Glioblastoma Treatment in Singapore

Glioblastoma is the most common primary brain tumour in adults. It develops from astrocytes, which support nerve function in the brain. This fast-growing tumour can affect different brain areas, causing symptoms based on its location. Understanding glioblastoma helps patients and families make informed decisions.

Dr Ng Zhi Xu
Senior Consultant Neurosurgeon

What Is Glioblastoma?

Glioblastoma is a type of brain cancer that starts in the glial cells, which support and protect nerve cells. It is classified as a grade 4 astrocytoma, meaning it is highly aggressive and fast-growing. Unlike tumours that stay contained, glioblastoma often spreads into nearby brain tissue, making it difficult to remove completely with surgery.

This tumour can form in any part of the brain but is most often found in the cerebral hemispheres, which control movement, speech, and thinking. It tends to form a central mass with finger-like extensions that invade healthy brain tissue. This pattern of growth is why treatment usually involves a combination of surgery, radiation, and chemotherapy.

Symptoms of Glioblastoma

Glioblastoma symptoms depend on the tumour’s size and location, as it disrupts normal brain function and puts pressure on nearby tissue.

Persistent headaches

Often worsens in the morning or when lying down. These headaches may not respond well to usual pain relief methods

Seizures

These may be the first sign of the tumour, ranging from brief episodes of confusion to more obvious convulsions

Memory and thinking difficulties

Problems with concentration, decision-making, or remembering things that were previously easy to recall

Speech problems

Difficulty finding words, slurred speech, or trouble understanding what others are saying

Weakness or numbness

Loss of strength or sensation in the face, arm, or leg, usually affecting one side of the body

Vision changes

Blurred vision, double vision, or loss of peripheral vision may occur

Balance and coordination problems

Difficulty walking, frequent falls, or clumsiness with hand movements

Causes and Risk Factors of Glioblastoma

Most cases of glioblastoma occur without a clear cause, though certain factors may increase the likelihood of developing this tumour.

  • Age: The condition most commonly affects adults between 45 and 70 years old, with risk increasing with age
  • Previous radiation treatment: People who have received radiation therapy to the head for other medical conditions have a slightly higher risk
  • Genetic conditions: Rare inherited disorders such as neurofibromatosis or Li-Fraumeni syndrome may increase susceptibility

Types of Glioblastoma

Glioblastoma is classified into different types based on how it develops and its genetic characteristics.

The most common type. It appears suddenly as an aggressive tumour without developing from a smaller, slow-growing tumour.

Starts as a lower-grade astrocytoma and becomes more aggressive over time. This type is less common and often affects younger adults.

This is the typical form seen in older adults. It grows quickly and is generally more resistant to treatment.

Less common and usually found in younger patients. It may respond better to certain treatments and tends to grow more slowly.

Diagnostic Methods

Several tests help confirm the diagnosis and determine the specific characteristics of the tumour.

Magnetic Resonance Imaging (MRI)

This detailed brain scan shows the tumour’s size and location

Computed Tomography (CT) scan

Provides cross-sectional images of the brain and may be used initially or when MRI is not possible

Tissue biopsy

A small sample of the tumour is examined under a microscope to confirm the diagnosis and determine genetic characteristics

Molecular testing

Laboratory analysis of tumour tissue identifies specific genetic changes that guide treatment decisions

Neurological examination

Assessment of reflexes, coordination, and cognitive function helps determine how the tumour affects brain function

Treatment Options

Surgery is usually the first step in treating glioblastoma. The goal is to remove as much tumour tissue as possible without affecting critical brain functions.

Craniotomy with tumour resection: The skull is opened to access and remove tumour tissue while avoiding areas that control speech, movement, or memory.

Awake craniotomy: The patient remains conscious during part of the surgery so the neurosurgeon can test brain function in real time and avoid damaging vital areas.

Image-guided surgery: Navigation systems provide detailed brain imaging to help the neurosurgeon precisely locate and remove the tumour.

Intraoperative monitoring: Real-time testing during surgery tracks brain signals to protect important functions throughout the procedure.

Other treatments are used after surgery to target remaining tumour cells and manage symptoms.

Radiotherapy: High-energy beams are directed at the tumour site to slow or stop its growth. This is usually given daily over several weeks.

Chemotherapy: Drugs such as temozolomide are used alongside radiotherapy to kill cancer cells or prevent them from multiplying.

Steroids: Medications like dexamethasone reduce swelling in the brain and help relieve symptoms such as headaches or weakness.

Anti-seizure medication: Prescribed if seizures occur, these help prevent further episodes and support daily functioning.

When to See a Neurosurgeon

A neurosurgeon should be consulted as soon as glioblastoma is suspected or confirmed. Early involvement is important for accurate diagnosis, surgical planning, and coordination of care with other specialists.

 

You may be referred to a neurosurgeon if you experience:

  • Persistent or worsening headaches, especially if they are different from your usual pattern
  • New seizures without a known cause
  • Weakness, numbness, or coordination problems affecting one side of the body
  • Difficulty with speech, memory, or personality changes
  • Imaging results showing a brain mass or suspected tumour
Dr Ng Zhi Xu

Dr Ng Zhi Xu

Senior Consultant Neurosurgeon

Dr Ng is a fully registered specialist in Neurosurgery, with sub-specialty interests in neurotrauma, neuro-oncology, and spine surgery.

  • Bachelor of Medicine and Bachelor of Surgery (MBBS) from Yong Loo Lin School of Medicine, National University of Singapore 2007
  • Basic Surgical Training at TTSH and KTPH 2008-2010
  • Basic Neurosurgical training NUH and KTPH 2010-2012 (Service Registrar)
  • Advanced Neurosurgical training and residency NUH 2013 – 2017
  • Fellowship training in Neurosurgery at Addenbrooke’s Hospital, Cambridge, United Kingdom from 2015 – 2016
  • Intercollegiate Fellowship of Royal Colleges of Surgery (FRCSGlasg) for Neurosurgery, 2016

During his term in KTPH, he developed a deep interest in teaching and organized numerous General Practice (GP) and nursing forums to promote the sharing of common neurosurgical conditions. While there, he was also the director for residency teaching in KTPH.

Dr Ng has done research collaborations with both National Neuroscience Institute (NNI) and NUH. He currently has ongoing research grants with NUH, which focuses on developing modified stem cell treatment for resistant brain cancers.

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    Glioblastoma

    Frequently Asked
    Questions

    Will I be able to drive after treatment?

    This depends on your symptoms, especially if you have had seizures or changes in coordination or awareness. Your neurosurgeon or medical team will assess your fitness to drive and advise accordingly.

    How quickly does glioblastoma grow?

    Glioblastoma grows rapidly, which is why early treatment is essential. Growth rates can vary based on the tumour’s biology and individual factors.

    Can glioblastoma spread to other parts of the body?

    It rarely spreads outside the brain and spinal cord. However, it can grow into other parts of the brain, affecting various functions.

    How long does treatment take?

    Treatment usually starts with surgery, followed by radiotherapy over six to seven weeks, often combined with chemotherapy. Chemotherapy may continue for several months, depending on your response and overall condition.