Long-Term Survivors of Glioblastoma | Expert Surgeon

• Long-term glioblastoma survival
• How does genetic makeup of a tumor impact survival?
• MGMT in long-term glioblastoma survival
• IDH in long-term glioblastoma survival
• Tumor recurrence
• Working towards a cure

Glioblastoma is the most aggressive type of brain tumor and is brain cancer; However, a small group of patients survive 5, 10, and even 20 years after initial diagnosis. Younger patients with good health at diagnosis and those with favorable tumor genetics (MGMT promoter methylation and IDH mutations, specifically) tend to survive longer. Although the average life expectancy after a diagnosis with glioblastoma is between 14 and 16 months, patients with certain tumor genetics have a median survival time of 22 and 31 months.

The longest glioblastoma survivor has lived for more than 20 years after diagnosis. While long-term survivors have been documented, these cases are uncommon. Here, we will shed some light on what factors impact survival in patients with glioblastoma to provide a realistic outlook on prognosis.

Long-Term Glioblastoma Survival

Glioblastoma, also known as grade IV astrocytoma, is the most aggressive type of brain tumor. This devastating disease is infamous for taking the lives of many patients, with special media attention focusing on politicians, artists, scientists, and entrepreneurs. The voices of long-term survivors are often less widely heard. Although the average life expectancy after diagnosis is 14 to 16 months, approximately 1% of patients survive at least 10 years. Currently, the longest anyone has survived a glioblastoma is more than 20 years and counting.

But what makes this small group of glioblastoma patients so special? Researchers are investigating differences between glioblastoma patients that survive for long periods of time and those that unfortunately succumb early to the disease. Several factors appear to come into play. A younger age (20 – 40 years old) and good functional status at diagnosis is associated with longer survival. Surprisingly, some of the strongest factors for prolonged survival come from the genetic makeup of the tumor.

How Does Genetic Makeup of a Tumor Impact Survival?

Although glioblastomas have some genetic changes in common, no glioblastoma tumor is identical. In fact, some glioblastomas may have genetic changes that make current therapies work better. The most widely known genetic mutations are in the DNA repair enzyme O6-methylguanine-DNA methyltransferase (MGMT) and an enzyme involved in metabolism called isocitrate dehydrogenase (IDH).

MGMT in Long-Term Glioblastoma Survival

MGMT is a DNA repair enzyme normally found in healthy cells. MGMT is usually a beneficial enzyme. It helps repair your DNA when it becomes damaged by the environment, toxins, and other exposures in your everyday life. While MGMT is normally a good thing in healthy cells, it is a bad thing in tumor cells. Chemotherapy used to treat glioblastomas (such as Temodar) damage tumor DNA in an attempt to signal cell death. MGMT in a tumor cell prevents this chemotherapy from working as well. This causes treatments to be less effective.

In some glioblastomas, there are low levels of MGMT due to a phenomenon called “promoter methylation”. A promoter is a sequence of DNA that can turn a gene on or off. When a carbon and three hydrogen atoms (methyl group) are transferred to parts of the promotor in a process called methylation, this usually turns the gene off. Therefore, MGMT promoter methylation prevents the enzyme (MGMT) from being created by tumor cells.

Glioblastoma MGMT promoter methylation is positive news. This means that the MGMT gene is making less of the DNA repair enzyme (MGMT) for the tumor to use against chemotherapy treatment. The tumor will have a difficult time repairing itself and is more likely to shrink following chemotherapy with medications, such as Temodar. Patients with tumors that have MGMT promoter methylation are reported to survive longer (with a median survival time of 22 months) compared to those without MGMT promoter methylation (a median survival of between 14 to 16 months).

IDH in Long-Term Glioblastoma Survival

IDH is an enzyme involved in the biochemical breakdown of foods to energy and the creation of other important products for the cell (metabolism). Mutations in IDH are commonly seen in glioblastomas that have evolved from a glioma of a lower grade, such as a grade II or III astrocytoma or oligodendroglioma. Having an IDH mutation in the tumor is favorable for the patient, as it impairs the tumor’s metabolism and slows growth. Patients with glioblastoma carrying an IDh2 or IDh3 mutation have a longer median survival time of 31 months.

Tumor Recurrence

Unfortunately, many glioblastomas recur. The recurrent tumor is usually of the same type and often retains most of the genetic makeup from the initial tumor. They most commonly appear less than 2 cm from the initial tumor site but can arise in more distant locations. Since the recurrent tumor shares many similarities with the initial glioblastoma, the treatments will also be very similar.

Working Towards a Cure

Researchers are actively testing new therapies to treat glioblastoma. Experimental therapies include the use of anti-tumor antibodies for targeted destruction, vaccines to enhance the patient’s own immune system response, and gene therapy to deliver anti-cancer genes to the tumor. Speak to your physician about possible clinical trials that you could participate in.

Receiving the diagnosis of glioblastoma can be difficult to digest. Involve healthcare providers that will compassionately support you on your journey. Although survival statistics are meant to provide factual historical data, each glioblastoma patient is different, and each day we make progress towards understanding this disease and broadening treatment options.

Resources

• National Brain Tumor Society
• American Brain Tumor Association
• Brain Tumor Foundation
• Children’s Brain Tumor Foundation
• Pediatric Brain Tumor Foundation
• Glioblastoma Foundation

Brain Tumor Facts

There are more than 100 distinct types of primary brain tumors, each with its own spectrum of presentations, treatments, and outcomes. More than any other cancer, brain tumors can have lasting and life-altering physical, cognitive, and psychological impacts on a patient’s life. And, despite years of research, brain cancer survival rates have remained little-changed in recent years, even while survival rates for many other cancers have been significantly improved.

The following statistics and facts provide a snapshot of the burden primary brain tumors cause to Americans of all walks of life. Additional references are noted at the bottom of the page, but for a majority of the information listed below the figures stem from population statistics sampled during the 2015-2019 time period and analyzed in 2022, and reflect the latest available data at that time.

