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Nursing Care of Glioblastoma Multiforme


A glioblastoma multiforme (GBM) is a type of brain tumour called an astrocytoma. Astrocytomas are some of the most common brain tumours. They develop from the highly vascular and quickly reproducing astrocyte cells in our brain and are often malignant. They are graded on their severity from grade 1 (low severity) to a grade 4 (high severity). These grades are dependent on the malignancy growth rate, its blood supply, its similarity to normal cells, its invasion potential and the presence of any necrosis.

A stage 1 GBM is the least malignant tumour. It’s slow growing and has a good long-term survival rate following surgery. At the other end of the scale, a stage 4 GBM is the most malignant tumour and often invades the surrounding area, reproducing quickly.

GBMs are the most common stage 4 astrocytoma tumours, with many patients dying from their tumour within a year of diagnosis. These tumours are most common in men between 50 and 70 years of age, and are uncommon in children, however, the cause of GBMs remains relatively unknown.

What are the Symptoms of a GBM?

Often the symptoms of a GBM are caused from increased intracranial pressure, a result of the tumour growth. Therefore, common symptoms include headaches, confusion, memory loss, nausea, vomiting and drowsiness. But like any type of ailment associated with the brain, the symptoms may differ depending on the part of the brain affected. Some patients may experience personality changes, visual changes, speech difficulties, seizures or body weakness similar to strokes. These symptoms vary in their onset but usually develop over a period of weeks.

How are GBMs Diagnosed and Treated?

Diagnosis is most often achieved with an MRI and, if possible, a biopsy of the tumour. If the patient has high intracranial pressure, the first line of treatment would focus on relieving the pressure. This often involves surgery, such as a resection of the tumour, decompressive craniotomy or cerebral spinal fluid drainage. Raised intracranial pressure can also be medically managed by controlling hypertension, preventing seizures, controlling anaemia, and through the administration of steroids.

Fibrous astrocytes of brain tissue.

Fibrous astrocytes of brain tissue showing many long and thin processes. Golgi’s silver chromate method.

Like many other malignant brain tumours, GBMs can be treated with surgery, radiotherapy, chemotherapy or a combination of these treatments. However, most GBMs are difficult to fully remove through surgery because their borders are almost like tentacles, hence why other treatments such as chemotherapy and radiotherapy are often also needed.

My Patient has a GBM, What is Their Prognosis?

People with stage 3 and 4 GBMs have a lower chance of survival than those with a less severe grade. 27% of patients with a stage 4 GBM survive up to 2 years after their diagnosis. However, if the individual is under the age of 60, generally healthy and fit, has normal brain function and was able to have all of their tumour surgically removed then they have an increased chance of survival.

How Do I Look After a Patient With a GBM?

Caring for a patient with a GBM requires a holistic approach, we need to not only be involved with the medical treatment of their tumour, but also provide psychosocial care. The emotional and psychological impact of being diagnosed with a GBM is quite substantial, particularly as these patients are facing a terminal brain tumour. They will also be physically and socially impacted by the changes the tumour may have already caused to their lifestyle, due to symptoms such as memory problems and personality alterations.

It is recommended that a treatment plan be provided that caters to all aspects of the physical, medical and psychosocial impact of the GBM.

The medical treatment being provided to the patient, which may include chemotherapy, radiotherapy and medication management, will also impact the individual’s health more broadly. Any side effects from the medical management of a patient with a GBM must be swiftly dealt with. This may include nausea and vomiting, loss of appetite, fatigue, pain and skin abnormalities.

Their families should also be involved in their treatment and, as nurses, we will need to ensure that family members’ psychological health is maintained. This can become very difficult, especially as the tumour advances. Patients will quickly move from a fit and healthy lifestyle, to one ravished by a diagnosis of a glioblastoma multiforme brain tumour, to a discussion around palliative care. As a nurse, you will play a pivotal role in the provision of both physical and psychosocial care throughout this period.

SEE ALSO What is Complex Regional Pain Syndrome

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References

  1. American Brain Tumor Association 2014, Glioblastoma (GBM), viewed 28 August 2015, http://www.abta.org/br…ma.html
  2. International RadioSurgery Association 2015, Glioblastomas, viewed 28 August 2015, http://www.irsa.org/…a.html
  3. Holland, EC 2000, ‘Glioblastoma Multiforme: The terminator’, Proceedings of the National Academy of Sciences of the United States of America, vol. 97, no. 12, pp. 6242-6244, viewed 28 August 2015, http://www.ncbi.nlm.nih.gov/p…3/
  4. Cancer Council Australia 2011, Adult gliomas (astrocytomas and oligodendrogliomas): A guide for patients, their families and carers, viewed 28 August 2015, http://www.cancer.org.au/cont…rked.pdf
  5. Rangel-Castillo, L, Gopinath, S & Robertson, CS 2008, ‘Management of Intracranial Hypertension’, Neurologic Clinics, vol. 26, no. 2, pp. 521-541, viewed 28 August 2015, http://www.ncbi.nl…2989/

Cover Imagery Attribution: “Glioblastoma (1)” by No machine readable author provided. KGH assumed (based on copyright claims). – No machine readable source provided. Own work assumed (based on copyright claims).. Licensed under CC BY-SA 3.0 via Wikimedia Commons – https://commons.wikimedia.org/wiki/File:Glioblastoma_(1).jpg#/media/File:Glioblastoma_(1).jpg; “AFIP-00405558-Glioblastoma-Radiology” by The Armed Forces Institute of Pathology – http://peir2.path.uab.edu/scripts/acdis.dll?cmd=see&fp=/dbih/AFIP/00405558.tif&fmt=jpg&q=100&h=512. Licensed under Public Domain via Wikimedia Commons – https://commons.wikimedia.org/wiki/File:AFIP-00405558-Glioblastoma-Radiology.jpg#/media/File:AFIP-00405558-Glioblastoma-Radiology.jpg

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