain.

  Radiation therapy is usually recommended after surgery and may be combined with chemotherapy. For people who can't undergo surgery, radiation therapy and chemotherapy may be used as a primary treatment.

• Chemotherapy. Chemotherapy uses drugs to kill cancer cells. In some cases, thin, circular wafers containing chemotherapy medicine may be placed in your brain during surgery. The wafers dissolve slowly, releasing the medicine and killing cancer cells.

  After surgery, the chemotherapy drug temozolomide (Temodar) — taken as a pill — is often used during and after radiation therapy.

  Other types of chemotherapy may be recommended if your glioblastoma recurs. These other types of chemotherapy are often administered through a vein in your arm.

• Tumor treating fields (TTF) therapy. TTF uses an electrical field to disrupt the tumor cells' ability to multiply. TTF involves applying adhesive pads to your scalp. The pads are connected to a portable device that generates the electrical field.

  TTF is combined with chemotherapy and may be recommended after radiation therapy.

• Targeted drug therapy. Targeted drugs focus on specific abnormalities in cancer cells that allow them to grow and thrive. The drugs attack those abnormalities, causing the cancer cells to die.

  Bevacizumab (Avastin) targets the signals that glioblastoma cells send to the body that cause new blood vessels to form and deliver blood and nutrients to cancer cells. Bevacizumab may be an option if your glioblastoma recurs or doesn't respond to other treatments.

• Clinical trials. Clinical trials are studies of new treatments. These studies give you a chance to try the latest treatment options, but the risk of side effects may not be known. Ask your doctor whether you might be eligible to participate in a clinical trial.
• Supportive (palliative) care. Palliative care is specialized medical care that focuses on providing relief from pain and other symptoms of a serious illness. Palliative care specialists work with you, your family and your other doctors to provide an extra layer of support that complements your ongoing care. Palliative care can be used while undergoing other aggressive treatments, such as surgery, chemotherapy or radiation therapy.