Brain Tumor Facts

• An estimated 1 million Americans are living with a primary brain tumor [1]
• Approximately 72% of all brain tumors are benign
• Approximately 28% of all brain tumors are malignant
• Approximately 59% of all brain tumors occur in females
• Approximately 41% of all brain tumors occur in males 
• An estimated 94,390 people will receive a new primary brain tumor diagnosis in 2023
  • An estimated 67,440 will be non-malignant (benign) in 2023
    • Non-malignant meningiomas are the most commonly occurring primary non-malignant brain tumors, accounting for 39. 7% of all tumors and 55.4% of all non-malignant tumors
  • An estimated 26,940 will be malignant in 2023
    • Glioblastoma is the most commonly occurring primary malignant brain tumor, accounting for 14.2% of all tumors and 50.1% of all malignant tumors
• The median age at diagnosis for a primary brain tumor is 61 years
• The five-year relative survival rate for all patients with primary brain tumors is 76%
  • Survival rates vary by age at diagnosis and tumor type and generally decrease with age
  • For patients with non-malignant brain tumors, the average five-year relative survival rate is 91.8%
    • The most common primary non-malignant brain tumor, meningioma, has a average five-year survival of 88.2% after diagnosis 
    • For patients with malignant brain tumors, the five-year relative survival rate following diagnosis is 35.7%
    • For the most common form of primary malignant brain tumors, glioblastoma, the five-year relative survival rate is only 6. 9% and median survival is only 8 months
• And estimated 18,990 people will die because of a malignant brain tumor (brain cancer) in 2023 [2]
• Brain cancer is estimated to be the 10th leading cause of cancer death in 2023 for both males and females in all age groups [2]

• Approximately 3.9% of all brain tumors cases diagnosed occur in children ages 0-14 years 
• An estimated 3,920 new cases of primary childhood brain tumors are expected to be diagnosed in 2023 
• Brain tumors are the most commonly diagnosed solid cancer in children ages 0-14 years, as well as the leading cause of childhood cancer-related death 
• 13,657 children were estimated to be living with a primary brain tumor in the U.S. in 2010 [3]
• The five-year relative survival rate for all primary childhood brain tumors is 83.1% 
  • For primary malignant childhood tumors, the five-year relative survival rate is 75.6% [4]
• The most common brain tumor types in children ages 0-14 years are:
  • Pilocytic astrocytomas (18. 7%)
  • Other gliomas (15.3%)
  • Embryonal tumors (12.2%)
    • Medulloblastomas make up the largest percentage of embryonal tumors (68.3%)
    • Atypical teratoid/rhabdoid tumors (AT/RT) make up the second largest percentage of embryonal tumors (17.2%)
• Gliomas account for approximately 49.4% of tumors diagnosed in this age group

• Approximately 5.7% of all primary brain tumors occur in children and adolescents, ages 0-19 years
  • Approximately 1.7% of all brain tumors occur in the adolescent (15-19) population
  • Infants less than one year of age have the highest incidence of brain tumors of all children and adolescents 0-19 [3]
• An estimated 5,230 new cases of primary brain tumors in children and adolescents will be diagnosed in the U.S. in 2023
• Brain tumors are the most common cancer in children and adolescents ages 0-19 years in the U.S. [3]
  • Brain tumors are the most common cancer overall in adolescents ages 15-19 years in the U. S. [2]
• The five-year relative survival rate for all primary pediatric brain tumors (0-19) is 83.9% [4]
  • For malignant tumors, the five-year relative survival rate is 75.6%
• Pediatric brain tumors are the leading cause of cancer-related death among children and adolescents ages 0-19 years [2] 
  • AT/RT and high-grade gliomas have the lowest relative survival after diagnosis for patients 0-19 years with a brain tumor [3]
    • High-grade gliomas cause the greatest proportion of deaths (44.2%), followed by medulloblastoma and AT/RT [3]
  • Pilocytic astrocytoma has the highest survival rates after diagnosis
  • Relative survival rates generally improve with increasing age at diagnosis in this population group, with poorest survival in those less than a year old at diagnosis [3]
• The most common primary brain tumor types in children and adolescents ages 0-19 years are:
  • Pilocytic astrocytoma (15.3%)
  • Other gliomas (12. 6%)
  • Embryonal tumors (9.2%)
    • Medulloblastoma account for the latest percentage of embryonal tumors in this population (69.5%)
• Gliomas account for approximately 44.6% of tumors in this age group (27.9% in ages 15-19 years)
• Tumors of the pituitary are the most common in the 15-19 age group (33.5%) 
• In children and adolescents, incidence is higher in females than males
• Incidence rates are highest among children and adolescents who are White compared to children and adolescents who are Black, Asian or Pacific Islander (APIA), or American Indian and Alaskan Native (AIAN) 
• Incidence rates are highest among children and adolescents who are non-Hispanic compared to children and adolescents who are Hispanic
• It was estimated in 2009, that a total of 47,631.5 years of potential life were lost due to brain tumors in children and adolescents in the US [3]

• Approximately 14.3% of all primary brain tumors occur in the AYA population
• An estimated 11,660 new cases of primary brain tumors will be diagnosed in AYA patients in 2023
• Brain tumors are the second most common cancer overall in individuals ages 15-39 and the second leading cause of cancer related death in those 15-39 years of age
• The five-year relative survival rate for AYA patients diagnosed with a primary brain tumor is 90. 9%
  • The rate is 71.7% for malignant tumors and 98.3% for non-malignant tumors
• The most common primary brain tumors in the AYA population are:
  • Tumors of pituitary (36.0%) 
  • Meningiomas (15.9%)
  • Nerve sheath tumors (8.6%)
• Gliomas account for approximately 24.8% of all primary AYA brain tumors and 82.4% of all malignant tumors in this group
• AYA had higher rates of relative survival than adults greater than 40 years old for all histopathologic types. Though one-year relative survival for most tumor types was higher for AYA than children, five- and ten-year survival were usually higher for children as compared to AYA.

