What’s the difference between glioblastoma and other gliomas?

Glioma is an umbrella term for tumors that arise from glial cells, the supporting cells of the brain. Gliomas are classified on a scale from Grade 1 to Grade 4, with lower grades growing more slowly and higher grades growing more aggressively. Glioblastoma is specifically a Grade 4 glioma and is treated differently than lower-grade tumors.

How quickly does glioblastoma need to be treated?

Glioblastoma grows quickly, and treatment typically begins within days to a few weeks of diagnosis rather than months. Patients with imaging or symptoms that suggest glioblastoma should be evaluated by a neurosurgical oncologist as soon as possible so a treatment plan can be built around their specific situation.

Can I get a second opinion on a glioblastoma diagnosis?

Yes, and it’s encouraged. Second opinions are common in glioblastoma care and can confirm the diagnosis, identify additional treatment options, and clarify clinical trial eligibility. Outside imaging and pathology can be reviewed before a consultation so the discussion focuses on options and next steps.

Glioblastoma

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Overview

What Is Glioblastoma?

Glioblastoma is a type of brain cancer that starts in the brain itself, rather than spreading there from somewhere else in the body. It’s the most common type of brain cancer in adults, and about 13,000 people are diagnosed with it each year in the United States.

Common symptoms include headaches, seizures, weakness on one side of the body, or changes in memory, mood, or speech. Symptoms depend on where in the brain the tumor is growing.

Treatment usually starts with surgery to remove as much of the tumor as possible, followed by radiation and chemotherapy to target what surgery can’t reach. Dr. Sherman has experience treating glioblastoma at Rutgers Cancer Institute in New Brunswick, NJ.

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The information on this page is general educational information and is not medical advice. It does not create a doctor-patient relationship or reflect a treatment recommendation for any individual. Treatment decisions require an individual evaluation by a qualified physician.

Most of the symptoms associated with glioblastoma — headaches, fatigue, nausea, trouble concentrating — are also symptoms of a hundred other things that are far more common and far less serious. A single bad headache is almost never a brain tumor. Feeling foggy for a week isn’t either. The question isn’t whether you’ve ever had one of these symptoms. It’s whether something about your experience right now fits a pattern that warrants imaging.

Here’s what makes symptoms worth investigating.

They’re getting worse over weeks, not better. Tumor-related symptoms tend to progress. A headache that’s gradually worsening over a month, or weakness that was mild two weeks ago and is noticeable now, is a different situation from a bad flu week or a stressful stretch at work. Problems that are steadily escalating deserve attention, even if each individual day seems manageable.

They’re persistent, not episodic. Migraines come and go. Tension headaches respond to rest, hydration, or over-the-counter medication. Tumor symptoms don’t fully resolve between episodes. If a symptom is always there in the background even when it’s mild, that’s worth noting.

They’re worse in the morning. Headaches caused by a brain tumor are often worse right after waking up, because pressure inside the skull increases while lying flat. Morning headaches that improve once you’re up and moving are a specific pattern, and one worth mentioning to a doctor.

They affect one side of the body or one specific function. Weakness, numbness, vision changes, or coordination problems that affect the left side but not the right, or that affect speech but nothing else, are called focal symptoms. Focal symptoms point to a specific location in the brain and are always worth evaluating. General fatigue or “feeling off all over” usually isn’t.

A first-ever seizure. A seizure in an adult who has never had one before is never normal and always warrants brain imaging, even if everything seems fine afterward. Most first seizures turn out to be from something other than a brain tumor, but imaging is how that gets ruled out.

Multiple new symptoms building up together. One symptom alone is usually nothing. Several new symptoms appearing in the same few weeks — a new headache pattern plus some hand weakness, or memory changes plus vision issues — is a cluster worth taking seriously.

When to treat it as an emergency. Sudden severe symptoms, loss of consciousness, sudden inability to speak, sudden loss of vision, or a sudden change in one side of the body should be treated as an emergency. Go to the nearest emergency room rather than waiting for an appointment.

For everything else, getting in to see a specialist within a few days to a couple of weeks is usually the right pace. You don’t need to panic. You also don’t need to wait.

If your primary care doctor or emergency room physician saw something concerning on a scan, or if your symptoms suggest something in the brain needs to be investigated, the diagnostic process usually unfolds in a predictable order.

Magnetic Resonance Imaging (MRI)

An MRI of the brain is the standard first test for any suspected brain tumor. It uses powerful magnets and radio waves to produce a highly detailed image of the brain’s soft tissue, with far more clarity than a CT scan. The exam is typically done in two parts: one set of images without contrast, and a second set after a contrast agent called gadolinium is injected through an IV. The contrast helps highlight areas where the brain’s normal protective filter has been disrupted, which is common in aggressive tumors like glioblastoma. On imaging, glioblastoma often appears as a mass that takes up contrast brightly around its edges, with a darker center and swelling in the surrounding tissue. An experienced neuroradiologist can often recognize the pattern immediately, but imaging alone cannot confirm the diagnosis. Several other conditions can look similar on MRI, and confirming glioblastoma requires examining the actual tumor tissue under a microscope.

