Glioblastoma Awareness with Dr. Alicia Zukas

Glioblastoma is among the deadliest brain cancers, claiming more than 14,000 lives each year, according to the national Glioblastoma Foundation.

"Sometimes glioblastoma can look like a monarch butterfly spreading its wings," says Dr. Alicia Zukas, a neuro-oncologist in MUSC Health's Department of Neurosurgery. "We call these butterfly gliomas. But, looking under the microscope, a glioblastoma cell is shaped like a star. They’re called astrocytes, which is Greek for 'star cells.'"

In 2016, the World Health Organization started changing the way brain tumors are identified, no longer diagnosed by their starry appearance but instead based on their genetic features. These criteria have been further refined over the last year.

"A glioblastoma diagnosis is no longer made through examination of tissue under a microscope," Dr. Zukas says. "Instead, the diagnosis is confirmed at the molecular level and is based on the tumor’s genetics. This means that some tumors that behave like glioblastoma are no longer diagnosed as such and are, instead, a different type of brain tumor. This also means that some patients who previously would not have been diagnosed with glioblastoma are now considered to have it."

Dr. Zukas says the emphasis on the genetic makeup of glioblastoma is not to be confused with a genetic link in families, which is rare. "Although glioblastoma can run in families, it is incredibly uncommon. Moreover, glioblastoma is not a lifestyle cancer, meaning it’s not caused by smoking or the result of a patient’s habits or activities. Researchers have not found a link between glioblastomas and cellphone use. There seems to be nothing that a patient did or did not do to cause this."

Glioblastoma can develop at any age, but it typically afflicts individuals in their 60s. Dr. Zukas says she expects to see more cases as the growing population ages. Symptoms might include a new headache, loss of balance, and vomiting. "Usually, glioblastoma isn't diagnosed until someone shows up at the ER after having a new neurological problem. That’s about 70 percent of our new diagnoses. About a third of those patients come in because they had a seizure," she says.

Some progress has been made over the decades in the treatment of glioblastoma and other brain tumors. The standard treatment for glioblastoma and other brain cancers includes surgery, when possible, followed by radiation in the morning combined with oral chemotherapy at bedtime for 6 weeks to try to control the tumor. Cognitive and occupational therapy are also recommended because the medicines can cause fatigue and impact sleep cycles and thinking, she says. MUSC Health offers a fourth option for adults whose tumor has returned: the Optune cap, a device that is worn on the patient’s head and uses electrical fields that slow, stop, or destroy cancer cells in glioblastoma.

"A patient who functions better will have improved quality of life and tolerate treatment better," Dr. Zukas says. "A glioblastoma tumor is like a jellyfish with long tentacles. We can cut out the body, but we can’t get to all the tentacles. Thus, our goal is to have a well-controlled tumor without incapacitating the patient. Our team removes as much of the tumor without leaving the patient with a deficit. We want our patients to be better off after surgery than before surgery."

Clinical trials offer another treatment option, as well as the opportunity to help improve treatment outcomes and contribute toward a cure, Dr. Zukas says. Currently, 1,758 studies, including several at MUSC, are in the pipeline, and 328 trials are recruiting right now nationwide. Every clinical trial in the United States can be found at clinicaltrials.gov, and Hollings Cancer Center trials are on the MUSC website.

"When I tell my patients their diagnosis, I also tell them about clinical trials, which are available for newly diagnosed patients and then also to stop the tumor when it starts growing again. I encourage every person to participate in research and become part of the cure."

To learn more about the Brain & Spine Center, visit the MUSC Health Brain & Spine Tumor Program website or call 843-792-9300 to schedule an appointment.