Support Bob Breech's Fight Against Glioblastoma

My name is Debra Breech-Vilhauer. I am the oldest daughter of Bob Breech. He has recently had some health issues. On May 24th, doctors found 3 small tumors on his brain, Doctors say that it is a Grade 4 Glioblastoma.

He will be starting his first round of radiation within the next week so we are unsure what/or how it will affect him. His age is a deciding factor in the effectiveness of the Radiation. After the initial round of radiation, we will reevaluate the process and/or prognosis.

We have moved him out of his apartment and into independent living but due to the memory issues, we will have to move him into the assisted living/memory care unit to assist with his care.

He currently has memory issues so having this conversation, with him, is difficult as he does not remember very well.

Glioblastoma is a type of cancer that starts as a growth of cells in the brain or spinal cord. It grows quickly and can invade and destroy healthy tissue. Glioblastoma forms from cells called astrocytes that support nerve cells. Glioblastoma can happen at any age.

Glioblastoma (GBM)

Glioblastomas (also called GBM) are malignant (cancerous) grade 4 tumors. 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 are diffusely infiltrative and invade nearby regions of the brain. They can also sometimes spread to the opposite side of the brain through connection fibers (corpus callosum) or the ventricular system. It is exceedingly rare for glioblastomas to spread outside of the brain and spinal cord.

Glioblastomas commonly arise de novo, meaning they begin as a grade 4 tumor with no evidence of a lower-grade precursor. De novo tumors are the most common form of glioblastoma. 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. Alternatively, secondary glioblastomas may progress from a lower-grade astrocytic tumors (grade 2 or 3) and evolve into grade 4 tumors over time. In general, these tumors tend to be slower growing initially, but can progressively become aggressive.

In 2021 the World Health Organization (WHO) updated CNS tumor classifications, incorporating new knowledge gained from additional molecular markers and new diagnostic techniques. What used to be classified as Glioblastoma, IDH mutant is now classified as Astrocytoma, IDH mutant, grade 4. For information on Astrocytoma, IDH mutant, grade 4, please see our web page on Astrocytoma (Adult type). 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.

Location

Glioblastoma is most commonly found in the frontal lobe, followed by the temporal, parietal, and occipital lobes.

Symptoms

Patients with glioblastomas develop symptoms rapidly due to mass effect from the tumor itself or from the fluid surrounding the tumor that causes further brain swelling (edema). Common presenting symptoms at diagnosis include:

Seizures

Severe headaches

Memory and language problems

Changes in personality and behavior

Muscle weakness or paralysis

Fatigue

Issues with coordination

Speech, hearing, and vision problems

Other symptoms may occur depending on the size and location of the tumor.

Treatment

Glioblastomas can be difficult to treat for the following reasons:

They are fast-growing and invade nearby brain tissue, making 100% removal nearly impossible.

The blood-brain barrier prevents certain treatments from being able to reach the tumor and be effective.

They have many different types of tumor cells (heterogeneous) and can change over time, which makes them difficult to treat.

Because of this, the treatment plan for glioblastoma may combine several approaches, including surgery, radiation therapy, chemotherapy, clinical trials, Tumor Treating Fields (TTFields), and targeted therapies.

Surgery is often the first step in treating glioblastoma. Surgery allows the medical team to get a biopsy and make a diagnosis, relieve pressure on the brain, and safely remove as much tumor as possible. Glioblastomas are diffuse and have finger-like tentacles that infiltrate the brain, which makes them very difficult to remove completely. This is particularly true when the tumors are growing near important regions of the brain that control functions such as language and movement/coordination.

Radiation and chemotherapy are used to slow down the growth of residual tumor after surgery and for tumors that cannot be removed with surgery. Tumor Treating Fields (TTFields), which act to disrupt rapid cell division, may also be offered in combination with chemotherapy.

Standard of care treatment for newly diagnosed GBM depends on a variety of factors, including molecular biomarkers (MGMT status & IDH mutation) and age. Recurrent GBM is treated based on the patient’s response to initial treatments and assessment of disease progression. Some patients may also be eligible for clinical trials. In a disease like glioblastoma, clinical trial participation is often highly encouraged both in the newly diagnosed setting and in recurrence. To learn more, download the ABTA’s Clinical Trials brochure.

Prognosis

Prognosis means a prediction of outcome. This information is usually based on information gathered from groups of people with the same disease. It is important to remember these statistics are not individualized.

The 5-year relative survival rates for glioblastoma by age group are as follows:

Children (ages 0-14): 19.4%*

Adolescents & Young Adults (ages 15-39): 26.0%*

Adults (ages 40+): 5.6%*

*These percentages represent the prior classification of Glioblastoma which included what is now considered Astrocytoma, IDH mutant, grade 4.

Incidence

Glioblastomas represent about 14% of all primary brain tumors. On average, more than 12,000 glioblastoma cases are diagnosed each year in the United States.

Glioblastomas are slightly more common in men than in women.

Age Distribution

Glioblastomas can occur at any age but are more common in older patients between the ages of 65 and 74. The median age of a glioblastoma diagnosis is 65.

Risk Factors

The exact cause of glioblastoma is unknown. The majority of glioblastoma patients have no family history or identifiable risk factors. Patients with Li-Fraumeni syndrome, neurofibromatosis, Turcot syndrome, Lynch syndrome, or constitutional mismatch repair deficiency syndrome, however, may be at higher risk of developing high-grade gliomas like glioblastoma. Exposure to ionizing radiation as a result of radiation therapy for childhood brain tumors or leukemia is also a risk factor for high-grade gliomas.

100% of the money raised will go towards continued care for Dad as well as to make him feel comfortable.