Episode 53: Glioblastoma - And the Forgotten Scientist - Anatomy Of Illness

Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Recently, you have been suffering from persistent headaches, which have been especially severe

(00:04):
in the mornings.
Additionally, you have been experiencing blurry vision.
You attributed these symptoms to needing new glasses and brushed them off as just minor
issues.
Despite these signs, you go to work as usual.
However, during a discussion in the office, you suddenly collapse and have a seizure.

(00:30):
Hello and welcome to Anatomy of Illness.
Today's episode is about glioblastomas.
Today's episode is very special because it is our one year anniversary.
Thank you to all of you who have stuck with us in the past year and to all of you new
listeners along the way.
And welcome if this is your first episode.
We love having you here too.

(00:51):
But anyway, before we get into the condition, we are going to start with the history.
So why do we know glioblastomas exists?
We begin in the year 1800 with Berns.
This is where the first case of a primary non-metastatic tumor in the central nervous
system was found.
So this is a tumor that started in the brain rather than a tumor that broke off and landed
there.
This was published in a British scientific research report.

(01:12):
This primarily spoke about the gross morphological structure of the tumor on autopsy.
So what could really be seen just by looking at it with your own eyes?
No fancy equipment and definitely no microscopes.
Now we move on to 1804 and meet Abernety, who will discuss diffuse tumor formation with
no clear border in the central nervous system.
So this is where you are unable to tell where the tumor stops and the healthy tissue starts.

(01:34):
Around this time, it was known as a medullary sarcoma in the English speaking world.
For those in France, it was called encephaloide.
And for those in the German speaking world, it was more often known as fungus medullare.
With the introduction of light microscopes, we would be whisked away into the era of histology.
Landing us in the year 1865 with a German pathologist by the name of Robert Virchow.

(01:55):
Dr. Virchow would be the first to publish a comprehensive description through the use
of a microscope.
He claimed that these tumors originated from the glial cells in the central nervous system
and described the difference between the healthy cells and the tumors that he saw under the
microscope.
He was also the first person to use the term glioma to describe these tumors.
With his work, he designated two groups when it came to these gliomas.

(02:17):
Low grade, which is what we call grade one, and grade two, gliomas, and high grade, which
correspond to grade three and grade four gliomas in the 2016 WHO classifications.
Now we jump forward to 1925 to meet Percival Bailey and Harvey Cushing.
Harvey Cushing was a neurosurgeon out in Boston who was collecting brain tumor specimens.
No, it was not a hobby like grandma's spoon collection.

(02:40):
There was a scientific purpose behind this.
Well around this time, doctors knew some tumors were aggressive, they would spread rapidly
and would be malignant cancers, whereas others would be benign and very slow growing.
But how do you know which is which?
Well that is why Cushing was collecting them.
He was hoping the specimens would hold all the answers to that question.
So Dr. Bailey, who also believed in Cushing's cause, began to group the tumors into length

(03:04):
of patient survival, hoping that they would reveal the secrets of the tumor behavior.
Dr. Bailey then would examine these specimens, which ended up being more than 400 in total.
He correlated the clinical outcome with the microscopic appearance of the tumor, leading
to the 1925 publication.
That explains how the structure of a tumor could actually guide the treatment and also
the prognosis.

(03:24):
So how long someone may actually survive.
In this publication, they called the most malignant and clinically atypical form of
glioma a spongioblastoma multiforme because they were so atypical and did not resemble
the healthy glial cells at all, nor did they resemble the other glioma cells from other
types of tumors.
They also had as part of their other classifications, astrocytoma.

(03:46):
These were said to arise from the astrocytic glia.
These are the star-shaped glial cells that help to provide structure.
These cells have a hand in most things.
They help with nutrition, repair, neuronal development, and so much more.
These astrocytomas resembled the astrocytes, which is why they were said to arise from
them.
Now we move to between 1934 to 1941.

