Glioblastoma: clinical presentation, diagnosis, and management

Abstract

• Early symptoms of brain tumours in adults are non-specific, and patients may present multiple times to primary care services before they are referred for investigation. Look for symptoms of raised intracranial pressure (such as headaches exacerbated by lying down, triggered by the Valsalva manoeuvre, or associated with vomiting or visual disturbance), combinations of symptoms (such as headache plus cognitive impairment, headache plus weakness, headache plus personality change), and symptoms that progress over time. New onset focal or generalised seizures in adulthood also warrant investigation for a brain tumour. • In patients with symptoms or signs suggestive of a brain tumour, arrange urgent magnetic resonance imaging of the head with and without contrast through a rapid access “suspected cancer” pathway, when available. In patients with suspicion of raised intracranial pressure, arrange a same day clinical assessment and contrast enhanced computed tomography of the head. • Glioblastoma is the most common primary brain cancer. Standard treatment includes maximal safe resection followed by concomitant radiotherapy and temozolomide chemotherapy and then adjuvant temozolomide. Disease progression is expected in all cases and consideration of further treatment should take into account the patient’s performance status, tumour size, tumour location, and time since first treatment. • Key supportive medications may include corticosteroids for vasogenic oedema and antiepileptic medication if seizures occur. • Because of the incurable and rapidly progressive nature of glioblastoma, close collaboration between multidisciplinary teams in tertiary care hospitals and primary care services is recommended. Early involvement of general practitioners and specialist community palliative care teams can assist patients and caregivers with advance care planning as well as management of symptoms, physical and cognitive impairment, communication difficulties, and the innate uncertainties about disease progression.