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Suggest Treatment For Stage 4 Glioblastoma Multiforme

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Posted on Mon, 11 Jul 2016
Question: DEAR SIR MY WIFE AGED 34 SUFFERING FROM GLIOBLASTOMA MULTIFORMAE STAGE 4 HAS UNDERWENT 35 CYCLES OF RADIATION IN FEBRAURY 2016.her tumor is located in left thalamus mid brain . RIGHT NOW SHE IS AT HOME WITH NURSUNG CARE AND HER HEALTH IS WORSENIG HER RIGHT ARM AND LEG IS PARALYSED SHE CANNOT OPEN HER EYES ANA ALSO DIFFICULTY IN SWALLOWING IS THIS LAST STAGE OF BRAIN CANCER PLEASE SUGGEST
doctor
Answered by Dr. Ishu Bishnoi (1 hour later)
Brief Answer:
Prognosis of GBM

Detailed Answer:
Hi Kksiyal, thanks for asking from HCM.


I can understand your concern. It is sad that your wife is suffering from Glioblastoma Multiformae (GBM). I presume that the treating neurosurgeon has told you the severity of tumor.

I am sorry to say that it is one of the worst kind of brain tumor. Thalamic region is a bad location. The good thing is she has received chemotherapy and radiotherapy. The ongoing paralysis could be XXXXXXX to

: Tumor edema following chemotherapy and radiotherapy
or
: Progressive increase in size of tumor

Is this the last stage of tumor? May be. Because tumor is causing deterioration in her brain function. Last stage means when patient goes into irreversible coma. Till now, she is not in coma. You can hope for some improvement.

Kindly get a plain CT head done and ask treating doctor about tumor size/edema and herniation or you can message me. According to the report, she can be given some relief by

: Head end elevation throughout day or night
: Give her decongestant like syrup Glycerol with lemon water after proper prescription along with diuretics like Furosemide. Avoid dehydration.
: Increase the dose of steroid (If she is receiving) like Dexamethasone according to her body weight after proper prescription.
: If needed, shift her to neuro ICU for intubation and ventilation.

Be brave. Above treatment can provide some relief and may delay the last stage.

Hope it will help you. If still in doubt, do let me know.

Thanks. Take care.
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Ishu Bishnoi (23 hours later)
dear doctor i have uploaded report of recent ct brain contrast please go through it and she was operated earlier for biopsy on right side skull bone (craniotomy) now that part has grown please suggest
doctor
Answered by Dr. Ishu Bishnoi (29 minutes later)
Brief Answer:
Management and prognosis

Detailed Answer:
Hi Kksiyal, welcome back.

I have read your question and CT report. The report is suggestive of extensive tumor (5.4x4.6cm size) which is involving very important area of brain (left thalamo-capsular and midbrain).

I am really sorry to say that tumor in this area of brain carries very bad prognosis and inoperable. If neurosurgeon will try to operate, it will cause severe damage to vital areas of brain which may cause irreversible coma. You have two options

: Palliative treatment - It is symptomatic treatment which she is already receiving. But she is deteriorating as tumor is growing in size. The operative site swelling and pushed bone can be managed by treating hydrocephalus. This hydrocephalus can be managed by VP shunt procedure. You can discuss it with your surgeon. If she can be taken up for surgery, at least get VP shunt done.
To further reduce swelling, give antiedema measures which I already mentioned in previous answer. Follow all steps to get maximum benefit.

The problem occurs when patient becomes resistant to treatment as a result of progressive growth of tumor. In such case, patient goes into coma and on ventilatory support. As there is no good treatment available till now, patient is then managed only by ventilator till last breath. You have to be strong if you face such condition and make tough decision.

: Surgery - You and your surgeon can take risk and operate her. Maximum safe gross resection of tumor can be done. But there are high chances of severe damage or death.

There is no good treatment. You have to choose between two. Sorry to say that her report is very bad.

Hope you will be brave and take care of her and yourself. Thanks.
If any doubt, do let me know.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Ishu Bishnoi (22 hours later)
dear sir
i have uploaded photo of patient which shows growth of skull bone please advice it should surgically operated or some other remedy can be done
if not operated what will happen
doctor
Answered by Dr. Ishu Bishnoi (45 minutes later)
Brief Answer:
No photo is uploaded

Detailed Answer:
Hi xxxxxxxxxxx, welcome back.

I have read your question. There is no photo of patient. Only CT report is attached with question. Kindly retry.

You can read my previous answer about progression of disease and coma. The progressive increase in tumor can cause further protrusion of bone, stretching of skin and in late stage, wound formation through which brain matter may come out. Clinically, patient consciousness will deteriorate to irreversible coma level and then loss of brain function.

The surgery carries high risk and tumor can't be removed completely. Only thalamic portion can be removed. The midbrain portion will be left as such. Another possibility is VP shunt to treat hydrocephalus only.

Hope it will help you. I will provide you more information once you upload the photo.

Thanks. Take care.
Above answer was peer-reviewed by : Dr. Arnab Banerjee
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Answered by
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Dr. Ishu Bishnoi

Neurologist, Surgical

Practicing since :2007

Answered : 901 Questions

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Suggest Treatment For Stage 4 Glioblastoma Multiforme

Brief Answer: Prognosis of GBM Detailed Answer: Hi Kksiyal, thanks for asking from HCM. I can understand your concern. It is sad that your wife is suffering from Glioblastoma Multiformae (GBM). I presume that the treating neurosurgeon has told you the severity of tumor. I am sorry to say that it is one of the worst kind of brain tumor. Thalamic region is a bad location. The good thing is she has received chemotherapy and radiotherapy. The ongoing paralysis could be XXXXXXX to : Tumor edema following chemotherapy and radiotherapy or : Progressive increase in size of tumor Is this the last stage of tumor? May be. Because tumor is causing deterioration in her brain function. Last stage means when patient goes into irreversible coma. Till now, she is not in coma. You can hope for some improvement. Kindly get a plain CT head done and ask treating doctor about tumor size/edema and herniation or you can message me. According to the report, she can be given some relief by : Head end elevation throughout day or night : Give her decongestant like syrup Glycerol with lemon water after proper prescription along with diuretics like Furosemide. Avoid dehydration. : Increase the dose of steroid (If she is receiving) like Dexamethasone according to her body weight after proper prescription. : If needed, shift her to neuro ICU for intubation and ventilation. Be brave. Above treatment can provide some relief and may delay the last stage. Hope it will help you. If still in doubt, do let me know. Thanks. Take care.