Glioblastoma: clinical presentation, diagnosis, and management

What you need to know1. Early symptoms of brain tumours in adults are non-specific and patients may present multiple times to primary care services before they are referred for investigation.Look out for symptoms of raised intracranial pressure (e.g.headaches exacerbated by lying down, triggered by Valsalva maneuver or associated with vomiting or visual disturbance), combinations of symptoms (e.g.headache plus cognitive impairment, headache plus weakness, headache plus personality change) and symptoms which progress over time.New-onset focal or generalized seizures in adulthood also warrant investigation for a brain tumour.2. In patients with symptoms or signs suggestive of a brain tumour, arrange an urgent MRI head with and without contrast through a rapid-access 'suspected cancer' pathway, when available.In patients with suspicion of raised intracranial pressure, arrange a same-day clinical assessment and contrast-enhanced CT head scan.3. Glioblastoma (GBM) is the most common primary brain cancer.Standard treatment includes maximal safe resection followed by concomitant radiotherapy and temozolomide (TMZ) chemotherapy and then adjuvant TMZ.Disease progression is expected in all cases and consideration of further treatment should take into account the patient's performance status, tumour size, location and time since first treatment 4. Key supportive medications may include corticosteroids for vasogenic oedema and anti-epileptic medication if seizures occur 5. Due to the incurable and rapidly progressive nature of glioblastoma, close collaboration between multidisciplinary teams in tertiary care hospitals and primary care services is recommended.Early involvement of GPs and specialist community palliative care teams can assist patients and caregivers with advance care planning as well as management of symptoms, physical and cognitive impairment, communication difficulties and the innate uncertainties about disease progression.