Grade 4 glioblastoma


The Glioblastoma (also called Glioblastoma multiforme) is the most common malignant brain tumor of adults (it is rarely found in children). It is approved by the WHO Grade 4 and with it that highest severity assigned. Generally are more men than women and more people in the white than the black population are affected by glioblastoma, with middle to older age being the main manifestation time for this malignant brain tumor (the mean age of onset is 64 years). Every year around 3 out of 100,000 inhabitants in Germany fall ill.

The degenerated cells of the glioblastoma come from the so-called Astrocytes of the brain from (= cells of the glia of the CNS; supporting cells), which is why the glioblastoma is often referred to in the literature under the name "Astrocytoma Grade IV" can be found.

A distinction is made between primary and secondary glioblastoma, the primary developing directly and in a short time from vital astrocytes and predominantly patients around the age of 60/70. Year of life concerns.

The secondary glioblastoma, on the other hand, arises from an already existing astrocytoma of a lower degree (WHO 1-3) and is therefore considered the end stage of a long-term, progressive brain tumor disease. Of these, however, are more likely to be patients around 50/60. Year of life affected. The primary glioblastomas are twice as common as the secondary ones.

Read more on the topic: Glioblastoma - course of the individual stages

As a rule, a glioblastoma develops in the white matter of one of the two cerebral hemispheres (preferably in the frontal or temporal lobes), although it quickly infiltrates the other hemisphere through the bar. In imaging, its shape often resembles that of a butterfly, which is why it is often referred to as a "butterfly glioblastoma".

Find out more about the topic here: Course of a glioblastoma

What does the end stage look like?

Of course, it is problematic to make general statements about how the end stage of a glioblastoma disease will look like for those affected. The courses are too different from patient to patient for that. Nevertheless, some statements can be formulated that are generally true.

As the term “end stage” suggests, there is usually no hope of a cure for those affected. Most of the patients are very weak in the end stage and therefore bedridden and dependent on intensive care.

Due to the lack of a cure, the focus is on alleviating the symptoms. These usually worsen in the course of the disease and are accordingly most pronounced in the end stage. They include severe headaches and morning sickness with vomiting, which are due to the increased intracranial pressure caused by glioblastoma.
End-stage headaches are often more diffuse in nature, i.e. affect the entire head and not just the tumor area. They usually occur suddenly and then keep increasing. In addition, some affected people also show changes in personality, for example become aggressive or very lacking in drive. In addition, recurrent epileptic seizures occur frequently. Occasionally, the increased intracranial pressure can also lead to temporary disturbances of consciousness up to permanent "twilight states".

Depending on where the glioblastoma is located, other symptoms can also occur. If the glioblastoma growth affects the language center, for example, difficulties in speaking or finding words can also be noticed. If it affects the motor center, movement disorders can result. Visual disturbances when the visual center in the brain is affected are also possible

If the tumor continues to grow, it can eventually displace parts of the brain downwards. There, areas of the brainstem responsible for regulating breathing can become trapped, resulting in respiratory arrest and death.

You might also be interested in: End-stage glioblastoma


Most glioblastomas develop sporadically, that is, isolated and often without a known cause. Backed up by studies, only ionizing radiation (e.g. x-rays in high doses, for example during radiation therapy) is the triggering cause, the exposure of which can lead to glioblastoma.

Is Grade 4 Glioblastoma Hereditary?

Whether or not glioblastoma is inheritable has not yet been conclusively clarified. It is known, however, that people with other heritable diseases are at increased risk of developing glioblastoma.

These rare diseases include: B. Turcot's syndrome (combination of polyps in the intestine and brain tumors), neurofibromatosis type 1 and 2 (occurrence of neurofibromas = nerve tumors), tuberous sclerosis (combination of brain tumors, skin changes and benign tumors in other organ systems) and the li Fraumeni syndrome (multiple tumor disease).

The majority of all glioblastomas, however, presumably arise sporadically as a result of spontaneous mutations, which lead to errors in the astrocytes and thus to uncontrolled cell growth or to uncontrolled cell reproduction.