• Approximately 81.7% of all primary brain tumors occur in the adult population
• An estimated 79,340 adults age 40+ will be diagnosed with a primary brain tumor in 2023 in the U.S.
• Brain tumors are the seventh most common tumor type overall and the sixth most common cause of cancer related death among persons ages 40+ years
• For adults ages 20+ years, age-specific incidence rates for primary brain tumors are highest among those age 85+
• The five-year relative survival rate for adults diagnosed with a primary brain tumor is 72. 5%
  • The five-year relative survival rate for those ages 40+ years is 21% for malignant tumors and 90.3% for non-malignant tumors
• The most common primary brain tumor types in adults are:
  • Meningiomas (46.1%)
  • Glioblastoma (16.4%)
  • Tumors of the pituitary (14.5%)
• For 2023, the highest number of new cases is predicted in those age 65+ years
• Older adults (40+ years old) had poorer survival than children (0-14 years) in nearly all primary brain tumor types

• Overall, people who are Black have slightly higher incidence rates of primary brain tumors compared to other races, followed by people who are White, APIA, and AIAN
  • Incidence rates of non-malignant brain tumors are highest in people who are Black, followed by people who are White, APIA, and AIAN
  • Incidence rates of malignant brain tumors are highest in people who are White, followed by people who are Black, AIAN, and APIA
• Incidence rates for specific brain tumor types vary**:
  • Individual who are White have significantly higher incidence rates for glioblastoma, all other astrocytomas, embryonal tumors, and nerve sheath tumors compared to people who are Black
  • Individual who are Black have higher rates of meningioma and pituitary tumors compared to people who are White
• Overall incidence rates of brain tumors are higher in people who are non-Hispanic than people who are Hispanic 
• Individuals who are Black, non-Hispanic have poorer survival outcomes compared to people who are White, non-Hispanic with the exception of glioblastoma, unique astrocytoma variants, other neuroepithelial tumors, other hemopoietic neoplasms, germ cell tumors, and neoplasms unspecified
• Individuals who are AIAN, non-Hispanic have poorer overall survival as compared to individuals who are White, non-Hispanic in many tumor types, though the small size of this population means that many of these associations are not biologically significant
• Individuals who are APIA, non-Hispanic have improved survival in many tumor types compared to White, not Hispanic, though many of these associations were non-significant
• Hispanic ethnicity was associated with improved survival in most brain tumor types

*The U. S. Census Bureau defines race as a person’s self-identification with one or more social groups, which can include white, Black or African American, Asian, American Indian, Alaska Native, Native Hawaiian, and/or Other Pacific Islander. Federal statistical standards used by the Census and the National Center for Education Statistics, conceptualize a person’s ethnicity into one of two categories: Hispanic (or Latino/a/x) or Not Hispanic (Latino/a/x). A Hispanic (or Latino/a/x) person can self-report as any race.

**While there are several tumor types where significant differences in incidence were observed by race and/or ethnicity, in most cases the actual difference in incidence rates is small and may not be significant. 

• Overall, incidence rates for all primary brain tumors are higher in females (58.7% of diagnoses) than in males (41.3%)
• Non-malignant primary brain tumors occur more often in females (64.4%) than in males (35.6%)
• Malignant primary brain tumors occur more often in males (55. 8%) than in females (44.2%)
• Incidence rates for specific brain tumor types vary by sex. For example, glioblastoma is more common in males, while meningioma is more common in females
• Overall, males have higher mortality rates from malignant brain tumors than females, and generally worse survival outcomes with the exception of glioblastoma, malignant gliomas, embryonal tumors, other hematopoietic neoplasms, and germ cell tumors

• Unlike other types of cancer, primary brain tumors are not staged. They are grouped according to the WHO Classification of Tumors of the Central Nervous System, which assigns a “grade” of 1-4 based on how aggressive the tumor is predicted to behave, clinically
  • Grade 1 tumors, such as some meningiomas, are the lowest and typically least aggressive grade. Grade 4 tumors, such as glioblastoma, are the highest and most aggressive grade of tumors
• Only a few treatments have ever been approved for the more than 100 types of brain tumors. None of these extend survival more than two years on average, or are considered to be curative. [5]
  • For many tumor types, surgery and radiation remain the standard of care, and national guidelines suggest that clinical trials remain the best place to care for patients
• Survival rates for adult and pediatric patients with brain tumors have not changed significantly over the past 45 years despite major improvements made in the treatment of other cancers.
• Each year, approximately 70,000-200,000 patients are diagnosed with brain metastases (metastatic brain tumors/secondary brain tumors), while ~100,000 will die every year as the result of brain metastases [6] [10]
  • The incidence of brain metastases appears to be increasing [7]
  • Several studies have cited that the percentage of patients with cancer who will develop brain metastases is anywhere from approximately 10% to 30% [8] [9]
  • Virtually all cancers have been associated with the ability to metastasize to the brain
    • These include melanoma (where it’s been estimated that most cases will metastasize to the brain), lung, breast, renal, and colorectal cancers [10] [11] [12]
  • Metastatic brain tumors are five times more common than primary brain tumors (those that originate in the brain). [9]

Notes

• Unless otherwise notes, all statistical figures have been sourced from the Central Brain Tumor Registry of the United States (CBTRUS) in CBTRUS Statistical Report: Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States in 2015–2019, Oct. 2022 (www.cbtrus.org).
  • Quinn T Ostrom, Ph.D., M.P.H, Mackenzie Price, M.P.H, Corey Neff, M.P.H, Gino Cioffi, M.P.H, Kristin A Waite, Ph.D, Carol Kruchko, B.A, Jill S Barnholtz-Sloan, Ph.D, CBTRUS Statistical Report: Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States in 2015–2019, Neuro-Oncology, Volume 24, Issue Supplement_5, October 2022, Pages v1–v95, https://doi.org/10.1093/neuonc/noac202
• Brain tumor statistics are typically classified as “brain and other central nervous system (CNS) tumors” in research reports. For ease and clarity, in this document we use “brain tumors” as shorthand to include both tumors occurring in the brain and other central nervous system locations, such as the spine.  
• Unless otherwise noted, all references on this page refer to primary brain tumors, and all stats refer to U.S. populations.

