Glioblastoma is an aggressive and fast-growing cancer that originates in the brain or spinal cord. It forms from cells called astrocytes, which are star-shaped cells that support the health of nerve cells. This article provides clear and direct information about the disease’s progression, the symptoms that arise, and the care options available during its final stages.
The Progression of Glioblastoma
The life-limiting nature of glioblastoma stems from its behavior within the brain. These tumors are highly infiltrative, meaning they do not grow as a single, contained mass. Instead, they have microscopic, tentacle-like projections that extend into surrounding healthy brain tissue, much like the roots of a tree spreading through soil. This diffuse infiltration makes complete surgical removal nearly impossible.
This feature is a primary reason for the high rate of tumor recurrence. Even after a maximal safe surgical resection, where surgeons remove as much of the visible tumor as possible, the remaining invasive cells continue to multiply rapidly. These leftover cells can form new tumors, which are often in a more therapy-resistant state. The relentless advancement of these cells, despite treatments like radiation and chemotherapy, is what makes the disease so challenging to control.
Neurological and Physical Decline
As a glioblastoma tumor grows and infiltrates brain tissue, it disrupts normal neurological functions, leading to a range of symptoms. The specific signs depend on the tumor’s size and location within the brain. These changes often begin subtly but worsen rapidly as the disease progresses.
Cognitive functions are frequently affected, leading to noticeable changes in a person’s mental state. This can manifest as memory loss, confusion, and a decline in the ability to process information. Personality and mood shifts are also common, and individuals may struggle with planning, decision-making, and concentration.
Motor and sensory deficits arise as the tumor impacts the parts of the brain controlling movement. Progressive weakness or numbness, often on one side of the body (hemiparesis), can make walking and maintaining balance difficult. This may lead to a gradual loss of mobility and an increasing need for physical assistance.
Communication can become profoundly challenging. Patients may develop aphasia, which is a difficulty with speaking or understanding language. Other physical symptoms include persistent headaches that may be worse in the morning, the onset of seizures, and overwhelming fatigue that is not relieved by rest.
The Final Stages and Cause of Death
The terminal phase of glioblastoma is characterized by a progressive decline in neurological function. In the final weeks and days, a person becomes increasingly drowsy and sleeps for much of the day. This state of heightened fatigue and reduced consciousness eventually leads to unresponsiveness as the brain’s functions are further compromised.
The primary physiological mechanism leading to death is a severe increase in intracranial pressure (ICP). This pressure builds as the tumor grows and causes surrounding brain tissue to swell, a condition known as edema. The skull is a fixed structure and cannot expand to accommodate the growing mass, causing the pressure inside to rise to dangerous levels.
This intense pressure can lead to brain herniation, where the pressure physically pushes brain structures out of their normal position. The most severe consequence is the compression of the brainstem, the part of the brain that connects to the spinal cord and controls the body’s most basic automatic functions.
When the brainstem is compressed, its ability to regulate breathing and heartbeat is fatally disrupted. The signals that maintain a regular respiratory rhythm and pulse are interrupted, causing these functions to cease. This failure of the body’s life-sustaining systems, directly caused by the pressure from the tumor, is the most common cause of death from glioblastoma.
Palliative and Hospice Care
Palliative care is a specialized approach focused on maximizing comfort and quality of life for individuals with glioblastoma. This care can be initiated at any stage of the disease, often alongside curative treatments like chemotherapy and radiation. The primary goal is to provide relief from the symptoms and stress of the illness, addressing the physical, emotional, and social needs of both the patient and their family.
To manage the symptoms of glioblastoma, palliative teams use several interventions. Steroids, such as dexamethasone, are prescribed to reduce brain swelling (edema), which can alleviate headaches and some neurological deficits. Anti-seizure medications are used to control or prevent seizures, and various pain management strategies are employed to ensure the patient remains comfortable.
Hospice care is for when a person is approaching the end of life, with a life expectancy estimated to be six months or less. The focus shifts away from treating the cancer and centers on providing comfort, maintaining dignity, and offering comprehensive support. A hospice team, which includes doctors, nurses, and therapists, works to manage symptoms and provide emotional and spiritual support in a home or inpatient setting.