(04:06):
This is due to a large amount of research being published with German neuropathologist
Hans Joachim Scherer.
He is essentially the backbone of glioblastomas, one of the founding fathers of it.
However, he has been mostly forgotten with the passing of time, sadly.
To summarise his years of work, Dr. Scherer suggested that rather than looking at the
individual cells when it comes to brain cancer tumors, we should look at the whole tumor

(04:30):
sample.
He also came to the conclusion that astrocytomas can progress to glioblastomas, which was a
term he coined to replace spongioblastomas.
He also claimed there were two kinds of glioblastomas, primary glioblastomas, so they were new cancers.
These were extremely aggressive and secondary glioblastomas.
These arose from astrocytomas.
They were slower and had a better prognosis.

(04:52):
He also found that in some cases they would have neovascular proliferation, so new vascular
growth that resembled the kidneys glomeruli.
This is called glomerolisation.
The glomeruli or glomerulus are clusters of blood vessels inside of the kidney that help
to filter the blood.
And finally, he described pseudopalisading necrosis, also known as the Scherer formation.

(05:14):
This is when tumor cells surround areas of necrosis, which is a form of cell death.
This can also be an indicator of an aggressive tumor.
The advancements into the knowledge behind glioblastomas would kind of idle for quite
some time.
This would be until 2008.
This is when a study that took Cushing and Bailey's work to the next level was published.
In this, they studied more than 200 samples of glioblastomas.

(05:37):
They found several abnormal molecular changes that were driving the growth of aggressive
tumors.
These would help to personalize treatment.
And even more recently, in 2024, we have the case of Professor Richard Scolyer, who you
may have heard about.
He is a melanoma researcher in Australia.
Melanoma being a type of skin cancer we covered in episode 40.

(05:58):
But why do we care about someone who is making strides in curing skin cancer?
We are talking about brain cancer here.
Well, unfortunately, Professor Scolyer was diagnosed with a form of glioblastoma that
was rather aggressive with this form.
Most diagnosed don't live longer than a year.
So Professor Scolyer, along with his colleague, who is a world renowned medical oncologist,

(06:20):
Professor Georgina Long, they decided to try the immunotherapy that they had been using
to treat the melanomas.
His scans, checking for the brain cancer a year later, showed no signs of the tumor.
Although this is not currently a treatment, and I know I normally do speak quite negatively
about self-experimentation, their work may lead the way for potential cures in the future.

(06:40):
If you're enjoying this episode and think someone else might benefit from it, be sure
to share it.
What actually is a glioblastoma?
A glioblastoma is a malignant cancer, which is a stage four cancer of the brain, more
specifically of the glial cells.
These glial cells are the support cells of the neurons, the neurons of the cells you
normally think about when it comes to the brain.
So what causes a glioblastoma?
In most cases, the exact cause of a glioblastoma isn't known.

(07:03):
What happens is the cells in either the brain or the spinal cord have changes in their DNA,
which are mutations.
These mutations change the instructions about how often to multiply and cell death, causing
an increase in cell growth quite quickly.
This then leads to a tumor.
There are some risk factors involved when it comes to developing a glioblastoma.
These include getting older.

(07:24):
Glioblastomas can occur at any age, but are more common in older adults.
Radiation exposure.
People with ionizing radiation exposure have a higher risk of developing glioblastomas.
Inherited conditions.
There are several genetic conditions that increase your risk of developing a glioblastoma.
These include Lynch syndrome and Li-Fraumeni syndrome.
Sorry, I've just had a pop up on my screen.

(07:44):
It says, don't forget to check out merchanatomy.com for the coolest merch.
But anyway, back to glioblastomas.
How do we diagnose a glioblastoma?
There are several tests that can be done to help doctors to diagnose glioblastomas.
These include blood tests.
These can be done to help get a general picture of your health.
And in some cases, markers for diseases can be checked through blood tests.

(08:04):
Blood tests can also be done to check for genetic and hereditary conditions that may
increase your risk of glioblastomas.
MRI.
This is the preferred first test in most cases.
This test can help find tumors and areas affected by stroke in the brain.
It helps to rule things in and out when it comes to a diagnosis.
Magnetic resonance spectroscopy.
This is a test that can be done as part of an MRI.

