Running head: GLIOBLASTOMA MULTIFORME 1
Glioblastoma Multiforme
Joshua Fleming
Liberty University
09/16/2013
GLIOBLASTOMA MULTIFORME 2
Glioblastoma Multiforme
The patient in room 124-2 is a 37 year-old Chinese female who is being admitted
post hospitalization at Lynchburg General Hospital where she presented on August 26th
with the complaint of a headache. A CT scan showed a 2.7x2.4 cm mass with local
hemorrhage. She was then taken to the operating room for a craniotomy, and was found
to have a recurrent tumor as well as a local hemorrhage. The tumor was resected and
decompressed, and she was taken back to neurosurgery ICU postop. She was placed on
Decadron and Keppra for seizure prophylaxis and Famotidine was used for GI
prophylaxis. She has been diagnosed with glioblastoma multiforme, and has since been
transferred to Skilled Care on August 30th for admission for PT and OT. This patient has
no past medical history (PMH) present on her chart due to her residence in another state.
She does have a family history (FH) of a father with colon cancer, and a mother with a
benign abdominal tumor. Glioblastoma multiforme will be discussed as well as the care
of this patient while she is in the hospital.
Glioblastoma Multiforme (GBM) is a tumor that arises from the glial cells in the
brain. It is the most common malignant primary brain tumor. This type of tumor is
typically aggressive, and infiltrates the brain tissue it surrounds. GBM is the more
common name for a grade IV astrocytoma, and is the most deadly of all astrocytomas
(WebMD, 2012). GBM is a poor prognosis, with most patients dying within a year, and
none have long-term survival expectations. One of the reasons that this particular type of
tumor does not respond to interventions is the complex character of the tumor itself.
There are many ways in which the tumor is multiforme.
GLIOBLASTOMA MULTIFORME 3
“The tumor is multiforme grossly, with areas of hemorrhage and necrosis. It is also
multiforme microscopically with regions of pseudopalisading necrosis, pleomorphic
nuclei and cells, and microvascular proliferation. And it is multiforme genetically, with
various deletions, amplifications, and point mutations leading to activation of signal
transduction pathways downstream of tyrosine kinase receptors such as epidermal growth
factor receptor (EGFR) and platelet-derived growth factor receptor (PDGFR), as well as
to disruption of cell-cycle arrest pathways by INK4a-ARF loss or by p53 mutations
associated with CDK4 amplification or Rb loss” (PubMed, 2000a).
There are also genetic anomalies that are specific to this tumor. Inside of the
tumor there is a genetic heterogeneity with a massive amount of sub-clones that live in
the cell population. Because of this and their topographically diffuse nature it is not
common for this disease to be cured by surgery. The tumor cells can also be located in
various places in the brain, which results in an inability to completely resect the tumor.
The glioma cells migrate through the parenchyma, surround neurons and vessels, and
migrate through white matter tracks. The ultimate result is the spread of the tumor cells to
the regions of the brain that are vital for the patient’s survival. Though GBM masses can
be visualized with an MRI, the neoplastic cells extend far beyond what can be visualized
by this technique (PubMed, 2000b).
The care for patients diagnosed with this specific disease process has not changed
for decades. Care consists of as much tumor resection as is safe, followed by
chemotherapy and radiation. Under the best circumstances, the entire enhancing tumor
visualized by MRI can be removed, which is then followed by radiation and
chemotherapy. Even with these measures the mean survival of the disease is only
extended from two to three months to one year. (PubMed, 2000c)
There are not many alternatives to this standard of care, and though it may seem
useless, surgery of the mass in the brain increases the quality of life for the patient
dramatically. Following that, the patient will need to understand that there is no solution
GLIOBLASTOMA MULTIFORME 4
to this problem that is definite. From there the patient can choose to have chemotherapy
and radiation, which will slow the progress of more masses being formed.
124-2 has made progress in her recovery since arriving at the skilled care unit,
and has recently started to walk with assistance. Encouraging as much activity as can be
tolerated by the patient will help to shorten her recovery time inside the hospital, and
allow her to spend as much time with her family in her last days.
GLIOBLASTOMA MULTIFORME 5
References
Holland EC. Glioblastoma multiforme: the terminator. Proceedings of the National
Academy of Sciences. 2000;97(12):6242–6244. PubMed.
WebMD, (2012). Glioblastoma Multiforme. Retrieved from
http://www.webmd.com/cancer/brain-cancer/glioblastoma-multiforme
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