References

[1] Porter KR, McCarthy BJ, Freels S, Kim Y, Davis FG. Prevalence Estimates for Primary Brain Tumors in the United States by Age, Gender, Behavior, and Histology. Neuro Oncol. 2010.; 12(60):520-527.

[2] Siegel, RL, Miller, KD, Wagle, NS, Jemal, A. Cancer statistics, 2023. CA Cancer J Clin. 2023; 73( 1): 17- 48. doi:10.3322/caac.21763

[3] Central Brain Tumor Registry of the United States Fact Sheet for Pediatric Brain Tumors 2022

[4] Quinn T Ostrom, Mackenzie Price, Katherine Ryan, Jacob Edelson, Corey Neff, Gino Cioffi, Kristin A Waite, Carol Kruchko, Jill S Barnholtz-Sloan, CBTRUS Statistical Report: Pediatric Brain Tumor Foundation Childhood and Adolescent Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States in 2014–2018, Neuro-Oncology, Volume 24, Issue Supplement_3, September 2022, Pages iii1–iii38, https://doi. org/10.1093/neuonc/noac161

[5] National Brain Tumor Society analysis

[6] Workshop on Product Development for Central Nervous System Metastases

[7] https://www.ncbi.nlm.nih.gov/books/NBK470246/ 

[8] Nayak L, Lee EQ, Wen PY. Epidemiology of brain metastases. Curr Oncol Rep. 2012 Feb;14(1):48-54.

[9] https://www.hopkinsmedicine.org/health/conditions-and-diseases/metastatic-brain-tumors 

[10] https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Metastatic-Brain-Tumors

[11] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6064184/ 

[12] Lamba N, Wen PY, Aizer AA. Epidemiology of brain metastases and leptomeningeal disease. Neuro Oncol. 2021 Sep 1;23(9):1447-1456. doi: 10.1093/neuonc/noab101. PMID: 33908612; PMCID: PMC8408881.

How quickly a brain tumor develops. Life expectancy

How long does a brain tumor grow? The growth rate of neoplasms in the brain area depends on their histological structure, location, stage of the pathological process, and individual characteristics of the organism.

Causes of tumors

The true causes of the development of neoplasms of the central nervous system remain poorly understood. The following reasons can provoke the formation of tumors:

1. Exposure to ionizing radiation.
2. Violation of the process of laying the structures of the central nervous system at the stage of intrauterine development.
3. Chronic contact with toxic components.
4. Past traumatic brain injury.
5. Genetic pathologies (neurofibromatosis, Turkot syndrome, Von Hippel-Landau syndrome).

Triggering factors for the appearance of brain tumors

Neoplasms of the central nervous system, like other tumors, are formed when the process of uncontrolled cell division is triggered, while dividing cells can have different degrees of differentiation. The previously listed unfavorable factors can start the process of cell division.

Risk factors for tumors

Risk factors for tumors of the central nervous system include:

1. Male gender.
2. HIV infection.
3. Constant contact with refined petroleum products, pesticides, arsenic, lead and mercury.
4. Age less than 8 years and more than 79 years.
5. Previous radiation therapy.

Classification of tumors

Depending on the histological structure, brain tumors are divided into several types.

1. Astrocytomas. This glial type tumor is formed from astrocyte cells of the same name. Brain astrocytomas can have a different degree of malignancy and carry a different level of danger to human health and life.
2. Oligodendrogliomas. This type of brain tumor is formed from oligodendrocyte cells of the same name. A neoplasm can develop at any age, but is more common over the age of 30, predominantly in male patients.
3. Ependymomas. The neoplasm is formed from epindemocytes located in the region of the ventricles of the brain. A neoplasm is diagnosed with the same frequency both in children and in patients of mature and elderly age.
4. Mixed gliomas. Mixed type gliomas have a mixed cellular composition, unpredictable pattern and growth rate.
5. Pituitary adenomas. The tumor is benign in nature and is formed from glandular pituitary tissue.
6. CNS lymphomas. Lymphomas of the central nervous system are among the most aggressive malignant pathologies. This type of tumor can develop in any of the brain structures.
7. Meningiomas. This type of neoplasm is formed from the cellular elements of the arachnoid membrane of the brain. In most cases, meningiomas are benign.

Symptoms of brain tumors

Focal symptoms of tumors of the central nervous system include:

1. Memory impairment.
2. Decreased tactile, pain and temperature sensitivity.
3. Paralysis and paresis.
4. Decreased visual acuity.
5. Hearing impairment.
6. Epileptic seizures.
7. Change in written and spoken language.
8. Auditory and visual hallucinations.
9. Decreased intelligence.
10. Cognitive disorders.
11. Loss of coordination.

General cerebral signs of CNS tumors include:

1. Dizziness.
2. Vomiting attacks not dependent on food intake.
3. Chronic headache, predominantly in the morning.

Diagnostics

To detect benign and malignant neoplasms of the central nervous system, the following diagnostic methods are used:

1. Magnetic resonance imaging.
2. Computed tomography.
3. Electroencephalography.

Additional diagnostic methods include ophthalmoscopy and computed perimetry.

Tumor Treatment

Both surgical and non-surgical treatment options are used to treat brain tumors.