Biopsy or Surgical Resection

Tissue can be obtained in one of two ways. A stereotactic biopsy removes a small sample of the tumor through a tiny opening in the skull, using image guidance to precisely target the area of concern. This is typically used when the tumor is in a location that makes surgical removal too risky. The more common approach for glioblastoma is surgical resection, where the neurosurgeon removes as much of the tumor as can be safely taken out during the same operation that provides tissue for diagnosis. Maximal safe resection is both the most effective first step in treatment and the most reliable way to obtain enough tissue for complete analysis. The decision between biopsy and resection depends on the tumor’s location, the patient’s overall health, and how confident the imaging findings are.

Pathology and Molecular Profiling

Once tissue is obtained, a neuropathologist confirms the diagnosis and determines the grade under a microscope. For glioblastoma, pathology alone isn’t the end of the workup. Modern diagnosis requires molecular profiling, which analyzes the tumor’s DNA to identify specific features that guide treatment decisions. The most important markers include IDH mutation status (which determines whether the tumor is true glioblastoma or a related disease with different treatment), MGMT methylation status (which predicts how well chemotherapy is likely to work), and EGFR alterations (which can affect eligibility for targeted therapies and clinical trials). Comprehensive molecular profiling has become routine at NCI-designated cancer centers, including Rutgers Cancer Institute, the only NCI-designated comprehensive cancer center in New Jersey. Modern glioblastoma management relies on molecular profiling alongside traditional pathology.

Glioblastoma is almost always treated with a combination of therapies rather than a single approach. The standard path is surgery first, followed by radiation and chemotherapy given together, then a period of continued chemotherapy and ongoing surveillance.

Surgery: The Foundation

Surgery is almost always the first step. The goal is maximal safe resection, which means removing as much of the visible tumor as possible without damaging the parts of the brain that control speech, movement, memory, and other essential functions. Research has consistently shown that the more tumor that can be safely removed at the first operation, the better the long-term outcomes tend to be. Surgery also provides the tissue needed for molecular profiling, which shapes every decision that follows.

Several specialized surgical techniques are available depending on the tumor’s location and characteristics. Awake craniotomy, where the patient is awake for parts of the procedure, allows brain function to be mapped in real time and is used for tumors in or near areas controlling speech or motor function. Fluorescence-guided surgery uses a fluorescent marker to make tumor tissue visible under specialized light, helping distinguish it from healthy brain. Laser Interstitial Thermal Therapy is a minimally invasive option that uses targeted heat to destroy tumor tissue and is sometimes used for deep-seated or recurrent tumors.

Radiation and Chemotherapy

After surgery, the standard of care is a six-week course of radiation combined with an oral chemotherapy drug, usually starting three to four weeks after the operation. Radiation is delivered in small daily doses Monday through Friday, and the chemotherapy is taken as a pill at home. After the initial six weeks, patients typically continue on chemotherapy alone in monthly cycles for six months or longer.

Clinical Trials

For some patients, a clinical trial is part of the treatment plan from the beginning rather than something considered only after standard treatment stops working. Clinical trials may test newer drug combinations, targeted therapies matched to specific molecular markers, immunotherapies, or devices like tumor treating fields. Whether a trial is appropriate depends on the tumor’s molecular profile, the patient’s overall health, and what’s currently enrolling.

How the Plan Gets Made

No two glioblastomas are identical. The right plan depends on the tumor’s location, its molecular features, the patient’s age and overall health, and their own priorities. Treatment decisions involve multiple specialties working in sequence: neurosurgery, radiation oncology, medical oncology, and neuropathology.

Treatments commonly used for this conditionBrain Tumor Surgery, Awake Craniotomy, Fluorescence-Guided Surgery, Laser Interstitial Thermal Therapy (LITT), and Clinical Trial Enrollment.

Technology

Using XR Technology To Advance Medical Care

Dr. Sherman integrates VR and AR visualization into surgical planning and patient education, giving patients a clearer picture of their diagnosis and the approach to treatment.

Common Questions About Glioblastoma

Published median survival with standard treatment falls in a range often cited as approximately 15 months, but this figure represents a midpoint across a very wide distribution of outcomes. Reported outcomes depend heavily on age, overall health, the extent of surgical removal, molecular markers like MGMT methylation, and access to clinical trials. Some patients in published series live considerably longer than the median. Individual prognosis depends on factors that can only be assessed by a treating physician.

Glioblastoma is currently considered incurable, but it is treatable, and treatment can meaningfully extend life and preserve quality of life. Survival has improved over the past two decades with advances in surgical technique, radiation, chemotherapy, and emerging therapies tested in clinical trials. The goal of treatment is to control the disease for as long as possible while maintaining neurological function and independence.

Diagnosis begins with an MRI of the brain with and without contrast, which can strongly suggest the presence of glioblastoma but cannot confirm it on its own. Confirmation requires examining tumor tissue under a microscope, which is obtained either through a stereotactic biopsy or during surgical removal of the tumor. The tissue is then analyzed for molecular markers that guide treatment decisions.

Next Step

Newly Diagnosed or Seeking a Second Opinion?

Dr. Sherman is accepting new patients at Rutgers Cancer Institute in New Brunswick, New Jersey. Whether you’ve just been diagnosed or you’re looking for another perspective on a treatment plan, a consultation is the first step toward understanding your options.

Schedule a Consultation 732-235-6333