The means of choice for diagnosing glioblastoma are imaging procedures such as computed tomography (CT) and magnetic resonance imaging (MRI), which are usually performed with the help of contrast agent in order to better visualize the tumor.

However, a glioblastoma can only be definitively confirmed and secured by a brain biopsy or a removal of tumor tissue, which is then examined histologically. To rule out differential diagnoses (e.g. lymphoma, brain abscesses), cerebrospinal fluid punctures and an electroencephalogram (EEG) can be performed in individual cases.

Read more on the subject at: Brain biopsy

Because glioblastomas are among the more aggressive brain tumors and have often already grown infiltratively at the time of diagnosis, so that the entire brain is usually already infected with tumor cells, complete removal of the tumor is usually no longer possible.

Therapeutically, therefore, there are only various methods available that serve to reduce tumor mass, but do not lead to complete healing. On the one hand, the main mass of the tumor is removed with the help of neurosurgical operations, which can be done either conventionally or innovatively with fluorescence-assisted surgery.

The operation is usually followed by irradiation of the brain and chemotherapy with cytostatics. For the treatment of the brain edema surrounding the tumor, glucocorticoids (e.g. cortisone) are traditionally given.

What is the life expectancy?

Already from the division into grade 4 (highest category) of the WHO classification for brain tumors it can be deduced that the life expectancy in patients with glioblastoma is relatively low. This is mainly due to the rapid and displacing growth. The average life expectancy in patients with glioblastoma is a few months to two years. However, around 5-10% of those affected are still alive 5 years after the diagnosis.

Life expectancy is strongly dependent on the location of the glioblastoma and the stage in which the tumor is at the time of diagnosis (do not confuse stage with grade!).
Therapy also plays a major role: if therapy is completely dispensed with, life expectancy is only around 2 months on average. If an operation is carried out to remove the tumor tissue, this increases to an average of six months. The combination of surgery and radiation and / or chemotherapy increases life expectancy to around 12 months. However, radiation and chemotherapy naturally also have considerable side effects, which to a certain extent pay for a longer life. Therefore, some of those affected consciously forego these measures.

The possibility of making a more precise prognosis depends on the age of the patient as well as the type of treatment and the so-called Karnofsky Index (KPS).

Read more on the subject at:

  • Life expectancy with a glioblastoma
  • Glioblastoma prognosis

Is healing possible?

Unfortunately, according to current medical knowledge, the cure of a glioblastoma is not possible. This is mainly due to its suppressive growth and also to the fact that malignant cells of the tumor are distributed throughout the brain via the cerebral fluid and thus trigger a "wildfire"

The therapeutic measures in the form of surgery, radiation and chemotherapy can only alleviate the symptoms, slow down the physical decline and thus have a life-prolonging effect.

Can You Survive Grade 4 Glioblastoma?

According to the current state of medicine, a glioblastoma is incurable. Such a disease cannot be survived permanently. Surgery, radiation, and chemotherapy can at least slow the progression of glioblastoma.

In this way, life expectancy can be increased from around 2 months without therapy to around a year. In isolated cases, patients even survive for up to 5 years after the diagnosis.



Chemotherapy is one of the ways to slow down the progression of glioblastoma and thereby increase the life expectancy of the patient. It can be used alone or in addition to radiation therapy and surgery.

Commonly used chemotherapy drugs include, for example, cytosine arabinoside, carmustine or vinblastine. In addition, a genetic test can be used to find out whether the patient has a certain gene mutation. If this is the case, the chemotherapy drug temozolomide, which has been shown to be relatively potent in the treatment of glioblastoma, can be used.

More information on the topic chemotherapy you'll find here.


In the recent past, methadone has received great attention as a beacon of hope in connection with gliobastoma therapy. Scientists expected great advances in the treatment of glioblastoma from the use of the active ingredient, which is otherwise used to treat opiate addiction, in combination with the established chemotherapy drugs.

The latest studies, however, dampen these hopes: In cell culture analyzes, methadone could not have a positive effect. For this reason, the general use of methadone in glioblastoma is not recommended and the use of the active ingredient is initially limited to special clinical studies.