• Alternative to surgery – If the tumor is small or unresectable, alternative treatments may be used.
• Radiotherapy – remote radiotherapy is used for therapeutic purposes, while the frequency of radiation sessions is 5 times a week, and the total course of treatment lasts several weeks. Also, brachytherapy and stereotaxic surgery methods are used for therapeutic purposes in brain neoplasms, which allow tumors to be removed using a concentrated stream of ionizing radiation.
• Chemotherapy – for chemotherapy, alkylating agents (Carmustine, Temodal, Nimustine, Temozolomide, Lomustine) as well as drugs from the group of cytostatics (Cytarabine and Methotrexate) are used. Chemotherapy drugs can be given in the form of capsules and tablets, or given intravenously.
• Targeted therapy for in brain cancer includes the use of anti-angiogenetic drugs, cyclin-dependent kinase inhibitors. The antisense oligonucleotide technique is also used.
• Combined Radiation and Chemotherapy – The combination of radiation and chemotherapy is often used as a palliative care for patients with inoperable CNS neoplasms. Also, this method allows to increase the three-year survival rate in patients with gliomas with a low level of malignancy.
• Cryosurgery – Tumor freezing method is used for widespread and hard-to-reach CNS neoplasms. Often, cryosurgery is used in elderly patients.

What are the consequences of a brain tumor?

When a tumor of the central nervous system is formed, a person runs the risk of facing the following consequences:

1. Depressive disorders.
2. Convulsions.
3. Violation of the CSF outflow process with subsequent development of hydrocephalus (hydrocephalus).

Rehabilitation period

Depending on the nature of the lost functions during the development of a CNS tumor, during the rehabilitation period, patients are prescribed therapeutic and restorative massage, physiotherapy exercises and physiotherapy procedures. In case of violation of the auditory function, classes are held with an audiologist and medications are prescribed that improve the transmission of impulses between neurons.

Brain tumor.

Lifespan.

How long do people live with a brain tumor?

The term brain tumor combines a whole group of heterogeneous pathologies localized in the cranium and having a benign or malignant nature. The mechanism of development of certain neoplasms in the brain area is based on the process of uncontrolled division of the cellular elements of the central nervous system. Symptoms of a brain tumor and life expectancy directly depend on the type of neoplasm and the level of its malignancy.

Varieties of brain tumors and prognosis of survival

Each malignant tumor differs in such criteria as histological structure, growth characteristics, as well as the rate of increase in volume and the nature of metastasis. The prognosis of survival largely depends on the stage at which treatment of the brain tumor was started.

Meningioma

This variant of the tumor develops from the cells of the arachnoid mater of the brain. As a rule, the neoplasm is of a benign nature. The prognosis for survival in meningioma depends on the type of neoplasm and its histological structure. If the tumor does not show signs of cellular atypia, then such meningiomas do not recur after radical removal. Surgical removal of neoplasms of this type, located in the region of the base of the skull, cavernous sinus and falx-tentorial angle, always causes technical difficulties.

Neoplasms of this type, located in the cranial vault, recur in 3% of cases after removal within 5 years from the date of surgery. If a benign neoplasm was operated on in a timely manner, then the recurrence index within 5 years from the date of surgery is about 3%. If the neoplasm is malignant, then if the operation is performed within 5 years, the recurrence index ranges from 38 to 80%. In benign tumors, the prognosis is relatively favorable, depending on the timing of the start of treatment. An unfavorable prognosis concerns multiple and atypical meningiomas. Also, life expectancy in this disease is affected by comorbidities such as atherosclerosis, diabetes mellitus, coronary heart disease.

Astrocytoma

This neuroepithelial primary brain tumor originates from astrocytes (stellate cells) and is located directly in the brain. Astrocytomas can have varying degrees of malignancy, which affects the prognosis for survival and life expectancy of patients. In general, survival prognosis for astrocytoma is poor. If the disease was detected at stage 1, then the life expectancy of such patients does not exceed 5 years.

Ependymoma

This type of tumor structure is formed from ependymal tissue located in the ventricles of the brain. Ependymomas account for at least 8% of the total number of neoplasms of the central nervous system. Most often, the tumor is localized in the posterior cranial fossa, and is characterized by slow growth. The five-year survival rate for a timely detected and removed tumor is 65-80%. The most negative prognosis regarding survival applies to anaplastic ependymomas, since this variant of neoplasms is rapidly spreading with the CSF flow.

Life expectancy at different stages of a brain tumor

Each stage of a brain tumor is accompanied by characteristic structural and functional changes in the central nervous system. Such changes and the degree of their neglect directly affect lives with a similar diagnosis.

Stage 1. For stage 1 brain tumors, rapid progression is not typical. If at this stage the necessary treatment was carried out, and the patient’s body adequately perceived it, then the survival prognosis is relatively favorable. About 70-75% of patients survive within 5 years.

Stage 2. The life expectancy of patients with a diagnosed brain tumor at stage 2 depends on the type of neoplasm, its level of malignancy and growth rate. By analogy with stage 1, a tumor in stage 2 does not rapidly increase in volume, but at the same time slowly infiltrates into adjacent healthy areas of the brain. Life expectancy of more than 5 years is possible only if there are no recurrences of the disease.

Stage 3. At stage 3 of pathological changes, the formation of a tumor with an average level of aggressiveness is observed. At this stage, there is a serious threat not only to health, but also to human life. Some stage 3 tumors are inoperable. The average life expectancy of patients with an operated brain tumor at stage 3 is 1-3 years.

Stage 4. At the 4th stage of the pathological process, the prognosis for survival is extremely unfavorable, since the atypical structure rapidly increases in volume, affects nearby areas of the brain by infiltration and metastasis. Also, metastases spread through the bloodstream throughout the body, causing the development of a secondary tumor focus. Life expectancy at stage 4 is 1-2 years.