(08:26):
This measures the metabolites and biochemical processes in the tumor and also in the healthy
parts of the brain.
CT scan.
This is a tool used for those who cannot have an MRI.
It can find fresh areas of bleeding, calcium deposits, and changes to the skull bones.
Stereosonic needle biopsy.
This is a needle guided by either a MRI or a CT that takes out a small part of the tumor

(08:46):
to be looked at.
This helps with diagnosis and also helps with formulating a treatment plan.
We'll get right into the symptoms and treatment right after this little break.
If you have been enjoying this episode so far, don't forget to support us on Buy Me
a Coffee.

(09:10):
What symptoms might you have if you had a glioblastoma?
Some of the symptoms you might have include having headaches, especially ones that hurt
more in the morning or are worse in the morning, confusion or a decline in your brain function.
This may be issues with thinking and understanding information.
There may also be issues with memory or memory loss, speech difficulties, vision changes,
including blurry, double vision or loss of peripheral vision, personality changes or

(09:34):
irritability, trouble with balance or coordination, seizures, especially in those who have never
had a seizure before or do not have a seizure condition like epilepsy.
If you want to learn more about epilepsy, we covered it in episode 19.
You may also have nausea and vomiting.
There may also be a reduced sensation of touch and muscle weakness in the face, arms or legs.
The symptoms will vary from person to person and also depend on where the glioblastoma

(09:57):
is.
How do we treat glioblastomas?
Currently, glioblastomas are not curable, so treatment currently focuses on shrinking
the tumor and improving quality of life.
The first step in managing a glioblastoma is often surgery.
This surgery is done in cases where the tumor is easily accessible and the person is in
good health.
Otherwise radiation therapy and chemotherapy may be recommended instead.

(10:19):
There are many treatments that can be done as part of glioblastoma management.
These include radiation therapy.
This treatment uses X-rays to damage the cancer cells to prevent cell growth.
Intensity modulated radiation therapy, also known as IMRT.
This delivers radiation to the tumor specifically whilst minimizing the radiation to the healthy
brain tissue nearby.
Stereotactic radiosurgery, also known as gamma knife radiosurgery.

(10:42):
Fun fact, this is not an actual surgery.
It is a very precise type of radiation therapy.
Chemotherapy.
These are medications that are designed to help kill the cancer.
Laser interstitial thermal therapy, also known as laser ablation.
This is a treatment that uses a laser to destroy the tumor.
Immunotherapy.
This is using your body's immune system and training it to attack the tumor cells.

(11:05):
Are there any famous people who have or have had glioblastomas?
There is Tom Parker.
He was one of the members of the band The Wanted.
He was diagnosed with an inoperable glioblastoma back in 2020 after having two seizures.
After his diagnosis, he was an advocate and raised awareness of the condition.
Sadly, he passed away in 2022.
There was also Neil Pearst, the drummer from Rush.

(11:26):
He passed away in the beginning of 2020.
This was after having this form of cancer for three and a half years.
There are several movies featuring brain cancer and glioblastoma, including the 2018 film
Here and Now.
This film follows the main characters 24 hours after being diagnosed with glioblastoma.
We go through her processing the diagnosis, but also trying to explain it to those around
her and her figuring out if she wants to actually share it.

(11:48):
If you would like to check out a foundation, there is for those in the US, the Glioblastoma
Foundation.
They support researchers to develop treatments for glioblastoma, including targeted therapies.
Their goal is to prolong survival and increase quality of life for those with glioblastomas.
For those in the UK, there is the Brain Tumor Charity.
Their goal is to double brain cancer survival rates by 2030.

(12:09):
They are a research-led charity that is helping to fund research into cures and treatments
for different forms of brain cancer, including glioblastomas.
And for those in Australia, there is the Cure Brain Cancer Foundation.
They are an organization that increases the awareness of brain cancer in Australia, assisting
the research and advocates for those experiencing it.
If you want to check out the sources, social media links, or any other links, you can head

(12:29):
to anatomyofillness.com.
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If you would like to join us, we would love to see you over on Discord or Instagram.
You can also check us out on YouTube for more great content.
Otherwise stick around for the next episode.

(12:57):
Did you know the brain cannot actually feel pain?
That is right, there are no pain receptors in the brain itself.
There are pain receptors in the meninges, which are the protective layers that cover
the brain, and the periosteum, which is the protective layer on the bone, as well as pain
receptors in the scalp.

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Episode 53: Glioblastoma - And the Forgotten Scientist

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