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Glioblastoma

The most common glioma is glioblastoma. It is malignant and to this day cannot be permanently cured.

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WHAT IS A GLIOBLASTOMA?

Brain matter has two major components:
The actual nerve cells, neurons with the task of processing information, and the supporting or adhesive substance called glia. Neurons virtually stop dividing in adulthood, which is why true nerve cell tumors are rare. Glial cells, however, can form a variety of brain tumors, all of which are collectively called „gliomas“ after their cell of origin. The most common glioma is glioblastoma. It is malignant and to date has no permanent cure. All available forms of treatment – surgery, radiation, chemotherapy, alternating electric fields, heat and others – attempt to shrink the tumor and stop its growth without harming the patient. 

Classification
The cells of the glioma are the supporting cells of the central nervous system, i.e. the glial cells. Depending on the presumed cell of origin (astrocyte or oligodendrocyte), a distinction is made between astrocytomas and oligodendrogliomas. Often, ependymomas are also counted as gliomas; ependymomas arise from the cells lining brain ventricles (ependyma). There are so-called glioneuronal tumors, which originate from cells that can still become both glial cells and nerve cells (neurons). However, gliomas are not only classified according to their presumed cells of origin, but also according to growth rate or malignancy. A distinction is made here between WHO grades I (benign) to IV (very fast growing, malignant). The use of WHO grades also allows to describe the frequent phenomenon of degeneration (malignant progression). Many WHO grade II and III astrocytomas and oligodendrogliomas can transform into more malignant WHO grade III or grade IV tumors (glioblastomas) during progression. However, primary (directly arising) glioblastomas are more common. Today, molecular alterations are also taken into account in the classification of gliomas. Of particular importance is the detection of mutations (genetic alterations) of the IDH1 gene, which can sometimes be achieved quite simply by immunostaining on a tissue section. For the diagnosis of an oligodendroglioma, neuropathology must detect the loss of genetic material of chromosomes 1 and 19 (LOH 1p/19q or codeletion 1p/19q). Other molecular alterations important for diagnosis include the BRAF, TERT, ATRX, and H3F3A genes. The so-called promoter methylation of the MGMT gene plays a role in the decision for or against chemotherapy in glioblastoma. 

Data

Astrocytomas:
The most common gliomas, accounting for over 60%; this form of cancer includes glioblastoma, the most commonly diagnosed and malignant primary brain tumor type.

Oligodendrogliomas:
10% of all gliomas

Ependymomas:
5 to 10% of all gliomas

Mixed gliomas (oligoastrocytomas):
5 to 10% of all gliomas

Facts

In Europe, there are about 24,000 new patients with glioblastoma per year. Compared to other tumors, gliomas, and thus also glioblastoma, are rather rare! 

Compared to other tumors e.g. of the female breast (400,000/year), the prostate (375,000/year) or the lung (approx. 360,000/year), gliomas, thus also glioblastoma, are rather rare (data for 2018, European Cancer Information System ECIS). However, treatment is more difficult, and a cure is not currently achievable, unlike for many other tumors. Risk factors for developing glioblastoma are not known except radioactive (ionizing) radiation, heredity is uncommon. 

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In Europe, about 48,000 people are diagnosed with brain tumors each year.

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Of these, about 24,000 are diagnosed with glioma each year in Europe. 

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In Germany, about 4000 people per year are diagnosed with glioma. 

Symptoms

Headache that cannot be explained, disorders of the senses such as vision may be affected. Similarly, disorders of speech count as a symptom of glioma / glioblastoma. 

Unusual, persistent headache not otherwise explained may be due to pressure from a growing tumor mass. Other symptoms depend on the location in the brain. If the tumor sits close to nerve pathways controlling movement, clumsiness and paralysis develop. Otherwise, disturbances of the senses (sight, hearing, smell, touch, taste) or speech are possible. Seizures are often the first symptoms. Sometimes a brain tumor is first noticed because the affected person’s characteristics gradually change: they may become slow, forgetful or grumpy. This is often difficult to recognize even for relatives, because such changes are not uncommon even in healthy people under stress and strain. 

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