Surgical treatment of brain cancer

Life expectancy after undergoing surgical treatment for brain cancer directly depends on the stage at which the operation was performed. The best prognosis for survival and life expectancy is observed with stage 1 cancer, provided that the disease does not recur later. If surgical care was provided at an early stage, then life expectancy after surgery can be up to 5 years. On average, this figure is 1-3 years. Not only the prognosis for survival, but also the cost of treating brain cancer depends on the stage at which oncology was detected.

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body. The degree of danger of such neoplasms depends on the area of ​​\u200b\u200btheir location. The closer a tumor in the brain is to vital centers, the more likely it will lead to the death of a person. But not every brain tumor is a sentence. Many of them are quite successfully treatable. Let’s talk about what a brain tumor is, what neoplasms are, what can cause a brain tumor, and what you can count on when you hear such a diagnosis.

Contents

1. Brain tumor – what is it?
2. Gliomas
3. Meningeal tumors
4. Pituitary tumors
5. Germ cell tumors
6. Metastatic brain tumors
7. Childhood tumors

9000 9 How can you get a brain tumor?

8. Meningeal brain tumor – prognosis
9. Neuroepithelial brain tumor – how long to live?
10. How long do people live with a brain tumor from embryonic tissue?
11. Metastatic brain tumor – how long to live?
12. Where to go in case of brain cancer?

Brain tumor – what is it?

A tumor is a volumetric formation, which is a group of atypical cells that rapidly increase their population. A brain tumor can be either benign or malignant.

All neoplasms of the central nervous system are divided into primary and secondary:

• Primary – those that have developed directly in the brain
• Secondary – are metastases of malignant neoplasms of other localization (lungs, kidneys, etc.)

There are a large number of different classifications of tumors of the nervous system. But the histological structure of the neoplasm and its location are of the greatest clinical importance.

Primary tumors are divided into two large groups according to localization:

• Brain tumors – up to 90% of all tumors of the central nervous system
• Tumors of the spinal cord – 10% of neoplasms of the central nervous system

There are also oncopathologies with localization simultaneously in the brain and spinal cord. But their share of the total number of tumors is insignificant – it is a fraction of a percent.

Neoplasms can also be of origin:

• Intracerebral – originate from brain cells
• Extracerebral – originate from blood vessels, nerve sheaths, fragments of embryonic tissue, pituitary gland

Malignant primary brain tumors of intracranial localization have a number of features that distinguish them from cancer of any other localization:

1. They practically do not metastasize. That is, they do not form daughter tumors in the lymph nodes and other organs.
2. The central nervous system is separated from the rest of the body by the blood-brain barrier. Therefore, such tumors usually do not extend beyond the brain.
3. Due to the high risk of damage to functionally important areas of the brain, most of these tumors are inoperable.

Due to the above reasons, classification of neoplasms by TNM (tumor size, regional and distant metastases) is practically not used in neurooncology. The stages are determined based on the histological type of the neoplasm, and not the prevalence of the oncological process.

According to WHO, 10 histological types of tumors of the central nervous system are distinguished:

• From neuroepithelial tissue
• From the meninges
• From nerves
• From hematopoietic tissue
• Germinogenic – from germ cells
• Cysts and tumor-like formations
• Neoplasms growing into the cranial cavity
• Tumors of the Turkish saddle (this is a fragment of one of the bones of the skull in which the pituitary gland is located)

900 09 Metastatic tumors

• Unclassifiable neoplasms

Gliomas

Gliomas are tumors of neuroepithelial tissue. They make up more than half of all neoplasms of the central nervous system. Such a brain tumor is most often the result of genetic mutations. These include glioblastomas, astrocytomas, and ependymomas. Some develop for a very long time – for years. Others progress rapidly and lead to the death of the patient within a few months.

Gliomas have 4 grades of malignancy. Usually tumors of 1-2 degrees are called benign, neoplasms of 3-4 degrees are called malignant. The latter include glioblastoma and anaplastic astrocytoma, the most common neuroepithelial tumors of the CNS. They account for up to 80% of all neoplasms of this type.

Meningeal tumors

Meningeal neoplasms account for about 20% of primary CNS tumors. 95% of cases of oncological diseases of this type are meningiomas. The remaining 5% are fibrous histiocytomas, hemangiopericytomas, melanomas, diffuse sarcomatosis, and others.

Some risk factors for meningeal neoplasms have been identified. Here is what can cause a brain tumor:

• Head injuries
• Ionizing radiation (including radiation therapy)
• Eating nitrites brain. The reason is a mutation at the 22q12.3-qter locus.

  According to the malignancy, meningiomas are divided into 3 groups:

  • Grade 1 – includes 9 histological types, the most common of which are meningoepithelial (60% of cases), transitional or mixed (25%) and fibrous (12%)
  • Grade 2 – these are atypical meningiomas, which are marked by rapid cell division and rapid growth
  • Grade 3 – anaplastic meningiomas (old name – meningosarcomas)

  Occasionally, multiple brain tumors occur. Their causes are not known. They make up about 2% of all diagnosed meningiomas. Such neoplasms are characterized by a favorable clinical course. AT 90% of cases a person lives with them a full life, without any symptoms. Only 10% of cases require surgical removal of tumors.

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  Up to 10% of all intracranial neoplasms are pituitary tumors. They are almost always benign. They usually develop from the cells of the adenohypophysis (the anterior lobe of this gland). Such neoplasms are called adenomas, and if they have a diameter of less than 1 cm – microadenomas. What causes a brain tumor of the corresponding localization has not yet been established.

  Although some risk factors are known:

  • Brain infections
  • Traumatic brain injuries
  • Toxin poisoning
  • Use of oral contraceptives
  • Obesity

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  Causes of a tumor in the brain that grows from pituitary cells may be due to a mutation genes. Of no small importance is hereditary predisposition. At what age can a brain tumor of adenohypophyseal origin develop? This is one of the “youngest” tumors. It occurs in everyone, including children. The peak incidence occurs in working age – from 30 to 50 years.

