Glioblastomas can be difficult to treat for the following reasons: Glioblastomas are now classified as Astrocytoma IDH-wildtype tumors with at least one of the following: microvascular proliferation, necrosis, EGFR amplification, TERT promoter mutation, or combined gain of chromosome 7/loss of chromosome 10 copy number changes. For information on Astrocytoma, IDH mutant, grade 4, please see our web page on Astrocytoma (Adult type). What used to be classified as Glioblastoma, IDH mutant is now classified as Astrocytoma, IDH mutant, grade 4. In 2021 the World Health Organization (WHO) updated CNS tumor classifications, incorporating new knowledge gained from additional molecular markers and new diagnostic techniques. In general, these tumors tend to be slower growing initially, but can progressively become aggressive. Alternatively, secondary glioblastomas may progress from a lower-grade astrocytic tumors (grade 2 or 3) and evolve into grade 4 tumors over time. They tend to be more aggressive and are more common in patients 60 years of age or older, though younger patients may also be affected. De novo tumors are the most common form of glioblastoma. Glioblastomas commonly arise de novo, meaning they begin as a grade 4 tumor with no evidence of a lower-grade precursor. It is exceedingly rare for glioblastomas to spread outside of the brain and spinal cord. They can also sometimes spread to the opposite side of the brain through connection fibers (corpus callosum) or the ventricular system. Glioblastomas are diffusely infiltrative and invade nearby regions of the brain. The tumor is predominantly made up of abnormal astrocytic cells, but also contains a mix of different cell types (including blood vessels) and areas of dead cells (necrosis). Glioblastomas (also called GBM) are malignant (cancerous) grade 4 tumors.
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