  Most pituitary adenomas are not accompanied by severe symptoms, so their detection rate is low. Usually, treatment is carried out in a conservative way (normalization of the level of hormones in the blood). When it stops working, surgery is used.

  Germ cell tumors

  Germ cell tumors in the brain develop from embryonic tissue. These neoplasms include germinoma, choriocarcinoma, yolk sac tumor, and embryonic carcinoma. They are located in the region of the epiphysis. The most common is germinoma. It is up to 0.5% of all brain tumors in Europeans, and up to 3% in Asians. The reasons why this brain tumor occurs more often in the Asian population is not known. It is diagnosed more often in boys. The tumor is malignant – it metastasizes through the cerebrospinal fluid (liquid that bathes the brain).

  Metastatic brain tumors

  About 20% of CNS tumors are metastatic brain tumors. The causes of these diseases are obvious: it is the spread of metastases from other parts of the body. Their actual prevalence is believed to be even higher. Indeed, cancer patients with grade 4 cancer are often not examined too carefully due to the inappropriateness of in-depth diagnostics. Even if there is a suspicion that they develop a brain tumor against the background of cancer of a different localization, such patients are no longer referred to neurosurgeons.

  What can cause such a brain tumor? The most common causes are:

  • Lung cancer – 40% of CNS metastatic cases
  • Breast cancer – 10%
  • Kidney cancer – 7%
  • Stomach or intestine – 6% average 5%

  Childhood tumors

  Even children can get a brain tumor. Among childhood oncological diseases, brain neoplasms account for about 20%. This is the second place after leukemia. More often they are observed in children of the first year of life. In babies, teratomas are mostly found. In older children, benign astrocytomas (more than 30%), primitive neuroectodermal tumors (medulloblastoma, pineoblastoma – 20%) and ependymomas (15% of cases among children older than 1 year) predominate.

  At present, it is not known for certain how a brain tumor develops in children. It has been found that boys develop them more often than girls. The reasons why a brain tumor occurs more often in male children have not been established.

  How can I get a brain tumor?

  Patients often ask their doctor how to get a brain tumor. They suggest that knowing the causes, it will be possible to prevent the disease. Unfortunately, it is not. For many types of cancer, the underlying etiological factors have indeed been established. For example, it is well known that lung cancer occurs mainly due to smoking, papillomavirus infection leads to cervical cancer, and viral hepatitis C leads to liver cancer. But what causes a brain tumor is still not known. Despite numerous clinical studies, scientists have not been able to determine the causes of a brain tumor.

  However, some risk factors have been identified:

  Radiation . There are many ways to get a brain tumor due to radiation. Most often, this is radiation therapy for cancer or occupational hazards (radiologists, workers in nuclear industries). In children in the old days, the cause of a brain tumor was X-ray therapy, used for fungal infections of the scalp.

  Communication is not always clear. After all, the first symptoms appear only 10-15 years after exposure. But a retrospective analysis of medical records shows what can develop a brain tumor. Anamnesis data demonstrate that CNS neoplasms are more often observed among people who have experienced radiation exposure.

  Does this mean that a brain tumor comes from radiography, fluorography or computed tomography? After all, these methods are based on the effects of ionizing radiation. No, no such connection has been established. Even dozens of years ago, when the devices were much less perfect and gave dozens of times more radiation load, there were no grounds to believe that a brain tumor could occur as a result of the diagnostic procedures being carried out. Today, the devices used are so precise and perfect that they give minimal radiation without damaging the cells and without causing mutations.

  Heredity . Some genetic anomalies have been established, due to which there may be a brain tumor. These include neurofibromatosis type 1, type 2, tuberous sclerosis, Hypeel-Lindau disease, Li-Fraumeni syndrome. There are other genetic causes of brain tumors, but they are much rarer.

  Immunity . One of the varieties of neoplasms of intracranial localization is lymphoma. This brain tumor can occur against a background of reduced immunity. This leads to AIDS, treatment after organ transplantation (immunosuppressive therapy), long-term use of immunosuppressants and glucocorticoids in dermatological diseases or systemic connective tissue lesions.

  Several mythical causes should also be noted. Many people are afraid of them, but these fears are false.

  So, here’s what can’t cause a brain tumor:

  • Using a mobile phone – contrary to popular belief, it does not emit ionizing radiation
  • Playing football (footballers often hit the ball with their heads)
  • Exposure to electromagnetic fields
  • Hair dye
  • Stress and bad habits

  We also note several controversial reasons why a brain tumor can occur. These risk factors have been suggested but not yet conclusively proven.

  Of which:

  • Aspartame (diabetic sweetener)
  • Exposure to vinyl chloride (occupational hazards in the plastics industry)
  • Viral infections
  • Exposure to petroleum products

  9000 2 Thus, scientists still do not know exactly what could be causing brain tumor. Therefore, the only thing you can do to prevent this disease is not to expose yourself to massive ionizing radiation and, if possible, maintain a good immune system.

  Meningeal brain tumor – prognosis

  Meningiomas have a high survival rate. The clinical course of the disease is favorable. Usually these are neoplasms of the 1st degree of malignancy. If there are no pathological symptoms, a surveillance strategy is applied. Surgical treatment may not be required because most of these brain tumors have a favorable prognosis.

  The first thing patients are interested in is how long they live with a brain tumor of meningeal origin? It depends on a number of factors. First of all – on the degree of malignancy, as well as the treatment performed.

  If a brain tumor was completely removed during the operation, how long people live depends solely on their age and state of health, because a meningioma with a probability of 95% does not recur. Only 5% of patients experience recurrence within 15 years after surgery.

  But sometimes the neoplasm is localized in the functionally active structures of the CNS. In such cases, complete removal is not possible. However, even if it was partially removed, the risk of recurrence within 15 years is only 50%. In the remaining 50% of cases, the tumor remains the same size – it does not increase. If meningioma grows, it responds well to treatment with radiation therapy. Even in malignant meningioma, radiation helps control tumor growth for at least 5 years.

  The age of the patient is also important. Below you can see the data on how many live with a brain tumor from the meningeal membranes, depending on age.

  The percentage of five-year survival is indicated – that is, the number of people who live for 5 years or more after diagnosis: 71%

  In most cases, after 5 years, the tumor does not recur if it was completely removed during surgery.

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  Neuroepithelial brain tumor – how long to live?

  If you have been diagnosed with a neuroepithelial tumor of the brain, how long to live, it is impossible to say unequivocally without establishing its histological type. How long a brain tumor develops depends on the structure of the neoplasm.

  Based on this parameter, 4 degrees of malignancy of neuroepithelial neoplasms of the central nervous system are distinguished:

  • Grade 1 – pilocytic astrocytoma
  • Grade 2 – protoplasmic, pleomorphic, gemistotic, fibrillar astrocytoma, xanthoastrocytoma and ependymoma
  • Grade 3 – anaplastic astrocytoma
  • Grade 4 glioblastoma

  Grade 1 and 2 neuroepithelial brain tumors are considered low degree of malignancy. They have a better prognosis. Grade 3 and 4 are neoplasms of high malignancy or simply malignant. The worst prognosis is characterized by a brain tumor of the 4th degree.

  How long do people live with glioblastoma ? Unfortunately, this tumor has a worse prognosis. It develops very quickly and is manifested by necrosis (death) of parts of the brain. From the moment the tumor appears to the first symptoms, sometimes not even months, but weeks pass. The average life expectancy for patients under 40 years old is no more than one and a half years, and for patients after 40 years – less than 1 year.

  Five-year survival rate in developed countries, by age:

  • Up to 45 years old – 19%
  • From 45 to 55 years old – 8%
  • From 55 to 65 years old – 5% fast enough. Often only radiation and chemotherapy are used. But these methods do not significantly extend the life of the patient. Unfortunately, glioblastoma is the most common glioma (neuroectodermal tumor). It makes up about 50% in the structure of these neoplasms.

    Anaplastic astrocytoma is another malignant brain tumor. How many live with this disease?

    Life expectancy, depending on the age of the patient at the time of diagnosis:

    • Up to 40 years – about 3 years
    • From 40 to 60 years – an average of 2 years
    • After 60 years – less than 1 year

    9000 2 Five-year survival rate, depending on age:

    • Up to 45 years – 54%
    • From 45 to 55 years – 32%
    • From 55 to 65 years – 14%

    The pathology is characterized by infiltrative growth. That is, the neoplasm penetrates the brain tissue, and does not displace them. Anaplastic astrocytoma is the second most common neuroectodermal tumor after glioblastoma. In the structure of these neoplasms, it is about 30%.

    The next most common CNS tumor from neuroectodermal tissue is oligodendroglioma . It makes up about 5% of all gliomas. The average life expectancy of patients in developing countries, including the CIS, is 6 years. In developed countries (Germany, USA) the figures are much better.

    Five-year survival, depending on the age of the patient at the time of diagnosis, is:

    • Up to 45 years – 88%
    • From 45 to 55 years – 81%
    • From 55 to 65 years – 68%

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    K Unfortunately, sometimes oligodendroglioma becomes malignant. In this case, it acquires a grade 3 malignancy, and the prognosis worsens. From what the brain tumor anaplastic oligodendroglioma develops, it is not known for certain. However, the life expectancy of patients is reduced.

    Five-year survival rates for this type of neoplasm in developed countries:

    • Up to 45 years – 71%
    • From 45 to 55 years – 61%
    • From 55 to 65 years – 46%

    Ependymomas are approx. 3% of gliomas. They are more common in children than in adults. More often these are benign tumors. Rarely, anaplastic ependymomas (grade 3) occur. There is no data on what causes this brain tumor in children. Survival rates vary widely across countries. In the CIS, the five-year survival rate for children from 3 years old is about 50%, for adults – 70%. In developed countries, statistics are much better due to better treatment.

    Five-year survival rate for patients with ependymoma in well-developed countries:

    • Childhood – 75%
    • Patients from 20 to 45 years – 92%
    • From 45 to 55 years – 89% 9001 0
    • 55 to 65 years – 86%.

    How long do people live with a brain tumor from embryonic tissue?

    Malignant germ cell tumors. They are found in children. They are characterized by metastases. The most common tumor is germinoma. She is the most favorable. In the vast majority of patients, even without the use of surgical methods, this malignant brain tumor is cured. How long do they live after treatment? Life expectancy is potentially the same as that of a person who has never suffered from this pathology. To cure the disease, radiation therapy is sufficient, and sometimes chemotherapy (in children under 4 years of age). The younger the age, the better the prognosis. Unfortunately, the prognosis for other types of germ cell tumors is much worse. They are very rare. But patient survival is extremely low. These are inoperable brain tumors. How long do patients live? Only 5% of patients after diagnosis will live more than 2 years. Radiation therapy and chemotherapy are used for treatment, since surgical treatment does not improve the prognosis. Operations are performed only palliative. For example, bypass surgery for blockage of the cerebral aqueduct.

    Metastatic brain tumor – how long to live?

    In many cases, cancer is detected after metastases have appeared in the CNS. How long they live with a brain tumor with its metastatic lesion depends on the treatment performed. In the natural course of the disease, the average life expectancy of patients is about 3 months. With surgical treatment or radiation therapy, it can reach 2 years or more. Life expectancy also depends on the histological type of cancer, location and number of metastases. In about 50% of cases, they are multiple, which worsens the prognosis.

    Where do I go if I have brain cancer?

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    Authors:

    The article was edited by experts in the field of medicine, medical specialists Doctor Nadezhda Ivanisova, Doctor Sergey Pashchenko.